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Biomedical subjects

P Boland

Publications and source records attributed to P Boland.

49 records · Page 3Linked to original sources
PubMed1985

Questioning assumptions about preferred provider arrangements.

The parties in any negotiation to contract for health care services delivered by a preferred provider organization (PPO) represent often divergent views and priorities. The assumptions of each participant in a PPO contracting process need to be thoroughly understood because of their impact on the subsequent business of providing, consuming, and paying for medical services. This article discusses 11 of the most common assumptions about PPOs made by providers, insurers, and purchasers. These assumptions have not been borne out to date by the experience of current PPOs and other alternative health care delivery systems.

Economic Competition↗
PubMed1981

A psychological profile of the transsexual. II. The female.

This research introduced standardized psychological measurement into the clinical assessment of the female transsexual. Twenty females with a presenting complaint of gender dysphoria were carefully screened to ensure high correspondence between their clinical pictures and current nosological concepts of transsexualism. All were administered the Derogatis Sexual Functioning Inventory as a part of their initial clinical work-up, and their profiles were contrasted with those of a comparison group of 143 heterosexual females. Results indicated hypermasculine gender role definitions and fantasy themes among the transsexual group with decrements in terms of sexual information and range of sexual experiences. The transsexual females revealed moderately dysphoric affect profiles but were unremarkable in terms of psychological symptoms. Overall, there was evidence of reductions in sexual drive; however, this result was highly dependent upon which indicator of drive was employed. The opportunity to obtain a systematic psychometric evaluation of this fascinating clinical group is viewed as a significant step in gaining an ultimate understanding of their condition.

Adult↗
PubMed1981

Stress fractures of the lower limb in patients with rheumatoid arthritis.

Thirteen patients suffering from rheumatoid arthritis had 19 stress fractures of the tibia or fibula. These patients characteristically presented with sudden, severe, unexplained pain with localised tenderness just below the knee or above the ankle. In seven patients examination of the adjacent joint indicated a flare-up of disease activity or a pyogenic arthritis. In six patients the diagnosis was delayed by the late appearance of callus in minute fractures. All patients had rheumatoid deformities of the ipsilateral lower limb: valgus deformities of the knee and subtalar joints occurred most frequently. All patients had osteoporosis; all except two had received steroid treatment and five had abnormalities of calcium metabolism. We suggest that deformities of the knee and ankle predispose patients with rheumatoid arthritis and osteoporosis to stress fractures of the tibia and fibula.

Adult↗
PubMedDate not supplied

Resection of the sciatic, peroneal, or tibial nerves: assessment of functional status.

BACKGROUND: Lower-extremity tumors are often treated by amputation rather than limb-sparing excision that sacrifices the sciatic nerve or a branch. This study assessed the functional outcome of major nerve sacrifice during limb-sparing resections for lower-extremity soft tissue sarcoma. METHODS: Patients who underwent division of the sciatic, tibial, or peroneal nerve(s) during limb-sparing sarcoma surgery (January 1982 through June 2000) were identified. Eleven surviving patients evaluated their pre- and postoperative functional status by self-administered questionnaire (six sciatic, two tibial, and three peroneal nerve divisions). RESULTS: Eighteen patients (10 male, 8 female; 14-84 years old) had nine primary and nine locally recurrent tumors. Tumors were high (16) or low grade (two). Five patients died of disease and two died of other causes. Median overall survival was 50 months. One of 11 reported increased pain. Eight had new phantom sensations with a median intensity of 4.5 (1 = least; 10 = most). All patients used an ankle brace to walk after a sciatic (four) or peroneal (one) division. Walking ability and distance after surgery was unchanged (nine), improved (one), and worsened (one). Standing improved in 7 of 11 patients. Proprioception in the affected extremity was retained in six. The median postoperative leg functional score was 8 (1 = worst; 10 = best). No patient developed foot ulcers. One patient underwent amputation for recurrence. All patients preferred their status over having an amputation. CONCLUSIONS: Objectively and subjectively, division of the major lower-extremity nerves causes acceptable functional deficits in most patients. Resection of affected sciatic nerve (branches) during limb-sparing tumor surgery is an excellent alternative to amputation.

Adolescent↗
PubMedDate not supplied

Medical group bankruptcies: an emerging problem.

This article explores the reasons why medical group practices and independent practice associations are filing for bankruptcy with increasing frequency. The problem stems from capitation payments by managed care organizations that are not sufficient to cover the costs of providing necessary care. The result is the dislocation of patients who have to find a new provider and providers who have to find a new practice setting. This article suggests that if the managed care industry could adopt clinical risk adjustment as a mainstay of physician compensation, medical groups and IPAs would have a far better chance of managing patient risk more successfully under capitation.

Bankruptcy↗