RESUMEN
Earlier experimental results show the role of altered pineal function in the development of the constant estrous-anovulatory (CEA) state induced by neonatal androgen sterilization (NA) or in the spontaneously developed anovulatory syndrome in the aging rat (AG-CEA state). Since norepinephrinergic (NE) innervation of pineal gland represents the main stimulus for melatonin secretion in mammals, in the present experimental series, the reactivity of pineal tissue to NE was investigated in in vitro perifusion system in rats suffering from NA-CEA or AG-CEA state, using the model of pineal body deprived from neural inputs. The data indicate that the 'melatonin deficiency' observed in the 2 types of anovulatory syndrome (NA-CEA and AG-CEA states) is due to disturbance of norepinephrinergic innervation of the pineal gland rather than to deficient secretory capacity of pineal tissue.
Asunto(s)
Anovulación/metabolismo , Anovulación/fisiopatología , Melatonina/metabolismo , Norepinefrina/farmacología , Glándula Pineal/metabolismo , Animales , Anovulación/inducido químicamente , Femenino , Técnicas de Cultivo de Órganos , Perfusión , Glándula Pineal/efectos de los fármacos , Ratas , Ratas Wistar , SíndromeRESUMEN
Horror stories abound about providers that have failed to modify their incentive systems and have exhausted their annual capitation budget in the first six months of the plan year. Aligning the business strategy and financial incentives in advance is the best way to ensure that your integrated delivery system's transition to capitation is a success story. Rarely are physicians or hospitals with experience limited to the fee-for-service arena prepared to jump into a managed care or capitated compensation system. The transition can be eased by implementing a "shadow" capitation or similar arrangement that will test physician performance under a risk arrangement in advance. The information can be used to restructure the compensation system to ensure that the behaviors being encouraged will promote successful care and fiscal management.
Asunto(s)
Redes Comunitarias/economía , Programas Controlados de Atención en Salud , Planes de Incentivos para los Médicos/economía , Capitación , Control de Costos , Programas Controlados de Atención en Salud/economía , Auto Remisión del Médico/legislación & jurisprudencia , Pautas de la Práctica en Medicina/economía , Salarios y Beneficios , Exención de Impuesto , Estados Unidos , Recursos HumanosRESUMEN
In response to the changing healthcare market, many providers are forming networks for managed care contracting. These networks may fail, however, if planning focuses on maintaining business practices of the past rather than responding to market forces of the future. Effective planning for managed care requires that network executives establish a vision of the future that is not shackled by experiences of the past, articulate a mission that outlines what the network's role will be in the future, and create strategies that will help the network fulfill its mission. Although financial data are necessary to measure a network's progress toward fulfilling its mission, data on past performance should not be used to shape a vision of the future.