Academic cardiology division in the era of managed care. A paradigm for survival.

The ability of academic divisions of cardiology to pursue educational and research missions in an era of market-driven managed care is being increasingly jeopardized. Indeed, several academic medical centers have been sold to for-profit entities, and many cardiology divisions have been forced to decrease staff and faculty reimbursements. Despite these threats, the academic division has unique strengths: (1) premium quality of care, (2) a single employer, (3) a somewhat uniform practice culture, (4) high-volume operators performing interventional procedures, (5) expertise in highly technical aspects of cardiology, and (6) the availability of physicians for outreach ventures. Therefore, we hypothesized that the cardiology division could be strengthened by collaborating with the medical center in the development of an aggressive and proactive managed care strategy. To this end, we developed a cardiovascular network having the academic center as its central focus but including a group of high-quality and geographically dispersed community-based physicians. These physicians were attracted by an economic package that provided protection from downside risk, participation in our managed care initiatives, and geographic exclusivity in an over-crowded market. In turn, the community-based physicians increasingly used the academic medical center for tertiary care, resulting in increased volumes and incremental profitability. Using this paradigm, we have now recruited approximately 40 community cardiologists. The resulting network provides access to a university cardiologist in most of the surrounding urban and rural counties and will allow us to compete effectively for capitated contracts.

Self-esteem of adolescent girls as related to weight.

The Rosenberg Self-esteem Scale was administered to 550 14- and 16-yr.-old (+/- 6 mo.) girls. Self-esteem scores were categorized by weight and weight by height. Scores on the Quetelet Index for obesity were correlated with self-esteem scores. Mean self-esteem of the low- and middle-weight by height group was significantly higher than the mean of the high-weight by height group. In analyzing weight alone, the self-esteem of the middle-weight group was significantly higher than the self-esteem of the high-weight group. The correlation of the obesity index and self-esteem indicated that as weight increased self-esteem decreased.

Self-esteem of adolescent females as related to race, economic status, and area of residence.

The Rosenberg Self-esteem Scale was used to measure the self-esteem of 109 14- and 16-yr.-old (+/- 6 mo.) girls. The self-esteem scores were categorized by economic status, race, and area of residence. For urban girls mean self-esteem of upper economic status subjects was significantly higher than that of those at the lower economic status. The self-esteem of upper economic status urban girls was significantly higher than the self-esteem of their rural peers. Finally, the self-esteem of the urban black girls was significantly higher than the self-esteem of the urban white girls.

The relation between plasma urate and placental bed vascular adaptation to pregnancy.

Placental bed biopsies were obtained at caesarean section from 34 women. Their plasma urate was directly related to maximum mean arterial pressure and inversely to adjusted birthweight; but it was related most closely to the histological appearances of the spiral arteries in the placental bed. Nine women had physiological changes in the spiral arteries: their mean urate (233, SD 28.9 mumol/l) was significantly (P less than 0.001) lower than the mean urate in those who did not have adequate physiological changes (339, SD 90.3 mumol/l) or that in the nine women who had atherosis (397, SD 153.2 mumol/l). Raised plasma urate appears to be better related to maternal vascular pathology than to the clinical condition or infant birthweight.

Framboesiform lesions in primary herpes simplex infection: a case report.

A 27 year old homosexual man developed unusual sacral lesions during a disseminated primary herpetic attack, which was confirmed by viral culture and rising antibody titre. The lesions had a striking framboesiform appearance and healed without ulceration or scarring. Review of modern and historical published reports suggests that this may be the first illustrated description of such infection.

Retention of urine in anogenital herpetic infection.

In 17 patients, 15 women and 2 men, acute retention of urine developed in association with an attack of anogenital herpes. Constipation, blunting of sensation over the 2nd and 3rd sacral dermatomes, and neuralgic pains in the same area (with absence of the bulbocavernosus reflex in some individuals) suggested localised lumbosacral meningomyelitis with involvement of mainly sacral-nerve roots. The urinary dysfunction persisted on average for ten days and in 4 patients was severe enough to warrant catheterisation. Anogenital herpes should always be considered as a possible cause of acute retention of urine in sexually active young people and the possibility of occult herpetic infection of the cervix and rectum should be investigated.