The mangement of DES-exposed patients at the Medical College of Pennsylvania

A brief account of an experiment concerning conception rates for Merino ewes grazing on high-estrogen and on low-estrogen cultivars is given. The ewes were mated to Merino rams for 8 weeks annually during March and April. Cycle lengths were measured over 5 mating periods on 87 Merino ewes and 62 crossbred ewes on high-estrogen cultivars and on 46 Merino ewes and 36 crossbred ewes on low-estrogen cultivars. There was a lack of significant interaction over time and of significant differences for mean cycle lengths between Merinos and crossbreds and between ewes grazing the 5 cultivars. The results support the conclusions of Underwood that the infertility of ewes grazing high-estrogen clover is unrelated to a disturbance of the estrous cycle. The results of Loghtfoot who found no significant difference in incidence of estrous and ovarian activity in 16 crossbred ewes and 16 control ewes grazing Dwalganup pastures are supported.     

Hearing loss. The physician's responsibility

Hearing loss is a very important and common problem in the United States, affecting 13 to 14 million people. It is primarily a medical problem, requiring diagnosis and, when indicated, treatment by a physician, preferably in collaboration with an audiologist. History taking is the most important part of the diagnostic process, followed by a physical examination with special attention to the head, neck, and ears. The primary object of the workup is to exclude all possible extrinsic causes of hearing loss. Intrinsic or genetic deafness is a diagnosis of exclusion. After the hearing loss has been classified as congenital or delayed and as genetic or nongenetic, a differential or working diagnosis can be made in all cases and a specific diagnosis in most cases. The hearing loss must then be identified as stable, progressive, or fluctuant over time. Follow-up at least every two years is important to check for possible changes in status.     

Understanding depression in women: The cognitive approach as an ally.

In commenting on J. M. Stoppard's (see record 1989-29654-001) discussion of the adequacy of cognitive/behavioral theories for understanding depression in women, it is argued that her charges are unfounded. Contributions made by these theories are discussed. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Wound infection: a physician's perspective

Infection in a wound represents a colony count of 10(5) or greater. Contamination is the presence of many surface organisms. Moist wound healing, not dehydration, protects and prepares the wound for coverage and closure. Relief of pain is a critical factor in achieving healing: a biological or pharmaceutical device can achieve protection and facilitate healing.     

Tying pay to performance: one critical care unit's approach

This article describes development and testing of a tool for determining an appropriate reward for staff performance in a critical care area. Outlined is the process of identifying and quantifying appropriate merit increases based on bedside performance as well as participation in other unit, hospital, professional and community activities. Positive results are reported after one- and two-year use.     

The intersubjective perspective and the client-centered approach: Are they one at their core?

Reviews the change from a 1-person to a 2-person psychology in psychoanalysis. In particular, R. D. Stolorow's (1994) intersubjectivity theory is presented and then contrasted with the client-centered approach to therapy. It is concluded that contemporary client-centered therapy is a 2-person psychology, and that well-trained client-centered therapists do reflect on their own subjectivity and how it influences the client. With their important similarities it seems that the client-centered and self psychology approaches to therapy are one at their core. Self psychology has more elaborate theorizing about the therapy process, while the client-centered approach is interested in applying its principles outside of therapy so that people can live more constructively. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The UCLA surgical approach to sphincteric incontinence in women

Stress urinary incontinence (SUI) in the female may be treated by a variety of non-surgical and surgical therapies. However, once the patient has chosen to undergo operative repair the ideal procedure is based on three considerations: the degree of anterior vaginal wall prolapse, the degree of incontinence and associated anatomic abnormalities requiring surgical repair. In the vast majority of cases vaginal wall sling is our procedure of choice for the surgical treatment of SUI in the female. Vaginal wall sling is based on sound anatomic principles, may be performed as an outpatient procedure and is equally efficacious for the treatment of SUI due to anatomic incontinence (urethral hypermobility) and intrinsic sphincter deficiency. Since vaginal wall sling is performed through a transvaginal approach, other associated manifestations of pelvic floor prolapse such as rectocele can be addressed and repaired simultaneously. When necessary the vaginal wall sling can be easily modified to repair large grade cystoceles.     

Recurrent anaphylaxis: diagnostic approach and management

The purpose of this study was to examine the effect of cycle rate (CR) variations on the metabolic cost and upper body forces during roller skiing with the V2-alternate technique on flat terrain. Nine highly skilled cross-country skiers roller skied at a paced speed of 18.0+/-0.1 km x h(-1) using their chosen CR, and CRs that were 10% slower and 20% faster. Oxygen uptake (VO2) was determined through collection of expired gases into a meterological balloon and poling forces were measured with piezoelectric transducers during the last 30 s of each four minute trial of roller skiing. One-way repeated measures ANOVA revealed that VO2 varied significantly with CR (p=0.02) with the chosen CR being significantly lower than the higher CR (p < 0.05). Poling forces and poling time were not significantly different among the CR conditions. The present results demonstrate that 1) an alteration in cycle rate affects metabolic cost of roller ski skating, 2) skiers tend to naturally select the most economical cycle rate, and 3) moderate variations in cycle rate do not appear to affect propulsive force generation through the poles in roller skiing.     

Chronic disease management: an outpatient approach

The current climate of managed care has sparked efforts to reduce costs in patient care. In many cases, this has resulted in more efficient methods of patient management: chronic disease management in an outpatient setting appears to be one such success story. For critical care nurses interested in working beyond the boundaries of a traditional ICU, chronic disease management clinics represent an alternative environment in which they may apply their skills. Nancy Brass-Mynderse, RN, MSN, CCRN, a clinical nurse specialist (CNS) with 18 years of experience in critical care, was instrumental in development of the Scripps Health Chronic Disease Clinic at Green Hospital of Scripps Clinic, San Diego, Calif. Brass-Mynderse currently supervises the operation of the clinic, along with Omana Kaliangara, RN, MSN, CFNP, a nurse practitioner. Brass-Mynderse received her bachelor's degree from the University of Arizona, Tucson, Ariz, and her master's degree from San Diego State University. She recently obtained her family nurse practitioner certificate from California State University, Dominguez Hills, Calif. Kaliangara received her bachelor's degree from San Jose State University, San Jose, Calif, and her nurse practitioner certificate from the University of California, San Francisco, Calif. After working in family medicine and a diabetic clinic, Kaliangara developed an interest in the management of chronic diseases. In an interview with CRITICAL CARE NURSE in September, Brass-Mynderse and Kaliangara took time to discuss the development and operation of the clinic, and to recount some of their success stories.