“pop-out” method of levonorgestrel implant removal

The “pop-out” technique is a method of levonorgestrel implant removal that uses digital pressure to direct implants through a small skin incision. This technique was developed, theoretically, to cause less bruising and patient discomfort by avoiding the use of instruments. The pop-out technique is the primary method used for levonorgestrel implant removal in the Magee-Womens Hospital resident clinic. We performed a retrospective analysis of levonorgestrel implant removals performed between July 1, 1995, and December 31, 1998. Of the 168 removals included in this analysis, 38 were performed by one of two attending physicians, and 130 were performed by the residents with attending supervision. The average time for removal was 12 ± 5 min (range 2.25–27 min) when the “pop-out” method could be used to remove all six implants, and 14 ± 7 min (range 2.25–59 min) for all removals. The removal time for residents was inversely proportional to the anticipated level of difficulty of the removal and to the number of previous removals performed. The removal time was significantly faster when residents were supervised by one of the attending physicians as compared with the other attending physician. Only 0.7% (7/1,008) of levonorgestrel implants were fragmented during removal. This review shows that the “pop-out” method is a reasonable alternative to other proposed methods of primary implant removal. The difference in the level of expertise of the attending physician may significantly influence removal time when training clinicians in levonorgestrel implant removal.     

The Emory Method: A modified approach to Norplant implants removal

Norplant^® implants were removed from fifty (50) patients using a modified approach to Norplant^® implant removal (Emory Method). Eighty-eight percent (88%) of the removals were accomplished in less than 10 minutes using this technique. The average time for removal of Norplant^® implants from 50 women included in the current study was 8 minutes. The Emory Method for Norplant^® implant removal includes three steps which are different from the technique developed by the Population Council. More anesthesia, a slightly longer incision and vigorous disruption of the tissue encapsulation surrounding the implants are recommended. The Emory Method is fast, safe and easy to perform. It has been successfully taught to over twenty-five clinicians.     

Partitioned association-linkage test: distinguishing “necessary” from “susceptibility” loci

Marker allele-disease association and linkage between a disease locus and a marker locus are two different phenomena. Linkage without evidence of association and association without evidence of linkage are possible observations. Linkage analysis uses marker loci and the phenomenon of recombination to look for disease-related loci which are presumably major contributors to disease expression (“necessary” loci). However, the phenomenon of association is more complex. One explanation for the existence of an association is that there is a “necessary” locus in linkage disequilibrium with a marker locus. Another explanation is that the marker locus itself (or a closely linked locus in linkage disequilibrium with the marker) is a “susceptibility” locus, which increases the probability of contracting the disease but is not necessary for disease expression. Although there are other possible explanations for the existence of an association, these two can lead to different results when family data from a disease showing association are analyzed for linkage between the associated marker and the disease. If the linkage disequilibrium hypothesis is correct, there will be evidence for linkage. If the susceptibility locus hypothesis is correct, there may be strong evidence against linkage. In this work, we explore a method that could indicate whether an association is due to a susceptibility locus or a necessary locus. We show that, by dividing families based on the presence or absence of the associated marker allele in a randomly chosen affected sib, calculating lod scores, and then calculating a heterogeneity statistic, we could distinguish whether linkage data came from a susceptibility locus or a necessary locus. © 1996 Wiley-Liss, Inc.     

“Abstinence” and “nonabstinence” models for the treatment of bulimia

One of the most controversial dimensions along which developing therapeutic approaches for bulimia can be differentiated is their allegiance to an “abstinence” or “nonabstinence” model. Through analogy to traditional treatment programs for chemical dependency, many self-help and professional programs for bulimia hold that the complete elimination of binge-vomiting behavior is a prerequisite for therapeutic work, and require abstinence from the inception of treatment. In contrast, the nonabstinence model suggests that a more gradual reduction in the frequency of episodes may be preferable in that it provides more opportunities for relapse prevention training and avoids reinforcing dichotomous thinking styles. The present paper reviews the theoretical and clinical arguments that have been advanced by each side, including the case for classifying bulimia as a substance abuse disorder. A strategy for investigating the relative efficacy of the two approaches is proposed. It is suggested that particular attention be paid to such variables as differential attrition, the effect of each modality on the accuracy of self-report, the need for continuing or supplementary therapy, the occurrence of treatment “casualties,” interactions between client characteristics and mode of therapy, and long-term results. In the interim before such data are available, a reasonable clinical recommendation may be the implementation of a “compromise” approach designed to maximize the advantages claimed by each model while minimizing possible risks.     

Teaching thinking skills: The “what” and the “how” of young children's thinking

This review illustrates current perspectives on young children's thinking, from the viewpoint of developmental psychology. Relevant findings from both cognitive developmental and information processing literatures are discussed. Specific abilities of preschoolers are highlighted, and practical suggestions are offered from both perspectives.     

“Missing Milestones”

Missing milestones are known to be a normal variant of development. The purpose of our study is to find if missing milestones always lead to normal development?

