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PubMed1994

[Slipped capital femoral epiphysis and biosynthetic growth hormone therapy. A case report].

The case of an adolescent male with short stature and partial growth hormone deficiency who developed a slipped capital femoral epiphysis during the treatment with recombinant growth hormone is reported in this paper. Our patient started GH therapy with recombinant growth hormone at the dose of 15 U/m2/week administered subcutaneously three times a week. After 6 months of GH therapy there was a satisfactory response to the therapy and his growth velocity improved significantly. Unfortunately the patient had pain of the left hip which was exacerbated by walking. The diagnosis of slipped capital femoral epiphysis was confirmed radiographically and treated surgically with internal fixation of the epiphysis with the use of Moore's pins. Treatment with GH was discontinued. After one year there was the complete resolution of the disease and the adolescent was able to return at his usual way of life. Slipped capital femoral epiphysis is a disease in which the anatomic relationship between the femoral head and neck changes by disruption of the epiphyseal plate. This condition can occur only before the epiphyseal plate closes. Patients vary in age from newborn infant to teenager, nevertheless slipped capital femoral epiphysis is probably the most common hip disease during adolescence, and is often associated with endocrine imbalance including growth hormone deficiency. The aetiology of slipped capital femoral epiphysis is still unknown although many theories have been proposed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

Slipped capital femoral epiphysis.

Slipped capital femoral epiphysis occurs during the adolescent growth spurt and is most frequent in obese children. Up to 40 percent of cases are bilateral. Recent classification methods emphasize epiphyseal stability rather than symptom duration. Most cases of slipped capital femoral epiphyses are stable and have a good prognosis if diagnosed early. Unstable slipped capital femoral epiphysis has a much poorer prognosis because of the high risk of avascular necrosis. Early radiographic clues are the metaphyseal blanch sign and Klein's line. Once diagnosed, treatment should begin immediately. The most widely accepted treatment for a stable slipped capital femoral epiphysis is in situ fixation with a single central screw. The treatment for an unstable slipped capital femoral epiphysis is much more controversial. Corrective osteotomy is usually reserved for treatment of severe deformities after the patient has stopped growing.

Diagnosis, Differential↗
PubMed1989

Capital investment for the future of biomedical research: a university chief financial officer's view.

The author explores the subject of capital needs in university biomedical research. Three main topics are covered: the universities' need for capital (which is great and growing fast); the sources of capital for universities (private donations, state and federal governments, institutional funds, and debt); and a review of federal policy, to determine whether the federal government is part of the problem of meeting universities' capital needs or part of the solution. For each topic, important assumptions, questions, and possible future trends and dangers are reviewed. The author calls for the university research community to face the difficult issues he has raised and consolidate their thinking in order to avoid potential dangers and to ensure the health of university science into the 21st century.

Capital Expenditures↗
PubMedDate not supplied

Capital--its application, access and attitudes.

Access to capital for group or network development is generally through one of three sources: current revenue, borrowing, or outside investors. Groups often have not planned well for their financial future, and consequently when integration or managed care opportunities arise, they can be without the necessary funds. This article addresses the acquisition of capital in the context of application (need), access (resources), and attitudes (concerns). Determining capital needs is the starting point, followed by investigating institutional resources, and then investigating the attitudes of the group toward accessing the needed capital.

Attitude↗
PubMed1998

Integrating base rate data in violence risk assessments at capital sentencing.

Prediction of violence in capital sentencing has been controversial. In the absence of a scientific basis for risk assessment, mental health professionals offering opinions in the capital sentencing context are prone to errors. Actuarial or group statistical data, known as base rates, have proven far superior to other methods for reducing predictive errors in many contexts, including risk assessment. Actuarial follow-up data on violent recidivism of capital murderers in prison and post release have been compiled and analyzed to demonstrate available base rates for use by mental health experts conducting risk assessments pertaining to capital sentencing. This paper also reviews various methods for individualizing the application of base rates to specific cases.

Actuarial Analysis↗
PubMed1999

Inferring capitation rates from aggregate health plans' costs.

Setting risk-adjusted capitation rates in health systems with centralized financing and decentralized delivery is one of the most intriguing policy issues. The common practice to set capitation group rates is based on individual data collected from either population surveys or medical records, using a single-and in most cases arbitrary-set of relative unit costs of services. This paper presents a method for estimating group-specific mean costs and capitation rates using a panel of aggregate cost data of the competing health plans and the composition of their populations. This method is used to estimate mean costs and capitation rates for the Israeli health care system. The limited data available severely constrains the range of estimable models, however, the results evoke some questions with regards to reimbursement and rates presently used, as well as to the methodology used to estimate them.

Adolescent↗
PubMed1994

Serious mental illness and capitation financing.

