Insurer Market Structure and Variation in Commercial Health Care Spending

ObjectiveTo examine the relationship between insurance market structure and health care prices, utilization, and spending.MethodsRegression models are used to estimate the association between insurance market concentration and health care spending, utilization, and price, adjusting for differences in patient characteristics and other market-level traits.ResultsInsurance market concentration is inversely related to prices and spending, but positively related to utilization. Our results imply that, after adjusting for input price differences, a market with two equal size insurers is associated with 3.9 percent lower medical care spending per capita (p = .002) and 5.0 percent lower prices for health care services relative to one with three equal size insurers (p < .001).ConclusionGreater fragmentation in the insurance market might lead to higher prices and higher spending for care, suggesting some of the gains from insurer competition may be absorbed by higher prices for health care. Greater attention to prices and utilization in the provider market may need to accompany procompetitive insurance market strategies.     

Evaluation of techniques for treating the bleeding wound

BACKGROUND: Despite the fact that the urgent control of active bleeding from external body surfaces demands a basic procedure, it is puzzling that this topic has received little if any attention in modern medical research. Elastic adhesive dressing (ELAD) has been proposed for dressing the bleeding wound. METHODS AND MATERIALS: Three techniques were compared over a simulated wound in a human model. Pressures generated between the chosen dressing surface and the underlying mock wound's cutaneous surface, time consumption, convenience, satisfaction and pain were tested for each technique. RESULTS: Sixty-eight experiments were performed over nine separate anatomical sites. Average pressures for field dressing, ELAD and manual compression were 33, 88 and 180 mmHg, respectively; these differences in pressure were statistically significant. Manual pressure was equally inconvenient for both patient and caregiver. The more proximal and wider anatomical regions were more difficult and time consuming to compress. The caregivers graded ELAD the highest level of convenience and general satisfaction. CONCLUSIONS: Field bandage testing reflected its inadequacy in controlling bleeding from most body regions. The results suggest that ELAD may be the hands-free technique of choice. We hope that this article will stimulate further research and elicit evidence on precisely which technique is most suitable for various anatomical location.     

Tricyclic alkylamides as melatonin receptor ligands with antagonist or inverse agonist activity

This work reports the design and synthesis of novel alkylamides, characterized by a dibenzo[a,d]cycloheptene nucleus, as melatonin (MLT) receptor ligands. The tricyclic scaffold was chosen on the basis of previous quantitative structure-activity studies on MT1 and MT2 antagonists, relating selective MT2 antagonism to the presence of an aromatic substituent out of the plane of the MLT indole ring. Some dibenzo seven-membered structures were thus selected because of the noncoplanar arrangement of their benzene rings, and an alkylamide chain was introduced to fit the requirements for MLT receptor binding, namely, dibenzocycloheptenes with an acylaminoalkyl side chain at position 10 and dibenzoazepines with this side chain originating from the nitrogen atom bridging the two phenyl rings. Binding affinity at human cloned MT1 and MT2 receptors was measured by 2-[125I]iodomelatonin displacement assay and intrinsic activity by the GTPgammaS test. The majority of the compounds were characterized by higher affinity at the MT2 than at the MT1 receptor and by very low intrinsic activity values, thus confirming the importance of the noncoplanar arrangement of the two aromatic rings for selective MT2 antagonism. Dibenzocycloheptenes generally displayed higher MT1 and MT 2affinity than dibenzoazepines. N-(8-Methoxy-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-10-ylmethyl)propionamide (4c) and -butyramide (4d) were the most selective MT2 receptor antagonists of the series, with MT2 receptor affinity comparable to that of melatonin and as such among the highest reported in the literature for MLT receptor antagonists. The acetamide derivative 4b produced a noticeable reduction of GTPgammaS binding at MT2 receptor, thus being among the few inverse agonists described.     

Evaluation of techniques for intravenous catheter and tubing fixation

OBJECTIVE: The aim of this study was to examine two techniques intended to prevent accidental displacement of intravenous catheters after proper establishment of infusion line access. METHODS: After catheter insertion and taping in position, fixation with gauze roll sequentially wrapped around the limb across which the tubing has been extended was compared with the use of a polyethylene roll manipulated by an attached "handle." The experimentation was performed on medical personnel serving as live models. RESULTS: Thirty-eight trials were conducted with 19 of each fixation technique. The variables measured were: time consumption, convenience, general satisfaction, and success score of the fixation. All of the measurements showed that the polyethylene roll was significantly the superior of the two methods. Despite forceful tugging of the tubing, polyethylene fixation virtually prevented any displacement whatsoever and was more than twice as rapid. CONCLUSIONS: We demonstrate a novel device allowing faster and more efficacious fixation of the infusion drip tubing and catheter suggested as the technique of choice in emergency medical field care.     

Open Microcomedone Extraction Facilitated by Polarized Dermoscopy

Microcomedonal lesions can be aesthetically and psychologically displeasing. The burden of comedones increases when considering their frequency and demand for time‐consuming attention. The objective of the current study was to describe a novel technique to facilitate open microcomedone extraction. The instrumentation used includes smartphone photography with dermatoscopy. The dermatoscope is an effective tool for diagnosing a broad range of dermatologic conditions. The polarized dermatoscope can facilitate execution of cutaneous procedures whenever magnification and optimal illumination are necessary. Its connection to a smartphone with a unique adapter enabled single‐handed examination of microcomedones. Under magnification with this unit, the involved lesions are photographed to clearly demonstrate the condition and achieve informed consent. The complete procedure can be recorded on video for documentation. In this case, four separate lesions of the left auricle of a young man were treated using direct pressure extraction. The procedure undertaken was rapid, convenient, and completed without any adverse sequelae. This procedure is recommended for similar cases using the dermatoscope, which does not require additional specific training and is readily available at no extra cost. This technique could be used in various dermatologic conditions.