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Physician employment: this time around, give finance a leading role.

Finance managers can play a leading role in determining the success of physician employment by addressing physicians' financial concerns. Physicians can benefit from financial managers' help in clarifying how practice decisions affect financial outcomes, and making the entire process transparent. Communication should include validation of data integrity, development of targeted reports, education, and frequent opportunities for dialogue.

Employment↗

[Precise recognition method of structure-function determinants of protein molecules].

This paper is devoted to a computer system designed for formal description and knowledge about protein structural-functional determinants. Structural-functional determinant is a region of amino acid sequence with certain structural, functional or evolutionary properties specific for each class of macromolecules. Here the problem is solved by a special method which allows to design programs able to distinguish these structural-functional determinants. The method is based on the expert system technology and integrated data bases.

Amino Acid Sequence↗

Health resources management and physician control in a San Francisco, California, hospital.

The continued escalation in health care spending has caused money to become an increasingly limited resource, which may eventually affect the ability of health professionals to provide complete health care services. Health care payers have stressed efficiency and the appropriateness of health care measures and are putting greater financial pressures on health professionals by making them more accountable for services provided. Hospitals and physicians must take a more active role in monitoring health care delivery and work together to improve performance efficiency. Efficiency can be gained through a comprehensive program that emphasizes high-quality care and the effective use of health care resources. The Health Resource Management Program is a model for carrying out this function that integrates data analysis and physician input and education.

Delivery of Health Care↗

Computerized patient management in a nephrology department.

An integrated approach is described for the computerized management of a nephrology department. On a medical point of view, the system comprises a minimum medical record for every patient, different specialized records and knowledge bases presently covering hypertension, diabetes and chronic renal failure. From a technical point of view, the methodology used integrates data and knowledge management techniques. Various individual reports facilitate patient management. For hypertensive patients, an expert system is combined with the record system. The results of a preliminary evaluation are reported and future developments considered.

Computer Systems↗

Psychologic factors in the multidisciplinary evaluation and treatment of erectile dysfunction.

The members of a multidisciplinary team treating sexual dysfunction must work together from different perspectives and training to determine an accurate diagnosis, choose an appropriate treatment, and evaluate those treatments systematically. Integrating data from both physical and psychologic evaluations is essential. Anxiety, depression, or other reactions to stress are seen as cognitive interferences that inhibit sexual arousal by distracting attention from erotic stimuli. The goals of sex therapy are to enhance attentional focus on sexual cues and to lessen distractions in the form of anxiety, conflict, or other stresses. Although there continue to be methodologic problems in outcome evaluation research of multidisciplinary treatment of sexual dysfunction, follow-up studies generally indicate improvements in sexual functioning, satisfaction, and self-esteem.

Ejaculation↗

Computer-assisted quality control: considerations for program design.

A well-designed laboratory computer system has the potential of enhancing all phases of quality control. Of most importance is the choice of an underlying approach that is statistically valid and robust. Specification of quality goals, participation in regional programs, and use of a flexible multi-rule approach are recommended. Careful attention to general and specific design is necessary to achieve full system potential. The design process must include detailed consideration of file and record structure, data integrity, flexibility of input and output, and display and report formats. For statistical run evaluation, theoretic validity, operational process, and ease of understanding by the user must be considered.

Computers↗

Solubilization and characterization of the beta-adrenergic receptor binding sites of frog erythrocytes.

Specific beta-adrenergic receptors present in membrane preparations of frog erythrocytes were identified by binding of (-)-[3H]dihydroalprenolol, a potent competitive beta-adrenergic antagonist. The (-)-[3H]dihydroalprenolol binding sites could be solubilized by treatment of a purified erythrocyte membrane fraction with the plant glycoside digitonin but not by treatment with a wide variety of other detergents. The binding sites appeared to be soluble by several independent experimental criteria including (a) failure to sediment of 105,000 X g for 2 hours; (b) passage through 0.22-mu Millipore filters; (c) chromatography on Sepharose 6B gels; and (d) electron microscopy. The soluble receptor sites retained all of the essential characteristics of the membrane-bound sites, namely rapid and reversible binding of beta-adrenergic agonists and antagonists; strict stereospecificity toward both beta-adrenergic agonists and antagonists; appropriate structure-activity relationships; saturability of the sites at low concentrations of ligand; no affinity for alpha-adrenergic drugs, nonphysiologically active catechol compounds, and catecholamine metabolites. Based on gel chromatography in the presence of detergent, the molecular weight of the soluble receptor is estimated to be no greater than 130,000 to 150,000. Equilibrium binding studies indicated a KD for the soluble receptor of 2 nM. Hill coefficients (nH) of 0.77 and curved Scatchard plots suggested the presence of negatively cooperative interactions among the solubilized receptors in agreement with previous findings with the membrane-bound sites. Kinetic studies indicated an association rate constant K1 = 3.8 X 10(6) M-1 min-1 and a reverse rate constant k2 = 2.3 X 10(-3) min-1 at 4 degrees. The kinetically derived KD (k2/k1) of 0.6 nM is in reasonable agreement with that determined by equilibrium studies. The soluble receptors were labile at temperature greater than 4 degrees but could be stabilized with high concentrations of EDTA. Guanidine hydrochloride and urea produced concentration-dependent losses of binding activity which were partially reversible upon dialysis. Trypsin and phospholipase A both degraded the soluble receptors but a variety of other proteases and phospholipases as well as DNase and RNase were without effect. Experiments with group-specific reagents indicated that free lysine, tryptophan, serine, and sulfhydryl groups may be important for receptor binding. These studies suggest that the receptor is probably a protein which requires lipids for functional integrity. Data obtained with the solubilized binding sites are consistent with the contention that these sites represent the physiologically relevant beta-adrenergic receptors which have been extracted from the membranes with full retention of their properties.

