The diffusion of information technology among health maintenance organizations

This article examines the information technology functions, staffing and cost, services provided, and advanced technologies among health maintenance organizations (HMOs) using a national sample of HMOs from mid-1995. HMOs have a well-developed capability to use data from administrative functions, such as claims processing. Nationally affiliated HMOs and HMOs in markets with greater HMO penetration support more IT functions. Relatively little work has been completed integrating clinical with administrative systems.

HMO financial arrangements with rural physicians

The growth of managed care in general suggests that a substantially larger number of rural primary care physicians will be asked to enter into risk-bearing contracts with Health Maintenance Organizations (HMOs) in the near future. This article describes the different types of payment and risk-sharing arrangements that exist between HMOs and primary care physicians and presents survey data relating to their prevalence in rural areas. Also, it describes in detail the payment arrangements used by four HMOs that contract with rural primary care physicians. The concluding discussion highlights policy issues regarding risk-sharing arrangements that are especially pertinent in rural settings.

Life after infertility treatment: a long-term investigation of marital and sexual function

After leaving in-vitro fertilization (IVF) treatment, both successful and unsuccessful women are generally lost to follow-up. In order to assess overall life satisfaction as well as marital and sexual adjustment after the completion of infertility treatment, three groups of women were studied: group 1 (n = 41), successful IVF women; group 2 (n = 16), unsuccessful IVF women who adopted; and group 3 (n = 18), unsuccessful IVF women who remained childless. All women who had completed a minimum of three IVF cycles between the years 1982 and 1993 were invited to participate in a 'life after infertility' follow-up study. Those who agreed were mailed a lengthy questionnaire which included questions about their reproductive history and infertility treatment, the impact of infertility on their marital and sexual relationship and their final thoughts about treatment. Four standardized questionnaires were also administered. Results revealed that women who became biological mothers through IVF were significantly more satisfied with their lives than women who were unsuccessful in IVF and remained childless (F = 8.62, P < 0.001). Childless women reported that infertility had exerted a significantly greater negative impact on their marriages than that reported by the other two groups. There were no significant differences, however, between the three groups on the standardized measures of marital and sexual satisfaction.

Trust me: technical and institutional determinants of health maintenance organizations shifting risk to physicians

This paper examines the factors that influence a Health Maintenance Organization (HMO) to shift risk to doctors through an incentive arrangement called capitation, where physicians are paid a fixed amount per patient for a period of time for any and all medical services required by the patient. Multispecialty-medical-group (Group) HMOs are more likely to shift risk than Independent Physician Associations (IPA) HMOs. Within IPA HMOs, larger enrollment per physician is positively associated with more risk shifting. We find that institutional factors signaling legitimacy play an important role in determining risk shifting. For-profit HMOs are less likely to shift risk, which we interpret as reflecting consumer distrust of for-profit HMOs. However, for-profit HMOs that are federally qualified, which we interpret as a signal of legitimacy, are more likely to shift risk.

Respiratory sinus arrhythmia versus neck/trapezius EMG and incentive inspirometry biofeedback for asthma: a pilot study

This pilot study compared biofeedback to increase respiratory sinus arrhythmia (RSA) with EMG and incentive inspirometry biofeedback in asthmatic adults. A three-group design (Waiting List Control n = 5, RSA biofeedback n = 6, and EMG biofeedback n = 6) was used. Six sessions of training were given in each of the biofeedback groups. In each of three testing sessions, five min. of respiratory resistance and EKG were obtained before and after a 20-min biofeedback session. Additional five-min epochs of data were collected at the beginning and end of the biofeedback period (or, in the control group, self-relaxation). Decreases in respiratory impedance occurred only in the RSA biofeedback group. Traub-Hering-Mayer (THM) waves (.03-.12 Hz) in heart period increased significantly in amplitude during RSA biofeedback. Subjects did not report significantly more relaxation during EMG or RSA biofeedback than during the control condition. However, decreases in pulmonary impedance, across groups, were associated with increases in relaxation. The results are consistent with Vaschillo's theory that RSA biofeedback exercises homeostatic autonomic reflex mechanisms through increasing the amplitude of cardiac oscillations. However, deep breathing during RSA biofeedback is a possible alternate explanation.

Study results show decline in HMO operating margins

In the early 1990s, virtually all HMOs reported healthy profits, especially in markets with low managed care penetration. However, a recent survey has revealed that HMO operating margins experienced sharp declines in 1995. Some reasons for these declines include: more competition as the healthcare marketplace has become more saturated with HMOs; aggressive price negotiations by employers; and rising HMO medical and administrative expenses. The study also revealed that all types of HMOs experienced operating margin declines, demonstrating that organizational structure was an unlikely contributing factor.

