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Biomedical subjects

A E Mills

Publications and source records attributed to A E Mills.

At least 19 recordsLinked to original sources
PubMed2001

Organization ethics or compliance: which will articulate values for the United States' healthcare system?

There have been two major stimuli leading to the institution of compliance/ethics programs. One has been Justice Department attention and the need for a government approved compliance program. The other has been the JCAHO's promulgation of standards addressing organization ethics issues. Many healthcare organizations have seen the requirements imposed on them by JCAHO (and the necessity to have a mechanism to address federal compliance as separate issues) and have developed two compartmentalized programs. But the intensity with which the government has pursued and will continue to pursue its "fraud and abuse" program means that most healthcare organizations now support and encourage the institution of compliance programs, while allowing organization ethics initiatives to become marginalized within the organization. This approach may ignore consideration of the larger issue of what each of these activities means for a healthcare organization that is attempting to define itself based on its stated values. Although using two separate groups to focus on these particular issues may fulfill the letter of the law for both the Federal Government and the JCAHO, we believe attention to these issues is better accomplished under the umbrella of a single committee. This pathway for attention to accreditation and compliance issues within an HCO is one that may serve the HCO better than two committees working on similar issues but with separate agendas. Nothing here should be construed as a suggestion that the goal of developing a comprehensive values-oriented organization ethics program should be abandoned. Instead, we have offered an assessment of the current environment and current direction of the healthcare organization--an assessment that leads us to the conclusion that instituting organization ethics programs that are not linked to or incorporated somehow within compliance programs will probably fail. This is a frustrating position for those who believe that compliance programs may ultimately undermine the goals of an organization ethics program. Nevertheless, it is important to realize that the legal compliance of an HCO, like its compliance to high standards of ethics, are considerations that determine the ethical climate of an organization. In the absence of a consensus concerning the values that should inform the larger healthcare system, it may be the only consideration that all healthcare organization stakeholders can agree upon, and so may represent the only stable and consistent platform ethically to evaluate the activities of the healthcare organization at the present time. This can be the basis for each HCO to develop its values-oriented ethical program which will define and support the organization's ethical climate for the organization, its staff, its patients, and its community.

Accreditation↗
PubMed2001

Traditional tests and job simulations: minority and majority performance and test validities.

Performance of 565 minority and 414 majority job applicants on traditional paper-and-pencil tests and on a telephone simulation that measured similar constructs was assessed. Models of the measurement characteristics of these 2 test batteries indicated larger subgroup mean differences on the traditional tests than on the simulation. Correlations between traditional tests were lower in the majority sample than in the minority sample, and the variance of the minority candidates' scores on the traditional tests was much larger than the variance of majority applicants' scores on the same measures. The validity of the simulation was lower than the validity of the traditional tests. This study replicates previous laboratory research that has indicated smaller subgroup differences on simulations than on paper-and-pencil tests and extends this research by providing evidence of the relative validity of these 2 types of measures.

Adult↗
PubMed1997

Corynebacterium pseudotuberculosis is a cause of human necrotising granulomatous lymphadenitis.

Corynebacterium pseudotuberculosis is a well recognised pathogen of farm animals, particularly sheep and goats. Human infection is a rare occurrence. This report describes suppurative lymphadenitis occurring in an adolescent boy who had contact with farm animals. The histological differential diagnosis of suppurative granulomatous lymphadenitis is discussed, and the importance of lymph node culture is stressed.

Adolescent↗
PubMed1997

Solar keratosis can be distinguished from superficial basal cell carcinoma by expression of bcl-2.

Criteria for the histological diagnosis of solar keratosis (SK) and superficial basal cell carcinoma (SBCC) are well defined. On occasion, however, the distinction can be difficult, particularly when evaluating small-punch or superficial shave biopsies in which the overall global architectural pattern of the lesion is not represented. As bcl-2 expression has been established in basal cell carcinoma, this study was undertaken to determine whether it could be employed as a basis for distinguishing SBCC from SK. Ten cases each of typical SBCC and SK were studied. Every example of SBCC showed strong uniform expression of the bcl-2 gene product Bcl-2, whereas all examples of SK were uniformly negative. It is suggested, therefore, that this simple technique is a reliable method for distinguishing these two closely related but disparate lesions.