Adrenergic beta-Antagonists↗

[Automaton resuscitation (author's transl)].

The aim of the Automaton Resuscitation is execution, watching and maintenance of a programme of intricate resuscitation tying for the first time the therapeutic to extemporaneous outflow of biological spoliation. This apparatus executes permanently and automatically the taking of biological fluid, estimates its outflow, amounts its total and realizes or the reinstillation of the fluid in the digestive tract or the order of intravenous perfusion tied to fluid spoliation according to an adjustable connection. A first self acting regulator for the juice intestinal reinstillation has been made in 1974. The second one with 4 units of continuous aspiration, data integration, reinstillation and perfusion tied with security had waked for 6 months. Moreover it allows with fiability the reinstillation of the gastric, duodenal, bilious, pancreatic or intestinal juice, on the other hand an intravenous perfusion tied to spontaneous spoliation (digestive) or instigated spoliation (provocated diuresis) and in a fundamental way simplifies the work of the physicians and the nurses.

Adult↗

Comparison of plasma protein changes induced by danazol and pregnancy.

Analysis of 25 proteins of supposed hepatocyte origin was performed on plasma from 7 females before and during treatment with danazol. The same 25 proteins were analysed in plasma from pregnant women in their third trimester. The general conclusions are that the major plasma proteins of hepatic origin have a biosynthetic regulation which is steroid insensitive but the biosynthesis of some minor components is highly steroid sensitive in a way that supports the theory that hepatocyte steroid receptors exist. The full hepatocyte steroid response (2-6 weeks) develops more slowly than the response of steroid dependent tissues (days). The plasma protein response with danazol administration is similar to the response to other 17-alpha-alkylated anabolic steroids and is in accordance with the theory that danazol competes with endogenous steroids for their receptors in all target tissues. The changes during pregnancy are mainly referred to the increased influence of oestradiol. Integrated data from this and earlier studies suggest that the level of sex hormone binding globulin in a sensitive way reflects the competition of androgen, oestrogens and gestagens at hepatocyte receptor level.

Blood Proteins↗

A child reading: some educational and psychological considerations.

This paper notes that reading is a significant and complex task; effective reading skills are crucial for educational success and psychological integration; Data from the Remedial Reading Clinic, Institute of Education and data from a reading survey amongst 1,157 Primary Six pupils from 18 schools is with the two aspects noted above as a framework. The work of Bruno Bettelheim, a noted child psychiatrist is given special attention.

Asia↗

Assessment and evaluation of child health associates.

More than 20 studies have been carried out of child health associates to assess their knowledge, training, and practice; their ability to interpret and integrate data; their cognitive knowledge and psychomotor and interpersonal skills; and their competence and effectiveness as a primary health care providers. The results of the assessment and evaluation studies of child health associates indicate that they can determine the health status and manage the health care of patients in ambulatory settings and in the newborn nursery with a degree of skill and competence approaching that of pediatricians. Child health associates can provide comprehensive primary health care for more than 90% of children seen in these settings. The high degree of acceptance of child health associates by families and their demonstrated proficiency and cost-effectiveness document that they can be an important source of primary health care for most children.

Attitude↗

The need for comprehensive diet studies to assess the relation of lipids to cancer.

Dietary lipids have been linked by both basic research and epidemiological evidence to the etiology of some cancers. It is yet unclear which lipid(s) may be active in the carcinogenic process, but one promising hypothesis concerns the interaction of cholesterol metabolites, considered a risk factor for colon cancer, and dietary fiber which may have a protective role. A multidisciplinary case control study currently underway is investigating the relationship and possible mode of action of fiber and bile acids on colon cancer. The study has epidemiological, biochemical, and pharmacological components that have been designed to integrate data on the intake and fate of lipids, dietary fiber, and other nutritional parameters in colon cancer cases and matched controls and in animal models. Subcomponents of the study deal specifically with the characterization of dietary fiber constituents and their in vivo effect on lipid metabolism.

Animals↗

Conflict of interest and the physician-researcher.

Conflicts of interest for the physician-researcher are not limited to direct financial support by a pharmaceutical or device manufacturer but rather include subtler indirect financial and research support. In addition, a physician's role as investigator may conflict with the role of patient advocate in ways that are not always recognized. Efforts to increase awareness of subtle conflicts of interest should help prevent and address patient harm and damage to data integrity.

