The nonphysician provider in the gastroenterology practice.

Our nonphysician provider (NPP) experience has transformed the functioning and image of our practice. It allows the practice to care for poorly compensated or noncompensated patients and contains costs under managed care. NPPs enable our physicians to maintain reasonable workloads and focus their energy and skills on high-level diagnosis and treatment.

Revenue enhancement for the practice and the endoscopic ambulatory surgery center.

Gastroenterologists, like all physicians, are attempting to control more of the services they provide by developing programs that enhance quality of care and practice revenues, reduce physician stress, and improve the physician's quality of life. Many opportunities exist to accomplish these goals, including those discussed in this article. The overriding feature of any such activity, however, must always meet the criteria of improving patient care.

Bile leak after laparoscopic cholecystectomy. Diagnostic and therapeutic application of endoscopic retrograde cholangiopancreatography.

Background: Laparoscopic cholecystectomy, introduced less than 2 years ago, is widely accepted by patients and physicians despite the lack of controlled trials comparing this technology with conventional cholecystectomy. Recent series have described a variable incidence of biliary tract injury with laparoscopic gallbladder removal. The primary interaction of endoscopic retrograde cholangiopancreatography with this technology is usually in the preoperative or postoperative diagnosis and treatment of common bile duct stones.

Some biochemical indices of nutrition in treated cystic fibrosis patients.

Postprandial levels of copper, ceruloplasmin, iron, total iron binding capacity, cholesterol, vitamin A, carotene, folic acid, vitamin C, albumin, and total globulins in plasma, of 25-OH-vitamin D in serum, and of glutathione reductase activity, an index of riboflavin status, in erythrocytes were determined in a group of 18 juvenile cystic fibrosis patients receiving specialized outpatient care with attention to diet, vitamin supplementation, and pancreatic enzyme replacement. Bone mineralization was assessed by radiographic and photon beam technique. In the plasma of cystic fibrosis patients, levels were elevated for copper, ceruloplasmin, total globins, and total proteins and were depressed for iron, vitamin D, vitamin A, carotene, and albumin.