Five payment models: the pros, the cons, the potential

Among the leading strategies to reform health care is the development and implementation of new payment models. The goal is to change the way physicians, hospitals, and other care providers are paid in order to emphasize higher quality at lower costs--in other words, to improve value. In an effort to build on its health care reform activities that began in 2005, the Minnesota Medical Association convened a work group in 2010 to develop recommendations on how payment reform can best be advanced. Among the work group's output was a comparative review of five payment models with respect to how they can support a value-driven health care system. This article summarizes the pros and cons of the five models--fee for service, pay for coordination, pay for performance, episode or bundled payment, and comprehensive care or total cost of care payment. It also offers the work group's recommendations for how these models might be applied in a reformed health care system.     

Associations between ward atmosphere, patient satisfaction and outcome

Previous studies have found important associations between the ward atmosphere and patient satisfaction. However, fewer studies have examined the relationship between ward atmosphere and outcome of treatment. The aim of the study was to examine whether or not differences in ward atmosphere were associated with differences in satisfaction and outcome. Eighty patients at three different ward units responded to a questionnaire at admission and by the time of discharge from the hospital. The questionnaire comprised the ward atmosphere scale, a five-item index of patient satisfaction, the Generalized Self-Efficacy Scale, an index of life satisfaction and the symptom checklist SCL-90R. The results showed that differences in the treatment environment between the ward units were associated with differences in patient satisfaction. There was mixed evidence for associations between ward atmosphere and outcome, while no associations were found between ward atmosphere and self-efficacy and life satisfaction. The results may suggest that the relationship between ward atmosphere and outcomes of treatment may be of a more indirect character than the relationship between ward atmosphere and satisfaction.     

单侧唇裂继发畸形修复中口轮匝肌的重建

目的介绍口轮匝肌复位重建在单侧唇裂继发畸形修复中的效果。方法对采用直线缝合法修复的唇裂患者，在行继发畸形修复中，选Millard旋转推进法设计皮肤切口，切开皮肤，将裂隙的健、患两侧的口轮匝肌进行解剖，在健侧，分离口轮匝肌达正常侧人中嵴处；在裂隙侧，将口轮匝肌从皮肤下解剖达10mm；在口腔裂隙的健侧从鼻棘，裂隙侧从鼻翼基部，将口轮匝肌从黏膜下分离出来。使用透明的尼龙线缝合肌肉。将裂隙健、患侧分离的口轮匝肌每侧水平分成4束，互相交叉缝合，然后缝合皮肤。结果术后患侧鼻孔大小、对称性、鼻小柱长度、鼻小柱的位置、患侧人中嵴、患侧唇峰、唇珠、人中凹、鼻尖的高度、突度的变化，术后均近似正常，近期效果满意。结论利用口轮匝肌的重建来修复单侧唇裂继发畸形，以恢复正常上唇正中解剖结构及对称的鼻孔大小，是一种有用的方法。     

Doing randomized controlled trials in a developing country: some practical realities

BACKGROUND: Formal randomized controlled trial results are often reported.The difficulties of doing such trials are not. Developing countriesrepresent a new field in which trials can be undertaken. Inthis context even less is known about the practicalities involved. METHOD AND RESULTS: A randomized, double-blind, parallel study took significantlylonger than expected to complete and subject recruitment andparticipation fell short of expectations. Different recruitmentstrategies were used and these performed differently in termsof enrolling trialists. Subjects most frequently left the trialin its early stages. CONCLUSIONS: Possible explanations for these findings include the demographyof the country, cultural factors, and the existence of an establisheddoctor-patient relationship. Keywords. Developing countries, drug treatment hypertension, randomized controlled trials, United Arab Emirates.     

Hypohydrotic Ectodermal Dysplasia Revisited

Ectodermal dysplasia is a rare disease with involvement of teeth,skin and appendages. We report a 2 year old boy presenting with recurrent fever,scarce facial and scalp hair and absence of sweating. Skin and hair biopsies were suggestive of hypohidrotic ectodermal dysplasia.     

Vitamin D Status of term exclusively breastfed infants and their mothers from India

Objectives: (i) To measure 25‐OH vitamin D levels in term infants at 10 weeks and 6 months and to correlate with maternal vitamin D levels at 10‐week postpartum (ii) To evaluate infants at 6 months for rickets. Patients and methods: A total of 179 exclusively breastfed infant–mother pairs 96 appropriate‐for‐gestational age (Group 1) and 83 small‐ for‐ gestational age infants (Group 2) recruited at 10 weeks. At 6 months, 52 in group 1 and 45 in group 2 were evaluated. Venous blood sample were collected at 10 weeks and 6 months in infants and at 10 weeks in mothers for calcium, phosphorus, alkaline phosphatase and 25‐OH vitamin D estimation. Results: Mean 25‐OH vitamin D levels of infants (n = 97) were 11.55 ± 7.17 ng/mL at 10 weeks and 16.96 ± 13.33 ng/mL at 6 months (p < 0.001). Mean vitamin D levels of infants in group 1 and group 2 did not differ at recruitment and 6 months (p > 0.05)). Maternal vitamin D levels in group 1 and group 2 were 8.89 ± 5.97 and 9.87 ± 6.44 ng/mL, respectively (p = 0.44). Significant correlation was observed between 25‐OH vitamin D of infants and mothers (p < 0.05). At 10 weeks, 55.67% infants, 70% mothers and at 6 months, 44.33% infants had vitamin D < 11 ng/mL. At 6 months, 16.49% infants developed rickets. Conclusions: Exclusively breastfed infants and their mothers are Vitamin D deficient, hence the need to improve vitamin D status.