Telemedicine and wound care management

Chronic wounds constitute a debilitating health care problem with significant clinical and social implications. Annual U.S. wound care costs are more than $20 billion and growing at 10% per year. The cost for these patients can be reduced dramatically by altering the wound care paradigm.     

Primary care psychologists in the Netherlands: 30 years of experience.

The primary care psychologist (PCP) in the Netherlands has 30 years of experience. The PCP is a generalist who, in close cooperation with the family physician and other providers of primary health care, has a mindset and manner of working that is largely determined by the context in which the PCP works. The specific attitudes and role of the PCP are described. The PCP provides services for a clearly delimited geographic region and is responsible for the provision of brief psychological help from a biopsychosocial perspective. In addition to psychological assessment and the provision of stepped care, the PCP also devotes considerable attention to prevention and health promotion. An orientation toward the community and the empowerment of clients stands central. The various tasks of the PCP are described in detail, and an educational curriculum for the specific 1-year training of the PCP is outlined. Lessons for other European countries and the United States are deduced from the Dutch experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Myocardial infarction in an intensive care unit for blacks. A review over 6 years

Ischaemic heart disease seems to be on the increase in South African Blacks, and medical staff should be more conscious of this. Fifty-four Black patients with acute myocardial infarction are presented and their complications and management while in an intensive care unit reviewed. Epidemiological aspects of ischaemic heart disease in South Africa are discussed.     

Breast health care. A review

Breast health care was rarely acknowledged in the health and science fields prior to this century and has only begun, in recent years, to receive attention outside of pregnancy/lactation or cancer screening and treatment. Yet much health care is involved with regard to this reproductive and sexual organ. With any group of clients, practitioners of women's health care must address an assortment of breast health matters. This article offers an overview of the history of breast health care, the epidemiology of benign breast conditions and cancer, the anatomy and physiology of the breast, and breast development over the lifespan. Also presented are a review of breast assessment and examination, suggestions for routine care of the breast, and an overview of major health issues related to this reproductive organ. Health issues addressed include, among others, nodular and cystic changes, nipple discharge, breast/nipple pain, mastitis, elective alterations, and cancer. Discussion is focused on the latest approaches to optimal breast health care.     

First experience with the use of compression cerclage Gundolf in orthopaedic and trauma surgery. A preliminary report

A frequent side effect of cyclosporin A (CsA) administration is gingival overgrowth. Although the molecular mechanisms of CsA-induced gingival overgrowth are still unknown, it has been postulated that CsA acts on lipopolysaccharide (LPS) to induce fibroblastic activity, which results in an increase of the extracellular matrix. Here we provide evidence that CsA is able to affect signal transduction of LPS-induced collagenase expression in fibroblasts. Treatment of fibroblasts with LPS caused activation of collagenase gene, activator protein-1 (AP-1) and c-Jun N-terminal kinase (JNK). These activations were blocked by CsA. We suggest that inhibitory effects of CsA on LPS-induced signal transduction may contribute to the mechanism of CsA-induced gingival overgrowth.     

Renal transplantation for patients 60 years of older. A single-institution experience

OBJECTIVE: The authors reviewed renal transplant outcomes in recipients 60 years of age or older. BACKGROUND: Before cyclosporine, patients older than 45 years of age were considered to be at high risk for transplantation. With cyclosporine, the age limits for transplantation have expanded. METHODS: The authors compared patient and graft survival, hospital stay, the incidence of rejection and rehospitalization, and the cause of graft loss for primary kidney recipients 60 years of age or older versus those 18 to 59 years of age. For those patients > or = 60 years transplanted since 1985, the authors analyzed pretransplant extrarenal disease and its impact on post-transplant outcome. In addition, all surviving recipients > or = 60 years completed a medical outcome survey (SF-36). RESULTS: Patient and graft survival for those > or = 60 years of age versus those 18 to 59 years of age were similar 3 years after transplant. Subsequently, mortality increased for the older recipients. Death-censored graft survival was identical in the two groups. There were no differences in the cause of graft loss. Those 60 years of age or older had a longer initial hospitalization, but had fewer rejection episodes and fewer rehospitalizations. Quality of life for recipients 60 years of age or older was similar to the age-matched U.S. population. CONCLUSION: Renal transplantation is successful for recipients 60 years of age or older. Most of them had extrarenal disease at the time of transplantation; however, extrarenal disease was not an important predictor of outcome and should not be used as an exclusion criterion. Post-transplant quality of life is excellent.     

Ethnicity and psychopathology: A meta-analytic review of 31 years of comparative MMPI/MMPI-2 research.