METHODS

This is a prospective case study on seven patients referred for motor developmental problems from July 1997 to February 1998 and then followed over a 2-year period. On each attendance, the multi-disciplinary team assessed children

RESULTS

We present a case series of seven children with “missing motor milestones”. Six of the seven, had tactile defensiveness but absent parachute reflexes on presentation

At the end of the two year period, 3 infants had normal development (Group I). One was discharged after 7 months. The second one had speech problems most likely secondary to her bilateral serous otitis media, with no other developmental problems. The third child acquired age appropriate milestones before the care was transferred to another hospital. Of the four in Group II, three developed global developmental delay and the fourth was diagnosed to have multiple cavernous haemangiomata in the brain. The pre-school alert panel was alerted for two of them possibly needing future help in school

Five of the seven children in our study were still being followed up after two years

CONCLUSIONS

Missing milestones in a subject can be a benign variation of normal motor development. However, they may also be the first sign to appear in children with neuro-developmental disorders

Tactile defensiveness may be the most useful early sign to enable the early diagnosis of non-weight bearing children with 'missing milestones'     

The case for “structural missingness:” A critical discourse of missed care

Stimulated by our conversations at the 2018 International Philosophy of Nursing Society Conference and our shared interests, the coauthors present an argument for augmenting the broader discussion of “missed care” with our synthesized concept called structural missingness. We take the problem of missed care to be largely grounded on a particular economic construction of the healthcare system within an era of what some are calling the Capitalocene, capturing the pervasive influence of capitalism on nature, humanity and the world order. Our perspective is that of the United States, however, extrapolations can be made to the social and healthcare systems in other countries. We are concerned with the underlying conditions that structurally reify inequality and ultimately undermine nursing practice. To situate the discussion, we briefly review existing literature on the contextualization of missed care. We understand contemporary circumstances of missed care as a function of the neoliberalization of healthcare, including the idea of nursing as a commodity. From this, we discuss the implications of missed care, which forms the basis of our critique. Synthesizing the term “structural missingness, we locate a moral imperative in the professional and disciplinary commitments of nursing to consider who and what have been left out. This moral imperative for the nursing profession, along with other social and health related professions, underscores our obligation to be involved in uncovering inequities and conceptualizing upstream solutions for structural missingness.     

A Couplehood Typology for Spouses of Institutionalized Persons With Alzheimer's Disease: Perceptions of “We”–“I”*

A qualitative analysis of 68 community‐dwelling spouses of institutionalized patients with Alzheimer's disease was conducted. The goal was to ascertain to what degree they perceived themselves as married. Five groups representing different degrees of couplehood emerged. Ranging from strong couplehood to no couplehood, groups were given the following terms: “’Til Death Do Us Parts,”“We, but …,”“Husbandless Wives/Wifeless Husbands,”“Becoming an I,” and “Unmarried Marrieds.” Ways to interpret this typology and implications for both further research and practitioners are described.     

The meaning of “physical fitness”

The understanding of the term "physical fitness" was determined for a randomly selected sample (n = 94) of a population using a self-administered mailed questionnaire. Subjects were asked to state and give a reason for their perceived level of physical fitness, to state their perceived performance level in a number of physical fitness tests (muscular strength, daily physical work capacity, fatness, level of regular physical exercise, exercise speed, and body flexibility), and to rate how well these tests measure physical fitness. The reason most frequently stated for perceived level of physical fitness was the level of habitual physical activity (43%); significantly less frequently (P less than 0.01-0.0001) cited were reasons related to health (23%), physical performance (12%), and obesity (3%). The variation in perceived level of physical fitness was best explained by the variation in imagined regular exercise and fatness (r2 = 0.66, P less than 0.0001) with no significant additional contribution from imagined performance in remaining fitness tests. The measurement of regular exercise was most favored as a test of physical fitness. These results, taken together with evidence of the physical and psychological health benefits of regular exercise, imply that the most appropriate measure of physical fitness for the average person is an assessment of the habitual physical activity level.     

Making the “new American workplace” safe and healthy: A joint labor-management-researcher approach

The American workplace is now in the midst of the most significant change since the advent of mass production. Whether these changes will lead to improvements in worker health and safety is not clear. This paper describes an approach to intervention and research—participatory action research (PAR)—that has the potential to redesign work organizations to improve performance while also improving health and safety. In the PAR method, researchers, managers, workers, and unions collaborate in a process of data-guided problem solving intended both to improve the system's performance and to contribute to general scientific knowledge. A case study example illustrates the use of a PAR approach in an automobile parts facility where labor, management, and researchers jointly conducted a longitudinal project aimed at reducing the major sources of stress and enhancing employee well-being. Results from the 6 year project suggest that, properly implemented, PAR has the potential to both lead to improved intervention and contribute to theoretical advances in occupational safety and health. The PAR approach to intervention research is contrasted with the total quality approach (TQA), and some suggestions are made for improving PAR research designs. © 1996 Wiley-Liss, Inc.