Minnesota medicine
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In recent years, decreasing funding for graduate medical education (GME) from private payers, combined with increasing competition between teaching and nonteaching hospitals for managed care contracts and cuts in federal aid to teaching hospitals, have led to a worsening financial crisis for the nation's teaching facilities. For more than a decade, Minnesota's teaching hospitals have been dealing with the same issues, and recent articles have discussed the impact that declining funding and a market increasingly dominated by managed care have had on graduate medical education. Although there is agreement that teaching hospitals have higher costs for patient care than nonteaching hospitals, relatively little research has been done to determine the magnitude of the costs of GME or to isolate their components. Using data from the Minnesota Department of Health's Medical Education and Research Costs (MERC) Fund, the author analyzes the costs to teaching facilities of providing clinical training to resident physicians and students and examines the sources of funding that are available to offset these costs.
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Peripartum cardiomyopathy (PPCM) is a disease of unknown etiology characterized by the onset of left ventricular failure during the period of 1 month antepartum to 5 months postpartum. The PPCM Project at Hospital Albert Schweitzer (HAS) in Haiti has identified 78 cases of PPCM since February 1, 2000, representing an incidence of 1 case per 350 to 400 live births, which is severalfold the estimated incidence in the United States. ⋯ Ongoing investigations have identified the presence of several anticardiac antibodies in many women at HAS who have PPCM, suggesting that PPCM is a unique form of dilated cardiomyopathy and supporting the hypothesis that PPCM has an autoimmune basis. Identification of a high-incidence area for PPCM presents a unique opportunity to make progress in defining potential risk factors, identifying high-risk mothers, detecting underlying etiologies, and discovering more effective new treatments of this often-fatal disease.