PSRO: a new direction for quality assessment in Otolaryngology

At the present time, the University of Michigan Hospital Department of Otorhinolaryngology has an 18-month experience in a quality assessment program directed toward compliance with PSRO legislation. This experience, we hope, provides an approach to the continuing assessment of medical care, whether it is for conforming to a particular legislative action or for the evaluation of patient care. It has been encouraging to the physicians involved that this is a program which is organized at the local level. It is oriented toward the local physician and in most instances will be administered by local physicians. The process of quality assessment has provided a milieu for educational experience and positive action toward correction of medical care problems. It has been said before that this may be the last opportunity for the physician to maintain control at the local level. This may be the opportunity for the profession to proceed with controlled quality assessment before outside agencies intercede.     

Climate strength: a new direction for climate research.

Climate strength was conceptualized within D. Chan's (1998) discussion of compositional models and the concept of culture strength from the organizational culture literature. Climate strength was operationalized in terms of within-group variability in climate perceptions--the less within-group variability, the stronger the climate. The authors studied climate strength in the context of research linking employee service climate perceptions to customer satisfaction. The hypothesis was tested that climate strength moderates the relationship between employee perceptions of service climate and customer satisfaction experiences. Partial support for the hypothesis was reported in both a concurrent and predictive (3-year) test across 118 branches of a bank. In the predictive study only the interaction of climate and climate strength predicted customer satisfaction. Implications for future research on climate and climate strength are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A proposal for a new direction to treat cancer

A new approach is proposed that has the potential to be a successful therapy for most disseminated cancers because it can circumvent the problems posed by three characteristics which are universally expressed by cancer cells: heterogeneity, plasticity, and the lack of a cancer specific or cancer associated characteristic which is not also shared by some normal cells. Analysis shows that almost all current and research approaches for treating disseminated cancers have the same fundamental strategy: they rely on an agent interacting individually and effectively with each cancer cell. We call all these approaches "lock and key" strategies to emphasize the need for this individual agent to cell interaction. The three characteristics preclude current approaches from successfully treating most disseminated cancers because they operate by a "lock and key" strategy which (a) only kills cancer cells expressing a single particular trait, (b) allows other cancer cells to adapt and survive the treatment, and (c) also kills the normal cells which express the same particular trait. The heterogeneity and plasticity of cancer cells can only be circumvented by an attack which is microregional (not cell by cell) and destructive (not killed by conventional endogenous or exogenous cytotoxic agents). All cells in each microregion must be destroyed, including those which do not express an exploitable trait. The proposed approach can achieve such microregional destruction by the delivery to, and long term immobilization of, a large number of radio-isotopes. The proposed approach exploits the additive contribution of multiple mechanisms to enhance tumor specificity of the microregions. Given that all targeting and killing agents are "imperfect", this is the only way specificity can be enhanced. The biological basis of these specificity enhancing mechanisms are well-known. However, they are ignored by current therapies because most of them can only be exploited in the context of the proposed approach. Some of the mechanisms reflect characteristics, such as heterogeneity, genetic instability, and tumor progression which are the result of the micro-evolutionary process of tumor development. These are virtually always present in, and virtually specific to, cancer. Others reflect the somewhat "imperfect" cancer associated characteristics of structures, including cancer cells, extracellular structures, and non-malignant cells within the tumor mass. The additive contribution of the multiple mechanisms gives the process the potential to destroy all the cancer cells with minimal non-tumor toxicity. The cornerstone of the proposed approach is a novel class of soluble chemicals. They can be administered intravenously to subjects, circulate throughout body fluids and are enzymatically converted into an insoluble material when the chemicals reach targeted sites. In this paper, these chemicals are called "soluble precipitable reagents" (SPR) to describe their ability to be converted from a soluble to an insoluble material. The insoluble material is called platform to indicate that it has the ability to bind various agents. The SPR chemicals enable a three-step process to be constructed which can deliver and retain a large number of radio-isotope atoms in tumor tissue. In step 1, a binary reagent comprised of an SPR attached to an imperfect cancer targeting agent is administered. The binary reagent is endocytosed and transported into lysosomes where the targeting agent moiety is digested and the detached SPR is converted by natural intracellular lysosomal enzymes into a platform. As will be discussed, a very large number of platform molecules can be made to accumulate inside targeted cells. In step 2, a supersensitive fraction of the cancer cells, including some which had accumulated platform in step 1, are killed by the administration of a very low dose of an anti-cancer agent. Very few, if any, normal cells will be killed by the very low dose. The death of the ce     

Review of In search of solutions: A new direction in psychotherapy.

