Terri: family-centered case management.
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Biomedical subjects
Publications and source records attributed to J Kanter.
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We have evaluated potential molecular mechanisms by which a group of synthetic lymphokine-like molecules, the 7,8-disubstituted guanine ribonucleosides, acts on second messenger pathways to augment the responses of murine B lymphocytes. Despite its extensive structural homology with GTP, 7-methyl-8-oxoguanosine (7-Me-8-oGuo), a prototypical disubstituted nucleoside, does not inhibit the binding of guanosine 5'-3-O-(thio)triphosphate either to purified G-proteins, or to G-proteins in situ in the plasma membrane. In contrast to anti-IgM antibodies, 7-Me-8-oGuo fails to induce elevation of intracellular free calcium in B lymphocytes. It does not elicit enhanced production of inositol phosphates in either unfractionated or large, cycling B cells (the cells on which it acts preferentially). It is unable to modify the cellular distribution or activity of protein kinase C, whereas phorbol 12-myristate 13-acetate, anti-IgD antibodies, and lipopolysaccharide do activate protein kinase C. Inhibitors of protein kinase C activity diminish stimulation of mRNA transcription by anti-IgD antibodies and lipopolysaccharide but not by 7-Me-8-oGuo. These data demonstrate that 7-Me-8-oGuo either uses a pathway distinct from that mediated by G-proteins, intracellular free calcium, inositol phosphates, and protein kinase C, or else bypasses the early events of this pathway, activating the cell at a point beyond their involvement. In either event, these nucleosides represent the only class of activator to date that is capable of driving B cell proliferation and differentiation without involvement of protein kinase C.
The burgeoning field of case management for long-term psychiatric patients has been handicapped by a lack of conceptual models that delineate the diverse activities of case managers. Based on the actual practice of case management, the author outlines a model of clinical case management that moves beyond the view of the case manager as a systems coordinator, service broker, or supportive companion. Using a contemporary biopsychosocial model of mental illness, the clinical case management model integrates the clinical acumen, personal involvement, and environmental interventions needed to address the overall maintenance of the patient's physical and social environment. Clinical case management involves 13 distinct activities, including engagement of the patient, assessment, planning, linkage with resources, consultation with families, collaboration with psychiatrists, patient psychoeducation, and crisis intervention.
Research on expressed emotion in the families of schizophrenic patients has seemed to offer a new perspective on environmental factors that cause relapse in schizophrenia. A review of the literature, however, reveals that while expressed emotion may predict relapse, there is no evidence that it causes relapse. Nor does the evidence support the continued linkage of the three components of expressed emotion--criticism, hostility, and emotional overinvolvement--in a single global variable. The authors also question the clinical significance of expressed emotion ratings and believe that treatment strategies based on them tend to blame relatives for the patient's continuing difficulties. They suggest that clinicians assess family responses in the context of the patient's behavior and life situation before helping families develop more effectual coping strategies.
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This study was designed to measure percentage of weight loss during simulated toothbrushing of five different composite resins. The surface roughness of each composite resin was also measured after each year of simulated toothbrushing for a period of 5 years. The following conclusions were reached: 1. Despite the loss of toothbrush efficiency, all composite resins tested tended to have a decreasing wear rate with the increasing time of toothbrushing. 2. Profile (with a soft filler) and Isopast (with a microsized filler) showed the greatest resistance to abrasion and retained the smoothest surface. 3. Prestige, which demonstrated the greatest percent weight loss, also has a soft barium filler. Loss of the filler as an alkaline reaction in water due to soluble barium compounds may cause the binder to release filler particles prematurely.
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For many years, mental health professionals and the families of schizophrenics have coexisted in an atmosphere of mutual distrust and hostility. In this paper, we would like to present some of our experiences in creating a more productive relationship with the families of long-term schizophrenic clients in an aftercare setting. We have found that it is possible to engage these families as allies in the long and difficult process of psychodynamically oriented psychotherapy and resocialization. In many instances, these families actually provide several of the major functions of a vital therapeutic milieu, including containment, support, and structure (Gunderson, 1978).
Laboratory studies were carried out to determine if there was one superior method to achieve the most intimate contact of a composite resin with its cavity walls. Three dentists restored 48 teeth by eight different techniques with two different composite resins. Photomicrographs showed very little difference in the size of the gap between tooth and composite resin regardless of which method was employed. The gap was smallest in the cavosurface area and greatest at the axio-occlusal line angle.
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