Substance P is associated with hypothalamic paraventricular nucleus activation that coincides with increased urotensin 2 mRNA in chicks

Exogenous administration of substance P (SP) exerts anorexigenic effects in both chicks and rats, but the central mechanism mediating this response is poorly understood. Therefore, this study was designed to elucidate mechanisms of SP-induced anorexia using chicks as models. Chicks that received intracerebroventricular (ICV) injections of SP dose-dependably reduced their food intake with no effect on water intake. Next, the diencephalon was isolated from SP-injected chicks and mRNA expression of neuropeptide Y (NPY), corticotropin releasing factor (CRF), urocortin 3 (UCN 3) and CRF receptors were measured but were not affected. When measured in the hypothalamus, mRNA abundance of these and NPY receptors, urotensin 2 (UTS2) and melanocortin receptor 4 (MCR4) were not affected by SP-injection. Quantification of c-Fos immunoreactivity in appetite-associated hypothalamic nuclei demonstrated that the paraventricular nucleus (PVN) was activated in SP-injected chicks. Finally, in the PVN isolated from SP-injected chicks, there was increased expression of UTS2 mRNA while CRF and UCN3 were not affected. Thus, the anorexigenic effects of SP appear to be mediated by PVN activation and may involve UTS2.

Making the most of working with a consultant

Key to working with a consultant is knowing when to use one, how to select the right one and how to work effectively with one. Most of the ordinary business of an organization can be carried out using its own internal resources. When this is not the case, the external viewpoint of a consultant can be helpful. Determining if a consultant can add value is considered a first step in the consulting process. Ideally, the imaging manager is involved in this step. Finding the right consultant, much like other major decisions, can be done by talking with friends or colleagues, even using the internet and AHRA Listserv. Depending on the size and nature of the engagement, a request for proposal (RFP) may be appropriate to identify the amount of expertise needed for a particular situation. When a list of potential consultants is created, the next step is to call the references of each to find the closet fit. The next step is to develop a contract or letter of understanding with the selected consultant. When agreement is reached, the consultant may then request preliminary information to begin work on the project. A further decision is to determine whether the consultant will only make recommendations or will actually help with implementation. The project typically concludes with delivery of the consultant's written report. A facility should expect some major and important new thoughts to come from the consultant's work. An effective partnership with a consultant can go far in attaining a goal of increased levels of service and decreased costs.

Equipment acquisition using various forms of leasing

How best to finance the acquisition of equipment is a major decision. It's important to understand the different kinds of lease structures before selecting one. Any purchase versus lease analysis should include an understanding of lease terms and conditions. Capital and operating leases are two categories under which all leases fall. Capital leases are accounted for much like a loan taken out to finance the purchase of an asset. An operating lease is accounted for differently, having no assets or liabilities booked on the balance sheet. Product acceptance, supply and demand and other less tangible factors play a role in the determination of lease rates. Internal factors must also be considered when making the decision to purchase or lease. It is critical that the method selected for financing be appropriately matched to the intended use of the equipment. An important factor when leasing medical equipment is how it will be disposed of at the end of the lease term. There are a variety of options available, from third-party sources to seeking trade-in credits, good toward the purchase of new equipment. It's important to consider the tax implications associated with leasing or buying assets.

Analyzing lease/purchase options

The authors' previous article, "Equipment Acquisition Using Various Forms of Leasing," covers information necessary for selecting among the different kinds of leases. This article explains how to reach a proper financial analysis, preferably using two phases. Using a representative example, the article guides the reader through the first phase and introduces the elements needing review in the second phase. Key elements include pretax aftertax and cash flow analyses. Different organizations use different yardsticks to measure the financials of a transaction, but in general, cash is king. Therefore, the most widely used comparison is the purchase versus lease IRR (internal rate of return) produced by measuring the cash flow of the purchase case compared to the cash flow of the lease case.

Asset management in theory and practice

Managing capital-intensive imaging environments continues to be a challenge for nearly all administrators. Asset management, the strategic management of equipment inventory, must include planning, assessment, procurement, utilization review, maintenance, repair and disposal of equipment to reduce costs and improve efficiency. It must involve some shared risk between the facility and the provider, whether an original equipment manufacturer (OEM) or independent service organization (ISO). An absence of risk in the arrangement implies the provider is offering service management or consulting. A case study reports on three hospitals in the OhioHealth system. Their immediate goal, as they began to investigate asset management: cut costs immediately. A cross-functional team from the three hospitals began its investigation of various options, including working with ISOs, OEMs and development of inhouse clinical engineering. After developing a process to evaluate vendors, the team was able to score each against their cost-reduction potential, quality and implementation skills. The team narrowed its selection quickly to two multivendor service providers. An initial contract guaranteed savings of 20 percent of the annual budget, with a projected two to five percent additional savings. OEM relationships were moved to a time-and-materials basis, and ISOs were used in selected areas. In addition, the internal inhouse clinical engineering services group was moved into a "first call" approach in some areas. That expanded role resulted in savings and improved response time. The process, although not without its problems, was viewed favorably overall.

Process redesign: making your film library work for you

When Riverside Methodist Hospitals in Columbus, Ohio, experienced serious problems in its radiology film library, administrators recognized that poor processes were to blame and used quality management techniques to create a new system. A radiology information system was part of Riverside's long-range plan, but an effective manual process was implemented first. Riverside had decided that closing the library to referring physician access would result in more successful operations. An Operational Changes Planning Committee composed of file clerks, technologists, managers, radiologists and referring physicians planned the redesign. The committee identified four goals: Reduce unmet requests. Improve response time. Benchmark operations of comparable organizations. Implement an effective manual process prior to automation. Steps in the redesign process included identifying the problem, applying statistical tools to the situation and understanding customer requirements. Flow charts, benchmarking, data collection within the department and focus groups provided important quantitative information. Creating an improved process included the following actions: Work simplification. Work elimination (especially non-value-added work). Uncovering and removing causes of delay. Automation of repetitive tasks via the RIS. Reduction and elimination of any rework steps. One important change was to close the library to physician access. There were moderate gains in effectiveness as a result of redesign of the manual process. Results have continued to improve, and the redesign process provided greater commitment and cooperation for the more significant improvements that followed the RIS introduction.

Climbing the ladder: evolution of a clinical advancement program

Clinical advancement programs have been popular in nursing for years and have only recently permeated allied health disciplines, including radiography. In this article, the author explores the evolution of a clinical advancement program at his institution, involving radiographers of all disciplines and sonographers. The evolution of the program at Riverside Methodist Hospitals over the last three-and-a-half years is explored as a follow-up to the article "Approaching Clinical Advancement in Radiology," published in Radiology Management 13.4, fall 1991.