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Ankle stability in basketball players is affected by footwear. Athletic shoe manufacturers have introduced specialized lacing systems and high-top performance shoes to improve ankle stability. These performance shoes not only aid in preventing ankle injuries, but also protect injured ankles.

The Medical Illness Severity Grouping System--called MEDISGRPS--is an admission-oriented patient severity grouping system that uses objective, key clinical findings to place patients in one of five severity groupings. Data from five hospitals indicate that severity level at admission is an important predictor of resource use, is essential for analysis of patients who deteriorate and/or respond poorly to therapy, and is useful to further specify DRGs. Measures of effectiveness and efficiency using MEDISGRPS are suggested.

The most pressing issue in health care delivery today is inflationary cost increases. The gatekeeping role of primary care physicians, particularly family physicians, may lower health care costs through a more judicious use of specialty referrals, expensive tests, and hospitalization. The study of such an impact is most readily carried out in the practice setting of health maintenance organizations (HMOs), where there is a defined patient population. Incomplete data and lack of sensitive indicators of the gatekeeping effect are limitations of this preliminary study. The results show, however, that the internal organization of an HMO does not influence hospital and ambulatory care utilization rates, with the exception that HMOs staffed by a group of salaried physicians (staff HMOs) reported higher ambulatory care utilization. No significant differences were demonstrated in hospital or ambulatory care utilization rates among the HMOs using more primary care physicians or family physicians than others. The results indicate that ambulatory care utilization rates are proportional to the number of physicians per 1,000 members. The results also suggest that there may be an inverse relationship between hospital utilization rates and the number of primary care physicians, especially if they are family physicians. Further studies need more specific indicators to evaluate the effect of the gatekeeping role in health care delivery.

The case is described of a 22-year-old man who presented with ulcerative keratitis as a complication of conjunctivitis that was caused by penicillinase-producing Neisseria gonorrhoeae. The need for first-line treatment with antibiotic agents that are resistant to beta-lactamase breakdown is discussed.

In the Worcester, Massachusetts, area, a community program is making health care more affordable through competition among managed-care health plans. Business and health care leaders have joined to assure that this competition focuses not only on price but also on quality and service, and that it benefits the entire community, including the elderly, poor, and uninsured. This paper describes the progress of the program to date as well as strategies for overcoming obstacles to further success.

Hospital financial managers have come to recognize that to profitably operate a hospital under DRGs, they must consider factors other than length of stay. They must also look at illness severity, medical care effectiveness, and treatment efficiency. It is therefore advantageous to develop a method that measures the effect of admission severity on DRG payment and provides information on medical care effectiveness and treatment efficiency improvements. The method described in this article, the admission severity measure, allows the manager to consider both these quality and cost issues.