This study of hospital employee tuberculin conversion rates was undertaken in a 516-bed urban general hospital to determine if employment in such a hospital placed employees at risk of infection with tuberculosis. Data collected on the tuberculin status of employees from 1971 through 1976 indicated that the five-year conversion rate for all employees in a hospital-wide testing program was 7.1 per cent. Employees at greatest risk for conversion were nonWhite, age 46 through 64, in the lowest socioeconomic

In an elderly nursing home resident who had taken excessive dosages of bulk laxative for many years, small-bowel obstruction developed, requiring surgical intervention. A carcinoma of the ascending colon probably was the immediate cause of the obstruction, which resulted in the accumulation and inspissation of the bulk laxative throughout the small bowel. Great care should be exercised in the long-term use of these laxatives.

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An Ohio insurance company's initiative to emphasize risk-adjusted clinical outcomes as criteria for selecting and reimbursing members of a network is stimulating a new emphasis on quality of care throughout the market area. Hospitals inside the network are cooperating to improve their collective results, while providers on the outside have launched major quality improvement programs in the effort to become measurably competitive with these centers of excellence. This case study in network selection demonstrates a new role for fiscal intermediaries in health care.

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