The importance of internal marketing: the case of geriatric services

Hospitals seeking to become more aggressive often are tempted to introduce programs prematurely. Using the example of a geriatric services program at a large hospital, the authors illustrate the dangers of neglecting internal marketing and offer recommendations for ensuring internal coordination prior to introduction of a product externally.     

Evaluation of patients with positive direct antiglobulin tests and nonreactive eluates discovered during pretransfusion testing

Charts from a series of 679 hospital patients with positive direct antiglobulin tests (DATs) were reviewed. Sixty-three adult patients who demonstrated positive DATs due to IgG only but with nonreactive eluates were selected for further retrospective evaluation. Those patients were noted to fall into four distinct categories: autoimmune diseases including SLE, renal diseases, multiple myeloma, and miscellaneous diseases. In 16 patients for whom serum IgG levels were available, a significant correlation existed between the strength of the DAT reaction and the serum IgG concentration. Several mechanisms that could be responsible for these findings are discussed.     

Analysis of cancers missed at screening mammography.

Analysis of 320 cancers found in a screened population between August 1985 and May 1990 revealed 77 cancers that were "missed" at screening mammography. The missed lesions consisted of cancers incorrectly diagnosed after mammography (false-negative results) but visible in retrospect (n = 19); cancers correctly diagnosed after mammography but visible in retrospect on an earlier mammogram (n = 47); and cancers that went undetected by the first of two readers (n = 11). Missed lesions were categorized according to type of miss, reason for the miss, breast density, lesion features, and lesion location. The missed lesion were compared with 121 cancers that were correctly diagnosed at screening mammography. The missed cancers occurred in women with denser breasts (P = .046), were less likely to demonstrate malignant microcalcifications, and were more likely to demonstrate a developing opacity as an indication of cancer (P = .005). An understanding of the characteristics of missed lesions may be a valuable aid in increasing the sensitivity of screening mammography.     

Unconscious perception of "extinguished" visual stimuli: reassessing the evidence.

When parietal-damaged patients fail to report a contralesional stimulus because of extinction, is this because the stimulus is not perceived, or because it is perceived but cannot reach conscious awareness? VOLPE et al. [10] reported an intriguing study that seemed to locate the problem at least partly in the transfer of information to conscious awareness. They showed patients with extinction pairs of stimuli, one in each hemifield. Although patients were predictably poor at reporting the identity of the contralesional stimulus, they were able to make accurate same/different judgements comparing the two stimuli. This was interpreted as evidence that both stimuli were perceived. In the present paper, we point out that the dissociation between identification and same/different matching could also be due to the possibility that less visual information about the contralesional stimulus is necessary to make a same/different judgement than to identify the stimulus, and that chance performance is considerably higher in the first than in the second type of task. In Experiment 1, we verified this by degrading one side of a stimulus display and "replicating" the dissociation with normal subjects. We also equated the amount of visual information needed for the two tasks by yoking the stimulus pairs on "different" trials of the same/different matching task with the choice pairs on a forced choice identification task. Under these conditions, the dissociation vanished. In Experiment 2, we administered these tasks to three parietal-damaged patients with extinction. When the original method was used, same/different matching was better than identification of the contralesional stimulus. With the forced choice identification method, the dissociation again vanished.     

Tricuspid valve prosthetic replacement. Early and late results with the Starr-Edwards prosthesis.

The total experience (154 patients) with ball-valve (Starr-Edwards) replacement of the tricuspid valve, alone and in combination, through Dec. 31, 1971, at the Mayo Clinic is reviewed. The early mortality rate with isolated tricuspid replacement was twice that for tricuspid replacement combined with replacement of other valves. Among patients receiving three valves, those with "functional' tricuspid insufficiency and those who were in New York Heart Association (N.Y.H.A.) Class IV preoperatively had a higher early mortality rate. The early mortality rate for the total group was 28%. Of those surviving tricuspid plus mitral valve replacement, 70% were alive at 3 years; at latest follow-up, 94% of those surviving were functionally improved. Of those surviving triple valve replacement, 56% were alive at 3 years; at latest follow-up, 93% of those surviving were functionally improved. Previous cardiac surgery with residual tricuspid valve dysfunction and severe disability, as judged by N.Y.H.A. class, influenced the outcome adversely. The experience reported here provides a standard against which never prostheses can be compared.