Innovation and restrictive conformity among hospital employees: individual outcomes and organizational considerations

Two factors characterize innovative organizational climates as perceived by nonmanagerial hospital employees. The first, innovation, comprises perceptions about the consequences or contingencies (e.g., punished, ignored, rewarded) of such proactive activities as implementing new ideas, questioning established methods, and communicating with other departments and the supervisor. The second, restrictive conformity, comprises perceptions about the consequences of risk-aversive, conflict-avoidant activities that suggest dysfunctional conformity (e.g., "sticking to the rules no matter what"). Positive personal outcomes--greater role clarity, organizational involvement, and satisfaction, and lower role conflict and willingness to leave the organization--are associated with innovation; negative personal outcomes are associated with restrictive conformity. The dialectical tension between conformity and innovation is discussed in terms of loose coupling and a reward systems perspective.     

Neuroprotective effects of eliprodil in retinal excitotoxicity and ischemia

PURPOSE: To evaluate whether eliprodil (SL82.0715), a NR2B-selective N-methyl-D-aspartate (NMDA) antagonist, is protective of retina subjected to an excitotoxic or ischemic insult. METHODS: To evaluate protection against retinal excitotoxicity, eliprodil was administered intraperitoneally before and after the injection of NMDA (5 microl, 20 nmol) into the vitreous of rats. Integrity of the retina was assessed by counting cells in the retinal ganglion cell layer (GCL) and measuring choline acetyltransferase (ChAT) activity. In a subsequent experiment, total retinal ischemia, as measured by a cessation of electroretinographic (ERG) activity, was induced in anesthetized rabbits by elevating intraocular pressure above systolic blood pressure for 65 minutes. After ischemia, recovery of ERG activity was assessed at 24 and 48 hours in animals treated with vehicle or eliprodil (1.0-10.0 mg/kg). RESULTS: Intravitreal NMDA injection resulted in a dose-related decrease in cells of the GCL and in ChAT activity. Eliprodil administered intraperitoneally at 10 mg/kg completely prevented the loss of ChAT and the loss of cells in the GCL. Twenty-four hours after retinal ischemia, A and B waves of vehicle-treated animals were suppressed by 60% to 70%. Eliprodil administered intraperitoneally at 10 mg/kg ameliorated the A- and B-wave depression throughout the 48-hour experiment. CONCLUSIONS: Eliprodil is neuroprotective of retinae subjected to either an excitotoxic or ischemic challenge and may be useful for treating a variety of retinal and optic nerve head disorders.     

Infection after cardiac transplantation: treatment and prognosis

Since July 1982, 18 patients have undergone orthotopic cardiac transplantation at the Texas Heart Institute with steroid and cyclosporine immunosuppression. There have been no deaths from infection despite 15 bacterial, 8 viral, 6 fungal and 1 protozoal infection episodes. With a total follow-up of 90 patient months (mean follow-up, 5.0 months; range 0.1 to 18 months), the incidence of infection is 33 episodes per 100 patient months (1.7 episodes per patient). Only 23 episodes (77%) required drug treatment. Compared to conventional immunosuppressive regimes, cyclosporine treatment is associated with a substantial reduction in the incidence and severity of infection in cardiac allograft recipients.     

咪唑斯汀治疗慢性荨麻疹临床疗效评价及对血清IL-4水平的影响

目的：评价咪唑斯汀治疗慢性荨麻疹的疗效，探讨IL-4在慢性荨麻疹发病中的作用。方法：对32例慢性荨麻疹患用咪唑斯汀治疗，评价疗效，记录不良反应。同时用ELISA法检测慢性荨麻疹患治疗前后及正常人血清IL-4的水平。结果：治疗1、2wk后总有效率分别为62．5％、84．4％(P＜0．01)，不良反应3例。治疗前血清IL-4水平较正常人明显升高(P＜0．01)；治疗后IL-4水平下降(P＜0．01)，与正常人比较差异不甚明显(P＞0．05)。结论：咪唑斯汀是一种有效、安全的治疗慢性荨麻疹的药物，能降低慢性荨麻疹患血清IL-4的水平。     

