Development of a local integrated health network

Integrated health networks are viewed as one possible organizational response to healthcare reform. This article discusses the variables that are critical to the development and success of a local integrated network. The case of a network currently under development is used to illustrate the underlying theory. Virtual integration is envisioned as the method by which the network comes together.     

The sustained increase in permeability produced by bradykinin is dose related

The purpose of this experiment was to determine in skin microvasculature the dose response to bradykinin (BRADY). Over a range 0, 0.2, 0.4, and 0.8 microgram/kg/min BRADY was infused into the femoral artery of anesthetized dogs while lymph was collected from the hind paw. After 4 hours of continuous BRADY, venous pressure was increased 20 to 30 mm Hg by tightening a tourniquet around the thigh to further increase lymph flow and achieve a filtration-independent lymph-plasma ratio, for albumin (R Alb), immunoglobulin G (R IgG), and immunoglobulin M (R IgM). These proteins were measured with immunoelectrophoresis and immunodiffusion. MEAN +/- SD, * p less than 0.05, ANOVA, DIFFERENT FROM LOWER DOSE. [Formula: see text] BRADY caused a dose-related increase in microvascular permeability up to 0.4 microgram/kg/min. The increase in the lymph-plasma ratio for the large plasma proteins (IgM, molecular radius 110 A) is of the same magnitude as for albumin, (molecular radius 36 A), and this suggests BRADY increased the number but not the size of "large pores" in the microvascular membrane.     

Translational Applications of Personality Science for the Conceptualization and Treatment of Psychopathology

Utilizing personality science within clinical assessment and intervention can aid in treatment planning. General personality constructs also are related to clinically relevant areas of dysfunction. However, personality continues to be underutilized in clinical settings. This article reviews current literature pertaining to the clinical applications of personality with a focus on dimensional models such as the Five‐Factor Model. With the advent of a dimensional personality model in DSM‐5, the clinical use of traits is an important topic of exploration. This review discusses the clinical significance of personality and personality pathology in various aspects of living (i.e., functioning, physical health, mental health), clinical applications and utility within clinical and treatment settings, and future research directions, as well as suggestions for further utilization of personality traits.     

Tension pneumoperitoneum resulting from endoscopic duodenal perforation: a case report

Tension pneumoperitoneum is defined as an accumulation of free air within the peritoneal cavity sufficient to cause respiratory or hemodynamic compromise. We report a case of a 75-year-old woman who underwent upper endoscopy for evaluation of severe upper gastrointestinal hemorrhage. During the procedure, she developed massive abdominal distension, raising concern about possible perforation. Endoscopy was terminated and prompt surgical consultation obtained. This revealed massive abdominal distension, hypotension, and elevated airway pressures. Tension pneumoperitoneum was suspected. There was immediate decompression via a small umbilical incision, after which the patient's condition stabilized. A full exploration was then carried out, allowing definitive surgical treatment of both the source of bleeding and the perforation. We review the literature regarding this unusual event.     

Pulmonary artery sling

Pulmonary artery “sling” indicates the vascular anomaly wherein the left pulmonary artery arises from the right pulmonary artery and traverses between the esophagus and trachea to enter the left lung. Respiratory symptoms may result from compression of the trachea and right mainstem bronchus by the anomalous vessel as well as by associated tracheo-bronchial defects. Six cases are described. The distinctive radiologic features include anterior indentation of the barium esophagogram and a characteristic pulmonary angiogram. Surgery is the usual recommended treatment for life-threatening airway obstruction, but results are often poor. In patients with less severe symptoms the physician's approach may be modified by the presence of associated intracardiac defects and intrinsic airway disease.