Palliation of malignant obstruction of the common bile duct by side to side choledochoduodenostomy.
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Biomedical subjects
Publications and source records attributed to M Stuart.
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Over nearly four decades (1911-1947) ICN established itself as an enduring organization for nurses in the midst of turbulent international politics, pressing healthcare demands and hardships of war. As women, ICN leaders had devoted themselves to their mission to improve the cause of nursing, economically, professionally and culturally. In the process the unifying missionary spirit of the early leaders underwent important transformations. In part, because of tensions resulting from diverse views from within, but most of all because of external influences of profound social change and the upheaval of war, the postwar identity of ICN was different.
The National Immunization Information Hotline (NIIH) has been providing information regarding immunizations to the public and to health care professionals since March 1997. We describe the operations of the NIIH, its experience over the first two and a half years of operation and lessons learned for other immunization hotlines. From 1998-2000, the hotline answered 246,859 calls. Calls concerning immunization information requests totaled 175,367; data about the calls were collected from 35,102. Approximately a third of the 35,102 calls were from health care providers. Of the remaining calls from the public, the greatest number of calls concerned childhood immunizations. Immunization schedule queries from the public increased 323.0% from 1998 to 2000. While the major goal of the NIIH is to provide accurate and reliable information to the public and to health care providers, data from the hotline can be used to monitor changes over time in calls concerning inquiries about the immunization schedule in addition to other variables of interest.
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Balance sheets are designed to assist decision-makers regarding outcomes in their practice setting. For this reason, they must include data generated in that practice setting and project the impact of a change in clinical practice on health outcomes, cost, and patient and provider satisfaction. To complete a balance sheet, it is often necessary to make assumptions that should be both conservative and realistic. Balance sheets are particularly useful for presenting all the expected outcomes of implementing a clinical guideline or other change in clinical practice and frequently lead to insights and improvements.
Managed health care in HMOs represents an innovation for which many physicians have not had preparation to assist adjustment. Successful adjustment in the HMO draws from organizational and individual variables; the former to promote enculteration, the latter to foster a "good fit." Individual factors include the physician's personality and stage of life. This article delineates roles of individual and organizational factors and develops the former with the use of psychological methods to assist the transitioning physician during the orientation period.
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Platelet glass bead retention by the Salzman and infusion pump techniques were compared in 36 control individuals, 10 patients with von Willebrand's syndrome and four patients with thrombocytopathies. No significant differences between the results of the two assays were observed. Eleven percent or less of the control individuals had diminished platelet glass bead retention. The mean percentage platelet retention of the von Willebrand's group and the thrombocytopathy group was less than the mean platelet retention of the control group. However, at least 50 percent of the patients with von Willebrand's syndrome had normal platelet retention by both methods. In the thrombocytopathy group, glass bead retention was more consistently diminished. Although an inverse correlation existed between the duration of bleeding time and the platelet retention assays, consistently diminished platelet retention results were observed only when the bleeding time was 18 minutes or longer. It has been concluded by us that while the glass bead retention assays may be helpful in characterizing certain types of platelet disorders, they are not useful screening assays in the diagnosis of von Willebrand's syndrome.
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