A theory of 4-stage therapy in psychiatric acute care--from the scene of hard emergency care

In a retrospective cohort study of 262 premenopausal breast cancer patients treated at the Mayo Clinic between 1965 and 1985, we investigated whether survival was associated with the timing of tumor removal during the menstrual cycle. Participants were women < or = 50 years old who had not used exogenous hormones, been pregnant, been lactating, or given birth within 6 months of diagnosis. The menstrual cycle day at surgery was used to assign women to group 1 (cycle days 0-7), group 2 (cycle days 8-15), or group 3 (after cycle day 15). Cox proportional hazards analysis adjusting for age at diagnosis, stage, tumor size, grade, and node involvement showed a nonsignificantly worse survival for group 2 than for group 3 [hazard ratio (HR), 1.41; 95% confidence interval (CI), 0.89-2.23]. Stratification revealed that the association between survival and timing of tumor removal during the menstrual cycle was slightly stronger among patients with stage II disease (adjusted HR, 1.56; 95% CI, 0.92-2.63). The association was the same among patients with stage II disease and node involvement (adjusted HR, 1.57; 95% CI, 0.82-3.03). Prospective studies using hormone measurements to define menstrual cycle status more accurately than the reported day of the menstrual cycle could provide further insight about the postulated association.     

Eighteen years of home care: from assistance by phone to a complete service within the health care system

A postal questionnaire was undertaken to assess the current facilities available for adolescents in Irish hospitals. A previous survey showned that no facilities existed whereas this survey demonstrates some improvements but adolescents are still admitted to adult wards, have inappropriate waiting facilities at outpatients and a limited number of joint Paediatric-Adult clinics. The ability of paediatricians to assess risk taking behaviour and the provision of age appropriate information at ward and outpatient level was assessed. The results demonstrate there is need for improvement in all aspects of adolescent care in Irish hospital services. This needs to be addressed promptly as 66% of the paediatricians surveyed were considering the development adolescent services in their hospitals.     

钢铁企业质量管理之我见

质量是企业的生命线,企业必须按照“三全”的质量管理原则,即：全员的质量意识、全员的参与、企业生产的全过程。企业建立科学的质量体系,以顾客为中心,持续改进产品质量,通过不断的创新和改进,使企业的管理和技术始终处于领先地位才能在市场竞争中取胜。     

Effects of prior diagnostic information on clinicians' causal attributions of a client's problems.

63 female social welfare students listened to a taped therapy interview, and the degree to which they attributed the client's problems to personality vs situational factors was explored. Results support the hypothesis that previous tentative diagnoses result in personality-based attributions. A recency effect suggested that personality attributions may be lessened by presenting situational information after hearing the client. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical care as physical injury from the viewpoint of the surgeon

The current criminal law regarding medical malpractice is based on the over 100 years old principle of personal injury, as defined in Section 223 of the criminal code. Attempts to revise this legislation have failed repeatedly in the past. The surgeon's duty of disclosure has gained pivotal importance, often being a handicap for differential surgical treatment. The lack of a specific criminal law regarding medical malpractice in combination with the theoretical construct of a surgical intervention as an authorized personal injury is disadvantageous for both patient and surgeon, since the surgeon is led to deny malpractice and therefore compensation by the liability insurance is not guaranteed. The threat with criminal penal for the surgeon which acted wrong but not gross negligent should be diminished by a definition of a specific criminal law on medical and surgical malpractice.     

Is anybody home? Basic neurologic assessment of the home care client

Clients with strokes, Parkinson's disease, multiple sclerosis, brain injury, or other conditions that are neurologic in origin abound in home care. Other clients may have neurologic deficits that are not so obvious. This article describes basic neurologic assessment and how it can be performed in the home setting with minimal inconvenience to the client and the nurse. Using a catchy mnemonic, the home care nurse can ensure that valuable information is obtained during the visit.     

Supervision of home care aides

The supervision of home care aides is of the utmost importance, since these aides provide needed services in the less controlled and out-of-sight private homes of patients. The role of the supervisor is demanding to assure compliance with accreditation, certification, and agency standards. Supervision of the paraprofessional staff also provides the opportunity to provide positive feedback as well as constructive criticism to assure that high-quality in-home services are provided to home-bound patients. Supervision also provides the opportunity to interact with the aides, show respect for them as individuals, and convey to them that they are an important member of the home healthcare team.     

Getting at the management of care within managed care

Although inhaled nitric oxide (INO) improves oxygenation in critically ill neonates, the neurodevelopmental outcome of premature neonates with severe hypoxemic respiratory failure treated with INO has not been reported. Mortality and prospective neurodevelopmental assessment in early childhood were studied in a cohort of 24 very low birth weight neonates (相似文献   

End-of-life decisions in the home care setting

Recent advances in the identification of genetic abnormalities associated with certain types of cancer have stimulated the development of screening and counseling programs for hereditary and familial forms of cancer. In 1995, such a program was established in a collaboration between three familial cancer clinics in Amsterdam. Given the potential impact of genetic screening and counseling on the psychosocial health of participants, it was considered essential that the program be evaluated from its inception to determine the participants' satisfaction with the services provided. A pilot study was initiated in which individuals who received genetic counseling for cancer were asked to provide feedback on the perceived quality of the services provided, and to identify areas in which additional services may be required. Preliminary results based on 36 counseled individuals indicated generally high levels of satisfaction with the care provided by the clinical geneticist and with the procedures at the familial cancer clinics. Several areas were identified that deserve additional attention: (1) the role of the family doctor in the genetic counseling; (2) communication of information regarding the possible impact of genetic counseling and testing on daily life; (3) communication between the clinical geneticist and other health care workers, and (4) psychosocial support during and after the process of genetic counseling.     

Postpartum home visits: extending the continuum of care from hospital to home

Crucial maternal, newborn, and family healthcare needs arise during the early postpartum period, providing the opportunity for home care nurses to extend the continuum of care from hospital to home. This study identifies common early postpartum problems discovered on home health visits and describes the related interventions of home health nurses. Correlational analysis revealed that young mothers, first-time mothers, breastfeeding mothers, and single mothers are priority candidates for follow-up home care.     

Development of the home care client satisfaction instrument

The method proposed by Sheiner and Beal plays a cornerstone role in the evaluation of the predictive performance. Recently, the Sheiner and Beal's method has been intensively used in pharmacokinetic studies, however, this method has been used in a somewhat confusing way by several authors. Therefore, if one wants to use this method, one might find different examples to follow in the pharmacokinetic literature. Meanwhile, several detailed points were not given by Sheiner and Beal in their original paper. Clearly, the principles suggested by Sheiner and Beal are simple, but the practical application is something of an art. In this work we addressed these detailed points and indicated the confusion in using the Sheiner and Beal's method.