Practical Regional Anaesthesia

Regional anaesthesia; from plexus blocks to skin infiltration; can be used to provide analgesia for most surgery. Cognisance must be taken of the following when choosing the dose of local anaesthetic agent : potency and toxicity of the drugs the site of injection the volume needed for the block the desired characteristics of the block (motor or sensory block) the patient's physiology

Health care at the crossroads.

The era of managed care is upon us, the result of a growing cost consciousness, an increasingly competitive marketplace and excesses on our parts as providers. Attention to the bottom line does not leave us much time to talk, connect and develop trust. If this trend continues, we are in danger of abandoning our basic commandment as healers, to act on behalf of our patients.

An Indian-controlled mental health program.

The control of health care programs for American Indians is shifting slowly from the federal government to the tribes. In 1971 the Apaches began operating a community mental health center on a reservation in northeastern Arizona. The tribal council appointed a 14-member board to administer the center; a majority of the members were Apaches. The board then hired an executive director who was not an Indian. There were 15 professional and paraprofessional staff members; 12 were Apaches or other Indians. In January 1976 the tribal council fired the director and disbanded the board of directors, although the clinic continued operation. The authors discuss sociocultural factors that influenced the center's development and give several reasons for the center's problems, including the general expectation that agencies run by Indians will not be successful.