Assessing the benefits of teleintensivist coverage in the ICU.

Issues that healthcare leaders should consider in determining whether to develop a teleintensivist program to support physician coverage in the ICU include those related to: Coverage. Scope. IT capabilities. Licensure of participating physicians and accreditation of the hospital. Payment. Potential impact on other ICU services. Performance measurement. Training and education.

The development and testing of glaze materials for application to the fit surface of dental ceramic restorations.

OBJECTIVES: The aims of the study were to develop and test overglaze materials for application to the fit surface of dental ceramic restorations, which could be etched and adhesively bonded and increase the flexural strength of the ceramic substrate. METHODS: Three glaze materials were developed using commercial glass powders (P25 and P54, Pemco, Canada). P25 (90 wt%) was mixed with P54 (10 wt%) to produce (P25/P54). P54 (90 wt%) was mixed with P25 (10 wt%) to produce (P54/P25). P25 (90 wt%) was mixed with 10 wt% of an experimental glass powder (P25/frit). Eighty-two disc specimens (14 mm x 2 mm) were produced by heat pressing a leucite glass-ceramic and were sandblasted with 50 microm glass beads. Group 1 control specimens (10) were sandblasted. Groups 2-4 (10 per group) were coated using P25/frit (Group 2), P25/P54 (Group 3) and P54/P25 (Group 4) overglazes before sintering. Groups 1-4 were etched for 2 min using 9.5% HF (Gresco, USA). Composite cylinders (Marathon v, Den-Mat) were light cured and bonded to the glazed and prepared disc surfaces and groups water stored for 8 days. Groups were tested using shear bond strength (SBS) testing at 0.5mm/min. Disc specimens (42) were tested using the biaxial flexural strength (BFS) test at a crosshead speed of 0.15 mm/min. Group 1 was tested as sandblasted (21) and Group 2 (21) after coating the tensile surface with P25/frit. Xrd, Eds and Sem analyzes were carried out. RESULTS: Mean SBS (MPa+/-S.D.) were: Group 1: 10.7+/-2.1; Group 2: 9.8+/-1.9; Group 3: 1.8+/-1.0 and Group 4: 2.6+/-1.7. Groups 1 and 2 were statistically different to Groups 3 and 4 (p<0.001), but there was no difference between Groups 1 and 2 and 3 and 4 (p>0.05). The mean BFS (MPa+/-S.D.) of the overglazed Group 2 (200.2+/-22.9) was statistically different (p<0.001) to Group 1 (150.4+/-14.3). SIGNIFICANCE: The P25/frit overglaze significantly (p<0.001) increased the biaxial flexural strength of the leucite glass-ceramic substrate and produced comparable shear bond strengths to an etched and bonded control. The application of etched overglaze materials to dental glass-ceramic and ceramic substrates may be useful in adhesive dentistry.

Consumerism: a matter of trust.

Remembering that hospitals exist first and foremost to serve their patients is at the core of understanding consumerism.

Price transparency: building community trust.

With the push from policymakers, payers, and consumers for hospitals to make their prices public, healthcare executives need to recognize two central issues related to price transparency: 1) meaningful price transparency involves helping patients and consumers understand their financial obligation for an episode of care, and 2) price transparency is key to the most critical success strategy for healthcare providers: building trust. This article reviews the history of pricing and billing practices and explores why price transparency is not easily achieved in today's environment. Pricing is a mystery even to those of us who work in the field, yet despite its complexity, the call for price transparency is not going to go away. For transparency, the goal should be to establish a rational pricing system that is easily explainable and justified to all stakeholders. Healthcare executives must make pricing a priority, understand cost, develop a pricing philosophy, understand the overall revenue requirements, examine market conditions and prices, and set up systems for review. A rational process of price setting should enhance community trust. In this matter there is nothing less at stake than the hearts of our community members.

Creating financial transparency in public health: examining best practices of system partners.

