Common sense quality management

How would you like to be responsible for an organization that achieved positive patient results, satisfied high-performing nurses, and had a healthy bottom line? Here's a common sense quality management model sophisticated enough to meet your needs and simple enough to implement at all levels of your organization.     

High rate of autoimmune thyroiditis in bipolar disorder: lack of association with lithium exposure.

BACKGROUND: We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and thyroid failure in outpatients with bipolar disorder compared with two control groups. METHODS: The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226), a population control group (n = 252), and psychiatric inpatients of any diagnosis (n = 3190) were measured. Thyroid failure was defined as a raised thyroid stimulating hormone level, previously diagnosed hypothyroidism, or both. Subjects were compared with attention to age, gender, and exposure to lithium. RESULTS: The TPO-Abs were more prevalent in bipolar patients (28%) than population and psychiatric controls (3-18%). The presence of TPO-Abs in bipolar patients was associated with thyroid failure, but not with age, gender, mood state, rapid cycling, or lithium exposure. Thyroid failure was present in 17% of bipolar patients and more prevalent in women. It was associated with lithium exposure, especially in the presence of TPO-Abs, but not with current rapid cycling, although an association may have been masked by thyroid hormone replacement. CONCLUSIONS: Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment. These variables appear to be independent risk factors for the development of hypothyroidism, especially in women with bipolar disorder.     

Carnitine palmitoyl transferase deficiency in malignant hyperthermia

The activity of carnitine palmitoyl transferase, an enzyme that catalyzes the transport of long-chain acylcarnitines into mitochondria, was quantitated in EB-virus-transformed lymphoblasts from 7 patients with susceptibility for malignant hyperthermia. Immunoreactive enzyme protein was also measured using an enzyme-linked immunosorbent assay. Cell lines derived from patients with carnitine palmitoyl transferase deficiency of muscle and from normal individuals were used as positive and negative controls, respectively. One patient with malignant hyperthermia had a deficiency in the enzyme activity which was comparable with that of the known carnitine palmitoyl transferase deficient patients. This individua?s lymphoblasts were also deficient in immunoreactive enzyme protein. All of the remaining patients with malignant hyperthermia were deficient only when the backward assay for carnitine palmitoyl transferase was used for quantitation. It is likely that a subset of individuals with a malignant hyperthermia phenotype have a primary deficiency of carnitine palmitoyl transferase and that others have a milder enzyme deficiency secondary to the primary defect in malignant hyperthermia. © 1993 John Wiley & Soncs, Inc.     

Endoscopic fixation of a double-looped semitendinosus and gracilis anterior cruciate ligament graft using bone mulch screw

Surgeons are switching to the four-bundled hamstring graft, composed of double-looped semitendinosus and gracilis tendons (DLSTG), to replace the torn anterior cruciate ligament. Mechanically, the DLSTG is superior; it is twice as strong and stiffer than a patella tendon graft, and the four bundles share load and mimic the function of the anteromedial and posterolateral bands of the native anterior cruciate ligament. Morbidity from tendon removal is minimal and by 3 months soreness disappears and isometric knee flexion strength returns to normal. It is safe for the patient to undergo aggressive rehabilitation without a brace and to return to sports activities at 4 months when the knee is reconstructed with a DLSTG graft. This report describes the rationale and technique for implanting the DLSTG in a femoral tunnel using rigid fixation instead of a compliant suture bridge. Fixation is achieved by looping the tendons over a post (Bone Mulch Screw) inside the femoral tunnel. The strength, stiffness, and biologic bond of the graft is enhanced by compaction of bone into the femoral tunnel thorugh a bore in the Bone Mulch Screw.     

The Use of Alefacept in the Treatment of Psoriasis

Journal of Cutaneous Medicine and Surgery -