The flexible budget process--a tool for cost containment.

This past year the authors have been using a new tool to examine and monitor their laboratory's expenditures. Called "flexible budgeting," this process has been used to analyze the cost behavior of all operating expenses, establish budget levels for different levels of activity, and monitor activity based on relative cost rather than simply the number of tests performed. The authors' experience has shown that this tool provides much more information than previous procedures. However, better methods need to be developed for monitoring expenditures so that this information can be used effectively.

Babies provide focus for quality improvement team.

The challenge of quality improvement (QI) is to take its principles and tools and apply them to active problems in the clinical laboratory. The authors describe a 2-year QI project in which the staff of the laboratory and the neonatal care unit (NCU) significantly improved the care of babies who undergo heelsticks to provide blood samples for laboratory testing. Examples of quality tools used during the project are provided. The success of the QI project is due to the consistent and ongoing efforts of both staffs to care passionately about their customers--the babies of the NCU.

Combination contraceptive effects on monthly cycle of plasma aldosterone, renin activity and renin substrate.

A post-ovulatory peak of fasting supine plasma aldosterone (PA) preceded or accompanied by an increase in plasma renin activity (PRA) was previously reported. These studies have now been extended in 4 additional normal menstruating women and 4 women taking oestrogen-progestogen oral contraceptive pills (OCP), all studied daily for an entire cycle. Distinct luteal phase increases in PRA were seen in the 4 normals, with 2 also demonstrating a rise in PA. Plasma renin substrate (PRS) was usually unvarying throughout the control cycles. The women taking OCP, on the other hand, all had PA and PRA peaks that were apparent by the fourth or fifth day of taking "the pill". All 4 of the treated women had elevated PRS levels but only one woman showed an increase which preceded the elevation of PRA and PA. Plasma cortisol levels were usually above the normal range in the women taking OCP. This study thus indicates that factors other than oestrogen-induced increased substrate production may be responsible for the PRA and PA rise during OCP treatment. Such factors might be the natri-uretic effects of oestrogens and progestogens or a direct effect on renin secretion by one of these steroids.