Assessing patient satisfaction and quality of care through observation and interview

The purpose of this study was to investigate patient satisfaction using an in-depth approach rather than the more common patient survey method. The authors conducted patient interviews and participant-oriented observations between patients, family members, and medical staff in a large teaching hospital to assess patients' perceptions of the quality of care provided on a medical-surgical unit. The observations were classified according to the Donabedian model of quality of care: technical care, interpersonal care, and amenities of care. Technical interactions (92.5%, or n = 123) were most common, followed by interpersonal interactions (5%, or n = 7) and interactions related to amenities of care (2%, or n = 3). Of the patients interviewed, 89% (n = 40) were satisfied with the treatment and quality of care they received. Of the 10% (n = 9) of patients who reported dissatisfaction with the hospitalization, most of the complaints were related to surgical procedures. Observations and patient interviews may provide a more informative and accurate assessment of patient satisfaction than a reliance on patient surveys as the sole measure.     

肝局灶性结节增生的不典型螺旋CT征象分析

目的探讨肝局灶性结节增生(FNH)不典型的螺旋CT征象。方法对病理证实或临床确诊的32例FNH患者37个病灶的螺旋CT征象进行回顾性分析。结果 37个病灶中,有 14个病灶直径≤3 cm,23个病灶直径>3 cm;7个病灶周边存在假包膜;22个病灶存在中央瘢痕, 其中有20个病灶直径>3 cm;所有病灶在动脉期均呈高密度,其中31个病灶肿瘤实质均匀强化。结论多发病灶、存在假包膜、无中央瘢痕、动脉期不均匀强化是FNH不典型的CT征象。征象的多样性与病灶的病理类型和病灶的直径相关。     

Use of E mu-PIM-1 transgenic mice short-term in vivo carcinogenicity testing: lymphoma induction by benzo[a]pyrene, but not by TPA

E mu-pim-1 transgenic mice are predisposed to develop lymphomas. Due to their low spontaneous tumour incidence and their increased sensitivity towards the lymphomagen ethylnitrosourea these mice may present an interesting model for short-term carcinogenicity testing. Here, we report on the further exploration of this transgenic mouse model with two additional carcinogens known to have, among others, the lymphohaematopoietic system as target, i.e. benzo[a]pyrene (B[a]P) and 12-O-tetradecanoylphorbol-13-acetate (TPA). B[a]P, given three times a week (by gavage) for 13 weeks at 4.3, 13 or 39 mg/kg body weight, resulted in a dose-related increase in lymphomas up to a 90% incidence in E(mu)-pim-1 mice during the observation period of 40 weeks. B[a]P also induced tumours of the forestomach within this observation period, though at a lower incidence and apparently equally effective in wildtype and transgenic mice. TPA, on the other hand, was unable to induce lymphomas (or tumours in any other organ) in either transgenic or wildtype animals within the observation period of 44 weeks, when applied dermally at the maximum tolerated dose of 3 microg/mouse, twice a week for 35 weeks. Molecular analysis showed that B[a]P-induced lymphomas in transgenic mice were of T-cell origin, 80% of which had elevated levels of c-myc expression. None of the lymphomas had increased N-myc expression and mutation analysis of the ras-gene family revealed a K-ras mutation in only one out of eight tumours investigated. Also, none of the lymphomas showed aberrant expression of p53 as determined by immunohistochemistry. It is concluded that the E mu-pim-1 mouse model will not be very suitable for short-term carcinogenicity testing in general: only genotoxic chemicals that have the lymphohaematopoietic system as target for carcinogenesis in wild- type mice, appear to be efficiently identified.      

应用白芨建立门静脉高压动物模型

目的寻求制作门静脉高压动物模型的最佳方法，并以此为基础从事肝硬化后门静脉血液动力学基础研究。方法以3组共15只兔为动物模型，分别以0.2％、0．4％、0.8％浓度的白芨粉为栓塞材料，开腹注入兔门静脉内，手术前后行门静脉测压、血管造影及病理学检查，最长观察时间阎周.结果以0．4％浓度白芨粉制作门静脉高压模型最佳，4周后肝脏体积缩小20％，门静脉压平均升高40％，病理呈典型坏死后肝硬化表现。结论以白芨粉为栓塞材料制作肝硬化门静脉高压动物模型方法简单、效果可靠已重复性好.以不同浓度的白芨栓塞剂来控制坏死后肝纤维化的程度是本试验的一大特点,本动物模型的建立对深入研究肝硬化门静脉高压的成因及治疗措施有着重要意义。     

原发性颅内恶性淋巴瘤的CT诊断

原发性颅内恶性淋巴瘤的ＣＴ诊断郭凡樊长姝北京铁路总医院ＣＴ室１０００３８提要对６例经手术病理证实的原发性颅内恶性淋巴瘤的ＣＴ表现进行分析后，认为对发生在中线区表现为均匀高密度，边缘清楚具有分叶征象的病灶，可作为ＣＴ的表现的特点。在放、化疗过程中出现肿...     