Traditional organization and financing of mental health care has not adequately served the needs of persons with serious mental illness. Capitation financing is being tested in several localities, but little experimental data has been yielded to date, and it is mixed. The results from the Rochester experiment were positive but limited, and some other pilots also reported positive experiences with capitation. Others have ended prematurely or confronted obstacles. Experimental findings are also anticipated from the Philadelphia and California pilots, and others are just beginning. Existing financing mechanisms, cost-shifting efforts, and professional cultures represent powerful obstacles to successfully implementing capitation financing for care of persons with long-term mental illnesses, and potential incentives to underserve enrollees require adequate accountability structures. In spite of obstacles, the goodness of fit between the needs of persons with serious mental illness and capitation flexibility warrant further exploration of this financing modality.

Capitation Fee↗
PubMed2001

The United Nations Convention on the Rights of the Child: a basis for jus cogens prohibition of juvenile capital punishment in the United States.

This article supports the position that the 1989 United Nations Convention on the Rights of the Child (CRC) articulates a prohibition of capital punishment of juveniles that now must be considered a norm of jus cogens. The article provides statistics and trends regarding juveniles who commit capital crimes and describes how the U.S. justice system handles such juveniles, including Eighth Amendment analyses of juvenile executions under the U.S. Constitution. The article also discusses community consensus regarding evolving standards of decency, describes international law on the capital punishment of juveniles, and outlines worldwide trends in juvenile executions. It then defines and describes the concepts of customary international law and jus cogens, applying these concepts to the problem of the execution of juveniles in the United States. The article concludes by suggesting that there is a moral imperative for universal prohibition of juvenile capital punishment and by speculating about the domestic effects of applying such a jus cogens norm in the United States.

Adolescent↗
PubMed2006

Arbitrariness and the death penalty: how the defendant's appearance during trial influences capital jurors' punishment decision.

This paper examines the impact of the defendant's appearance during the trial on capital jurors' punishment decision. The data used in this analysis were gathered by the Capital Jury Project (CJP), a national program of research on the decision-making of capital jurors. A series of multivariate logistic regression analyses were conducted using four aggravating circumstances related to the killing and eight defendant appearance variables as predictors of jurors' punishment decision at three points during the capital trial: (1) after the punishment phase ended, but before formal deliberation began; (2) when the first vote was taken on punishment at jury deliberations; and (3) at the final vote on punishment. Results indicated that when the defendant appeared emotionally involved during the trial (i.e. sorry and sincere) jurors either favored a life sentence or were undecided about punishment; however, when the defendant appeared emotionally uninvolved during the trial (i.e. bored) jurors either sought a death sentence or remained undecided. Policy implications will be discussed.

Capital Punishment↗
PubMed1989

Capitated payments for mental health care: the Rhode Island programs.

Capitation financing for the delivery of mental health care under public programs is receiving increasing attention from policymakers. Most initiatives in this respect are in the planning or early implementation stages. This paper describes five years of experience with capitated financing for mental health care in the state of Rhode Island. It discusses the motivation for the programs, their design, and the issues that have arisen with respect to their operation. The Rhode Island experience demonstrates that capitated financing for mental health care is feasible and that Community Mental Health Centers can operate effectively as providers of care under these arrangements. It also suggests that capitated programs can have unanticipated impacts on the operation of community-based mental health service delivery programs.

Capitation Fee↗
PubMed1983

A preimplementation assessment of a capitation reimbursement system using simulation.

Capitation is a system of reimbursement for services under which providers are paid a fixed amount per client served per time period. An experiment from April 1981 to December 1981 involved the use of a capitation system of reimbursement to pharmacies participating in the Iowa Medicaid drug program in 32 counties in Iowa. It was essential to demonstrate that cost savings were feasible and pharmacy reimbursement would be adequate before the capitation experiment was begun. An assessment of this issue was developed using simulation and data base management techniques. The positive results of this assessment gave evidence that cost savings due to capitation potentially could be realized by both the Medicaid drug program and pharmacists during the experiment.

Capitation Fee↗
PubMed1984

Designing a capital budgeting system that works.

Conventional capital budgeting systems do not fully reflect or adequately respond to the way in which capital expenditure decisions are actually made. Evidence also exists that the nature of this decision process is dependent on the type of the organization. This paper describes an empirically developed understanding of how capital expenditure decisions are being made, identifies ways to support and improve these decisions, and proposes an approach to linking the design of capital budgeting systems with the type of organization in which they are to operate.

Budgets↗
PubMed1985

The capital decision-making process in regionalized public health systems: some evidence from Sweden and Denmark.

This paper evaluates health capital policy in two regionally structured delivery systems, those of Sweden and Denmark. After a short overview of each nation's health care system, the paper examines the decision-making process for capital equipment and major capital construction in each country. By comparing aspects of system design and subsequent policy outcome, the paper highlights the degree to which capital policy can vary within an apparently similar regionalized framework.

