The uninsured consumer and hospital choice: an assessment of emergency department utilization.

The term "choice" has played an important role in the ongoing debate over health care reform in the United States. One of the major assumptions underlying reform efforts is that affordability drives consumers' choice of health care providers, particularly for the uninsured. In the state of Maryland, the issue of affordability is addressed by an "all-payor" system. In such a scenario, where enhanced choice opportunities are available for the uninsured, such consumers seem to be making choices which lead to the use of hospitals other than those which would be predicted based upon convenience or closeness of location alone.

A method for the determination of therapeutic and toxic concentrations of tricyclic antidepressant drugs in post mortem fluids and tissues.

A sensitive and reliable procedure is presented for the measurement of the common tricyclic antidepressant (TCA) drugs in a variety of biological specimens at therapeutic as well as toxic concentrations. The method employs GC/NPD and a column packed with 3% OV-17 on Chromosorb W-HP. The pH of specimen extraction was optimized at 8.6, and 1-chlorobutane:ethyl ether (3:1) was found to be an efficient solvent for the primary extraction. Recoveries for all TCA drugs were at least 50% for each specimen. Linearity of extraction was observed over a range of therapeutic and toxic concentrations with a correlation coefficient greater than 0.99.

Blood and tissue concentrations of tricyclic antidepressant drugs in post mortem cases: literature survey and a study of forty deaths.

Blood, urine, heart, liver, and psoas muscle concentrations of tricyclic antidepressant (TCA) drugs and their N-desmethyl metabolites were determined in forty medical examiner cases. The cases were evaluated for the role played by the TCA drugs in the cause of death and compared to a literature survey of previously reported cases. The incidence of the various individual TCA drugs as a factor and the significance of the disposition of the drugs and their metabolites is included. Comparing TCA drug concentrations in the heart and skeletal muscle and considering the differences in perfusion to these organs, TCA drugs and metabolites showed an affinity for the cardiac over the skeletal muscle. The case results were correlated with experimental studies to suggest the relationships of blood concentrations with toxicity.