Reformatting health care delivery.

The healthcare delivery system is undergoing great upheaval as individual providers respond to market pressures for aggressive cost reduction. Roles, relationships, processes, partnerships, and financing arrangements are on the table in the great race for competitive survival. The IDN department addresses issues inherent in the evolution of free-standing acute care centers and private medical staffs into integrated delivery networks.

Emerging knowledge.

The healthcare delivery system is undergoing great upheaval as individual providers respond to market pressures for aggressive cost reduction. Roles, relationships, processes, partnerships, and financing arrangements are on the table in the great race for competitive survival. The IDN department addresses issues inherent in the evolution of free-standing acute care centers and private medical staffs into integrated delivery networks.

Membership of institutional ethics committees.

There are no absolutes in regard to the composition of the institutional ethics committee. The basic principle of membership appears to be that it should be diverse in composition, large enough to provide a broad spectrum of perspectives, and yet small enough to function as a learning, dialoging, service panel. The average size appears to be 15 members, but the range is from 6 to 30.

Urinary excretion of alpha 2 mu-globulin and albumin by adult male rats following treatment with nephrotoxic agents.

Nephrotoxic agents such as puromycin aminonucleoside (PAN) and sodium maleate (MAL) have been used to induce experimental glomerular proteinuria and tubular disease, respectively. Current studies show that PAN caused a massive loss of albumin in the urine while not affecting the excretion of the smaller, sex-dependent alpha 2 mu-globulin. On the other hand, MAL which inhibits the reabsorption of proteins, increased the loss of both alpha 2 mu and albumin.