Conflict of Interest↗

The advance of technology as a prelude to the laboratory of the twenty-first century.

Technological changes in the clinical laboratory are usually driven by the goal of patient care optimization. In the last decade, the trend appeared to be directed at clinical laboratory decentralization. A new generation of analytical instruments, the biosensors, is redirecting laboratory testing closer to the patient, at the bedside, in the physician's office, and by the patient at home. These miniaturized biosensors are easy to operate, require small specimen size, and provide reliable results with rapid TAT. Thus far, bedside testing using biosensor technology appears to offer unique opportunities for earlier availability of clinical laboratory data, decision making, and more specific diagnosis, and faster and more frequent monitoring; these may translate into improved patient care and reduced hospital costs. It is likely that this trend will continue into the twenty-first century. Electrochemical sensors (e.g., for electrolytes, glucose, urea, and hematocrit) and pulse oximetry, having gained clinical acceptance, will probably be the leading instrumentation for bedside testing. Continuous monitoring either by near-infrared sensing technology or with an implantable sensor is valuable in the care of the critically ill patient. Acceptance for clinical use will depend on complete data integration and a favorable cost-benefit ratio.

Biosensing Techniques↗

[Relation between research and practice in analytic psychotherapy].

The technique of psychoanalytic treatment as an objective, operative-technological theory inevitably experiences a subjective refraction on analyst's personality and his or her own cognitive and interactional styles influencing therapeutic efficiency. Systematic clinical trials of treatment data integrating motions from psychoanalytic, social and cognitive science, reconcile the gap between research and practice, between basic science and application. It will be discussed how empirical research can delineate therapists' cognitive and perceptual skills and the process of transformation from declarative to procedural knowledge, further elaborated in reciprocal connection with practice. The models of Structural Analysis of Social Behavior (SASB) and Cyclic Maladaptive Pattern (CMP) are especially considered. We will also discuss the consequences for training in psychoanalysis.

Countertransference↗

A microchip for quantitative detection of molecules utilizing luminescent and radioisotope reporter groups.

Through the marriage of microelectronics and molecular biology, a miniaturized device is presented for ultrasensitive detection of labeled molecules. The novelty of the approach is the direct integration of a charge-coupled device (CCD) and a probe-based assay. Specifically, a CCD detector serves as an active solid support that quantitatively detects and images the distribution of labeled target molecules near the spatially addressable pixels. The device exploits the inherent characteristics of microelectronics that accommodate highly parallel assays, ultrasensitive detection, high throughput, integrated data acquisition and computation. Hence, the technology presented offers substantial practical utility to both research and clinical diagnostic applications that require quantitative analysis of bound molecules. Specifically for probe-based assays such as reverse dot blots, hybridization of radiolabeled or fluorescently labeled, target DNA can be quantitatively assessed within seconds due to the high sensitivity and direct coupling employed.

DNA Probes↗

Social intergration and change in activities of daily living in Japanese elderly.

The prospective association of social integration reported in 1987 with change in activities of daily living (ADL) over three years was examined in a cohort of 2200 Japanese elderly, aged 60 years and over. Social integration data was obtained from a national survey which measured both the quantity and frequency of attachment. Social ties were classified into five types: spouse, child(ren) living together, child(ren) living separately, friend, neighbor, and community group. Eight potential confounding variables--age, educational attainment, existence of chronic diseases, subjective well-being, drinking, sleeping hours, cigarette smoking, and exercise--were controlled using logistic regression analysis for each sex. Men who attended community group meetings more frequently had significantly less decline in ADL during the follow-up period for those who were ADL unimpaired at the baseline survey, and were also significantly more improved for those who were ADL impaired people at the baseline survey. Trends for women were not significant.

Activities of Daily Living↗

The need for security--a clinical view.

Systems which process patient health data of any kind are considered to be medical information systems. Some data can be categorized as non-personal, non-identifiable, or non-patient-based such as knowledge bases. Others are considered as highly sensitive because of the 'need to know' to deliver health care to patient. Access is not only justifiable for doctors and nurses, but, for specific purposes to administrative personnel and public health organisations. Of special concern are registers on sexually transmitted diseases, mental health and genetic diseases. In future, patients might gain more autonomy and also have access to some parts of their own record. Telematics allows them to update a data base and to consult a knowledge base. Clearly, physicians in charge of the cases have a responsibility that has been recognised by law in all Western countries. Access to patient's data should take into account this responsibility. Although most health professionals would still believe that confidentiality is the main issue, it appears that data integrity and availability are as important in the context of the 'paperless' electronic record. Information should be complete and correct, to be only accessed by authorized persons. The health care environment is characterised by an open nature of clinics that leaves them vulnerable to theft, damage and unauthorized access. Disclosure of information may affect the patient's social standing as well as their general health. The health professions lack sufficiently well-defined organisational structure, culture and perceptions to support security.

Computer Communication Networks↗