Results and policy implications of the resource-based relative-value study

The resource-based relative-value scale (RBRVS) is a measure of relative levels of resource input expended when physicians produce services and procedures. It is a function of the physician's work input, the opportunity cost of specialty training, and the relative practice costs for each specialty. This paper presents resource-based relative values (RBRVs) for selected procedures of four major specialties--family practice, internal medicine, general surgery, and thoracic and cardiovascular surgery. We compare RBRVs with current charges and find several general patterns. Invasive procedures are typically compensated at more than double the rate of evaluation-and-management services, when both consume the same resource inputs. Imaging and laboratory procedures fall between invasive and evaluation-and-management services. We analyze the financial implications of the RBRVS by developing a simple model and simulating the effects of an RBRVS-based fee schedule on physicians' revenues in various specialties. We use Medicare data to perform the simulation under the "budget-neutral" assumption. Results show that an RBRVS-based fee schedule affects specialties differently. The average family practitioner could receive 60 percent more revenue from Medicare, whereas the average ophthalmologist could lose 40 percent of current revenues. The effects on other specialties fall between these two.     

Total pancreatectomy with primary mesenteric vascular reconstruction.

Total pancreaticoduodenectomy with resection of the superior mesenteric artery and vein was performed in a sixty-two year old man with islet cell carcinoma of the pancreas. Arterial reconstruction was accomplished with an aortomesenteric interposition Dacron graft. The venous system was reanastomosed primarily, the infrapancreatic superior mesenteric vein to the portal vein in the hepatic hilum. This procedure, although it did not result in long-term survival, demonstrates the technical feasibility of wide regional resection for tumors of the pancreas impinging upon the mesenteric vasculature in the region of the neck and uncinate process.     

Zur Mikromorphologie auskleidender Gewebe der Bursa

Zusammenfassung Die auf Grund früherer Vermutungen angenommene Ähnlichkeit zwischen den auskleidenden Geweben der Gelenkkapsel und der Bursen konnte elektronenoptisch bestätigt werden. Auf Unterschiede zum Ganglion, welches unter ähnlichen Bedingungen wie die Bursa entsteht, wurde hingewiesen. Auch die Bursa kann durch Einwirkung wechselnder Druck- und Zugkräfte aus Bindegewebe entstehen. Ähnliche Verhältnisse scheinen auch bei der Regeneration der Gelenkinnenhaut nach Synovektomie zu bestehen.

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Summary A similarity between the cells of the bursa and the synovial lining cells, which had been postulated in previous studies upon the ganglion has been demonstrated. Differences between the respective cell types have been described and an approach for their explanation given. The bursa too may develope out of connective tissue by action of interchanging pressure and tension. The regeneration of synovium after synovektomy seems to be governed by similar conditions.

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Résumé L'hypothèse émise précédemment d'une similitude entre les cellules synoviales et les cellules des bourses séreuses a été confirmée. Nous avons souligné les différences avec les cellules des kystes synoviaux. Les bourses séreuses peuvent, comme ces derniers, se former suite à des successions de pression et de traction. Il semble bien que la régénération de la synoviale après synovectomie obéit aux mêmes conditions.

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Mit Unterstützung der Stiftung Volkswagenwerk.     

Longitudinal studies of plasma aldosterone, corticosterone, deoxycorticosterone, progesterone, 17-hydroxyprogesterone, cortisol, and cortisone determined simultaneously in mother and child at birth and during the early neonatal period. I. Spontaneous delivery.

In order to obtain the still lacking reference data of individual plasma steroids in the immediate postnatal period needed for the assessment of adrenocortical function in various neonatal maladaptation syndromes, aldosterone (A), corticosterone, deoxycorticosterone (DOC), progesterone (P), 17-hydroxyprogesterone (17-OHP), cortisol, and cortisone were simultaneously followed in the same human newborn in a single 250-500 microliters peripheral plasma sample obtained at constant times during the first week of life using a mechanized Sephadex LH-20 multicolumn chromatography and standardized RIAs. Mean concentrations in 12 spontaneously delivered full term newborns of either sex and in paired umbilical (UV) and peripheral maternal (MV) venous plasma are given in the table. Besides significant maternoumbilical gradients in each steroid, DOC, P, 17-OHP, and cortisone, originating predominantly from the fetoplacental unit, disappear rapidly with steadily increasing half-lives. A, corticosterone, and cortisol, however, remain elevated in comparison with later infancy, with the exception of a marked "glucocorticoid dip" in cortisol and corticosterone levels between 2 and 12 h after birth.     

Work Satisfaction and Performance of Physicians in Pediatric Outpatient Clinics

The sources and consequences of variations in work satisfaction are investigated in a study of approximately 100 physicians in six pediatric outpatient clinics, half of them associated with teaching hospitals and half with community hospitals. Measures of work satisfaction, role conflict, and performance are related to physicians' perceived internal and external reward values, controlling for clinic attributes and physicians' background characteristics, and differences between the two clinic types are documented. Implications of the study results for potential conflict between outpatient care and academic aims in teaching hospitals are discussed and avenues of possible further research are suggested.