Management reporting on the Web.

Driven by easy-to-use World Wide Web technology and new information integration concepts that have proven their worth in business and industry, online management reporting is now becoming an important strategy for improving operational performance in health care organizations. In this article, we provide an overview of these new information management concepts and describe our experience in planning and executing an enterprise-wide Web-enabled management reporting initiative. We also offer an inventory of the key organizational capacities that we found essential for developing and sustaining Web-enabled reporting services for health care managers.

Facilitating physician referrals on the World Wide Web: representation and appropriate utilization of clinical expertise.

In highly integrated and increasingly complex health care systems, the identification and proper utilization of clinical staff expertise are key factors for efficiently delivering high quality patient care. To achieve these capabilities on an enterprise-wide scale, we have embarked on a multi-phased project to develop World Wide Web (WWW)-based physician referral capabilities for two large teaching hospitals. Currently, users may search for information concerning the education, training, board certifications, and self-designated clinical interests of staff members. Address, phone number, email address, and a photo are also presented. Our experience indicates that institutional changes are required to successfully deploy and maintain online physician referral services and that accurate and equitable representation of clinical expertise and the incorporation of referral guidelines require an incremental introduction of a carefully planned program that addresses the needs of clinicians, administrators, and health care policy-makers.

Epinephrine effects on major cell types of the aqueous outflow pathway: in vitro studies/clinical implications.

We have investigated the possibility that direct cellular effects may mediate the action of EPI to lower the IOP. To do this, cultured HTM and SCE cells were grown as monolayers over a millipore-filter support structure. The monolayers were exposed to various adrenergic agonists and antagonists while flow of the perfusate (DME + 5% FBS) was measured using a specially-designed computer-linked apparatus. Exposure of the cells to 10(-5) M EPI for around 2 hours led to a rapid twofold increase in HC which gradually declines over the next 12 hours. Continuous exposure of either cell type (ie, HTM or SCE cells) to EPI or ISO resulted in a four- to eightfold increase with a maximal effect measured around 10 hours and a half maximal effect at 2.5 hours. Administration of c-AMP alone gave similar responses. In agreement with clinical studies, timolol blocks EPI's effect completely while betaxolol acted as a partial antagonist. These findings suggest that the cellular changes and the increase in HC are mediated by a beta-2 receptor. There are many similarities between the responses observed using our in vitro system and the IOP-lowering response observed in vivo after the topical application of EPI (eg, concentration, time course, duration, and magnitude). The clinical implications of these preliminary results are discussed and it is proposed that the described in vitro system may be useful to select new adrenergic drugs for glaucoma therapy.

Lipofuscin in amyotrophic lateral sclerosis.

Lipofuscin has been reported to accumulate in abnormal amounts in motor neurons of patients with amyotrophic lateral sclerosis (ALS). Microdensitometry was used to quantitate such lipid masses in spinal motor neurons in normal subjects compared with spinal motor neurons in ALS cases. No overall difference in lipofuscin level was found between the normal and the ALS material. Some neurons of intermediate size did show increased amounts of lipofuscin, which is attributed to shrinkage during degeneration by larger cells having proportionately more lipofuscin originally.

Extraocular muscle fibers: ultrastructural identification of iontophoretically labeled fibers contracting in response to succinylcholine.

Cat extraocular muscle fibers (from the superior rectus or inferior oblique) were penetrated in vivo with Procion red-filled glass microelectrodes. When stable penetrations were obtained, succinylcholine (Sch), 8 to 20 microng, was injected into the femoral vein. In some fibers, a depolarization-repolarization response was obtained with the same time course (2 min.) as the total muscle contraction. The depolarizing fibers were labeled iontophoretically. The ultrastructural characteristics of five depolarizing fibers and three control (nondepolarizing) fibers were then studied. The fibers that did not depolarize to Sch had the characteristics of singly innervated cells, whereas those sensitive to Sch had morphological characteristics of multi-innervated fibers.