Cost containment: the Pacific. Australia

In Australia, as in other countries, recession has accelerated government efforts to reduce the costs of health care. A variety of strategies have been introduced in different states. Cost-cutting measures have improved efficiency but have impacted patient care, particularly in the areas of new technology and high-cost drugs.     

Cost containment in clinical psychology: Critique of Biodyne and the HMO.

Cost containment has become the major theme of the day within health care. The growing "corporatization" of health services has drawn the attention of many clinical psychologists, and a number have expressed deep concern over the incursions of health maintenance organizations into psychologists' practice. They have claimed that the process of corporatization in health care has caused a genuine "crisis" that will destroy the practices of many psychologists, unless practitioners themselves adopt corporate methods and alter their mode of practice to fit a brief-treatment model. In this article, the context of pressures for cost containment is examined, and Cummings's proposed model for American Biodyne Centers is reviewed. Cummings's claim that Biodyne is an alternative to corporatization is questioned, as is the notion of crisis in health care. In the new models of corporate-inspired practice in psychology, the therapeutic relationship is poorly conceptualized, and patient interests are treated as secondary in importance to organizational demands for cost savings. In the absence of clear conceptualization of why, whom, and how clinicians hope to help, the professional status of clinical psychology is placed at serious risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Consumers and choice: Cost containment strategies for health care provision.

Examined consumer responses to 3 cost-containment strategies for providing health care. The data come from a random sample of 365 Los Angeles adults (aged 18–65 yrs) interviewed by telephone. It was found that aggregate sample responses were negative toward 2 strategies (labeled preferred provider and health planning) and positive toward the third (labeled self care). It was also found that demographic characteristics that predict approval of one strategy predict disapproval of other strategies. Findings, coupled with models assessing how and why segments of consumers respond as they do, suggest that no one strategy is likely to appeal to all consumers. Implications for the implementation of health care delivery systems inspired by containment strategies are discussed in the context of recent events in California. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lasers in urology

Ever since Mulvany first described use of Ruby laser for lithotripsy, urologists have been exploiting every possible application of this technology. Laser lithotripsy in the 1980s and now laser prostatectomy in the 1990s have dominated laser usage in urology. Applications of lasers for superficial lesions (e.g., condylomata acuminata and carcinoma of penis) have found an established role. Interests in laser welding, photodynamic therapy and fluorescence continues to grow and evolve. The laser industry at the same time is striving to provide more efficient lasers. High power lasers (Holmium:YAG, KTP:YAG) and laser machines combining double wavelengths (Nd:YAG and KTP, Ho: YAG and Nd:YAG) are commercially available. Diode lasers with their portability and reliability qualities can now provide high output powers in various wavelengths. Here, we have reviewed different lasers, laser tissue interaction and clinical laser applications relevent to urology.     

Cryosurgery in urology

Androgenic steroids and their non-androgenic 5beta-H metabolites enhance the number of colonies of hemoglobin synthesizing cells grown from rat bone marrow in response to a standard (0.25 unit/ml) concentration of erythropoietin. The target cells for two steroids were found to be different. Cells influenced by the androgen, fluoxymesterone (fluoxy), resembled cells responding to erythropoietin in their cycle characteristics, as measured by tritiated thymidine suicide, and in their physical characteristics, as determined by velocity sedimentation gradient separation. Cells responding to etiocholanolone (etio) had a much lower tritiated thymidine suicide rate and different sedimentation velocities. Preincubation of marrow cells with etio for two hours was sufficient to enhance erythroid colony growth by 84%, whereas a similar incubation with fluoxy produced no increment. These studies demonstrate that different classes of steroids may influence in vitro erythropoiesis by acting on distinct populations of marrow cells. Fluoxymesterone appears to act through cells already committed to respond to erythropoietin, while etiocholanolone appears to act on a separate, perhaps more primitive population of marrow cells.     

