How to get the most benefit from a changing home health care system

By 1998, a Medicare prospective payment system for home care is expected to be in place. Physicians must become more involved in home care, because they will be held accountable for the patients they refer and the services they order.     

How to get the most out of bone densitometry. Results can help assess fracture risk and guide therapy

Bone densitometry has well-established usefulness in assessing fracture risk. Anyone with a condition that might reduce bone mass or accelerate bone loss should undergo testing, as should postmenopausal women and perimenopausal women who are undecided about starting estrogen replacement therapy. When stratifying a patient's risk of fracture, clinicians should consider not only BMD but also age, lifestyle, concurrent illness, and family history. Almost all patients with BMD in the osteoporotic range on densitometry should be considered for pharmacologic therapy, and so should many of those with values in the osteopenic range. Periodic retesting with bone densitometry is appropriate to monitor the progress of age-related bone loss and response to therapy. There are differences among skeletal sites used in BMD measurement, particularly regarding response to therapy. In addition, there are differences in calibration among densitometry machines, so whenever possible, serial studies should be done on the same machine and by the same technologist.     

Vesicle traffic: get your coat!

The budding of transport vesicles from the Golgi complex is initiated by activation of the small GTPase ARF; the discovery of enzymes that can convert soluble ARF-GDP to the active, membrane-associated form ARF-GTP will shed light on the mechanism and regulation of the formation of transport vesicles.     

How to obtain funding for your project

Project development is an exacting and time consuming task. Grant applicants may expend inordinate amounts of time searching the literature on their topic area, consulting with experts in the field and others who have run similar research or projects, eliciting and incorporating the views of major stakeholders and developing a method to answer the research question. While those who are successful in attracting funding experience the elation that accompanies achievement, those whose applications are rejected may experience profound disappointment. The aim of this paper is to maximise the potential for researchers to celebrate their success by suggesting a number of strategies for avoiding the pitfalls of application development. Potential sources of funding are also discussed.     

How to spot depressed patients in your practice

The relationships between clozapine dosages, plasma concentrations, and clinical responses in Chinese schizophrenics were studied. Fourteen treatment-refractory schizophrenic patients were treated with clozapine for 12 weeks. Patients were assessed before and after 6 and 12 weeks of treatment using the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression (CGI), and the Simpson-Angus Scale for Extrapyramidal Side Effect. Plasma clozapine concentrations were determined by high-performance liquid chromatography. Ten patients (71.4%) responded after 12 weeks of treatment. Although the mean daily dosage at week 12 (373 +/- 90 mg/day) was lower than that reported in American trials (444 mg/day), the mean plasma clozapine concentration attained (1,078 +/- 385 ng/ml) was higher. This higher concentration may be due to the lower body wight and the preponderance of women among our patients, absence of smoking and alcohol use, and/or ethnic difference between Chinese and non-Chinese. There was wide interindividual variation in the plasma clozapine concentrations. Compared with other studies, the plasma clozapine concentrations and the response rate were higher. Although the sample size was small, the findings are suggestive of pharmacokinetic and pharmacodynamic ethnic differences in Chinese with clozapine therapy.     

How the trend to elective dental procedures influences your practice

Malignant mesenchymal tumours of the breast are rare neoplasms. Their incidence varies from 1%-3% of all malignant breast tumours (1). Stromal sarcoma of the breast is an extremely uncommon tumour (2). We present a rare case of advanced stromal sarcoma of the breast successfully managed with radical surgery and radiotherapy.     

Eight key questions to ask when your patient with asthma doesn't get better

Patients with asthma who are treated according to published guidelines usually have good outcomes. However, when these patients fail to improve despite our best efforts, a systematic review focusing on eight key questions can usually spot where the management plan went wrong. When we have to go back to the drawing board in the care of these patients, these are the important issues to consider: (1) Is it the environment? (2) Is it the workplace? (3) Is it noncompliance? (4) Is it lack of education? (5) Is it blunted patient perception? (6) Is it poor technique in administering medication? (7) Is it the wrong treatment? (8) Is it something other than asthma?     

Catching balls: How to get the hand to the right place at the right time.

Information specifying the future passing distance of an approaching object is available (in units of object size) in the ratio of optical displacement velocity and optical expansion velocity. Despite empirical support for the assumption that object size can serve as a metric in the perception of passing distance, the present series of experiments reveals that in catching a ball Ss do not rely on such "point-predictive" information. The angle at which real and simulated balls approached an S systematically affected verbal and manual estimates of future passing distance, as well as the kinematic characteristics of catching movements. To catch a ball, the S uses momentary action-related information instead of spatiotemporal estimates. The hand velocity is geared to information specifying the currently required velocity. This secures ending up at the right place in the right time, regardless of where this may be. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How I learned to help clients feel better and get better.

Summarizes several lessons that have become tenets of Rational Emotive Therapy that the author has learned from practicing individual and group therapy with thousands of clients for over 50 yrs. Stress is placed on helping clients get better in addition to their feeling better, and teaching them how to achieve unconditional self-acceptance instead of conditional self-esteem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)