Orbital pseudotumour is a non-specific inflammation of the orbit which forms a tumour-like mass composed of increased connective tissue and ground substance with vascular proliferation and an infiltrate of chronic inflammatory cells. No demonstrable aetiological agents are found locally, and there is no evidence of specific disease entities such as Hodgkins, SLE or temporal arteritis. The condition may present in many different ways to the otolaryngologist, and is therefore a rare but important differential diagnosis to be born in mind. We report a rare case of orbital pseudotumour presenting initially with involvement of the maxillary antrum and in association with Riedel's thyroiditis.

Female↗

PubMed1990

The influence of calcium alginate haemostatic swabs upon operative blood loss in adenotonsillectomy.

Although adenotonsillectomy is regarded as a minor procedure, it has been shown that 18% of patients may experience an operative blood loss of 10-20% of the total blood volume. The aim of this study was to determine whether calcium alginate haemostatic swabs reduce operative blood loss in adenotonsillectomy. Seventy-two patients (ages 2-12 years) entered a prospective trial in which the operation was performed either with normal gauze swabs or calcium alginate swabs. Thirty-six children were randomized to each group. The mean blood loss was found to be 34.9 ml (2.07% of total blood volume) and 47.8 ml (2.97% of total blood volume) respectively. Although there was no significant reduction in operative blood loss using calcium alginate, in both groups the blood loss was much smaller than that stated by the majority of previous workers.

Adenoidectomy↗

PubMed1990

Building blocks.

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Financing, Organized↗

PubMed1990

Monitoring the impact of Medicare's physician payment reform.

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Fee Schedules↗

PubMed1989

Collecting those debts.

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Accounting↗

PubMed1989

Facilities for employees.

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Facility Design and Construction↗

PubMed1989

The impacts on hospital costs between 1980 and 1984 of hospital rate regulation, competition, and changes in health insurance coverage.

In this paper, we report the results of an analysis of hospital expenses in 43 large SMSAs between 1980 and 1984. We found that hospital rate regulation--specifically Medicare's TEFRA and PPS and state multi-payer systems--was the single most important factor leading to the slowdown in the rate of increase in hospital costs between 1980 and 1984. In 1984, hospital costs covered by Medicare's PPS were 12.5% lower than they would have been in the absence of rate regulation, and in the four states covered by all-payer rate regulation, hospital costs were between 11% and 15% lower. In contrast, changes in the proportion of people either covered by employer-group health insurance or enrolled in HMOs, reduced hospital costs by less than 1%. Measures of competition suggest that hospital costs are higher where there is more competition. We also found that almost all of the effect of regulation on costs came from gains in the efficiency of producing hospital care and/or from reductions in the quality of care. It appears that controlling hospital payment rates gave hospitals a strong incentive to provide care at lower cost.

Catchment Area, Health↗

PubMed1989

Profits and fiscal pressure in the prospective payment system: their impacts on hospitals.

For hospitals that were under Medicare's Prospective Payment System (PPS) for one and two years in their 1985 fiscal year, this paper examines how variation in the fiscal pressure PPS imposed affected expenditures and other aspects of behavior. The analysis shows that in hospitals' second as well as first year on PPS, hospitals under greater pressure experienced greater behavioral change. However, second year changes were far smaller than changes in the system's first year. Evidence that variation in pressure reflects factors in addition to hospitals' relative efficiency and may undermine rather than promote appropriate cost containment leads the authors to propose modifications in PPS methods.

Costs and Cost Analysis↗

PubMed1988