Liability issues in managed care

The explosive growth in Managed Care Organizations as a mechanism for providing health care in the United States has generated an equal explosion in litigation and new legislation related to problems within this delivery system. Abuses have included the "gagging" of physicians from providing full disclosure of medical options for their patients, inappropriate denial of care, denial of specialty referral, false claims data, insurer insolvency, economic credentialling, deselection, financial disincentives to render care, and lack of appeal or grievance mechanisms. These issues and others have resulted in injuries to patients and damage to the patient/physician relationship. This article discusses some of the more dramatic litigated cases and endeavors to alert both physicians and patients to potential legal matters that should be considered before becoming involved within this structure.     

AOTA and managed care

The process of becoming a medical doctor in the Russian Federation is detailed in this paper. There has been a decline in the number of students entering the medical profession, as well as a marked decrease in the faculty members at the medical institutes since perestroika. This is secondary to a marked decrease in financial support as well as falling morale.     

Hospice and managed care

Carbon dioxide (CO2) lasers are capable of producing surface irregularities in human enamel which resemble those resulting from etching of enamel with orthophosphoric acid. This report presents the results of a laboratory study which examined the effect of selected tooth-related variables on shear bond strength between a current generation bonding agent (Scotchbond MultiPurpose) and acid-etched or laser-conditioned human enamel. There were no significant differences in shear bond strength between human maxillary central incisor teeth, first premolars, and third molars in either the acid etch or laser-conditioned groups. Polishing of enamel to give a flat surface increased the shear bond strength obtained with acid etching, but did not alter significantly bond strengths achieved with laser conditioning. There was a tendency for a higher bond strength with acid etching, but not with laser conditioning, in porcine molar enamel compared with human molar and bovine incisor enamel. In terms of the mode of operation of the laser, the repetitively pulsed mode resulted in a two-fold improvement in shear bond strength compared with the single pulse mode. These results indicate that shear bond strengths in the order of 10 MPa can be obtained reliably on human teeth using laser conditioning with pulsed modes in the absence of any other preparation of the natural enamel surface.     

The surge in Medicare managed care: an update

Purines of ATP, ADP, AMP and adenosine released from rat caudal artery with and without endothelium and the isolated smooth muscle and endothelial cells were examined, in order to determine the source. Treatment of intact segments of caudal arteries with noradrenaline (10 microM) for 3 min induced a large release of ATP, ADP, AMP and adenosine. However, if the artery segments had been denuded of their endothelial lining, noradrenraline induced only a slight release of purines. Endothelial cells in primary culture prepared from caudal arteries, when exposed to noradrenaline for 3 min released large amounts of purines, whereas vascular smooth muscle cells prepared similarly and passaged endothelial cells did not release purines upon exposure to noradrenaline. These results indicate that, of smooth muscle and endothelial cells of the vascular wall, only intact endothelial cells react to alpha-adrenoceptor stimulation by releasing adenine nucleotides and adenosine.     

An experimental study of the relation between nursing care and patient welfare.

4 experiments were conducted in an ongoing hospital setting to test the hypothesis that increasing the amount and quality of nursing care would produce improvements in patient welfare. Changes introduced on experimental wards consisted of increasing the size of the nursing staff, conducting inservice-education programs, and combining increased staffing and inservice education. With the exception of a reduction in patient complaints during 1 experiment, no improvement in patient welfare was produced. Results suggest that there is a limit to the contribution which nursing can make to patient welfare and that this limit is much closer to the existing level of care than was formerly thought. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Consumer protection in managed care: finding the balance

CD8+ cytotoxic T lymphocytes (CTL) have an established role in anti-viral immunity, but whether CTL function efficiently in the brain remains unclear. In particular, virus-infected neurons, which express only low levels of MHC class I antigens and are resistant to the induction of apoptosis, could constitute a relatively intractable CTL target. We have used immune lymphocytes adoptively transferred into the CSF to protect naive mice against an intracerebral infection with influenza A/WSN, a virus that infects neurons in the brain parenchyma and causes a lethal encephalitis. After in vitro restimulation, heterotypically immune spleen cells protected against A/WSN encephalitis in an H-2-restricted, CD8-dependent, CD4-independent manner. Adoptively transferred CTL clones were also protective. Homotypically immune spleen cells additionally mediated CD8-independent, H-2-unrestricted protection, probably due to the generation of A/WSN-specific plasma cells from memory B cells during in vitro restimulation. Thus after in vitro restimulation, either CTL or B cells adoptively transferred into the CSF protected against an acutely lethal intracerebral virus infection.