Late diagnosis of chronic granulomatous disease.

Modern era advancements in medical care, with improved treatment of infections, can result in delayed diagnosis of congenital immunodeficiencies. In this study we present a retrospective cohort of 16 patients diagnosed with Chronic Granulomatous Disease (CGD) at adulthood. Some of the patients had a milder clinical phenotype, but others had a classic phenotype with severe infectious and inflammatory complications reflecting a profoundly impaired neutrophil function. It is therefore of great importance to investigate the individual journey of each patient through different misdiagnoses and the threads which led to the correct diagnosis. Currently the recommended definitive treatment for CGD is hematopoietic stem cell transplantation (HSCT). Although survival of our patients to adulthood might argue against the need for early HSCT during infancy, we claim that the opposite is correct, as most of them grew to be severely ill and diagnosed at a stage when HSCT is debatable with potentially an unfavorable outcome. This cohort stresses the need to increase awareness of this severe congenital immunodeficiency among clinicians of different specialties who might be treating undiagnosed adult patients with CGD.

Consumers hungry for hospital fasting programs.

Supplemental fasting programs are one of the best outpatient money makers available to hospitals today. Opportunities are plentiful for hospitals that offer well-rounded programs. Now is the time for hospital to look at the program options available and decide which best meets their needs.

Hospitals cannot afford to be without access to MRI.

Although practicing state-of-the-art diagnostic medicine is impossible without access to magnetic resonance imaging, this high-ticket technology is a mixed blessing in an era of cost containment. The good news is that MRI's diagnostic capabilities continue to grow, and the prices for scanners are dropping. However, MRI services remain expensive, and reimbursement is declining. To get the maximum benefit from MRI, physicians must stay up to date with the latest advances, a task that hospitals can facilitate through educational programs. Hospitals need to plan carefully for the introduction or expansion of MRI services, but the end result will be better patient care.

Occupational health services gain favor for good reason.

Occupational health programs offer hospitals an opportunity to improve their bottom line with little financial investment. Hospitals that will be the most successful in capturing the business of employers are those that take the time to assess their markets carefully, tailor their programs to individual employer's needs, incorporate a strong sales component and consistently communicate with participating employers. Beyond capturing revenue from employers, the major benefit of occupational health programs lies in the relationships they allow hospitals to build with employees in their markets--40% of whom do not have a primary-care physician. Once introduced to the hospital, these patients and their families are likely to return to the hospital for future medical needs. The ability to establish relationships that can generate business for the hospital and its physicians for years to come makes occupational health one of the wisest and most profitable diversification strategies of the decade.

Mobile lithotripsy services: best bet for most hospitals.

During its short history, extracorporeal shock wave lithotripsy has revolutionized the treatment of kidney stones and may well have a substantial impact on gallstone treatment. The two technologies are potential money makers for hospitals if properly planned for and conceived. For the majority of hospitals, shared arrangements, whether they involve leases or joint ventures, are the key to a successful lithotripsy program. Rural and midsized communities have the greatest need for renal lithotripsy, and hospitals in these areas should explore mobile programs. Urban hospitals located in areas where there is already adequate access to lithotripters are well advised to work with established programs unless the price of lithotripters drops significantly. The demand for biliary lithotripsy remains uncertain, but one thing is clear: hospitals that don't prepare for it now will be left behind once the technology finds it niche.

Move quickly, but cautiously in outpatient cancer care.

In an ever-evolving environment of shrinking reimbursement, existing out-patient oncology programs may need to be re-evaluated, reconfigured and readied for what is likely to be an increasingly fiercer fight for profitability. Similarly, hospitals contemplating entering this market must act soon. The best opportunities exist for those hospitals that can establish themselves within the next few years. Consumer and physician demand for consolidated cancer services cannot be ignored. Now is the time to capture the loyalty of this significant market. And despite there being no guarantee of big and easy profits, hospitals that refuse to expand their cancer services to meet demand will surely be left behind.

The future looks bright for cardiac catheterization.

With heart disease the leading killer in the United States and all Western countries, cardiology continues to be one of the most important services a hospital can offer. Cardiac catheterization laboratories can be one of the top revenue-producing programs if a hospital offers a competitive, comprehensive program that attracts respected cardiologists. Cardiac catheterization remains the best diagnostic tool for cardiovascular disorders and an important therapeutic method for treating heart disease through procedures such as PTCA. If a hospital doesn't offer these services, it is losing patients to hospitals that do. Cardiac catheterizations laboratories are key to a hospital's success and will remain so for years to come.

Downsizing delicately, yet deliberately.

Downsizing is one of the unpleasant realities that hospitals increasingly are having to face. But with proper planning, it is possible to avoid downsizing disasters that demoralize staff and disrupt organizations. From market forecasting to managing the shockwaves, downsizing is among the planner's most challenging responsibilities.