Customer awareness and preferences toward competing hospital services.

Does unaided awareness of a hospital affect former patients' preferences for and intention to use the medical services of that hospital? Do customer preferences toward hospitals influence their intentions to use the medical services of those hospitals? To what extent does satisfaction with previous hospital stays affect former patients' intentions to return to the same hospital? The authors provide some tentative answers to these questions. The results of an exploratory field study of former inpatients of one hospital are reported. Several recommendations for research and hospital marketing strategies are provided.     

The Canadian Psychiatric Association practice profile survey: I. Methods and general sample characteristics.

OBJECTIVE: To describe the rationale, methodology, and general sample characteristics of the Canadian Psychiatric Association (CPA) practice profile survey, a national survey of psychiatrists and psychiatric practice. METHOD: Mail-in interviews were sent to all Canadian psychiatrists listed in their provincial registers and to all active CPA members (total = 3628). Respondents provided general information about their professional activities for one 24-hour day and detailed information for 1 randomly selected hour. Patient information--including sociodemographics, diagnostic profiles, functioning levels, risk of harm to self or others, and disposition--was elicited for 1 patient seen during the random hour as well as for the most seriously ill patient receiving clinical services that day. RESULTS: There was a 45.5% response rate. Questionnaires completed by nonpsychiatrists or with a large percentage of missing or incorrect data were eliminated (107 surveys), resulting in a final sample size of 1570. CPA members and those from Western Canada responded at a higher rate to the survey. The results suggest some cause for concern about future manpower shortages. Most psychiatrists practise eclectically, seeing patients across the life-span, and working in both community and institutional settings. The old and the young appear to be underserviced, compared with adults. CONCLUSIONS: This study represents an important step forward in evaluating the profile and activities of the profession.     

Bilateral neonatal Sturge-Weber-Dimitri disease: CT and MR findings.

The CT and MR features of cortical calcification and meningeal angiomatosis are typical of Sturge-Weber-Dimitri disease but are unusual in children less than 1 year of age. This case describes a child presenting with both of these features bilaterally in the neonatal period and represents an unusual presentation of this disorder.     

Dentoskeletal treatment changes in Class II subdivision malocclusions in submentovertex and posteroanterior radiographs.

The objective of this study was to evaluate the dentoskeletal changes consequent to orthodontic treatment in subjects with Class II subdivision malocclusions, treated with asymmetric extractions, compared with a normal-occlusion control group. The sample consisted of 3 groups, with 30 subjects in each: normal-occlusion subjects (group 1), untreated Class II subdivision subjects (group 2), and Class II subdivision patients treated with asymmetric extractions (group 3). All subjects had a full complement of permanent teeth at the beginning of treatment. The average ages of the subjects were 22.42, 15.76, and 18.57 years, respectively, in groups 1, 2, and 3. Measurements of relative differences in the spatial position of dental and skeletal bilateral landmarks were obtained from the submentovertex and posteroanterior cephalometric (PA) radiographs. The t test for independent samples was used to compare group 1 with groups 2 and 3 at different times. Results from the submentovertex radiograph showed that asymmetric extractions in Class II subdivision malocclusions will maintain the differences in the anteroposterior positions of right and left, maxillary and mandibular first molars, as would be expected with the treatment protocols used. There were no significant skeletal changes that could be attributed to the treatment approaches investigated or transverse collateral effects with the asymmetric mechanics used. It was also demonstrated that treatment of Class II subdivision malocclusions with asymmetric extractions produced corrections of maxillary and mandibular dental midline deviations with the midsagittal plane, without canting the occlusal plane or any other investigated horizontal plane, as seen in the PA radiograph. Treatment of Class II subdivision malocclusions with asymmetric extractions constitutes a beneficial approach to this problem.     

Tumor vascular signals in renal masses: detection with Doppler US

The vascularity of 49 renal masses (26 malignant and 23 benign lesions) was investigated with duplex Doppler ultrasound. Doppler signals obtained at the margins of renal masses were defined as "tumor signals" when the Doppler-shifted frequency of the lesion exceeded the frequency shift in the ipsilateral main renal artery. These exceeded 2.5 kHz with a 3-MHz insonating frequency. Among the 26 renal masses that subsequently proved to be malignant, tumor signals were obtained in 15 of 18 (83%) untreated renal cell carcinomas, in three of four Wilms tumors, and in two patients with metastases to the kidney, but not in the one patient with lymphoma. None of the 23 benign renal masses demonstrated tumor signals. Tumor vascularity in malignant lesions gives rise to abnormal, high-velocity, Doppler-shifted signals that can help in the differential diagnosis of renal masses.     

Energetic limits on reproduction: Maternal food intake

We examined the factors influencing maternal food intake and pup growth in Norway rats. Mother rats allowed pups in naturally large litters to grow at a slower rate than pups in naturally small litters. Pups reared by dams in a warm ambience (26°C) gained weight more slowly than dams at 22°C, and maternal food intake but not weight gain was depressed in the high ambient temperature. Pup growth at 18°C was unimpaired, with those dams eating no more and gaining no less weight than dams at 22°C. Nest material, however, was found to be essential for the successful rearing of young at cooler ambient temperatures. While restriction of food during gestation resulted in a marginally lower weight gain for the pups during the first 2 weeks postpartum, the dams appeared not to mobilize corporal stores or increase their food intake during lactation. Heavy body weight mothers did not eat any more, nor did they gain any less weight nor rear larger pups than light body weight dams. Rat mothers increased their consumption of a diet diluted with non-nutritive fiber to equal the nutritive intake of their controls, with their pups not differing in their growth rate. Pups reared by dams eating a high quality diet grew faster than pups with dams on the control diet. Food intake by mother rats is required during lactation relative to the amount of milk that is delivered to the pups, rather than to an absolute amount of food. Lactating females with a concurrent pregnancy neither increase their food intake nor appear to mobilize their corporal stores to deal with the added energetic drain of pregnancy. Indeed, their young grew somewhat more quickly than pups nursed by dams that were simply lactating. Taken as a whole, these results suggest that Norway rat dams apparently do not monitor and defend a maximal pup growth rate. Rather, rat dams seem to continue to defend their own homeostasis, and by doing so, allow the young to grow and survive under a wide variety of circumstances.