This study assessed burnout within a large Health Maintenance Organization. Primary care physicians and one psychiatric clinic staff were studied. The Maslach Burnout Inventory was used to develop frequency data in the areas of emotional exhaustion, depersonalization, and personal achievement. Among the primary care physicians, moderate emotional exhaustion, and depersonalization were found. Personal achievement was high. Among the psychiatric staff, high emotional exhaustion and depersonalization were found. Again, personal achievement was high. The entire professional group, with the one exception, was significantly higher in emotional exhaustion, depersonalization, and personal achievement than Maslach's normative sample. Psychiatrists and social workers had significantly higher scores on depersonalization than the primary care physicians or psychologists. High burnout in a Health Maintenance Organization setting suggests that managed health care providers may be more prone to burnout than fee-for-service practitioners. Several suggestions were made for such organizations to help alleviate burnout in their staffs.

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Congestive heart failure (CHF) is a chronic diseasethat is difficult to manage with today's home health technology. These fragile patients are often over or under diuresed due to the subjective nature of the symptoms and often misleading nature of the weight data available. The work presented here demonstrates that the ratio of extracellular water (ECW) to fatfree mass (FFM) derived from bioelectrical impedance analysis (BIA) is a more objective measure of fluid overload than traditional techniques. In particular, the results of an observational study are presented that show ECW/FFM to be superior to -weight at predicting CHF related clinical signs of fluid overload. The practicality of applying this research to clinical medicine is demonstrated by the development of a new BIA telemedicine device. This non-invasive, inexpensive technology can easily be integrated into modern care management programs.

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