When exercise goes awry: exertional rhabdomyolysis

Exertional rhabdomyolysis occurs when exercise, often of the eccentric type, damages myofibrils and sarcolemma, with release of the enzyme creatine kinase and pigmented myoglobin into the serum. Severe muscle soreness and dark urine are the hallmark symptoms, and renal failure may develop. Formerly a disease of military recruits, it is now seen more often in exercisers. Although a genetic trait may predispose, the illness probably can be avoided by common sense behavior such as a gradual increase in exercise intensity, proper hydration before, during, and after exercise, and avoiding exercise in extremely hot or humid environments.

The Lie/Bet Questionnaire for screening pathological gamblers

A 2-item questionnaire was derived from 10 DSM-IV criteria for pathological gambling. Subjects were 362 men, 191 classified as pathological gamblers and 171 as nonproblem-gambling controls. The two items were significant in sensitivity and negative predictive value and significant in specificity and positive predictive value.

Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: a large-scale retrospective study of 596 psychiatric outpatients

In the present study, a large-scale retrospective case review was undertaken to assess the incidence and type of sexual dysfunctions associated with serotonin reuptake inhibitor (SRI) therapy, in addition to the effects of three pharmacological antidotes (yohimbine, amantadine, cyproheptadine) on SRI-induced sexual dysfunctions. A retrospective chart review was conducted on 596 patients treated with SRIs in an outpatient psychiatric practice between July 1991 and September 1994. Patients who reported new-onset sexual dysfunction during this time were categorized as having SRI-induced sexual dysfunctions. Sexual difficulties were characterized by type and duration, and the background characteristics and psychiatric diagnoses of all patients were recorded. Psychiatric outcome and sexual functioning at follow-up were independently assessed by a single psychiatrist by means of a 4-point rating scale. Sexual dysfunction symptoms were clearly associated with SRI administration in 97 (16.3%) cases. The most common problems reported were orgasmic delay or anorgasmia and hypoactive sexual desire. Sexual difficulties were more frequent among men (23.4%) and married patients of both sexes (22.3%), whereas psychiatric diagnosis and type of SRI were unrelated to the occurrence of sexual problems. Of the patients with sexual dysfunction, 45 (46.4%) opted for a trial of antidote therapy with yohimbine, amantadine, or cyproheptadine. All three antidotes were found to be safe and relatively effective, although yohimbine was significantly more effective than amantadine or cyproheptadine in reversing SRI-induced sexual dysfunction.

Behavioral task-induced bronchodilation in asthma during active and passive tasks: a possible cholinergic link to psychologically induced airway changes

This study investigated pulmonary and autonomic reactions to active and passive behavioral laboratory tasks among asthmatic subjects. It also examined the relationship between airway irritability, as measured by the methacholine challenge test (MCT), and autonomic activity and reactivity to these tasks. Fifty-one asthmatic and 37 nonasthmatic subjects were exposed to psychological laboratory tasks involving either active (mental arithmetic and reaction time) or passive (films depicting shop accidents and thoracic surgery) response. The MCT was given to asthmatics in a separate session. Active tasks reduced respiratory impedance, as measured by forced oscillation pneumography. They also increased heart rate and appeared to block vagal activity, as measured by respiratory sinus arrhythmia (RSA). Airway irritability as assessed by the MCT was positively related to amplitude of RSA and to skin conductance levels. Our data suggest that active and passive behavioral tasks may produce different pulmonary effects among both asthmatic and nonasthmatic individuals. Engaging in tasks requiring active responses may produce temporary improvements in pulmonary function. No autonomic differences were obtained between asthmatics and nonasthmatics in physiological response to stress, but greater cholinergic receptor sensitivity was suggested among high responders to methacholine.

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An enzyme-linked immunosorbent assay (ELISA) for von Willebrand factor antigen (vWf-Ag) in canine plasma

A quantitative enzyme-linked immunosorbent assay (ELISA) has been developed to measure canine von Willebrand factor antigen (vWf-Ag) in plasma of the dog. A vWf-Ag antiserum was raised in rabbits and purified by preabsorption with the low molecular weight vWf-Ag-deficient fraction of canine cryoprecipitate, followed by affinity chromatography on protein-A Sepharose. The rabbit anticanine vWf-Ag IgG was used to bind the vWf-Ag of the test plasmas to the solid phase and to prepare the enzyme-antibody conjugate in ELISA. Normal rat serum was used as blocking agent. The standard curve was linear (r2 greater than 0.98) and reproducible after logit-log transformation. The interassay coefficient of variation (CV) in test plasmas with various vWf-Ag concentrations was never greater than 7.7%. Assayed values in dilutions of pooled normal canine plasma added to canine vWf-Ag-deficient plasma were linear between 0 and 100% (r2 = 0.99) and indicated excellent analytical recovery of vWf-Ag. In 18 dogs with various internal diseases, including von Willebrand's disease and haemophilia A, the coefficient of correlation between the results of the ELISA and those of electroimmunodiffusion (EID) was 0.93.