Financial transparency is based on concepts for valid, standardized information that is readily accessible and routinely disseminated to stakeholders. While Congress and others continuously ask for an accounting of public health investments, transparency remains an ignored concept. The objective of this study was to examine financial transparency practices in other industries considered as part of the public health system. Key informants, regarded as financial experts on the operations of hospitals, school systems, and higher education, were a primary source of information. Principal findings were that system partners have espoused some concepts for financial transparency beginning in the early 20th century--signifying an 80-year implementation gap for public health. Critical features that promote accountability included standardized data collection methods and infrastructures, uniform practices for quantitative analysis of financial performance, and credentialing of the financial management workforce. Recommendations are offered on the basis of these findings to aid public health to close this gap by framing a movement toward transparency.

The nucleation and crystallization of fine grained leucite glass-ceramics for dental applications.

OBJECTIVES: The aims of the study were to control the nucleation and crystal growth of selected aluminosilicate glass powders, to produce uniform leucite glass-ceramic microstructures consisting of fine (<1000 nm) grained leucite crystals. METHODS: A starting glass composition of wt%; 64.2% SiO(2), 16.1% Al(2)O(3), 10.9% K(2)O, 4.3% Na(2)O, 1.7% CaO, 0.5% LiO(2) and 0.4% TiO(2) was heated in an electric furnace and later quenched to produce glasses. The glass powders were ball milled to two different particle sizes and heat-treated using one and two-step crystallization heat treatments. Dta, Xrd, and Sem analyses was used to characterise and explore the crystallization kinetics of the glasses. RESULTS: Selected heat treatments of the glass powders produced a uniform distribution of fine tetragonal leucite crystals (mean+/-S.D.) 0.1+/-0.2 microm(2) in the glassy matrix, with minimal matrix microcraking in the glass-ceramics produced. The addition of a two-step heat treatment increased the leucite volume fraction in all instances. SIGNIFICANCE: Selected crystallization heat treatments and powder particle sizes were used to control the leucite crystal size, distribution and volume fraction, in order to produce uniformly distributed ultra fine grained tetragonal leucite glass-ceramics for dental applications.

The crystallization of an aluminosilicate glass in the K2O-Al2O3-SiO2 system.

OBJECTIVES: The aims of the study were to explore the nucleation and crystallization kinetics of an aluminosilicate glass in K2O-Al2O3-SiO2 system and to characterize it. OBJECTIVES: A starting glass composition of wt%; 64.2% SiO2, 16.1% Al2O3, 10.9% K2O, 4.3% Na2O, 1.7% CaO, 0.5% LiO and 0.4% TiO2 was heated in an electric furnace and later quenched to produce glasses. The glass powders were heat treated using differing heat treatment schedules and quenched. Dta, Xrd, Eds and Sem analyses were used to characterize and explore the crystallization kinetics of the glasses. RESULTS: Phase separation of the glasses was identified and characterized in the glasses. Tetragonal leucite, cubic leucite and sanadine glass-ceramics were produced. Fine leucite crystals (1 microm2) were crystallized with minimal matrix microcracking. SIGNIFICANCE: Amorphous phase separation appeared to be an important precursor to nucleation and crystal growth in the alkali aluminosilicate glasses explored. It was possible to control the crystallization of tetragonal leucite and sanidine phases by selected heat treatment of glass powders and monoliths, resulting in the production of fine grained tetragonal leucite glass-ceramics.

Good actors in a bad movie.

Given the current swirl of activity surrounding charging, discounting, and collection activities by hospitals related to the uninsured, many healthcare executives feel like good actors in a bad movie.

Capital allocation. Three cases of financing the future.

In hospitals and health systems, numerous worthwhile capital projects are competing for limited capital. Hospitals face demands for technology upgrades, facility renovations, and new services. Some projects cannot be delayed, even though they do not bring a direct financial return. Certain services are not themselves profitable but serve as patient gateways to more profitable services.