Hypnosis and cognitive-behavioral packages are effective in preparing pediatric oncology patients for bone marrow aspiration and lumbar puncture. However, the relative efficacy of different preparations has not been determined, and potent components of preparation packages have yet to be identified. Further, factors hypothesized to moderate effectiveness of preparation (e.g., cognitive development) have not been investigated. Finally, due to a failure to employ process measures, the extent to which hypothesized mediators of behavior change (e.g., self-efficacy) are modified by preparation is unclear. Following an overview of empirical investigations, we make recommendations for addressing these limitations in future research. 相似文献
Twenty cases of unilateral laryngeal paralysis are reported. Satisfactory follow-up intervals and data (videostroboscopy and glottographic analysis) were available on 12 patients. The excellent to normal phonatory quality achieved in many of these patients indicates that the ansa cervicalis to recurrent laryngeal nerve anastomosis is the procedure of choice in selected patients with unilateral vocal cord paralysis. Excellent medialization of the paralyzed cord, as well as correction of arytenoid malposition and thyroarytenoid muscle atrophy appear to explain the technique's success, since the reinnervated cord neither abducts nor adducts. We feel that this technique is the procedure of choice in younger patients, or those who use their voices professionally, since the phonatory quality achieved is superior to Teflon® injection or Isshiki thyroplasty, and the technique is reversible. 相似文献
Objective. This paper analyzes whether the rise in managed care during the 1990s caused the increase in hospital concentration. Data Sources. We assemble data from the American Hospital Association, InterStudy and government censuses from 1990 to 2000. Study Design. We employ linear regression analyses on long differenced data to estimate the impact of managed care penetration on hospital consolidation. Instrumental variable analogs of these regressions are also analyzed to control for potential endogeneity. Data Collection. All data are from secondary sources merged at the level of the Health Care Services Area. Principle Findings. In 1990, the mean population-weighted hospital Herfindahl–Hirschman index (HHI) in a Health Services Area was .19. By 2000, the HHI had risen to .26. Most of this increase in hospital concentration is due to hospital consolidation. Over the same time frame HMO penetration increased three fold. However, our regression analysis strongly implies that the rise of managed care did not cause the hospital consolidation wave. This finding is robust to a number of different specifications. 相似文献
Forty depressed patients and 36 age- and sex-matched controls were given 250 μg ACTH1–24 by
bolus. Plasma steroid hormone levels were measured prior to and 60 min after ACTH administration. The depressed patients had significantly greater cortisol (F), 11-deoxycortisol (S), androstenedione (AD), and 17-hydroxyprogesterone (17-OHP) responses (delta; p<0.05) and a marginally greater 11β-hydroxyandrostenedione (11β-OHAD) response (delta; p=0.091) than the controls. There was no significant difference in the corticosterone (B) response between the two groups.
With the exception of 11β-OHAD, all the steroid hormones were significantly negatively correlated with age in the controls, but only S and AD marginally demonstrated this relationship in the depressed patients. F, S, AD, 17-OHP, and B, but not 11β-OHAD, were significantly positively correlated with each other in the controls, but only F was significantly correlated with AD in the depressed patients. These data suggest that the hypercortisolemia found in some depressed patients involves increased precursor and metabolite levels both at baseline and in response to exogenous ACTH, compared to controls. Furthermore, variability in these precursors is greater in depressed patients, and their relationship to age is lost. These findings are consistent with the hypothesis that adrenal products other than cortisol also could be related to affective symptoms. 相似文献