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Accountability has become the fact of life for the health care provider and the delivery system. Until recently, accountability has been viewed primarily through the judicial process as issues of fraud and liability, or by managed care entities through evaluation of the financial bottom line. It is this second consideration and its ramifications that will be explored in this article. Appropriate measurement tools are needed to evaluate services, delivery, performance, customer satisfaction, and outcomes assessment. Measurement tools will be considered in light of the industry's unique considerations and realities. All participants, including insurers, employers, management, and health care providers and recipients, bear responsibilities which necessitate assessment and analysis. However, until the basic question, "Who is the customer?" is resolved, accountability issues remain complex and obscured. Accountability costs and impacts must be evaluated over time. They go way beyond bottom line cost containment and reduction. Accountability will be accomplished when the health care industry implements quality and measurement concepts that yield the highest levels of validity and appropriateness for health care delivery.

Alzheimer's disease has no specific treatment; care often must be directed to patient behavior. That is why education--of professional and family caregivers--is essential. The more caregivers know, the easier it is to ensure the Alzheimer's patient is comfortable and secure. The pointers in this article are therefore valuable to both professional and lay caregivers.

Twenty cases of methadone-induced pulmonary edema confirmed by clinical, laboratory and roentgenographic findings were extensively reviewed and the roentgenographic manifestations defined in terms of patterns, distribution, and duration of the process. Drug tolerance is a major factor in determining the severity of toxicity. Roentgenographic clearing in 48 hours or less, clinical improvement and pathogen-free sputum aspirates serve to differentiate edema from pneumonia.