The converging roads of HIM and managed care.

The authors explore the definition of managed care and how the health information manager's skills apply to a managed care setting. In addition, HIM professionals who have made the transition to the managed care setting share their experiences.

Randomized study of pre-induction cervical ripening with sequential use of intravaginal prostaglandin E2 gel.

OBJECTIVE: To evaluate the safety and efficacy of serial frequent intravaginal prostaglandin (PG) E2 gel applications in shortening the time required to achieve an inducible cervix. METHODS: From May 1, 1993, through April 30, 1994, 101 pregnant women with medical indications for induction of labor and Bishop scores less than 7 were randomized to receive intravaginal 2.5 mg of PGE2 gel every 6 hours or as often as every hour until the Bishop score was at least 7 or intervention was required. RESULTS: The mean total number of PGE2 gel applications was significantly different between the 1- and 6-hour groups, 6.5 and 4.4 PGE2 applications, respectively. The mean time from PGE2 application to delivery was similar, 42 and 45 hours, for the 1- and 6-hour groups, respectively. The intervention rate, occurrence of labor during ripening, and neonatal outcomes were also similar. CONCLUSION: Intravaginal application of 2.5 mg PGE2 gel as frequently as every hour appears to be safe, but it does not decrease the time interval to induction or delivery, nor does it decrease the cesarean rate.