Capital Expenditures↗
PubMed1998

Risk-adjusted capitation payments: developing a diagnostic cost groups classification for the Dutch situation.

In many countries market-oriented health care reforms are high on the political agenda. A common element of these reforms is that the consumers may choose among competing health insurers or health plans, which are largely financed through premium-replacing capitation payments. Since 1993, Dutch sickness funds receive risk-adjusted capitation payments based on demographic factors. It has been shown that the predictive accuracy of a demographic capitation model improves when it is extended with diagnostic information from prior hospitalizations, in the form of Diagnostic Costs Groups (DCGs). In this study a DCG classification is developed using Dutch cost data of sickness fund members of all ages. The study also dealt with the question of how to handle high discretion diagnoses. For the Dutch situation high discretion diagnoses may be defined as those diagnoses for which day case treatment is a possible alternative for a hospital admission. Grouping persons with a hospital admission for high discretion diagnoses together with people without an admission resulted in a slight reduction of the predictive accuracy of the DCG model. Adequate risk-adjustment is critical to the success of market-oriented health care reforms. The use of diagnostic information from prior hospitalizations seems a promising option for improving the capitation formula.

Capitation Fee↗
PubMed1997

Capitation. Theory, practice, and evaluating rates for gastroenterology.

Capitation risk contracting has the potential to combine insurance functions with medical care functions. Success depends on a careful consideration of the capitation rate and a thorough understanding of all capitation contract issues. Proper incentives to physicians in a specialty network stimulate a major reengineering effort to squeeze the inefficiency out of the system. Within the network, true peer review can effectively diminish variability in medical care. Such variability leads to increased cost without benefit to health status. The superior medical management of a capitated specialty network can create added value by coordinating more cost-effective and appropriate evaluation and therapy.

Capitation Fee↗
PubMed1996

Understanding capitation and pharmaceutical care.

Although capitation has not yet emerged as the predominant mode of payment for health care, many experts believe that this will happen within a few years, and that capitation will predominate among methods to pay for pharmaceutical care services as well. Capitation is confusing because it exists in many forms. This article: Explains alternative forms of capitation for pharmaceutical care services. Offers some thoughts on what might be acceptable and not-so-acceptable forms from the perspective of the pharmacy manager.

Capitation Fee↗
PubMed2000

Capitation funding in Australia: imperatives and impediments.

Health service funding mechanisms are pivotal in the pursuit of health system objectives, as they provide strong financial incentives for actors in the system to achieve policy goals. Underpinning funding mechanisms is a set of key economic principles, or objectives, that should guide their design and use: efficiency, equity, and accountability. The Australian health system has historically performed relatively poorly in relation to these objectives, with evidence of inefficiencies, inequities, and poor accountability in many areas of health services. The primary cause of these shortcomings may lie in the complex set of funding and delivery arrangements at the State and Federal levels of government. Potentially significant improvements in the performance of the health system would be available from the integration of the funding and delivery of services within a single tier of government, coupled with the development of a national weighted capitation approach to funding. To develop a national capitation funding model a number of unique factors require consideration, including the current fragmentation of services, the role of the private sector, the needs of indigenous populations, and the effects of rurality. The data available to develop a capitation model is of a level of detail and quality not readily found elsewhere. If policy statements promoting efficiency, accountability, and particularly equity are to be actively pursued, a national capitation model based on robust methods should become a cornerstone of Australian health system reform.

Australia↗
PubMed2003

Explaining capital punishment support in an abolitionist country: the case of The Netherlands.

A substantial minority (35%) of the Dutch population is in favor of capital punishment. In this paper, it is argued that in a staunchly abolitionist country such as The Netherlands, the existence and perseverance of such support can be better understood and explained by conceiving of capital punishment support in attitudinal terms as part of a law and order syndrome. Death penalty attitudes are analyzed by means of hierarchic logistic regression analysis. It is shown that support can be modeled quite well, partly in terms of general attitudes to criminal justice, partly in terms of political and sociodemographic parameters. Within the criminal justice attitudes complex, more support is found among those endorsing harsh treatment of offenders, those willing to grant far-reaching powers to justice authorities, those believing that the government is not delivering on the topic of crime fighting, and those who are concerned about the level of crime. Within the political context, more support is enlisted among people who abstain from voting and those who vote at either extreme of the political spectrum as opposed to central parties' supporters. In sociodemographic segments it is the younger and poorly educated who are the strongest supporters of capital punishment. It is suggested that endorsing capital punishment can be better understood as an expressive act, displaying dissatisfaction with judicial and political elites in the country.

Attitude to Death↗