Anesthesia information management systems as a cost containment tool

A systematic evaluation of the ability of different bacterial genera to transform 2,4,6-trinitrotoluene (TNT), and grow in its presence, was conducted. Aerobic Gram-negative organisms degraded TNT and evidenced net consumption of reduced metabolites when cultured in molasses medium. Some Gram-negative isolates transformed all the initial TNT to undetectable metabolites, with no adsorption of TNT or metabolites to cells. Growth and TNT transformation capacity of Gram-positive bacteria both exhibited 50% reductions in the presence of approximately 10 microg TNT ml-1. Most non-sporeforming Gram-positive organisms incubated in molasses media amended with 80 microg TNT ml-1 became unculturable, whereas all strains tested remained culturable when incubated in mineral media amended with 98 microg TNT ml-1, indicating that TNT sensitivity is linked to metabolic activity. These results indicate that the microbial ecology of soil may be severely impacted by TNT contamination.     

User fees: fair cost containment or a tax on the sick?

The federal government's reduction in transfer payments for health and education, in combination with a severe recession, has put provincial and territorial health ministries, health professionals and hospital administrators under immense financial pressure. In response, user fees are being discussed as one way to maintain medicare. Yet, charging levies for health services presents numerous ethical problems. User fees would end the universality of and accessibility to health care for many Canadians. Hence, they would constitute an unfair tax on the sick and the poor. The hardest hit would be the elderly, children, women, aboriginal people, the disabled and the chronically ill.     

Using message framing to promote acceptance of the human papillomavirus vaccine.

Objective: Use of message framing for encouraging vaccination, an increasingly common preventive health behavior, has received little empirical investigation. The authors examined the relative effectiveness of gain-versus loss-framed messages in promoting acceptance of a vaccine against human papillomavirus (HPV)-a virus responsible for virtually all cases of cervical cancer. Design: Undergraduate women (N = 121) were randomly assigned to read a booklet describing the benefits of receiving (gain-framed message) or the costs of not receiving (loss-framed message) a prophylactic HPV vaccine. After reading the booklet, participants indicated their intent to obtain the HPV vaccine. Main Outcome Measure: A 5-item composite representing intentions to obtain the HPV vaccine. Results: The effect of message framing on HPV vaccine acceptance was moderated by risky sexual behavior and approach avoidance motivation. A loss-framed message led to greater HPV vaccination intentions than a gain framed message but only among participants who had multiple sexual partners and participants who infrequently used condoms. The loss-frame advantage was also observed among participants high in avoidance motivation. Conclusion: Findings highlight characteristics of the message recipient that may affect the success of framed messages promoting vaccine acceptance. This study has practical implications for the development of health communications promoting vaccination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical technology and cost containment: two applications of operations research

The government proposes "common sense" regulations to help contain rising health costs due to the increasing use of high-technology procedures, such as computerized tomography scanning. Two illustrations are given showing that such ad hoc regulations may have the effect of increasing costs and are certainly far from the optimum obtained by known methods of operations research.     

Strategies for expanding clinical staff in an era of cost containment

Two patients are described with clinical and radiographic bronchiectasis which occurred after allogeneic bone marrow transplantation for haematological malignancy. Both had evidence of chronic graft versus host disease in other organs. Increased immunosuppression with corticosteroids resulted in clinical response, although both patients persisted with chronic mucopurulent sputum production and one had progressive airflow obstruction. Bronchiectasis may be an under-recognised manifestation of chronic graft versus host disease of the lung.     

Strategic choices for cost containment under a reformed U.S. health care system

The Clinton administration health reform proposal would impose global spending limits to bring the rate of increase in health care spending into line with the Consumer Price Index by 1999. This paper examines cost containment strategies available to states and health plans under externally imposed revenue limits. Drawing on the experience of state and local regulatory agencies, private sector managed care plans, and models in other countries, we contrast premium caps and provider rate setting as mechanisms to reduce growth in health care spending, and briefly consider the system-level regulatory structures necessary to oversee and control aggregate health care spending.     

The ABCs of developing a trauma newsletter

Two basic patterns of venous drainage of the stomach were found in rabbits. In the first, which is highly prevalent (27 cases-90.0%), the v. gastroepiploica dextra is present while no such vein is present in the second one. Other venous channels are represented by the v. gastrica sinistra and by tributaries of the v. lienalis. In cats there are also two basic patterns of the stomach venous drainage. The first highly prevalent type without the v. gastroepiploica dextra was found in 23 cases (76.0%); in the second type this vein was present. In rabbits the v. gastroepiploica sinistra was observed in 25 cases (82.5%), in cats in only two cases (6.6%). The v. gastroepiploica dextra in the rabbit is usually a tributary of the v. portae, while in cats it is a tributary of the v. lienalis. In ten rabbits (33.3%) there was a venous arch around the curvatura ventriculi major, while in cats it was absent. The great difference in the stomach venous pattern in rabbits and cats can be explained by the different zoological position of these two kinds of animals.     