How is the NaCl signal transmitted in NaCl-induced hypertension?

Is the NaCl signal perceived as a small increase in the concentration of NaCl in extracellular fluid? We used 8 g NaCl/100 g soluble nutrients and fed only a hypertonic (1.4% NaCl) or a hypotonic (0.45% NaCl) drink to Dahl salt-sensitive (DS) rats. After 12 weeks, 11 rats receiving the hypertonic drink had a mean blood pressure of 195 mm Hg versus 195 mm Hg in 12 rats receiving the hypotonic drink. Thus, the high-NaCl signal seems unrelated to a higher NaCl concentration in extracellular fluid, thereby suggesting volume signals. Most volume controls are near the third brain ventricle (3V). As a working hypothesis, high dietary NaCl may swell the tissues surrounding 3V, which is slitlike. Such swelling would partially close the upper part of the slit and cause ependymal cells and nerve fibers on opposite walls to touch, possibly leading to hypertension in susceptible humans or rats. To test this, we stereotaxically blocked the aqueduct with inert silicone to produce hydrocephalus of 3V in DS rats and thus prevent ependymal cells and nerve fibers from touching. After blocking or sham-blocking the aqueduct, either a 6% NaCl diet or a 0.23% NaCl diet was started. Intra-arterial blood pressure was taken after 6 weeks. A group of 28 sham-blocked rats and a group of 29 blocked rats, all fed a 0.23% low NaCl diet, had equal blood pressures averaging 130 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

[Changes in the pH and volume of gastric contents during pregnancy and labor]

We measured the volume and pH of gastric contents of 97 patients after induction of anaesthesia. The patients were divided into 3 groups: group I (N = 39): elective cesarean section, group II (N = 44): elective gynecological surgery, group III (N = 14): emergency cesarean section. The study was undertaken to ascertain whether pregnancy and labour would modify the volume and mean pH of gastric contents. Mean pH of gastric contents in the 3 groups were respectively 2.57; +/- 0.23; 3.21 +/- 0.29; and 2.77 +/- 0.42. There were no significant differences between the groups: Pregnancy and labour do not influence gastric pH. As far as gastric volume is concerned there is a significant difference between Group I and III (p less than 0.01) and Group II and III (p less than 0.01).

Psychopathology in medical inpatients and its relationship to length of hospital stay: a pilot study

A composite screening instrument measuring depression, anxiety, cognitive dysfunction, and pain identified 40 percent of a sample of general medical inpatients (30% of total patients before exclusions) as having significant psychopathology or pain, a reasonable number based on clinical incidence literature. These identified patients' hospital length of stay did not differ from the length of stay for other patients. The screen identified 21 percent as very depressed, 19 percent as very anxious, 15 percent as having cognitive dysfunction, and 11 percent with high pain levels. Depression, anxiety, and pain frequently occurred together. Further study is required to refine the instrument and assess its effectiveness at targeting patients for psychiatric intervention.

Murine erythrocytes contain high levels of lysophospholipase activity

Murine erythrocytes were found to be unique in the high levels of lysophospholipase activity in the cytosol of these cells. The specific activity of the enzyme in the cytosol of the murine cells is 10-times higher than in the cytosol of rabbit erythrocytes and approximately three orders of magnitude higher than those in the red cells of rat, man, pig and ox.

Retropharyngeal abscess

Two cases of retropharyngeal abscess are presented. The first case, that of a 4-year-old boy, was classical, diagnosed early, and treated with prompt incision and drainage. The second case was that of a 51-year-old man who developed complete upper airway obstruction, pneumothorax, and congestive heart failure prior to surgical drainage. These cases are presented to remind emergency physicians of this formidable entity and of the need for constant vigil in the management of this life-threatening pre-antibiotic relic.

Inadvertent intra-arterial injection of phentaramine: a complication of drug abuse

A female drug abuser inadvertently injected an intravenous injection of an oral anorexiant, phentaramine (Preludin), into her own brachial artery. Severe hand pain, vasospasm, and ischemia occurred. Treatment with regional axillary block, intravenous dextran, intra-arterial priscoline, and salicylate anticoagulation may have influenced a favorable outcome. Intimal damage, vasospasm, and various additive effects after intra-arterial injection contribute to the potential for serious sequelae. Prompt diagnosis, vasodilatation, elevation and compression, pain relief and, in some cases, surgery appear to improve salvage of what is frequently a major extremity injury.