ABSTRACT
Many healthcare organizations become disillusioned with their acquired medical practices within a few years of purchase because of major financial, operational, and political problems with their new networks. As postacquisition financial losses increase and relationships with physicians under contract decline, many healthcare organizations seek an escape from the situation. Three options for dealing with a failing acquisitions program are to do nothing until the physicians' employment contract expires, give the practice back to the physicians, or negotiate a contractual settlement in which the practice is returned to the physicians in exchange for a new contractual commitment to the healthcare organization. The third option offers the greatest potential for salvaging the arrangement and preserving the physician-organization relationship.
Subject(s)
Contract Services/economics , Financial Management/methods , Group Practice/economics , Practice Valuation and Purchase/organization & administration , Attitude of Health Personnel , Contract Services/standards , Group Practice/organization & administration , Negotiating , Organizational Affiliation/economics , Ownership , Practice Valuation and Purchase/economics , Professional Autonomy , United StatesSubject(s)
Colon, Sigmoid/physiology , Metoclopramide/pharmacology , Muscles/physiology , Aged , Colon, Sigmoid/drug effects , Electric Stimulation/methods , Electrodes, Implanted , Female , History, 16th Century , Humans , Male , Middle Aged , Muscle Contraction/drug effects , Muscle Tonus/drug effects , Muscles/drug effects , Myography , Sodium Chloride/pharmacologyABSTRACT
The human monosynaptic H-reflex system was examined for the presence of several parametric features of habituation. Dishabituation was present, but there was no indication of an increasing rate or extent of habituation during repeated sessions, nor was there any apparent habituation of the dishabituating effect of an extraneous stimulus. Furthermore, there was only a very small effect of stochastic stimulation. There was, however, a substantial effect of voluntary activation: contraction of the soleus tended to prevent habituation, while stretch of the soleus produced sensitization during repetitive stimulation. We conclude that the H-reflex is an extremely simple response system with little or no long-term plasticity.
Subject(s)
H-Reflex , Habituation, Psychophysiologic , Reflex, Monosynaptic , Adolescent , Adult , Electric Stimulation , Humans , Kinetics , Muscle Contraction , Skin/innervationABSTRACT
Use of the colonic potential difference as a means of assessing the efficacy of different suppressive steroid regimens was explored in a patient with incomplete 21-hydroxylase deficiency. Changes in the potential difference were found to closely reflect changes in the plasma concentration of hormones such as aldosterone, androstenedione, dehydroepiandrosterone, and dehydroepiandrosterone sulfate. Dexamethasone, which produced the most marked change in the potential difference, also produced the most suppression of the plasma steroid concentrations. It is suggested that the colonic potential difference can be used as a simple alternate means of assessing the efficacy of suppressive steroid therapy in some patients with 21-hydroxylase deficiency.
