Attracting managed care. Eight tips for working with a managed care provider

Managed care organizations won't work with a facility unless it offers what they need. These eight tips--and one case study--outline the key procedural changes and adjustments in attitude longterm care providers are making to accommodate managed care.     

Volunteers for community health. An Ohio hospital sponsors parish nursing programs for area churches and synagogues

Since 1989, St. Elizabeth Hospital Medical Center, Youngstown, OH, has been conducting a hospital-based, multidenominational volunteer parish nurse program, which now extends to 11 Roman Catholic, Lutheran, Presbyterian, Methodist, Jewish, and Greek Orthodox congregations. Seventeen volunteer nurses are involved, responding to needs within their congregations by providing a variety of healthcare and educational services while revitalizing the Church's healing ministry. Volunteers selected are competent, experienced registered nurses who can relate to and communicate with people of all ages, accurately assess health-related problems, and make appropriate nursing decisions. Parish nurses focus on preventive care, health maintenance, and personal responsibility for maintaining a healthy life-style. Volunteer nurses determine their own schedule, contributing as much time as they can. Each volunteer nurse is responsible for developing a record-keeping system, documenting his or her parish activities, and submitting a quarterly report of volunteer hours and activities to the hospital. Hospital supports include the initial two-day orientation; monthly meetings at the hospital for information sharing, education, and mutual support; and nursing continuing education programs In addition, an advisory committee provides program support and education. St. Elizabeth Hospital Medical Center is exploring several methods of enhancing its health ministry outreach to congregations in dire need of such services.     

Accelerated Differentiation in Response to Retinoic Acid After Retrovirally Mediated Gene Transfer of GAP-43 into Mouse Neuroblastoma Cells

Although substantial evidence exists for the involvement of growth-associated protein-43 (GAP-43) in neuronal development and regeneration, the precise role of this protein in neurite outgrowth is currently debated. To investigate the role of GAP-43 in the initiation of neurite outgrowth, we transfected a full-length cDNA coding for GAP-43 into a mouse neuroblastoma cell line (Neuro-2a) which can be differentiated to a neuronal phenotype using retinoic acid (RA). We show that the consequent overexpression of GAP-43 results in a change in the basic morphology of these cells, but is not in itself sufficient to induce the extension of neurites. However, overexpression of GAP-43 results in a marked acceleration of neurite formation in response to RA. We propose that while GAP-43 does not trigger the initiation of neurite extension, its expression is rate-limiting for neurite outgrowth in response to differentiation agents such as RA.     

Weight change in depression: influence of "disinhibition" is mediated by body mass and other variables.

The direction of weight change (gain or loss) in depression has recently been found to be a stable characteristic of patients across depressive episodes. A search for determinants of the direction of weight change revealed two candidates: the body mass index (BMI) (weight in kilograms/height in meters squared) and a psychological variable, "disinhibition" of dietary restraint. The present study, of 68 patients with a history of recurrent depression, found a significant correlation between BMI and weight change; in other words, heavier persons were more likely to gain weight if depressed. There was also a correlation between "disinhibition" and weight change. "Disinhibition" correlated with BMI and, when controlled for BMI, age and sex, the correlation between "disinhibition" and weight change fell to insignificance. We conclude that BMI along with age and sex mediated the correlation between "disinhibition" and weight change.     

Myoelectric and motor activity after proctocolectomy and ileal pouch-anal anastomosis in dogs

BACKGROUND: The aim of this study was to investigate the motor function of the ileoanal pouch and to evaluate its coordination with proximal small-intestine motility. METHODS: Proctocolectomy and ileal J pouch-anal anastomosis were performed in 12 dogs. Motility was recorded by serosal electrodes and strain gauge transducers. RESULTS: Transmission of the migrating motor complex (MMC) on the pouch appeared in only 37 of 109 measurements. On the ascending limb there was a constant irregular activity with no MMC detectable. Motility pattern of the pouch did not change postprandially. Spontaneous defecation always appeared independently from MMC transmission without an increase of electrical or mechanical activity or endoluminal pouch pressure. CONCLUSIONS: Ileal pouch motility is independent from motility patterns of the proximal intestine. Its random contractile activity might provide storage function and make the pouch act as a functional reservoir. Intrinsic pouch motility is not responsible for pouch evacuation under physiologic conditions.     

Toxic cardiogenic shock in a patient receiving weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin

A 54-year-old man was treated with weekly 24-h infusion of high-dose 5-fluorouracil (2600 mg/m2) and leucovorin (100 mg/m2) for metastatic colon cancer. At first, he tolerated the treatment well and no significant toxicity was identified. After a total of eight courses of treatment, a stable disease was observed, but mild shortness of breath was found on occasion. The patient had no previous history of cardiac disease and the heart performance assessed by left ventricular ejection fraction before treatment was normal. Unfortunately, acute pulmonary edema with lethal cardiogenic shock occurred during the ninth course of treatment, in spite of intensive medical treatment. The chest X-ray showed extreme cardiomegaly. Repeated assessment of his heart function by echocardiogram and ventricular ejection fraction revealed a very poor cardiac performance. Toxic cardiogenic shock during weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin is extremely rare. To the best of our knowledge, no case has been reported in the English literature. We report a case and the relevant literature about the incidence, clinical picture and possible pathophysiology on 5-fluorouracil-related cardioxicity is reviewed.