Antibodies, Monoclonal↗
PubMed1997

Primary squamous metaplasia of the breast.

A case of primary or idiopathic squamous metaplasia of the breast occurring in a 45-year-old woman is presented. Immunohistochemical studies suggested that the metaplasia had arisen in ductular epithelium. No evidence of neoplasia was identified.

Biomarkers, Tumor↗
PubMed1994

Evaluation of the New South Wales Cancer Council Pap Test Reminder Service.

This study aimed to assess the effect of reminder letters on Pap test rates for women enrolled on the New South Wales Cancer Council Pap Test Reminder Service and to identify predictors of response to the letter. Ten weeks after they had received their reminder letter a questionnaire was sent to 3086 women. It was completed by 1525 (49 per cent) women, of whom 1393 (91 per cent) said they had received their reminder letter. Of these 1393, 48 per cent (95 per cent confidence interval 46 per cent to 51 per cent) reported having a Pap test within 10 weeks of the reminder letter arriving. The proportion of women having a Pap test in response to the reminder letter did not differ by age, region of residence or language spoken at home. Women were less likely to have had a Pap test if they did not know how they were enrolled, were of low socioeconomic status or had some tertiary education. Women on the reminder service have 15-month rescreening rates at least 9 per cent higher than other women in New South Wales; for women aged 50 to 69 in nonmetropolitan areas the increase is estimated at 19 per cent. Reminder services may be a cost-effective way to increase Pap test rescreening rates. Reminder services need accurate records and to follow up changes in address and date of next test.

Adolescent↗
PubMed1993

A study of the services provided by the women's health nurses in a Sydney Area Health Service.

OBJECTIVES: To describe the client characteristics and nature of services provided by women's health nurses and to examine whether the goals set for the service are being met. DESIGN: A retrospective study of women's health nurse (WHN) records from 1987 to 1991. SETTING AND SUBJECTS: All women attending the women's health nurse in the Southern Sydney Area Health Service, 1987 to 1991. Older women and women of non English-speaking background are specific targets for this service. OUTCOME MEASURES: Pap test and breast self-examination practices were examined in relation to age and ethnic background. Use of general practitioner services was examined for all women attending the women's health nurse in 1991. RESULTS: Forty-five per cent of clients were aged over 50, and 29 per cent were from a non English-speaking background. Older women were more likely to return for subsequent visits to the women's health nurse. The practice of breast self-examination increased significantly between visits among all women. Forty-one per cent of women had not had a Pap test for at least three years, 93 per cent of these women were screened at their first visit. Eighty-seven per cent of women on their first visit and 86 per cent of women revisiting the women's health nurse had seen their general practitioner within the previous year. CONCLUSION: Women's health nurses are meeting the goals set for their service in relation to health promotion and the screening of women. Their services are perceived by their clients as complementary to those provided by their general practitioners.

Adolescent↗
PubMed1990

Mucin-secreting Wilms' tumor. Report of two cases.

Two children, ages 7 years and 14 months, with mucin-secreting Wilms' tumor were treated at the Red Cross War Memorial Children's Hospital in 1987. In both cases, examination of peripheral blood films disclosed the characteristic appearance of circulating mucin. In each case the blood film appearances returned to normal following nephrectomy. Both patients are in good health and apparently tumor free at 16 and 18 months follow-up.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Rhabdomyomatous mesenchymal hamartoma of skin.

A case of a solitary mesenchymal hamartoma occurring on the chin of a newborn infant is presented. The skin nodule exhibited an abnormal arrangement of dermal mesenchymal elements and, in particular, there was prominence of skeletal muscle. This lesion, which appears to be unique, has been termed rhabdomyomatous mesenchymal hamartoma of skin.

