Coronary vasoconstrictor effects of atriopeptin II.

Atrial natriuretic peptides lower arterial pressure, cardiac filling pressure, and cardiac output. In isolated, Langendorff-perfused guinea pig hearts, atriopeptin II, the 23-amino acid atrial natriuretic peptide, is also a potent coronary vasoconstrictor. The median effective dose for atriopeptin II in guinea pig hearts is 26 nanomoles, the threshold constrictor dose is 5 nanomoles, and flow nearly ceases at a dose of 100 nanomoles in perfused hearts at constant pressure. Similar concentrations of atriopeptin II also cause coronary vasoconstriction in rat and dog heart preparations. The disulfide bridge is necessary for vasoconstrictor activity; reduction of this bridge abolishes the activity, as it does the other biological activities of atrial natriuretic peptides.

Frequencies of hprt mutant lymphocytes in smokers, non-smokers, and former smokers.

Previous work with the autoradiographic mutant lymphocyte assay has provided information about the time-course of development of hprt mutations and the persistence of detectable mutant cells in human subjects following therapeutic exposures to genotoxic agents. These early studies also revealed elevations in frequencies of mutant cells in pretreatment blood samples from patients who were current tobacco smokers, but no information was available on former smokers. In the present study, blood samples were obtained from 21 healthy former tobacco smokers who had quit smoking at least 1 year before sampling, 42 subjects who had never smoked, and 23 tobacco smokers. Plasma from all samples was tested for cotinine, a metabolite of nicotine. Current smokers were categorized as heavy smokers (> or = 10 cigarettes per day, cotinine > or = 90 ng/ml plasma) and light smokers (< 10/day, cotinine < 90 ng/ml). Lymphocytes from the blood samples were isolated, cryopreserved, and later thawed and assayed with the autoradiographic hprt assay. The 21 former tobacco smokers had a mean variant (mutant) frequency (Vf +/- standard error) of 1.97 (+/-0.13) per million evaluatable cells. The Vf of 42 subjects who had never smoked was 1.74 (+/-0.13) x 10(-6), not significantly different from the former smokers. The smokers had Vfs of 8.09 (+/-0.78) x 10(-6) for 18 heavy smokers and 5.22 (+/-1.02) x 10(-6) for five light smokers. The two categories of smokers had frequencies of mutant cells significantly different from each other, and each was significantly higher than non-smokers and former smokers (P < 0.05). Vfs were significantly correlated with both cotinine concentrations and the number of cigarettes smoked per day, P < 0.001. This study demonstrates the sensitivity of the autoradiographic hprt assay for detecting mutagenic effects related to chronic low-level exposures to genotoxins, and indicates that this assay is more likely to detect the effects of recent rather than past exposures.

Patient rights meet managed care: understanding the underlying conflicts.

During the past several years, one of the favored areas for legislative (and editorial) debate in our Nation has been the proper level of legal protections that should be accorded to those individuals who have chosen to become members of managed care plans. As examined in the following article, this debate often rages with little notice being paid to the underlying conflicts between managed care and "patient's rights." Indeed, at times, the vociferousness of the debate obscures even those instances in which there is little fundamental conflict.

The role of the nursing school in the academic health center: report of a study.

This paper highlights for the nursing education community selected data from a recently completed study of the organization and governance of academic health centers, conducted under the auspices of the Association of Academic Health Centers and funded by the W.K. Kellogg Foundation. It is hoped that the limited information presented here will stimulate interest in the larger study. Presented and discussed are data derived from three different questionnaires used in the study. Top administrators in academic health centers were surveyed in order to produce information on the structural components and hierarchical relationships in contemporary academic health centers, the processes by which decisions are made and conflicts are resolved, and the conditions which administrators envision for their institutions in the future. Deans of nursing schools were part of the survey group, and their responses are examined along with those of deans of other health professional schools.

The dental school's role in academic health centers: report of a study.

This paper highlights for the dental education community selected data from a recently completed study of the organization and governance of academic health centers, conducted under the auspices of the Association of Academic health Centers and funded by the W. K. Kellogg Foundation. It is hoped that the limited information presented here will stimulate interest in the larger study. Data derived from three questionnaires used in the study are presented and discussed. Top administrators in academic health centers were surveyed to assemble information on the structural components and hierarchical relationships in contemporary academic health centers, the processes by which decisions are made, the way in which conflicts are resolved, and the conditions that administrators envision for their institutions in the future. Dental school deans were part of the survey group, and their responses are examined along with those of deans of other health professional schools.

Employee/independent contractor determinations.

Among the areas receiving increased scrutiny recently from the Internal Revenue Service is employee/independent contractor determinations. The IRS estimates an annual $1.5 billion loss of revenues because of misclassification of workers as independent contractors rather than employees. Organizations found to be in violation of the FICA withhold payment requirements could be subject to significant penalties and assessments.

Legal developments in managed mental health care.