Meta-analyses were performed on 25 comparative Minnesota Multiphasic Personality Inventory (MMPI) and MMPI-2 studies of 1,428 male African Americans versus 2,837 male European Americans, 12 studies of 1,053 female African Americans versus 1,470 female European Americans, and 13 studies of 500 male Latino Americans and 1,345 male European Americans. Aggregate effect sizes suggest higher scores for ethnic minority groups than for European Americans on some MMPI/MMPI-2 scales and lower scores on others. However, none of the aggregate effect sizes suggest substantive differences from either a statistical or clinical perspective. The MMPI and MMPI-2 apparently do not unfairly portray African Americans and Latinos as pathological. Effect sizes across studies generally did not vary as a function of sociodemographic variables, research setting, or use of the MMPI versus MMPI-2. It is recommended that additional between- and within-ethnic groups psychopathology research continue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Surgical treatments for orthopaedic complications in long-term haemodialysis patients--a review of 546 cases over the last 8 years

We reviewed 546 operative cases in haemodialysis patients during the past 8 years between June 1990 and May 1998. The average age of the 257 male and the 289 female patients was 57.1 years. The average period of haemodialysis was 14 years and 4 months. We discussed the etiology, pathological focus, frequency, symptoms, problems and operative indications. Carpal tunnel syndrome occurred most frequently, occupying 289 cases. Short-term postoperative results were positive in the initial case within 6 months after the occurrence of the first symptoms. Because no effective method preventing recurrence existed, synovectomy was used as much as possible in the initial operation. Surgical treatment was used for amyloid arthropathy in 15 shoulders. It was effective in cases resistant to any conservative treatment. For the knee joint, the arthroscopic synovectomy was performed in 8 cases, and total knee replacement in 6 cases. The results of the total knee replacement cases were good. However, recurrences were observed in 40% of the synovectomy cases. In the hip joint, the curettage and bone grafting were performed in 7 hips of 6 patients. All bone grafts were consolidated and there was no case of postoperative pathological fracture. In some cases with destructive spondyloarthropathy, the vertebrae involved spontaneously fused without severe kyphotic deformity. A case with mild pain and without neurological deficit can be treated conservatively. A case with severe pain, instability, and myelopathy indicates operative measures must be taken. Attention must be paid for a possible collapse of the grafted bone after the cervical level two anterior fusion. Haemodialysis patients are vulnerable to infection. This diagnosis is difficult to distinguish due to the weakened state of the immune system. Rigorous attention is required to prevent and detect infection in cases using artificial joints or instrumentation. The treatment of bone and joint disturbances from dialysis-related amyloidosis has become surgical due to the advancement of dialysis control. However, it remains one of the more conservative treatments. Determining the cause and establishing a method of treatment are desired as early as possible.     

A review of the déjà vu experience.

For more than a century, the déjà vu experience has been examined through retrospective surveys, prospective surveys, and case studies. About 60% of the population has experienced déjà vu, and its frequency decreases with age. Déjà vu appears to be associated with stress and fatigue, and it shows a positive relationship with socioeconomic level and education. Scientific explanations of déjà vu fall into 4 categories: dual processing (2 cognitive processes momentarily out of synchrony), neurological (seizure, disruption in neuronal transmission), memory (implicit familiarity of unrecognized stimuli), and attentional (unattended perception followed by attended perception). Systematic research is needed on the prevalence and etiology of this culturally familiar cognitive experience, and several laboratory models may help clarify this illusion of recognition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Twenty years of bogus pipeline research: A critical review and meta-analysis.

The bogus pipeline (BPL), a procedure intended to improve the truthfulness of self-reports, was examined in terms of the validity of its effects, its optimal procedural format, and its appropriate domain of use. Social psychological research that has used the BPL is reviewed and meta-analyzed. 31 studies were coded for effect size and relevant procedural characteristics. A significant mean BPL vs control condition effect was evident across these studies, indicating that the BPL engendered reliable effects consistent with a reduction in socially desirable responding. The BPL produced larger effects when task instructions required Ss to guess the BPL's output. These findings, coupled with previous indirect validation, provide reasonable documentation that the BPL shifts self-reports toward veracity. Past criticisms of the BPL are considered, and recommendations for its future use are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ambulatory phlebectomy. Literature review and personal experience

Outpatient varicose veins surgery, "Phlébectomie Ambulatoire" (FA) introduced by R. Muller in 1966, is now a widespread technique; modified by many authors with personal tips, FA enables most lower limb varicosities to be treated on an outpatient basis and under local anaesthesia. To achieve good functional results, an accurate preoperative diagnostic examination is mandatory; the authors present a review of the indications of FA and their personal experience. Precision in performing micro-incisions, accurate dissection of the varicosities in the subcutaneous tissue and an adequate postoperative elastic bandage guarantee good aesthetic results. At present the treatment of Saphena magna with FA is debated, but some authors have already reported encouraging results.     

Percutaneous biliary endoprostheses. Clinical experience of 6 years

The aim of this study was to assess the effectiveness and long term permeability of percutaneous biliary endoprostheses. Seventy three patients with biliary tract obstruction due to a primary malignant tumor (n = 60), lymph node metastases at the porta hepatis (n = 10) and benign stenosis of a biliary-enteric anastomosis (n = 3), were treated between 1985 and 1990. Plastic prostheses were installed in 63 patients and metallic in 10. The procedure had a 30% incidence of complications. Thirty three percent of the prostheses remained patent until patient's death. In 15 and 40% of patients, signs of prosthesis obstruction were observed three and six months after installation respectively, bearing in mind a mean survival of 24 weeks. In 90% of patients there was a clinical and laboratory improvement. Mortality was 30% at 30 days in the group of patients with malignant diseases. It is concluded that the installation of percutaneous biliary endoprostheses is a relatively safe and well tolerated procedure, with a low incidence of complications or mortality and that allows an effective biliary decompression.     