Defining the extent of cables loss in endometrial cancer subtypes and its effectiveness as an inhibitor of cell proliferation in malignant endometrial cells in vitro and in vivo

Loss of Cables expression is associated with a high incidence of endometrial hyperplasia and endometrial adenocarcinoma in humans. The Cables mutant mouse develops endometrial hyperplasia and following exposure to chronic estrogen develops early endometrial adenocarcinoma. The objectives of the current study were to determine if: (1) loss of Cables expression occurred in high grade endometrioid adenocarcinoma, uterine serous and clear cell carcinoma as observed in endometrial hyperplasia and low grade endometrial adenocarcinoma; (2) overexpression of Cables inhibited cell proliferation in endometrial cancer (EC) cells in vitro and in vivo; and (3) progesterone could regulate the expression of Cables mRNA. Hyperplastic endometrium and low and high grade endometrioid adenocarcinoma showed loss of Cables expression when compared to benign control secretory endometrium. Loss of Cables expression in serous and clear cell tumors was similar to that observed in endometrioid adenocarcinomas with greater than 80% showing loss of protein expression. Treatment of EC lines with progesterone increased cables expression in low-grade EC whereas it had no effect on cables expression in cells derived from high-grade EC. The progesterone-induced increase in cables was abrogated in the presence of a progesterone receptor (PR) antagonist, suggesting the PR mediates the increase. Cables overexpression inhibited cell proliferation of well differentiated EC cells and had no effect on the poorly differentiated EC cells. The capacity to form tumors was dramatically reduced in the Cables overexpressing cell lines compared to those cells containing the control vector. Collectively these results suggest that Cables is an important regulator of cell proliferation and loss of Cables expression contributes to the development of all types of EC.     

Cord serum ferritin concentrations and mental and psychomotor development of children at five years of age

OBJECTIVE: Our purpose was to evaluate the association between fetal iron status and mental and psychomotor development at 5 years of age. STUDY DESIGN: We evaluated the association of fetal iron status (umbilical cord serum ferritin concentrations) with test scores of mental and psychomotor development of 278 children. Six tests were given, including full-scale intelligence quotient (FSIQ), language ability, fine- and gross-motor skills, attention, and tractability. RESULTS: Compared with children with cord ferritin in the 2 median quartiles, those in the lowest quartile scored lower on every test and had significantly worse language ability, fine-motor skills, and tractability. They were also 4.8-fold more likely to score poorly in fine-motor skills and 2.7-fold more likely to have poor tractability than children in the median quartiles. FSIQ in the highest quartile was slightly, but not significantly, lower than the median quartiles, but the odds ratio for having a FSIQ score of less than 70 for children in the highest quartile was 3.3 (95% CI 1.2-9.1). CONCLUSION: Poor iron status (low ferritin) in utero appears to be associated with diminished performance in certain mental and psychomotor tests. The reason for the association between high ferritin concentrations and low FSIQ scores is unknown.     

Pediatric constraint-induced movement therapy for a young child with cerebral palsy: two episodes of care

BACKGROUND AND PURPOSE: This case report describes the use of "Pediatric Constraint-Induced Therapy (Pediatric CI Therapy)" given on 2 separate occasions for a young child with quadriparetic cerebral palsy. CASE DESCRIPTION: The child was 15 months of age at the beginning of the first episode of care. She had previously received weekly physical therapy and occupational therapy for 11 months, but she had no functional use of her right upper extremity (UE), independently or in an assistive manner. She scored from 5 to 7 months below her chronological age on developmental assessments in gross motor, fine motor, and self-help skills. INTERVENTION: Pediatric CI Therapy involved placement of a full-arm, bivalved cast on the child's less affected UE while providing 3 weeks of intensive intervention (6 hours a day) for the child's more affected UE (intervention 1). Therapy included activities that were goal oriented but broken down into progressively more challenging step-by-step tasks. Pediatric CI Therapy was administered again 5 months later to promote UE skills and independence (intervention 2). OUTCOMES: The child developed new behaviors throughout both interventions. During intervention 1, the child developed independent reach, grasp, release, weight bearing (positioned prone on elbows) of both UEs, gestures, self-feeding, sitting, and increased interactive play using both UEs. During intervention 2, she had increased independence and improved quality of UE movement, as supported by blinded clinical evaluations and parent ratings.