Hypopharyngeal cancer patient care evaluation

A survey was conducted to identify demographics and standards of care for treatment of hypopharyngeal squamous cell carcinoma in the United States. Data were accrued from voluntary submission of cancer registry and medical chart information from 769 hospitals representing 2939 cases diagnosed from 1980 to 1985 and 1990 to 1992. Clinical findings, diagnostic procedures employed, treatment practices, and outcome are presented. Overall, 5-year disease-specific survival was 33.4%, which segregated to 63.1% (stage I), 57.5% (stage II), 41.8% (stage III), and 22% (stage IV). Survival was best for patients treated with surgery only (50.4%), similar with combined surgery and irradiation (48%), and worse with irradiation only (25.8%). This analysis provides a standard to which current treatment practice and future clinical trials may be compared.     

The care of the terminally ill patient

Drs. Alejandro Goic (internist), Ramón Florenzano (psychiatrist), Bernardino Pi?era (physician and Catholic Bishop), Sergio Valdés (internist) and Rodolfo Armas (internist) participated in a round table about the care of the terminally ill, during a Postgraduate Course organized by the Chilean Society of Gastroenterology. After a general introduction, participants discussed the psychological aspects of terminally ill patients, about the sense of death from a Christian anthropological perspective, the terminally ill in intensive care units and finally about the education of medical students in this frequently neglected aspect of medical practice.     

The dental care of the psychiatric patient

The dental care of the psychiatric patient requies careful observatio and history taking. Medications used in the treatment of psychiatric illnesses demand care in treatment planning and prescibing. The nature and sequellae of many psychiatric conditions have a direct bearing on the clinical picture presented by the patient and the success of dental care. Implementation of care must have a significant component of flexibility in terms of treatment outcomes and the time and method of providing treatment. Particular emphasis must be placed uppon the establishment of effective oral hygiene programmes. The psychiatric patient suffers not only from a socially debilitating disease but also from society's opprobrium. With a modicum of effort, the dental profession can rise above that.     

The hematologic evaluation of the urologic patient

This article provides a framework for the hematologic evaluation of the urology patient. The discussion is based on an analysis of test results obtained from routine screening laboratory studies as the complete blood count and platelet count. The use of automated blood counts also provides quantitative indices of red cell morphology which facilitate the diagnosis of red blood cell disorders. To aid in categorizing hematologic disorders, abnormalities of the red blood cells, white blood cells, and platelets are discussed separately. In some circumstances where a disease process, such as bacteremia, alters more than one of the formed elements of the blood, this speparate analysis approach is less appropriate. Nevertheless, this division is generally useful in arriving at the correct interpretation of hematologic abnormalities. Within each category of abnormal test results, a variety of etiologies is listed. Elaboration is reserved for the entities commonly seen in hospitalized patients. For a more detailed discussion of the common disorders or for a more inclusive listing of the less common disorders, the bibliography lists a selection of useful references.     

Preoperative evaluation and postoperative care of the elderly patient undergoing major surgery

As the population ages and as surgical and anesthetic techniques advance, more and more elderly patients are referred for surgery. As a result, the physician must be increasingly aware of the aged response to surgery and the management of the geriatric surgical patient in the perioperative period. Elderly patients are prone to cardiac, respiratory, and infectious complications, and thus, they need to be screened for the presence of pre-existing disease. In addition, the geriatric patient needs to be carefully monitored in the proper postoperative environment to guard against untoward sequelae.     

The structure of patient satisfaction with outpatient medical care.

Patient satisfaction data for 2,226 patients (average age 55.8 yrs) in the Medical Outcomes Study were used to determine the dimensions of satisfaction with medical care, the relation between direct and indirect methods of assessing global satisfaction with care, and the extent to which visit-specific and global satisfaction with one's medical care covary. Results supported the multidimensionality of satisfaction ratings but showed substantial covariation among some dimensions. Direct and indirect methods of assessing global satisfaction with care also covaried markedly. Global satisfaction was significantly, albeit modestly, correlated with visit-specific satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Home care of the elderly. Oral cancer patient

Elderly patients with oral cancer present many challenges in the home healthcare setting. Timely detection of disease, appropriate and timely referrals, and the adverse effects of therapies, nutrition, and depression are discussed in this article. Using a case study, the author offers suggestions on the coordination of services of dental, medical, and nursing professionals and management of adverse dental effects.     

