A review of echocardiography in anaesthetic and peri-operative practice. Part 1: impact and utility.

Echocardiography is migrating rapidly across speciality boundaries and clinical demand is expanding. Echocardiography shows promise for evolving applications in the peri-operative assessment and therapeutic management of patients undergoing non-cardiac surgery, whether it be elective or emergency. Although evidence is limited with regard to significant impact on outcomes from anaesthesia and surgery, there is little doubt about the validity and power of two-dimensional real-time viewing of cardiac anatomy and function. Echocardiography can be used to assist in decision-making along the entire peri-operative pathway, and is increasingly delivered by the previously referring physicians. The discussion around more widespread incorporation of cardiac ultrasound into anaesthetic practice must take into account competency, training and governance. Failure to do so adequately may mean that the use of echocardiography is poorly applied and costly.

Rating managed care plans as business partners.

Managed care plans are driven to meet consumer quality of care demands. But, plans that meet these consumer demands do not necessarily meet provider expectations for quality business partnerships. Therefore, providers need to develop not only clinical performance indicators but also indicators that will help them evaluate managed care plans as business partners. Performance indicators should be developed to measure managed care plans' medical loss ratio, compensation cost/benefit, payment promptness, authorization convenience and promptness, insurance verification convenience and promptness, payment accuracy, medical management, provider relations responsiveness, member education effectiveness, recorded complaints, risk transfer, contract terms, and contract equity.

Capitating physician group practices.

To prepare for capitated payment, physician group practices must gather essential data on service utilization and cost of services, must develop appropriate compensation and incentive plans for physicians, and must analyze and, if necessary, modify their practices's clinical and business operations. Those group practices that take these steps will be positioned to profit from capitated payment.

Synergistic effect on reduction in blood pressure with coadministration of the renin inhibitor, CP-80,794, and the angiotensin converting enzyme inhibitor, captopril.

The effects of coadministration of a renin inhibitor, CP-80,794, and an angiotensin converting enzyme inhibitor, captopril, on blood pressure of sodium-depleted guinea pigs was studied. Dose-response curves for CP-80,794 (0.3-3.0 mg/kg i.v.) and captopril (0.03-1.0 mg/kg i.v.) were obtained either alone or in the presence of a submaximal dose of the other inhibitor. The hypotensive response calculated for each compound individually was subtracted from the combined dose response. The results showed that statistically significant synergy with captopril and CP-80,794 occurred when the area rather than the peak drop or duration of change in blood pressure was measured. The degree of the synergy indicated that to achieve the same reduction in blood pressure, the dose of each drug, below the high end of its response range, could be decreased approximately sixfold when administered in combination. It was determined that the plasma pharmacokinetics of CP-80,794 were not altered during coadministration, as plasma concentrations of CP-80,794 were similar in the presence and absence of 0.1 mg/kg i.v. of captopril. These results indicate that by inhibiting sequential enzymes in the renin-angiotensin system, synergistic effects can be produced. The relative safety of each inhibitor could be improved by large reductions in dose when used concurrently.