The marketing function in managed care systems.

As managed care spreads through the health care service industry, marketing professionals are faced with the challenge of marketing highly integrated systems. This paper explores three questions related to this development: (1) what is unique about managed care marketing, (2) how has managed care impacted health care marketing, and (3) what new strategies and trends will shape these developing markets?

Inaccuracy of nitrogen balance determinations in thermal injury with calculated total urinary nitrogen.

Many burn centers use nitrogen balance studies to estimate the adequacy of nutritional support. Nitrogen loss includes the sum of urinary urea nitrogen, nonurea urinary nitrogen, and losses from skin, wound, and stool. Urinary urea nitrogen is often used to calculate total urinary nitrogen by multiplying the urinary urea nitrogen by a factor of 1.25 to account for nonurea urinary nitrogen. This formula is appropriate when applied to a nonstressed individual who has fasted overnight but is not appropriate for patients who have undergone surgery or experienced trauma. We have undertaken this study to assess the predictability of this formula in patients with thermal injuries. Twenty-seven patients with major thermal injuries had random 24-hour urine collections, which were analyzed for both urinary urea nitrogen and total urinary nitrogen. In these patients with burns we found that urinary urea nitrogen represented approximately 65% of the directly measured total urinary nitrogen rather than 80% as assumed by the formula. This increase in the nonurea nitrogen loss is greater than that found after surgery or trauma. Individual measurements may underestimate losses by 20% to 60%. Directly measured total urinary nitrogen should replace calculated total urinary nitrogen as the index of urine nitrogen losses for nitrogen balance studies in patients with burns.

Down-regulation of homing receptors: a mechanism for impaired recruitment of human phagocytes in sepsis.

Receptors known as DREG adhesion molecules on human neutrophils and monocytes provide for homing of these phagocytic leukocytes to sites of inflammation. They mediate the initial adhesive interaction of the leukocytes to vascular endothelial cells and are then shed from the cell surface in response to chemotactic factors and inflammatory mediators. Systemic accumulation of these agents following major injury or sepsis may therefore promote shedding of DREG receptors from circulating leukocytes and impair their recruitment to sites of inflammation. To test this hypothesis, we have analyzed the expression of DREG receptors on neutrophils and monocytes from 25 patients admitted to the Surgical Intensive Care Unit. Receptor expression was measured by flow cytometry of cells stained with murine monoclonal DREG-56 anti-DREG antibody. For 14 nonseptic patients, mean monocyte positivity for DREG was reduced from 64% to 40%. For 11 septic patients, mean neutrophil and monocyte positivity for DREG was reduced from 94% to 82% and 64% to 34%, respectively. These results suggest that monocytes are more affected than neutrophils in vivo by conditions expected to stimulate shedding of DREG and that sepsis promotes shedding of these adherence receptors. Accumulation of DREG-negative monocytes in association with sepsis may be sufficient to impair their recruitment to inflammatory sites and limit their contribution to host defense against infection and tissue repair.

Segmenting the mental health care market.

The authors report the results of a segmentation study of the mental health care market. A random sample of 387 residents of a western city were interviewed by telephone. Cluster analysis of the data identified six market segments. Each is described according to the mental health care services to which it is most sensitive. Implications for targeting the segments are discussed.

The nature of physician's services: marketing implications.

A specific system for classifying services is applied to physicians' services in an attempt to better understand those services. Other services organizations are identified that are similar to these services along each of the dimensions suggested by the classification system. In addition, marketing insights and implications are offered for marketing physicians' services.

Segmenting health care markets: large versus small businesses.

What differences exist between provision of health care benefits, cost containment measures, and health care concerns between large and small companies? This issue of DRG Monitor examines these differences through the analysis of responses to a survey and suggests strategies that hospitals and other health care providers may employ to target both markets.

Dissecting health care markets: large versus small businesses.

This article reports the results of a mail survey of businesses in Tulsa, Oklahoma (population 377,900 in the city and 745,300 in the surrounding metropolitan area). The purpose of the research was to analyze differences in health care provision and perspectives between large and small businesses. The survey of 3,200 members of the city's chamber of commerce yielded 640 responses. Analysis of the data revealed distinct differences between the two segments of the health care industry. The findings suggest that market opportunities exist for the development of health care delivery system programs aimed at small businesses.

Off-axis multipass amplifier as a large aperture driver stage for fusion lasers.

A multipass amplifier configuration is described which has potential as a large aperture, high gain driver stage for fusion laser systems. We avoid the present limitations of large aperture switches by using an off-angle geometry that does not require an optical switch. The saturated gain characteristics of this multipass amplifier are optimized numerically. Three potential problems are investigated experimentally, self-lasing, output beam quality, and amplified spontaneous emission output. The results indicate comparable cost for comparable performance to a linear chain, with some operational advantage for the multipass driver stage.