Chin↗
PubMed1989

Transient dyserythropoiesis occurring during the involutionary phase of stage IV-S neuroblastoma.

An acutely ill 6-month-old female infant presented with massive hepatomegaly, accompanied by severe anemia with peripheral normoblastemia and thrombocytopenia. Bone marrow examination revealed erythroid hyperplasia with gross erythroid dysplasia, reduced granulocytic precursors, and virtually absent megakaryocytes. The bone marrow also contained completely necrotic cells occurring in clumps as well as singly. The appearances suggested bone marrow involvement by neuroblastoma. Accordingly, combination chemotherapy was instituted and laparotomy was performed as soon as her clinical condition had improved. Left adrenalectomy was carried out, because a small adrenal nodule of ganglioneuroma was present. Liver biopsy showed expansion of portal tracts by loose fibrous connective tissue containing hemosiderin deposits and some degenerate cellular debris, consistent with areas of involuted metastatic neuroblastoma. Complete recovery followed, and subsequent bone marrow examination was entirely normal. It is thought that the dyserythropoiesis probably resulted from the release of toxic metabolites from regressing neuroblastoma.

Adrenal Gland Neoplasms↗
PubMed1988

Circulating megakaryocytes and platelet production in children with congenital cardiac defects undergoing cardiac catheterisation.

The literature has recently focused attention on the lung as a source of platelet production. Thirty-two children with normal lungs admitted to hospital for investigation of congenital heart disease were studied with the intention of showing a relationship between left atrial platelet counts and pulmonary blood flow. This was not demonstrated. Mean platelet counts were 296 X 10(9)/l (right atrium) and 304 X 10(9)/l (left atrium). There was no significant difference between the two results. It is suggested that previous studies were performed on subjects with significant acquired disease and that in young children with no pulmonary disease the lung is not a major source of platelet production.

Cardiac Catheterization↗
PubMed1988

Undifferentiated primary hepatic non-Hodgkin's lymphoma in childhood.

This report describes a case of primary non-Hodgkin's lymphoma occurring in the liver of an 11-year-old boy. Preoperative imaging established a large mass confined to the right lobe of the liver; complete removal was effected by right hepatic lobectomy. At presentation, there was serological evidence of active hepatitis B infection, which was confirmed histologically in the nonneoplastic portion of resected liver. The right lobe of liver was virtually replaced by a multinodular tumor mass that histologically resembled small-cell lymphoma. No evidence of either a B- or T-cell lineage could be established by immunophenotyping. However, immunohistochemical staining for panleukocyte markers demonstrated membrane staining. Gene rearrangement studies were not available. The patient remains well with no evidence of disease 2 1/2 years after surgery.

Antigens, Differentiation↗
PubMed1987

Acute promyelocytic leukemia. A childhood cluster.

Nine children with acute promyelocytic leukemia (APL) are presented. This series of children represents 7% of all acute leukemias and 21% of acute myelogenous leukemias seen during the same period at the Red Cross War Memorial Children's Hospital. These figures are much higher than the incidence quoted in other series of childhood leukemia. In addition, most of those children came from a confined geographic area. Two of the patients were younger than 2 years of age. The youngest patient with APL previously reported in the literature was 24 months.

Bone Marrow↗
PubMed1986

Bone marrow changes in neuroblastoma.

Bone marrow examination at the time of diagnosis of neuroblastoma was performed in 48 new cases prior to instituting therapy. Bone marrow involvement by neuroblastoma was present in 20 patients (approximately 42%). In this study the trephine biopsy was a more reliable technique than marrow aspiration in establishing the presence of metastatic disease, but in a single case the trephine biopsy was negative with metastatic cells present in the aspirate. Myelofibrosis secondary to metastatic neuroblastoma was a frequent finding, being the predominant feature in 6 cases. Bone marrow involvement by neuroblastoma was usually associated with the presence of a primary adrenal tumor and occurred only infrequently with extra-adrenal primary origin. Bone marrow involvement was usually present at the time of presentation in case where the primary tumor was located in the adrenal gland.

Biopsy↗