Accreditation and associated quality assurance efforts.

Discusses accreditation programs and the quality assurance efforts associated with them. The demands of consumers and purchasers of services, expressed in governmental action, have forced more direct and systematic efforts to assess and assure service quality. Time- and cost-efficient methods for assessing quality are available, but their use is resisted by organized medicine, which controls most accreditation and quality assurance activities in health care. The involvement of psychologists in the programs is discussed. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute esotropia may be a presenting sign of intracranial neoplasm

Here we report eight consecutive patients with intracranial neoplasm at different ages clinically presenting with acute esotropia. Among these patients, two had divergent paresis, four had bilateral abducens paresis and the other two had unilateral abducens nerve paresis. All of these patients have intracranial neoplasm demonstrated by neuroimaging studies. Besides of acute esotropia, four had papilledema, one had optic atrophy, and three had associated other neurological signs. Of the eight patients, three patients are children, and the other five are adults. In the adult group, four patients are less than 45 years old. In conclusion, acute esotropia may be an early presenting sign of brain tumor and careful evaluation of associated clinical symptoms/signs is mandatory, especially in the young age group.     

An abscess may be hiding another

Xanthoerythrodermia perstans (XEP) is a distinctive variant of large-plaque parapsoriasis. Along with alopecia mucinosa and lymphomatoid papulosis, there is a strong association between large-plaque parapsoriasis and evolving cutaneous T-cell lymphoma (CTCL). In some reports, large-plaque parapsoriasis was suggested to be a precursor lesion that converted to CTCL in 10 to 30 percent of cases. We describe a patient who presented clinically with both XEP and alopecia mucinosa and was subsequently shown to have CD-30 CTCL.     

Faulty washers and soiled micropipettors may generate false positive serological results

BACKGROUND: Serological markers such as HBsAg and anti-HIV may be present in serum at very high concentrations and this may give rise to erroneous diagnoses due to cross-contamination. OBJECTIVES: To investigate poor equipment maintenance and use, including contamination with human serum, as a potential source of erroneous assay results. STUDY DESIGN: The potential of microtitre plate washers and micropipettors to transfer material between microplate wells and between specimens was examined. For the study of micropipettors we recruited 19 UK diagnostic laboratories. RESULTS: Four out of seven plate washers in use, until adjusted, had the potential to cause false positive HBsAg reactions. The centering of the probes that delivered the wash fluid, delivery pressure, wash volume and the use of a pre-programmed card to direct the washing procedure were important variables. We investigated soiling of tip cones of micropipettors. In every laboratory human IgG could be detected in at least a third of eluates from micropipettor tip cones; only 31 (14%) of 222 showed no evidence of contamination with human serum. Only one laboratory submitted eluates devoid of specific antibodies. Anti-HAV was the marker most commonly found (n = 68), followed by HBsAg (n = 27) and anti-HIV (n = 20). Seven micropipettor eluates from two laboratories were radioactively contaminated. CONCLUSIONS: Recommended precautions are regular checking, cleaning and servicing of equipment, care in interpreting weak reactions, reference back to serum left on the clot of the original specimen and testing of a follow up specimen. Poorly maintained immunoassay equipment can readily generate false positive results due to low-level cross-contamination, particularly with the current highly sensitive HBsAg and anti-HIV assays.     

Psychotherapy process-outcome correlations may be misleading.

A standard criterion for judging the value of a psychotherapy process component (e.g., reflection of feeling) is the degree to which it correlates with outcome measures. It is argued that this model overlooks wide variation in client requirements for particular process components and therapist responsiveness to those requirements. Any such responsiveness tends to attenuate (and may even reverse) the process–outcome correlation. Under optimum conditions, process components covary responsively with client requirements but not with outcomes. Deviations from optimum would not improve outcomes. Thus, for expertly conducted therapy, the expected correlation of process components with outcomes approaches zero, even for components that help to cause those outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pet ownership may be a factor in improved health of the elderly

The familiar adage "pets are good for your health" is an interesting but largely untested theory. A new model was developed, based on pet ownership leads to better self care, to show possible associations between pet ownership with eating, exercise, nutritional status, and specific cardiovascular risk factors. Seniors aged sixty and above were solicited mainly at senior congregate meals program sites in north-central Colorado (n = 127) to participate in this cross-sectional, observational study. Statistical analyses of questionnaire, anthropometric, physiological, and biochemical data were performed. Dog owners walked significantly longer than non-owners (p < 0.05), and pet owners had significantly lower serum triglycerides than non-owners (p < 0.01). Results suggest that pets may be good for your health.     

The life you save may be your own

Intravesical potassium sensitivity can readily elicit abnormal epithelial permeability responses in subjects with diseased bladder, primarily interstitial cystitis. The technique involves eliciting responses in each subject to 40 cc of plain water or 40 cc of potassium chloride solution (40 mEq per 100 cc water). The subjects are asked to rate their subjective responses 3-5 minutes after instillation of the test solution and told to compare the water and potassium. An abnormal provocation to potassium but not water is considered a positive response and a useful way to delineate people with epithelial dysfunction and loss of permeability control. On the other hand, normal subjects will not respond to either the water or potassium.     

HSP90alpha gene expression may be a conserved feature of vertebrate somitogenesis

The extent of non-recognition of episodes of diarrhea by mothers was investigated. The sample included all 124 children under 3 years of age and their mothers or caretakers in 16 villages of Soong Noen District, Nakhon Ratchasima Province, Thailand. Data on the occurrence of diarrhea were obtained from an on-going surveillance study from December 1988 through February 1989. The surveillance study recorded all episodes of diarrhea, as defined by health professionals. Unrecognized diarrhea was defined as episodes perceived by mother, father and caretaker as a normal development process, namely 'su' or 'po'. Baseline characteristics of the sample were obtained from a community survey conducted in November 1988. The study showed that about half of the episodes of diarrhea were unrecognized as diarrhea by the mother and caretaker and labeled as 'su' or 'po' at onset, and among this group only 11.5% were later recognized as diarrheal disease.     

Family therapy may be dangerous for your health.

Suggests that family therapy as a treatment approach that requires the involvement of the entire family may not be in the best interests of individual family members. The priority given to the good of the family as a whole leads to risks for individuals. By being required to participate in therapy, individuals may have to subordinate their own goals and give up limited confidentiality and privacy. The acceptance of the traditional family as the ideal family model may foster stereotyped roles that disadvantage individuals and limit their well-being. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)