Computer modeling in urology

A family of structurally related intrinsic membrane proteins (facilitative glucose transporters) catalyzes the movement of glucose across the plasma membrane of animal cells. Evidence indicates that these proteins show a common structural motif where approximately 50% of the mass is embedded in lipid bilayer (transmembrane domain) in 12 alpha-helices (transmembrane helices; TMHs) and accommodates a water-filled channel for substrate passage (glucose channel) whose tertiary structure is currently unknown. Using recent advances in protein structure prediction algorithms we proposed here two three-dimensional structural models for the transmembrane glucose channel of GLUT1 glucose transporter. Our models emphasize the physical dimension and water accessibility of the channel, loop lengths between TMHs, the macrodipole orientation in four-helix bundle motif, and helix packing energy. Our models predict that five TMHs, either TMHs 3, 4, 7, 8, 11 (Model 1) or TMHs 2, 5, 11, 8, 7 (Model 2), line the channel, and the remaining TMHs surround these channel-lining TMHs. We discuss how our models are compatible with the experimental data obtained with this protein, and how they can be used in designing new biochemical and molecular biological experiments in elucidation of the structural basis of this important protein function.     

Imaging in pediatric urology

A multitude of disorders of the genitourinary tract can occur in children. Although some entities may be diagnosed clinically, radiologic imaging is often necessary for diagnosis and management. The radiologic work-up has been discussed using a problem-oriented approach in five clinical situations: urinary tract infection, hydronephrosis or hydroureter, trauma, swollen scrotum, and hematuria. This discussion provides some general guidelines, although the evaluation of each child may need to be individualized depending on their specific clinical symptomatology.     

Antimicrobial prophylaxis in urology

Antimicrobial prophylaxis in surgery has proven to be effective in controlled randomized trials. Usage in Urology is known at least since the '30s although its effectiveness has only become known since 1979. METHODS: Review of literature related to surgical antibiotic prophylaxis, more specifically urological surgery, basically from 1991 to 1995, but without overlooking those papers that have become classics due to their impact. RESULTS AND CONCLUSIONS: Efficacy of antimicrobial prophylaxis in urological surgery is nowadays beyond all doubt. Usage is indicated in the presence of sterile urine and dosage must be short, in single dosis in the immediate pre-operative or within 24 hours after the procedure. However, there is a number of issues that deserve to be treated in more detail for better understanding. Those are the establishment of adequate prophylactic regimes in renal transplantation and the use of antimicrobials based on their pharmacokinetic characteristics to optimize the prophylactic purpose.     

Role of biofilm in urology

The particular organization of bacteria as a biofilm on surfaces plays an essential role in urology because of the increasing use of prosthetic materials. Although the biocompatibility of the various materials used is now more effectively controlled, colonization of surfaces by microorganisms is frequent and the formation of a biofilm is responsible for difficulties encountered during treatment of prosthetic infections. The problems concerning the detection and eradication of biofilm led the authors to propose a brief review of the growing understanding of biofilm in urology over the last five years.     

Legal problems in everyday urology

Docetaxel is a new taxoid antineoplastic agent with clinical efficacy especially in breast cancer. One of the most distressing side-effects induced by docetaxel is alopecia. We studied the prevention of alopecia by using a cold cap in 98 patients receiving 100 mg/m2 docetaxel by 1 h i.v. infusion every 3 weeks. One patient was lost to follow-up. 83 patients (86%) were evaluated as a success to the cold cap, as they presented WHO grade alopecia < or = 2 and no need to wear a wig. 14 patients (14%) had to wear a wig; among them; 7 patients withdrew before the evaluation at three cycles. The cold cap is a very effective technique with minimal side-effects for docetaxel-treated patients.     

Current clotting concepts in urology

A modern outline of the physiology of coagulation, a simple approach to the use of laboratory investigation for patients with possible clotting disorders in unexplained hematuria and several illustrative cases are presented. The diagnosis and management of localized fibrinolysis in the genitourinary tract and intravascular coagulation as possible causes of post-prostatectomy hemorrhage are discussed. A minimum of a platelet count, fibrinogen assay and, if possible, measurement of fibrinogen-related antigens should be obtained before administration of epsilon aminocaproic acid.     

Current role of coagulase-negative staphylococci in urology

Coagulase-negative Staphylococci (CNS), considered for many years to be commensal bacteria of the skin are now recognized as major agents of nosocomial infection. Bacterial factors (increased resistance), host factors (immune status) and multiplication of the portals of entry (presence of foreign material) have contributed to the increased incidence of nosocomial infections. The importance of the role of NCS in urology is due to their great capacity to colonize catheters and most prostheses. The particular organization of these bacteria into a conglomerate called biofilm is responsible for prosthetic infections, which can impair renal function and can sometimes be life-threatening. The authors review the current increase of the number of CNS isolated in urology departments and describe the various therapeutic strategies that can be proposed to eradicate these bacteria.