Telemedicine in the care of the end-stage renal disease patient

Juvenile pleomorphic adenoma of the parotid gland represents an extremely rare tumour entity and is comparable to congenital tumours of the salivary glands concerning its embryonal structure. The clinical detection of the tumour in a 7-year-old girl does not exclude that the tumour had developed either earlier or immediately after the birth. The high cellularity and the evidence of primitive epithelial and myoepithelial cellular structures do not justify its classification as a malignant tumour. However the presence of embryonal tissue structures associated with the end of the third month of embryogenesis is characterized by more solid cell formations in partly verticulate arrangement. The absence of further differentiation into lobular structures and differentiated duct or acinic cell formations may be due to cell arrest. Differential diagnosis of juvenile pleomorphic adenoma must distinguished it from other congenital salivary gland tumours (e.g. congenital basal cell adenoma, hybrid basal cell adenoma-adenoid cystic carcinoma, sialoblastoma, salivary gland anlage tumour.     

Changes in supervision as counselors and therapists gain experience: A review.

Considerable research relevant to counselor and therapist development has been done since E. L. Worthington's (see record 1988-21517-001) review. Additional support has surfaced for Worthington's conclusions: There is support for general developmental models, perceptions of supervisors and supervisees are consistent with developmental theories, the behaviors of supervisors change as counselors gain experience, and the supervision relationship changes as counselors gain experience. Although the types of research used and the sophistication of data analysis have improved somewhat, too few studies directly address changes over time for trainees in supervision. Suggestions are given for future research in supervision to reflect the level of specificity necessary to investigate developmental models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in supervision as counselors and supervisors gain experience: A review.

Reviews research bearing on whether and how counselors and supervisors receive or give different types of supervision of psychotherapy as they each gain experience. Most theories describing changes in supervision of counselors as they gain experience are similar. They posit changes in the supervisee, with supervision environments being matched to the changing needs of the supervisee. There are 3 theories concerning how the supervisor changes as he/she gains experience. Empirical findings are consistent with theories of counselor development but only weakly supportive of the theory that actual supervision environments are matched to supervisee needs. Empirical findings on changes in supervisors as they gain experience reveal few differences in supervisors at any level beyond the master's degree. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

中美在城市水源地供水过程中生态补偿的差异性

饮用水源保护是确保饮用水安全的重要保障.为了深入探讨不同国家生态补偿的经验教训,以城市供水系统为案例,分析美国纽约州与中国北京密云水库在城市供水过程中生态服务付费的差异性.结果表明:虽然美国和中国之间的生态补偿制度具有一定的独特性,但美国在市郊水库为纽约市政供水过程中的补偿效应值得中国借鉴.中国的生态补偿中的关键步骤必须包括生态效益评价的数量化和货币化.此外,现有研究结果认为,美国在公众参与生态补偿全过程的做法值得中国效法,而中国的退耕还林工程的生态效率和效益值得美国借鉴.     

Sclerosis of esophageal varices. Results of 10 years experience

Before they give their results, the authors, whose experience of sclerosis of oesophageal varices under the oesophagoscope has so far involved 157 patients, deal specifically with the problems facing the anaesthetist and resuscitator when this technique is used, tolerance of the product injected and possible accidents. Firstly, they point out the unsuitability of the patients referred to them by their medical or surgical colleagues. By implication therefore, treatment should only be undertaken with the assistance of a team of experienced resuscitators and every precaution taken to mitigate the effects of possible accidents to these patients who are particularly at risk. These cases are mainly characterized by serious haemorrhages (seven cases described, one resulting in death). Oesophageal injury is, on the other hand, the exception where trained personnel are involved (2 minor mucosal tears out of more than 800 oesophagoscopies). Finally, secondary parietal oesophageal necrosis occurs. Quininaemia assessment after injection of quinine-urea confirms that the product is being efficiently eliminated. Overall results reveal a survival rate of 61 p. 100 after more than a year and 20 p. 100 after more than than three years. These figures underline the limitations of therapeutic possibilities and the serious prognosis for this result of portal hypertension. This leads the authors to express a wish that the procedure should be used as a measure to prevent haemorrhage as soon as the presence of varices is realized. On the other hand, they reject on practical grounds emergency sclerosis of oesophageal varices, as a direct heamostatic method, since, according to their statistics, this almost invariably results in failure.     

Prenatal diagnosis of chromosome abnormalities. Three years of experience

Six hundred and eighty one diagnoses were established by means of cell culture and chromosome analysis on amniotic fluid obtained either by late amniocentesis or at the time of therapeutic abortion. Each prenatal diagnosis involved: 1. Genetic consultation. 2. Supervision of the pregnancy before amniocentesis. 3. Amniocentesis in the obstetric department. 4. Confirmation of the diagnosis when an abnormality of the foetus was discolvered. 5. Supervision of the pregnancy following the anmiocentesis and examination of the infant at birth and during the first year of life. The indications for chromosome studies and the results are discussed.