There has been rapid development in recent years of employer programs aimed at controlling the skyrocketing costs of providing mental health care benefits to employees. This column, which is based on a presentation at a Client Briefing Conference conducted by Epstein Becker & Green, P.C., on September 13, 1989, in Dallas, Tex., discusses some of the legal issues that have arisen in connection with the various plans that have been developed.

The role of schools of allied health in the academic health center: report of a study.

This paper highlights selected data from a recently completed study of the organization and governance of academic health centers. The study was conducted under the auspices of the Association of Academic Health Centers and was funded by the W.K. Kellogg Foundation. It is hoped that the limited information presented here will stimulate interest in the larger study. Data derived from three different questionnaires used in the study are presented and discussed. Top administrators in academic health centers were surveyed to produce information on the structural components and hierarchical relationships in contemporary academic health centers, the processes by which decisions are made and conflicts are resolved, and the conditions that administrators envision for their institutions in the future. Deans of schools of allied health were part of the survey group, and their responses are examined along with those of deans of other health professional schools.

Legal issues raised by private review activities of medical peer-review organizations.

Increasingly, medical peer-review organizations are entering into contracts with insurance companies and self-insured employers to conduct utilization reviews and quality-of-care assessments. Such private review activities raise new legal issues, requiring analysis of state law as well as federal law. This paper analyzes several of the most important of these legal issues, and suggests some directions for peer-review organizations to take in order to avoid unnecessary legal problems.

Professional Standards Review Organizations and confidentiality: the question of public access to medical peer review data through the Freedom of Information Act.

The degree of confidentiality to be accorded data gathered and analyzed by Professional Standards Review Organizations (PSROs) in the course of their medical peer review activities is a crucial and controversial issue in health policy. In late 1977, a consumer organization in Washington, D.C. sought access to data in the hands of the local PSRO through a lawsuit under the Freedom of Information Act, touching off a continuing debate throughout the country. That lawsuit is now on appeal. The courts, the Congress, and the Department of Health and Human Services have all been involved in the ongoing controversy. PSROs, practicing physicians, and health care consumers all have an interest in the outcome. This article analyzes the PSRO Program and its data confidentiality problems, examines in detail the lawsuit that sparked the controversy, and assesses the overall impact of this case on the PSRO program and on federal regulation of the health care system in general.

Policy-making and governance in academic health centers.

Treating academic health centers (AHCs) as unique organizations that merit serious investigation, the authors outline key changes which have shaped today's AHCs, discuss various modes of AHC organization and governance, and analyze certain factors which make AHC policy-making so complex. In addition, they assess the relevance of certain policy-making models, concluding that no one model completely describes AHC governance. They suggest that the contingency theory of organizations offers a useful perspective on AHCs and point to matrix management as one contemporary method being tried in an effort to cope with the problems of AHC governance. Finally, the authors offer a set of decision-making continua as an alternative to governance models for analyzing policy-making in AHCs.

The legal framework for effective competition.

Largely because of its indifference to spiraling costs, the professional domination model is being replaced by a market model based on competition among managed care plans and integrated delivery systems. In general, the more fully integrated previously competing providers become--for instance, by assuming financial risk together--the less legal risk is present, because of a decreased possibility of improper conspiratorial or collective behavior. Nevertheless, provider joint ventures and integrated delivery systems face a complex interaction of practical challenges and various legal and regulatory risks. This chapter explores ways in which laws involving fraud and abuse, self-referral, private inurement, corporate practice of medicine, Medicare reimbursement policy, and antitrust enforcement affect typical integrated delivery systems. From a legal standpoint, it might seem logical that the laws regulating health care providers would support and promote integration. A permissive legal environment to foster development of an integrated service network model assumes its development in a delivery system in which networks are at financial risk for the services provided. However, many of the laws and regulations governing integrated provider development were established at a time when joint ventures and other alliances were organizing in a predominantly fee-for-service environment and were generating significant increases in health care costs without producing demonstrable efficiencies or quality enhancements. The results is a fundamental inconsistency in government policy. The demand for collaboration by purchasers and legislatures does not necessarily cause the vast body of health care regulators to revise their concerns that many of the very collaborative activities being encouraged trigger potentially illegal acts and relationships. In a market model, the application of federal and state antitrust laws is especially important. In 1993 and 1994, the Department of Justice and the Federal Trade Commission jointly issued "Statements of Antitrust Enforcement Policy" in a number of areas of provider uncertainty. For integrated delivery systems, the primary focus of antitrust analysis is "market power." Systems without market power (i.e., the ability to force a purchaser to do something that the purchaser would not do in a competitive market) cannot harm consumers and should be free from serious antitrust risk. Where a network may have market power, its activities may be limited only if demonstrable anticompetitive effects outweigh the benefits of the efficiencies claimed by the new arrangement. The chapter concludes that vigorous antitrust enforcement may be required to promote market competition among integrated networks of providers and the managed care plans they serve.