Agenesis of the corpus callosum.
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Abnormalities, Multiple↗
Biomedical subjects
J V Cook
Publications and source records attributed to J V Cook.
Effects of Asn87 and Asp318 mutations on ligand binding and signal transduction in the rat GnRH receptor.
The gonadotrophin-releasing hormone (GnRH) receptor is unlike other G-protein coupled receptors in that the highly conserved amino acids, Asp in the second transmembrane region and Asn in the seventh, are interchanged. Site-directed mutagenesis studies mutated these residues back to their normally conserved positions. Two single mutants Asn87Asp & Asp318Asn and one double mutant Asn87Asp Asp318Asn were transiently expressed in COS-1 cells and their effect on binding to GnRH and inositol phosphate production measured. The single mutant Asp318Asn had no effect on ligand binding but abolished GnRH-dependent inositol phosphate production, whereas mutations Asn87Asp and Asn87Asp Asp318Asn show a complete loss of GnRH binding and subsequent inactivation of its second messenger system.
Amino Acid Sequence↗
The use of standardized assessment in occupational therapy: the BaFPE-R as an example.
Before 1970, most assessments administered by occupational therapists were informal and nonstandardized. Since the 1970s, the use of scientifically sound instruments has increased. One such standardized assessment, the Bay Area Functional Performance Evaluation (BaFPE), was developed to measure the functional performance of psychiatric clients. This study was designed to explore the use of a revised version of BaFPE as an example of standardized assessment in occupational therapy. The BaFPE was selected as an example of an assessment extensively used in psychiatric occupational therapy practice. A qualitative study that used in-depth semistructured interviews was conducted with a convenience sample of occupational therapists. The occupational therapists who were interviewed described and explained making several adaptations and modifications to the recommended administration and scoring of the BaFPE. An analysis of the interview data suggested that standardized assessments are valued as indicators of professional status. However, the interview responses also suggested that the demands of test standardization were incongruent with the values that guide occupational therapy practice. The findings of this study suggest that the future development and use of standardized instruments should be consistent with the values of the profession. In particular, assessments that recognize the diverse nature and needs of individual clients are required.
Humans↗
Are multiple examinations of the gall-bladder helpful?
The pattern of use of the oral cholecystogram and ultrasonocholecystography in the investigation of 1014 patients prior to cholecystectomy was analysed. Three hundred and sixty-eight (36.3%) of our patients had both an oral cholecystogram and an ultrasound examination of the gallbladder. In 193 (52.4%) of these the initial investigation was positive: the second test in this group was rarely helpful and sometimes confusing. Overall the predictive value of a positive first study was 98.5%. We conclude that the use of further investigation following an initially positive result is not justified. By these criteria 18.5% of patients had an unnecessary second investigation.
Adolescent↗
Psoas nodes--an overlooked site of metastasis from testicular tumours.
This paper describes six patients with testicular tumours in whom computed tomography (CT) scanning at presentation (one case) or relapse (five cases) showed metastases to sites on the psoas muscle at, or below, the level of the aortic bifurcation. Evidence for the existence of retroperitoneal lymph nodes low on the psoas muscles is presented and the importance of recognising this as a possible site of metastasis from testicular tumours is discussed.
Adult↗
Van Buchem's disease with classical radiological features and appearances on cranial computed tomography.
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Female↗
Double-contrast computed tomographic arthrography of the shoulder joint.
Dislocation of the shoulder joint can cause post-traumatic injury to certain anatomical structures, which may lead to recurrent dislocation. The operative visualization of some of these abnormalities may be difficult and their identification preoperatively allows selection of the appropriate surgical approach and avoids the necessity for lengthy surgery. Fifty-one patients with a history of recurrent dislocation, single dislocation or suspected recurrent subluxation as a cause of pain were examined over a 3-year period by double-contrast computed tomographic (CT) arthrography. Thirty-five patients had a demonstrable abnormality and 13 were considered suitable for surgical intervention on radiological criteria. A further 12 patients were advised to have surgery on a combination of clinical and radiological grounds. Eleven of these have so far had surgery, eight of which required an arthrotomy and the CT findings have been confirmed in all these cases. The results of CT arthrography in the patients examined are reported and the technique, normal anatomy and pathological findings are described. The technique is suggested as the imaging method of choice in recurrent dislocation.
Adolescent↗
Systemic mastocytosis affecting the skeletal system.
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Bone Diseases↗
Evaluating HMO/IPA contracts for family physicians: one group's experiences.
This article reports the experience of a 15-person primary care group with two health maintenance organization/independent practice association (HMO/IPA) contracts. In 1986 the group received over $1.5 million in capitated payments from the plan to cover medical care of approximately 4,000 patients. The expenses exceeded the income for one plan. Analysis of primary care, specialty care, and ancillary services provides insight into factors that must be considered in evaluating HMO/IPA contracts. Eleven questions that should be asked before signing contracts and guidelines for utilization review and quality assurance are reviewed.
California↗
Medical management committees promote quality and cost-effective managed care.
MedSpan, a managed care organization, believes it should provide physicians with maximum input regarding utilization management and practice guidelines. This has been accomplished through nine committees, all of which report to a Medical Management/Quality Management Committee. This committee structure has allowed MedSpan to avoid the unilateral imposition of guidelines and has enhanced the quality of care and service while decreasing utilization and reducing costs. Examples of specific physician committee actions are included in this article.
Connecticut↗
Innovation and leadership in a mental health facility.
For 3 1/2 years an occupational therapist persevered in efforts to introduce an innovative outpatient service of multidisciplinary team case management within a general community hospital. The service was intended to meet the needs of discharged clients with severe mental illnesses who were attempting to live successfully and satisfactorily in the community. The reality of attempting to initiate change in medical bureaucracies involves ongoing negotiation and persuasion, issues of power and politics, differing cultural visions, and strongly committed leadership. This case study describes the developmental process of innovation and the contribution of occupational therapy philosophy and practice to the therapist's emergent leadership in promoting cultural change. Some of the lessons to be learned from this case study by others who would attempt institutional innovation include articulating a clear vision that uses new language, building coalitions, and being flexible and persistent.
Community Mental Health Services↗