Program evaluation of mobile dental services for children with special health care needs

This paper summarizes an evaluation of the Elk Mobile Dental Program for children with special health care needs. Evalutation results indicated overall client satisfaction with mobile dental unt services in the absence of competent community based dental care. Evaluator recommendations included expanding the mobile dental services along with a continued effort to establish permanent community based dental care for children with special healthcare needs. Recommendations for program improvement in the areas of patient care, service coordination, and ongoing continuous quality improvement evaluation were provided to program personnel and funding organizations. Many of the improvement recommendations were initiated during the process of the program evaluation.     

Incidentally detected adrenal tumours (incidentalomas): histological heterogeneity and differentiated therapeutic approach

Abstract. Objectives. To find a differentiated therapeutical approach to incidentalomas. Design. Prospective study of incidentalomas: their histology, hormonal activity, and growth if primarily non-operated. Setting. Admissions to an academic tertiary care centre because of incidentaloma. Patients. Thirty-eight female, 25 male, 27–85 years old. Interventions. Ultrasound, computed tomography and adrenal scintigraphy when appropriate; investigations to exclude malignancy giving metastasis into the adrenal gland; ACTH, Cortisol, aldosterone, renin activity, androgene, catecholamine measurements; surgery or follow-up. Main outcome measures. Rate of malignancy; linkage of tumour size to probability of malignancy; prevalence of tumours with subtle hormone excess. Results. Cortical adenomas occurred in 13/31, metastases in 7/31 of the histologically confirmed cases. In 10/31 cases, the computed tomography indicated a size that was smaller than the pathological size (mean = 20 mm). 20.6% of all incidentalomas and 61.5% of the 13 operated corticol adenomas showed subtle hormonal activity. Twenty-seven incidentalomas < 30 mm were folio wed-up (3–41 months; mean 18 months) and showed growth in only one case. Sensitivity, specificity, and predictive value (PV) of a tumour ≥ 30 mm to indicate malignancy were: 1.0, 0.56 and 0.27, respectively. The PV of a < 30 mm tumour to exclude malignancy was 1.0. Conclusions. Oncological screening tests are necessary in all incidentalomas. Tumours ≥ 30 mm should be operated but smaller ones can be followed-up, because they are usually benign and rarely show progressive growth. Cortical adenomas with subtle hormonal overproduction and hypertension, diabetes or osteoporosis should be operated, irrespective of their size, but in the absence of relevant clinical symptoms they can be followed-up.     

Inpatient group psychotherapy program: A model

This article describes the group psychotherapy program on an eight bed short term adolescent psychiatric service. We will focus on the working relationship within the multidisciplinary team, the impact of the group on the total program, and the interactional process within the group. Also discussed are recurrent themes, leader's tasks and stages of adolescent inpatient treatment. Edith Bernstein is a social worker who is currently in private practice in Rochester, New York Jacquelynn Schultz Duquette is a nurse who is currently on the staff of Genesee Mental Health Center, Children and Youth Division, Rochester, New York.     

Macrophage control of normal and leukemic erythropoiesis: identification of the macrophage-derived erythroid suppressing activity as interleukin-1 and the mediator of its in vivo action as tumor necrosis factor

Macrophages have been shown to directly influence the growth and development of mature erythroid progenitors (CFU-E) in normal and erythroleukemic mice. We examined the mechanism by which macrophages mediate their effect on in vivo erythropoiesis. As reported for whole macrophages, serum-free supernatants (SN) from normal resident peritoneal macrophages suppressed in vivo normal and conventional Friend virus (CFV)-infected CFU-E and caused clinical regression of CFV- induced leukemia in mice. Macrophage SN had no effect on the erythropoietin (EPO)-independent CFU-E characteristic of infection with the polycythemia-inducing strain of Friend virus (FVP), or progression of FVP leukemia. Using biochemical, immunologic, and functional assays, the erythrosuppressive factor in macrophage SN was identified as interleukin-1 alpha (IL-1 alpha). The in vivo erythroid suppressive effects of macrophages, macrophage SN, and IL-1 alpha were reversed by simultaneous treatment with EPO. IL-1 alpha itself had no effect on CFU- E colony formation in vitro. Pretreatment of animals with antibodies to murine tumor necrosis factor-alpha (TNF-alpha) completely abrogated the suppression of CFU-E by macrophages, macrophage SN, or human recombinant IL-1 alpha. These results suggest that macrophages regulate erythropoiesis by production of IL-1 alpha, which in turn mediates its in vivo suppressive effects on CFU-E through TNF.     

Evaluating the Older Patient's Ability to Function

There are over 25 million Americans age 65 years and older, and the majority live independently. Advancing age increases the likelihood that some will require assistance in daily living. Nurse practitioners who serve this population can aid older adults to maintain independence as long as possible. This requires knowledge about physiological age changes as well as changes from pathological conditions and how each can affect function. In an effort to detect functional impairments, vital information can be gathered through a review of functional ability as well as observation of selected measures of function. Incorporation of tools that measure functional status can assist practitioners in determining need for formal health and psychosocial support services.     

Pain in the healthy full-term neonate: efficacy and safety of interventions

Healthy neonates are exposed to the noxious stimulus of pain during routine care. Venipuncture and heel sticks are a regular part of a newborn’s life. Circumcision is another common procedure for male infants, at least in the United States. The exposure to noxious stimuli enacts the stress response and has specific negative physiological effects. Research suggests that multiple painful experiences have a negative impact on future pain responses. Several interventions for the amelioration of pain during these procedures have been suggested. They include use of anesthetics, oral sweet solutions, pharmacological agents, nonnutritive sucking, breastfeeding, music, and other mechanical comfort measures. This article discusses the efficacy and safety of these interventions in the neonatal period.