Electrical cardioversion of atrial fibrillation or flutter with conscious sedation in the age of cost containment

OBJECTIVE: To determine if there is a significant difference in the degree of pelvic organ prolapse assigned during examination in the standing position compared with the dorsal lithotomy position with the patient performing maximal Valsalva maneuver. METHODS: Fifty-one women with symptoms of pelvic organ prolapse were examined in both the dorsal lithotomy position, while performing maximal Valsalva, and in the standing position at the same visit by one of two examiners. Nine site-specific measures and summary stages were recorded, as outlined by the International Continence Society's classification system for pelvic organ prolapse. The data were analyzed by Wilcoxon signed-rank test and correlation coefficients. RESULTS: The mean age was 52 +/- 15 years. Excellent correlation was noted between all six points representing the vaginal prolapse. The R values for point Aa were 0.97, Ba 0.96, C 0.98, Ap 0.97, Bp 0.96, and D 0.97. The total vaginal length, perineal body, and genital hiatus measurements were performed in the dorsal lithotomy position with the patient at rest and were not repeated. The stages were identical in 48 of 51 patients. The average stage in the dorsal lithotomy position was 2.3 and in the standing position, 2.3. There was no statistically significant difference between the stage or any of the measured points in the dorsal lithotomy and standing examinations. CONCLUSION: The degree of pelvic organ prolapse can be assessed adequately in the dorsal lithotomy position with the patient performing maximal Valsalva. It is not necessary to routinely repeat the examination in the standing position.     

Use of an injection assist to help deliver a painless injection

The plasma cell gingivitis condition, an uncommon, nonmalignant lesion, is characterized by an offending allergen which causes a massive plasma cell infiltration in gingival connective tissue. Occasionally, soft tissue biopsy of affected and normal tissues is necessary for proper diagnosis. Blood analysis may rule out other systematic disorders with oral manifestations. This case report describes the condition.     

Using message framing to motivate HIV testing among low-income, ethnic minority women.

This study compared the effectiveness of 4 videotaped educational programs designed to motivate HIV testing among low-income, ethnic minority women. 480 women were assigned randomly to watch one of 2 gain-framed or 2 loss-framed videos. Consistent with prospect theory, participants' perceptions of the certainty of the outcome of an HIV test moderated the effects of framing on self-reported testing behavior 6 months after video exposure. Among participants who reported being certain of the test's outcome, those who saw a gain-framed video reported a higher rate of testing than those who saw a loss-framed message. Among women who perceived the outcome of HIV testing as relatively uncertain, gain- and loss-framed videos led to similar rates of self-reported testing, with some advantage for the loss-framed message. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using a cost-construction model to assess the cost of educating undergraduate medical students at the University of Texas--Houston Medical School

Spontaneous resolution of deformities after excision of facial skin lesions has been known and used for a long time by plastic surgeons. The resorption mechanism of deformity is based on natural skin expansion, and seems to be directly related to the action of the muscles of facial expression and their skin relations. Natural expansion has been shown to be effective in children. Between 1990 and 1994 excision of skin lesions, including congenital nevi, leading to postoperative deformity of the cheek, labial commissure, nose, eyelid and forehead, was performed on 35 patients, aged from 3 month to 12 years. The average follow-up is 24 months. For 26 patients (74%), natural resorption was observed 4 or 6 weeks later with good aesthetic results. For 6 patients (17%), the deformity persisted 3 or 6 months later, but did not require any further surgery. For 3 patients (9%), a second operation was necessary. Using the skins natural capacity for expansion in the treatment of facial skin defects in children is a method of reconstruction which has already been used for excision in enforced position. The platysma and muscles of facial expression by their action on skin mobilisation, allow natural expansion. A better knowledge of cutaneous biomechanical properties enables plastic surgeons to find an alternative to other classical methods.     

Opening the mind to close it: Considering a message in light of important values increases message processing and later resistance to change.