Endovenous management of saphenous vein reflux. Endovenous Reflux Management Study Group

PURPOSE: This study assessed clinical outcomes of two catheter-based endovenous procedures to eliminate or greatly mitigate saphenous vein reflux.Materials and Methods: A computer-controlled, dedicated generator and two catheter designs were used to treat 210 patients at 16 private clinic and university centers in Europe. The Closure catheter applied resistive heating over long vein lengths to cause maximum wall contraction for permanent obliteration; the Restore catheter induced a short subvalvular constriction to improve the competence of mobile but nonmeeting leaflets. RESULTS: Closure treatment caused acute obliteration in 141 (93%) of 151 limbs; Restore treatment, shrinking one or more valves, acutely reduced reflux to less than 1 second in 41 (60%) of 68 limbs. Closure treatments were associated with early recanalization (6%), paresthesias (thigh, 9%; leg, 51%; P <.001), 3 skin burns, and 3 deep-vein thrombus extensions, with 1 embolism. Restore treatments were thrombogenic (16%) despite prophylactic anticoagulation, and treated valves enlarged over 6 weeks, becoming less competent. Clinical Efficacy Assessment Project clinical class was significantly improved after both treatments, up to 1 year. At 6 months, 87% of 53 Closure patients were class 0 or 1, 75% were symptom-free, and 96% of 55 treated limbs were completely free of reflux. Fourteen of 31 Restore patients (45%) had no symptoms, but 55% were class 2 or lower and only 19% had less than 1-second reflux. CONCLUSION: Closure treatment is clinically effective, albeit with offsetting complications and early failures; these are being addressed through four procedural modifications. Restore valve shrinking, although conceptually attractive, is too problematic to be competitive with Closure treatment or saphenectomy.     

Low bone mineral density and risk of fracture in white female nursing home residents

CONTEXT: Low bone mineral density (BMD) is a strong risk factor for fracture in community-dwelling white women, but the relationship in white female nursing home residents, for whom fracture rates are highest, is less clear. OBJECTIVE: To assess the relative contribution of low BMD to fracture risk in nursing home residents. DESIGN: Prospective cohort study with baseline data collected April 1995 to June 1997, with 18 months of follow-up. SETTING: Forty-seven randomly selected nursing homes in Maryland. PATIENTS: A total of 1427 white female nursing home residents aged 65 years or older. MAIN OUTCOME MEASURE: Documented osteoporotic fracture occurring during follow-up as a function of baseline BMD measurements higher vs lower than the median, and after controlling for demographic, functional, cognitive, psychosocial, and medical factors. RESULTS: A total of 223 osteoporotic fractures occurred among 180 women. Low BMD and transfer independence were significant independent risk factors for fracture in this nursing home sample (P<.001) and the 2 factors acted synergistically (P =.06) to further increase fracture risk. Compared with women whose BMD was higher than the median (0. 296 g/cm(2)), those whose BMD was lower than the median had an unadjusted hazard ratio for risk of fracture of 2.1 (95% confidence interval [CI], 1.5-2.8); women who were independent in transfer had a hazard ratio of 1.6 (95% CI, 1.2-2.2) compared with women dependent in transfer. Among residents independent in transfer, those with BMD below the median had a more than 3-fold increase in fracture risk compared with those with higher BMD (unadjusted hazard ratio, 3.1; 95% CI, 2.2-4.4). Among residents dependent in transfer, those with BMD below the median had a 60% increase in fracture risk (unadjusted hazard ratio, 1.6; 95% CI, 1.1-2.3). Adjustment for covariates did not alter the BMD-fracture relationship. CONCLUSIONS: Our data indicate that low BMD and independence in transfer are significant predictors of osteoporotic fracture in white female nursing home residents. JAMA. 2000;284:972-977