Strategic stakeholder management. First round results from 'Facing the Uncertain Future'.

Authors summarize preliminary results from the first round of a two-round modified Delphi study called "Facing the Uncertain Future." Health care experts were asked to comment on the status of the health care industry in 1994 when the study began and their predictions for change by 1999. Major findings based on the 580 responses received include: (1) the continued movement of the U.S. health care industry from a primarily private insurance industry to one in which medical groups and hospitals will be members of integrated delivery systems/networks (IDS/N); (2) the increasing dominance of the components of IDS/Ns in 1999 (components are defined as: medical practices, system hospitals, managed care organizations and IDS/Ns); and (3) the potential effects of IDS/Ns on the health care industry, including: increases in cost effectiveness, quality of administrative management and the quality of physician leadership, as well as decreases in availability of advanced medical technology and the duplication of ancillary services, facilities and equipment. The study is being conducted jointly by the Medical Group Management Association and Texas Tech University with funding from Abbott Laboratories.

The economic cost of migraine. Present state of knowledge.

The costs of medical care and lost productivity associated with migraine headache impose an economic burden on society. Knowledge of the costs that can be attributed to migraine would provide a basis for evaluating alternative diagnosis and treatment strategies. The most widely used approaches to analyzing the cost of illness analysis are the willingness-to-pay and human capital methods. Using these as a framework, all recent published studies (from 1980 to the present) relevant to the economic cost of migraine were reviewed. The literature reviewed demonstrates that the economic burden of migraine headache is substantial. To estimate the cost of migraine to society more precisely, data are needed on incidence and prevalence among carefully selected samples representative of the underlying population. Use of medical care must be expressed as units of specific types of services rendered over known periods. Health insurance coverage, an important determinant of access to care, should also be known. Absenteeism and work losses must be linked to occupation and earnings levels.

CRAHCA (Center for Research in Ambulatory Health Care Administration)--your research resource.

CRAHCA serves as a broad-based research resource for the study of medical practice management. In their article, Steven S. Lazarus, Ph.D., associate executive director, and Anna M. Bergström, research director, outline many of the projects undertaken by the Center in its 20 years and some of the significant publications and findings that have resulted from them.

Rehabilitation services in rural communities: delivery by hospital based and local teams.

Since rehabilitation services are generally not available on a local basis to rural communities, a rural service delivery approach, the Coordinated Ambulatory Rehabilitation Evaluation Services (CARES) Project, was established. The program demonstrated a local rural rehabilitation capability based on primary care physicians, a local hospital, and nonphysician rehabilitation providers working cooperatively with a rehabilitation specialty hospital 640km away. Service delivery profiles of the hospital and local teams were compared for pediatric and adult clinics. The project was successfully implemented with 281 patients seen in their local areas.

Non-ossifying fibroma or benign lipoblastoma of bone--an electron-microscopic and histochemical study.

An ultrastructural and histochemical analysis was made of a lesion identified by light microscopy as a non-ossifying fibroma of bone. A histogenetic sequence was traced from spindle-shaped fibroblast-like cells to multivacuolated lipoblasts with abundant glycogen. These lipid-laden cells showed remarkable similarity to some cells of a well differentiated liposarcoma. Others have interpreted the lipid-containing cells of non-ossifying fibroma as representing fibroblasts which have imbibed or synthesized lipid or lipid-laden macrophages. Our studies demonstrate that this tumour consists of primitive mesenchymal cells with partial maturation to early lipoblasts, suggesting its classification as a benign lipoblastoma of bone.

Early presentation of carcinoma of the small bowel in Crohn's disease ("Crohn's carcinoma"). Case reports and review of the literature.

We report here 3 cases of adenocarcinoma of the small bowel complicating Crohn's disease ("Crohn's carcinoma"). In 2 cases, the adenocarcinoma was discovered in the first attack of enteritis. In only one other case in the literature, a similar presentation was described. A review of 59 reported cases of adenocarcinoma of small bowel in Crohn's disease, together with these 3 cases reveals that: (a) the cancer develops at a younger age than in carcinoma de novo; (b) there is no difference in incidence of carcinoma in the first, second, and third decades after the onset of symptoms of Crohn's disease; (c) in 73% of cases, the neoplasm rose in the ileum; (d) in all but 1 case it developed in inflamed segments of bowel; (e) in 31% of cases the cancer developed in a bypassed segment of bowel. This analysis clearly demonstrates that "Crohn's carcinoma" is a complication in Crohn's disease and not a chance coexistence of two diseases in the same patient.