The evaluation and diagnosis of the dizzy patient

In conclusion, the assessment of the dizzy patient is indeed complex and far-reaching. The expertise of family practitioners, internist, neurologists, otolaryngologists, and neurosurgeons at times is essential and one should not feel inhibited about referring the patient for further evaluation to our colleagues so that the patient may best be served and resolution of the patient's complaints may result.     

Intraoperative patient care. Multiple injuries

Analysis of the shift in the marital structure of Nepal between 1961 and 1971 indicates that the marital structure of 1971 is more favorable to a higher CBR (crude birthrate). Although there has been a slight inc rease in the age at marriage, over 90% of Nepali women were married by the ages 20-24 years in 1971 and the decline in the incidence of widowho od has increased the proportions of potential child-bearing women and consequently the number of births. Thus shifts in the marital structure between 1961 and 1971 could have provided little impetus to a decline in the CBR of the country.     

The malpractice controversy and the quality of patient care

The widespread doctor strikes of 1975 stimulated belated attention to a crisis in malpractice insurance. Most state legislatures responded only to a shadow crisis in insurance as they rallied to the defense of health care providers. The smouldering substantive crisis--the reality of malpractice--is now galvanizing institutions and professions into aggressive activities for quality assurance and renewal of trust between patient and doctor. New procedural experiments offer prospects for preserving economy and equity by containing the causes of malpractice suits within the health care system itself.     

Contraceptive choice and patient compliance. The health care provider's challenge

Contraceptive compliance is a multifaceted issue that is influenced by many factors. These factors can directly affect the level of patient compliance, thereby affecting contraceptive method efficacy rates. A review of the literature reveals many studies about contraceptive compliance but a dearth of studies addressing how to change noncompliant behaviors. This article describes the contraceptive methods currently available and their efficacy rates. Patient characteristics and the components of compliance are described as they affect contraceptive efficacy and patient care. Suggestions are made for the use of alternative terminology to include adherence to or continuance of a contraceptive method. Health care providers should realize the impact they can have on a patient's education, decision-making process, and ultimate compliance with a contraceptive method. It is the patient, however, who ultimately makes the decision, either actively or passively, to comply or not and whether to have an unplanned pregnancy.     

Indicators for quality evaluation of inpatient patient care in an ENT clinic

According to the law (Section 137 SGBV) in Germany, hospitals have to implement quality-assurance (QA) programs, which are now of particular importance in times of ongoing structural change in health care. External as well as internal methods of QA are well established and can serve as parameters for single processes and outcomes in most cases. However, there is still an urgent need for methods measuring the quality of total hospital performance. Indicators are powerful instruments for this purpose. They reliably reflect clinical outcome, physicians' and nurses' activities, administration and can be regarded as instruments for general hospital performance in otorhinolaryngology. We describe the process of definition, development and application of quality indicators for measuring quality in health care. Furthermore, we present a critical overview of selected indicators in otorhinolaryngology, general medical indicators and indicators concerning administrative problems. Because of current developments in German health care the application of quality assurance methods similar to the system of indicators presented is strongly recommended.     

Harbinger. I: The development and evaluation of the first PACT replication

While Assertive Community Treatment (originally known as the PACT program) is now recognized around the world as an effective model for rehabilitation of persons with severe mental illness, this was not the case 20 years ago. Harbinger of Grand Rapids, in Kent County, Michigan, was the first replication of the PACT model which sought fidelity and included an experimental design for assessing effectiveness. The design and results are presented from an initial 30-month and a follow-up 66-month evaluation of Harbinger. The 30-month evaluation showed significant differences favoring Harbinger vs, the control group on independent living, employment, and client functioning. At 66-months, there were fewer experimental-control group differences. The differences in results are analyzed in terms of design and data collection problems, changes in the treatment environment for the control group, and the longitudinal course of mental illness. The discussion focuses on next steps in ACT research, utilizing program theory to better establish the mechanisms for successful intervention models.