Management strategies in patients with bleeding ulcers are based on ulcer appearance. We assessed the level of agreement among endoscopists regarding the labeling of endoscopic features of bleeding ulcers and also evaluated the effect of a short teaching session on the level of agreement. Two hundred two endoscopists at the 1992 American College of Gastroenterology Postgraduate Course answered multiple-choice questions using interactive keypads. They were shown 6 slides of typical ulcer stigmata of recent hemorrhage, attended a brief teaching session, and then saw 6 different slides of comparable stigmata plus 2 additional slides. Color of stigmata was assessed in 9 slides. Information on years of endoscopic experience and numbers and types of procedures performed was also obtained. The proportion of correct answers before the teaching session increased significantly with years of experience, reaching a plateau in endoscopists who were 6 years or more beyond training. The proportion of correct answers for physicians performing no more than 5 upper gastrointestinal endoscopies per month was significantly lower than for those performing more than 5 per month: 33/56 (59%) compared with 647/891 (73%), a difference of 14% (95% CI, 0.4% to 27%; p = 0.03), but performance of a greater number of endoscopies was not associated with a further increase in the rate of correct answers. The total number of correct answers increased from 845/1181 (72%) before the teaching session to 1268/1554 (82%) afterwards, a difference of 10% (95% CI, 7% to 13%; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Medical, Continuing↗

PubMedDate not supplied

Experimental studies on the virus of "Q" fever.

The virus isolated by Derrick from cases of fever produces characteristic pathogenic effects on monkeys and mice. A well-defined febrile reaction, during which the blood is infective for guinea-pigs, follows subcutaneous inoculation of virus in the monkey. Mice inoculated intraperitoneally show enlargement of spleen and liver with characteristic histological changes. In sections and smears of infected mouse liver and spleen large numbers of rickettsial organisms are visible. These occur in relatively large intracytoplasmic microcolonies. Inoculation of mouse virus into guinea-pigs and monkeys gives a febrile reaction with a very short incubation period. Cross immunity tests indicate that mouse virus is identical with guinea-pig virus. The virus produces an inapparent infection in albino rats. The virus survives, but does not produce characteristic lesions on the chorio-allantois of the developing egg. The virus is filterable with difficulty through relatively permeable (0.7 mu) gradocol membranes. Agglutination of semi-purified rickettsial suspensions by immune human monkey and guinea-pig sera has been observed; this reaction appears to be specific.

Animals↗

PubMedDate not supplied

Prognostic nutrition factors in lung cancer patients.

To examine the effect of nutritional support via intravenous hyperalimentation (IVH) on tolerance, response, and survival, a prospective study of patients with adenocarcinoma of the lung receiving chemotherapy with or without IVH was undertaken. Results indicated a more favorable survival in patients with a greater than 74% initial triceps skinfold and a less than 4% initial weight loss. The effect of IVH was reflected by greater weight gain in those patients receiving nutritional support 10 days prior to chemotherapy or simultaneous with chemotherapy; however, IVH had no significant advantage to improved survival or response.

Adenocarcinoma↗

PubMedDate not supplied

Quick response programs: effective management of a population in crisis.

In our present health care system, emergency departments have become the gatekeepers of the acute care system for the elderly. These departments need other alternatives to in-hospital treatment for elderly patients. The Windsor-Essex County Quick Response Program was developed as an innovative alternative to assist Hotel Dieu of St. Joseph Hospital's emergency department with this complex client population. This article describes the program, provides a rationale for this specialized service, offers suggestions for program success and reports on its accomplishments during the first year of operation.

Acute Disease↗

PubMedDate not supplied

Staffing in secure units.

Explore the source record for details and available documents.

Dangerous Behavior↗

PubMedDate not supplied

Thallium myocardial scintigraphy and its use in the assessment of coronary artery disease.

Since coronary artery disease often first manifests as sudden death or myocardial infarction before symptoms develop, the early detection of disease may identify patients at risk for an acute event. Stress redistribution thallium-201 scintigraphy provides a useful, noninvasive method for assessing the presence of CAD as well as for evaluating the extent of disease. The principles and methods of thallium scintigraphy are described herein in addition to its clinical application. The availability of noninvasive thallium-201 scintigraphy has added to the physician's ability to accurately diagnose CAD, to objectively evaluate the effects of coronary artery bypass surgery, and to assess patients with acute myocardial infarction.

Adult↗

PubMedDate not supplied

Managed care: the challenge for nurse managers.

Health care reform is upon us even though the final legislative processes have not been enacted. Nurse managers cannot wait for health care reform. A revolution is happening all around us in many ways with large payers, our customers, aggressively negotiating new models of reimbursement. The nurse manager's challenge is to develop a responsive organization that can change quickly to meet the needs of this new environment in the shortest period of time. The successful nurse manager of the future will take the leadership role in making these changes.

Decision Making, Organizational↗