Past research showed that considering a persuasive message in light of important rather than unimportant values creates attitudes that resist later attack. The traditional explanation is that the attitudes come to express the value or that a cognitive link between the value and attitude enhances resistance. However, the current research showed that another explanation is plausible. Similar to other sources of involvement, considering important rather than unimportant values increases processing of the message considered in light of those values. This occurs when the values are identified as normatively high or low in importance and when the perceived importance differs across participants for the same values. The increase in processing creates resistance to later attacks, and unlike past research, individual-level measures of initial amount of processing mediate value importance effects on later resistance to change. Important values motivate processing because they increase personal involvement with the issue, rather than creating attitudes that represent or express core values. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mice without a functional relaxin gene are unable to deliver milk to their pups

We have used gene targeting to generate relaxin (rlx)-deficient mice. The majority (15 of 17) of homozygous (rlx-/-) mice are fertile and produce normal litters. However their mammary development is deficient; pups are unable to suckle and die within 24 h of birth unless cross-fostered to a wild-type (rlx+/+) foster mother. The nipples of rlx-/- animals do not enlarge significantly during pregnancy, and their histology retains the appearance of the virgin state. Breast parenchyma is somewhat underdeveloped at term even though milk is produced. Mammary ducts become grossly dilated in these animals. Heterozygous (rlx+/-) mice lactate normally. The interpubic ligament does not relax during pregnancy in rlx-/- mice. Plasma osmolality during late gestation was significantly higher (P < 0.001) in rlx-/- mice than in wild-type controls.     

Autonomic responses to shock-associated words in a nonattended message: a failure to replicate

Names of cities were shock associated and then embedded in material presented to the nonattended channel in a dichotic listening and shadowing situation. Despite earlier claims of differential responding to city names in the absence of awareness, no such differential responding was found. A test for conditioning following the dichotic listening task found that the subjects had been conditioned. Postexperimental interviews found that the subjects were aware of the city-shock contingency and had expected to be shocked during the dichotic listening task. Comparisons are made with other studies of galvanic skin responses to unattended words.     

Metered-dose inhaler to deliver methacholine in bronchial provocation testing: a pilot study

BACKGROUND: Nonspecific bronchial provocation tests may be simplified by the use of hand-held devices to deliver methacholine. OBJECTIVE: To study the feasibility of using a metered-dose inhaler (MDI) to administer methacholine in bronchial provocation tests, and the ability of such a device to diagnose bronchial hyperresponsiveness (BHR) accurately. METHODS: In an open randomized crossover pilot study, we compared the provocative dose that induces a 20% fall in FEV1 (PD20 FEV1) obtained with the methacholine MDI with that obtained using a conventional nebulizer in 20 hyperresponsive and 20 nonhyperresponsive subjects. The MDI delivers 400 doses of 100 microg of methacholine, and was used via a spacer. Bronchial hyperresponsiveness (BHR) was defined as a PD20 FEV1 <2,000 microg with the conventional test using the nebulizer. The tests were performed in each subject in a randomized order, 1 to 7 days apart. RESULTS: Of the subjects who had a nebulizer PD20 FEV1 <2,000 microg, all but one had an MDI PD20 FEV1 <800 microg. When 800 microg was taken as the threshold for the diagnosis of BHR with the MDI test, the accuracy of this test to diagnose BHR was 97.5%, and the two tests were highly concordant for the diagnosis of BHR (Pearson chi2, 36.19; p<0.0001). CONCLUSION: A hand-held device may be suitable for delivery of methacholine during bronchial provocation tests, if these results are confirmed in large samples.     

Intraperitoneal in vivo gene therapy to deliver alpha 1-antitrypsin to the systemic circulation

The utility of replication-deficient recombinant adenovirus vector-mediated transfer and expression of the alpha 1-antitrypsin (alpha 1AT) cDNA to peritoneal mesothelial tissues was evaluated as a means of delivering alpha 1AT to the systemic circulation. Preliminary studies with Ad.RSV beta gal, an adenovirus vector expressing the Escherichia coli lacZ gene (beta-galactosidase), showed that intraperitoneal injection of 10(9) plaque-forming units (pfu) to cotton rats resulted in beta-galactosidase activity in mesothelial cells lining the peritoneal cavity. After intraperitoneal administration of 10(9) pfu of Ad alpha 1AT (an adenovirus vector containing the human alpha 1AT cDNA), human alpha 1AT was detectable in serum for up to 24 days, with a maximal level of 3.4 micrograms/ml at 4 days. Expression of the exogenous gene was localized to the peritoneal mesothelium as PCR analyses detected no evidence of expression of the exogenous gene in any other tissues evaluated. Anti-adenovirus vector antibodies were detectable in serum after intraperitoneal administration of the recombinant vectors, including antibodies with neutralizing activity. Repeat administrations of adenovirus vectors to the peritoneal cavity at 1 wk and 1 mo after the initial dose failed to show gene expression, but repeat administration 3 mo after demonstrated measurable gene transfer and expression. Together these observations suggest replication-deficient adenovirus-mediated gene transfer to the peritoneal mesothelium offers a promising means to transfer alpha 1AT to the systemic circulation, although immunity induced against the adenovirus may limit frequent repetitive dosing.