Pseudoinoculum barbae: beard-induced contact dermatitis.
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Biomedical subjects
Publications and source records attributed to R O Bischof.
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Numerous challenges face academic medicine in the era of managed care. This environment is stimulating the development of innovative educational programs that can adapt to changes in the healthcare system. The U.S. Quality Algorithms Managed Care Fellowship at Jefferson Medical College is one response to these challenges. Two postresidency physicians are chosen as fellows each year. The 1-year curriculum is organized into four 3-month modules covering such subjects as biostatistics and epidemiology, medical informatics, the theory and practice of managed care, managed care finance, integrated healthcare systems, quality assessment and improvement, clinical parameters and guidelines, utilization management, and risk management. The fellowship may serve as a possible prototype for future post-graduate education.
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The authors have examined managed care from several perspectives in this article. A look at the origins of managed care provided a historical perspective. The current state of managed care and its issues were presented. Finally, the authors speculated what the future may bring in terms of both continued current trends and significant changes in managed care. The authors hope that this presentation provides some insight to the practicing physician on how to work in a world with managed care and what the future may bring. Managed care brings changes in the way physicians practice, but it also offers physicians many opportunities to improve the quality and cost-effectiveness of health care. Managed care is the wave of the present and of the future. It is the health care market's choice to address the challenges that health care faces in quality, cost-effectiveness, accountability, access, and choice. Although there are numerous proposed, alternative, and theoretic solutions, managed care has insurmountable momentum. It will be molding the shape of health care as society enters the twenty-first century.
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BACKGROUND: Insect stings are a common injury. One of the most important aspects of stings is prevention through patient awareness. Little is known, however, about when most stings occur. This study was designed to define the seasonal pattern of stings. METHODS: A retrospective review of the sting activity at a large emergency department (over 40,000 visits annually) was conducted for a 5-year period from 1991 to 1996. The clinical/financial data system identified 449 sting victims during this period. The average rate of stings was calculated for each month of the year. RESULTS: The 2 months with the highest sting rates were August and September. The monthly sting rates in late summer and autumn were significantly higher than for late spring and summer (P = .002). Sting rates in other months were much lower. CONCLUSIONS: This study suggests that the highest incidence of stings occurs in late summer and early autumn. This is when yellow jacket "delirium" occurs, in preparation for cold weather. If studies in other settings confirm this pattern, the information can be used in modifying behavior to prevent stings.
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A medical intern presented with a rash that proved to be an unusual presentation of stethoscope dermatitis, a form of nickel contact dermatitis. The stethoscope as a cause of occupational side effects is reviewed.
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