Defined contribution--the future for health care.

Employers are seeing breathtaking health care premium increases. As action-oriented people, they are not going to cough up additional money to pay for these rate increases. The real question is what solution might employers move to? The most logical answer is defined contribution--a way that employers could give employees health benefit funding that resembles what they have already done in pension funding. Today, facing massive cost pressures from their health care premiums, many employers are wishing that they could create or use the equivalent of a defined contribution plan for health care. The next major evolution of defined benefit health financing needs the full-scope functional equivalent of a 401 (k) administrator to make the concept work--someone to give employers the tools needed for employees to make meaningful choices. Up until now, no one has been able to give consumers meaningful data about health care and health benefit alternatives. A viable 401 (k) health administrator will need to offer an array of choices that will work for all players.

Therapeutic Heat and Cold for Athletic Injuries.

In brief Soft-tissue responses to injuries result in impaired neuromuscular function. Therapeutic heat and cold can minimize this injury response and maximize functional recovery. Before determining which type of treatment is most appropriate at a given stage, the team physician must understand not only the expected physiologic response to each modality but also the athlete's individual response to a given mode. For example, although cryotherapy has broad applicability to sports injuries, many athletes tolerate cold poorly. The author discusses both the art and the science of treating injuries with therapeutic heat and cold.

Comparison of four ankle splint designs.

Plaster splinting is often considered the initial immobilization method for acute ankle injuries. Although the posterior splint design is most commonly recommended, clinical experience suggests that it is not the most durable in the outpatient setting. To determine the sturdiness of the four most common splint designs, each was tested for its resistance to plantar flexion 30 minutes after application. The splints tested were: standard posterior, ridged posterior, modified figure-of-eight, and sugar-tong. In six healthy subjects, significantly less plantar flexion was achieved with the sugar-tong splint than with the other designs. In addition, more force was generated per degree of plantar flexion achieved with the sugar-tong than with the other designs. These results suggest that the sugar-tong splint may be preferred in the acute treatment of ankle injuries based on its greater strength.

Sportsmedicine Forum.

A Forum For Our Readers Sportsmedicine Forum is intended to provide a sounding board for our readers. Perhaps you have a special way to treat a common medical problem, or you may want to air your views on a controversial topic. You may object to an article that we have published, or you may want to support one. You may have a new trend to report, Identified through an interesting case or a series of patients. Whatever your ideas, we invite you to send them to us. Illustrative figures are welcomed. Address correspondence to Sportsmediclne Forum, The Physician And Sportsmedicine, 4530 W 77th St, Minneapolis 55435.

Abscess incision and drainage in the emergency department--Part I.

Superficial abscesses are commonly seen in the emergency department. In most cases, they can be adequately treated by the emergency physician without hospital admission. Treatment consists of surgical drainage with the addition of antibiotics in selected cases. Incision is generally performed using local anesthesia, with intraoperative and postoperative systemic analgesia. Care must be taken to make a surgically appropriate incision that allows adequate drainage without injuring important structures. Postoperative care includes warm soaks, drains or wicks, analgesia, and close follow-up. Antibiotics are usually unnecessary. Complications of incision and drainage include damage to adjacent structures, bacteremic complications, misdiagnosis of such entities as mycotic aneurysms, and spread of infection owing to inadequate drainage. The infectious agents responsible for abscess formation are numerous and depend largely on the anatomic location of the abscess. Staphylococcus aureus accounts for less than half of all cutaneous abscesses. Anaerobic bacteria are common etiologic agents in the perineum and account for the majority of all cutaneous abscesses. Abscesses at specific locations involve special consideration for diagnosis and treatment and may require specialty consultation.