Reviews the book, In search of solutions: A new direction in psychotherapy by Williams Hudson O'Hanlon and Michelle Weiner-Davis (see record 1989-98511-000). This book is a presentation of solution-oriented therapy, which derives from the work of Milton Erickson. The book also draws upon research from the Mental Research Institute's work in brief therapy, and from the Brief Family Therapy Center in Milwaukee, where the second author was part of the research team. The book, however, is not a presentation of research; there are no discussions of statistics or research design. What the book does discuss is implementing solution-oriented therapy, an approach which focuses on the strengths of clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Creating a population-based linked health database: a new resource for health services research

Cytologically, the distinction between bronchioalveolar carcinoma and reactive/reparative processes of respiratory epithelium can be difficult. Retrospectively, we have identified 11 consecutive cases of bronchioalveolar carcinoma from the cytology files of University Missouri-Kansas City/Truman Medical Center. On average, a combined 5.71 cytologic/histologic procedures were performed before reaching a definitive diagnosis for this group. An additional seven random cases of reactive/reparative respiratory cases of adult respiratory distress syndrome patients were used as a control. Cytomorphometric analysis was performed. The mean average nuclear diameter for the carcinoma group was 13.76 microns and for the reactive/reparative group was 13.29 microns. There was no statistical difference between the two groups (paired student t test, P > .05). It appears from our data that mean nuclear diameter is not a discriminator for the cytologic distinction between bronchioalveolar carcinoma and reactive/reparative respiratory epithelium and that the accepted cytologic parameters of for bronchioalveolar carcinoma are more valid.     

5 a day for better health: a new research initiative

Liver function tests and liver morphology were studied in 18 patients with cystic fibrosis (CF) for a period of 3 years. The patients were 5-19 years of age at the start of the study. Nine patients received regular supplementation of essential fatty acids (Intralipid) and nine sex- and age-matched patients, with as similar clinical status as possible but without fat emulsion treatment, were followed as controls. There were no significant differences between the two groups with regard to the parameters of liver function, including determinations of bile acids in serum and urine. Histological examinations of liver biopsies suggested less progression of liver disease in the fatty acid supplemented group, including fatty infiltration of the hepatocytes, evaluated morphometrically. The results show that regular supplementation of fat emulsions has no negative effects in the liver of patients with CF, and the lessening of progression of liver damage suggests that essential fatty acid deficiency might contribute to the liver damage in this disease.     

Dioxins: is it time for a scientifically based assessment of risks for human health?

This paper highlights the effect of dioxin exposure on human health, as was discussed at the BgVV Symposium, held June 17, 1996, at the Auditorium of the Institute of Pharmacology at the Free University (H?rsaal des Instituts für Pharmakologie an der Freien Universit?t Berlin), Thielallee 67, 14195 Berlin.     

网络会计是未来会计发展的方向

在网络经济环境下 ,会计信息系统的变化 ,网络会计的特征 ,网络会计对传统会计的影响 ,传统会计在会计基本理论和实务上的变化和发展 ,阐明网络会计是未来会计的发展方向。     

Sharing in practice: new partnerships for health

A vital part of health care, sharing in practice is not a vision for the future but the reality of today. Below, the meaning and implications of sharing in practice not just for nursing but for health care.     

Occupational health psychology: origins, context, and direction.

Rapidly changing conditions of work and employment have brought the topic of work organization and health to the forefront of concern in occupational safety and health. This article begins with a historical overview of psychology's contribution to the occupational safety and health field. It then argues that the changing work environment creates new and special needs for research and application by psychologists in the area of work organization and health. The article also describes new initiatives by national health organizations in the United State and Europe to frame a new field of study that focuses on the topic of work organization and health, called occupational health psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Auditory inspection time and intelligence: What is the direction of causation?

Inspection time (IT) is an index of speed of perceptual processing that correlates at moderate levels with tests of mental ability. A key issue has been the question of the direction of causation: is IT causal to individual differences in intellectual ability, or is a fast IT a consequence of having a high IQ? The direction of causation was assessed by administering auditory inspection time (AIT) tests and tests of verbal and nonverbal ability to 104 school children at age 11, and 2 years later at 13 years. Three competing structural equation models were tested by using the cross-lagged panel data: that AIT at age 11 causes later IQ; that IQ at age 11 causes later AIT; and that there is equal reciprocal causation. Various goodness-of-fit indexes indicated that the first model was the most acceptable. AIT accounted for about 6% of the variance in cognitive ability 2 years later. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ombudsman: a new role for advanced practice nurses in psychiatric-mental health nursing

TOPIC: The role of ombudsman for advanced practice nurses in psychiatric mental health nursing. PURPOSE: To describe the role of ombudsman and its fit with nursing as seen in the Price Spratlen Ombudsing Model. SOURCE: The author's own experiences as both an advanced practice nurse and an ombudsman. CONCLUSION: Because of downsizing, reorganization, and a general trend toward mutual distrust in large organizations, being an ombudsman has been named one of the "25 hottest careers." Advanced practice nurses in psychiatric mental health nursing, by virtue of their knowledge of interpersonal, preventive, and systems theories, are in a unique position to fill this role.     

Trial consultation: A new direction in applied psychology.

Increasingly, professional psychologists are faced with the challenge of the changing marketplace, and some choose to meet that challenge by forging new career paths. In this article, the field of trial consultation is reviewed with special emphasis on common tasks trial consultants undertake. It is argued that because of the large number of civil and criminal trials conducted annually and the comparatively small proportion of consultants, the field remains an untapped source of career options for psychologists who have many of the skills necessary to be successful trial consultants. Controversies concerning the effectiveness of trial consultation, ethical issues surrounding its use, and suggestions for appropriate training in the field are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)