Francis N. Lohrenz

Impact of Membership in an Enrolled, Prepaid Population on Utilization of Health Services in a Group Practice

Members of prepaid group-practice medical-care plans are believed to use more ambulatory, but fewer inpatient, services than populations served by fee-for-service practitioners. It is not known whether these differences are attributable to the prepayment aspects of the plan or to other circumstances. We studied the impact on use of services of only one factor-prepayment at the Marshfield Clinic, Wisconsin--with all other factors, including group practice, held constant. The findings were derived from the experience one year before, and two years after, the initiation of the prepaid program. Results showed that prepayment alone resulted in significant increases in both inpatient and ambulatory care (about 100 per cent in ambulatory-care visits, 75 per cent in hospital discharges, and 60 per cent in hospital days). These increases were far greater than comparable increases in the fee-for-service population served by the Clinic.

Familial decrease in corticosteroid-binding globulin

Abstract Despite continuing extensive investigations of the corticosteroid-binding globulin (CBG) in man, to date no reports of a familial alteration in its plasma concentration have appeared. The present report gives information on studies done on 3 generations of a family found to have diminished plasma CBG concentration. CBG concentration in the propositus was 17 mg./L. (normal 23–46 mg./L.), was 17 mg./L. in her mother, 16–20 mg./L. in 2 brothers and 16–17 mg./L. in 2 sisters. Three of 4 members of the third generation were abnormal (15–20 mg./L.). The response of plasma CBG in the propositus to estrogen was subnormal with an increase of only 22 mg./L. following I week of 5 mg. diethylstilbestrol (normal 32–89 mg./L.). Morning plasma 17-OHCS concentration was significantly below normal in affected individuals (mean 6.7 μ g. 100 ml. ), but nonprotein-bound 17-OHCS concentration was normal. Urinary 17-OHCS excretion was 4.2–5.6 mg. 24 hrs. (normal 4–10 mg. 24 hrs. ). The mode of inheritance appeared to be autosomal dominant, and the affected members were healthy, intelligent and prolific.

Cholecystectomy Peer Review: Measurement of Four Variables

Process and outcome analyses were carried out on a group of patients who had uncomplicated cholecystectomy. The postoperative length of stay and patient satisfaction were also measured. A random sample of 80 charts was selected from 222 eligible records for process analysis. Outcome was evaluated in 218 of the 222 eligible patients against explicit criteria. More patients were in the symptomatic and back-to-work group than expected. The peer consensus was that these results were not related to the surgical procedure or specifically related to gallbladder disease. Ninety-five per cent of the patients assessed care as good or excellent, and 90 per cent felt the length of postoperative stay was satisfactory. When the patients were divided according to surgeon, significant differences in the length of postoperative stay were found in the 154 patients without common bile duct exploration. After the findings were presented to the surgeons through an educational program, changes occurred which resulted in a decrease of nearly one day in the postoperative hospitalization.

Circadian rhythm of human urinary amino acid excretion in fed and fasted states

Abstract The amino acid excretion of human males was studied by collection of three hour urines and analysis of these for acidic and neutral amino acids. The excretion pattern for males who were eating three meals daily was characterized by high values during the day and declining values during the night with a nadir between 0200 and 0800 hours. During the day there were three maxima each of which occurred in a time period follow-a meal. Males in the fasting state showed values that were significantly lower during the first study period (0800–1100 hours), and from this point they slowly decreased during the day reaching a nadir at 0200–0500 hours. The values for all of the amino acids rose during the second morning of the fast reaching values for the 0800–1100 period that were approximately the same as those for the first morning of the fast. In the fasting state the total 24-hour excretion of the ten amino acids measured was only 51 per cent of that for the normal fed state. It is suggested that there is a basic rhythm of amino acid excretion characterized by a maximum value at mid-morning and a nadir in the early morning hours and in addition to this basic rhythm the ingestion of food causes an increase in urinary amino acid excretion.

Adrenal cortical activity in depression

Summary We have presented a pilot study of ten depressed patients as well as preliminary data from another study which suggests alternations in the diurnal pattern of steroid excretion in depression. We found evidence that the patients own rating of his affect may be an accurate predictor of increased adrenal cortical activity. Limitations of the rating instruments are apparent, and it is suggested that further studies be conducted to investigate correlations of the patients rating of his depression with that of an observer and with adrenocortical activity.