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Family planning education as an integral part of day care services in Korea.

The Integrated Day Care Program (IDCP) in Korea provices family planning classes as an integral part of comprehensive day care services for low-income families. The program was initiated by CARE in 1973, with support from the Korean government, and has received important inputs from national family planning agencies. A review of the first two years' accomplishments shows that mothers participating in the IDCP knew more about, were more favorable toward, and were more likely to practice family planning than mothers using day care centers that were not a part of the program. Findings also demonstrate the potential for program expansion: the substantial numbers of friends and relatives brought by mothers to the classes, and the number of IDCP and non-IDCP mothers indicating a willingness to use family planning clinic services in the day care setting.

Adult

Applying the nursing process to patient care in the operating room.

Using the nursing process in operating room nursing helps to assure personalized, continuous, and integrated care for the surgical patient. The steps in the nursing process clearly demonstrate the role and functions of the O.R. nurse as a professional member of the surgical team and as a component of the health care system. By this means the patient is assured of protection and quality care.

Nursing Assessment

An audit of the care of diabetics in one general practice.

I designed and implemented a simple audit of the care of diabetic patients on one general practitioner's list. The audit demonstrated a lack of adequate care in some aspects, so it was used to improve the care offered in future by designing a method of diabetic follow-up incorporating an effective recall system, shared and integrated care between doctor and nurse, and a clear method of recording essential information.I suggest that audit is not adequately completed until the new systems developed have themselves been adequately audited and consequential changes in care measured.

Diabetes Mellitus

[Adverse reactions to drugs in hospitalized medical patients (author's transl)].

Prospective research showed that unwanted side-effects resulting from medical therapy were found in 20,6% of all patients hospitalized in our medical clinic during a period of one year. Part of these side-effects was considered a possible reason for admission to the hospital and a cause of complications during the clinical treatment. The side-effects were classified according to their severity, duration, symptomatology and pathogenesis. Furthermore, the frequency of side-effects was studied with regard to age, sex and groups of drugs. It was possible to predict about 80% of the side-effects by considering pharmacological properties and individual risk-factors. The careful integration of these criteria into the treatment plan and the observation of the course of the disease is the basis for calculating the probability of occurrence of side-effects.

Adolescent

Body image and the process of reconstructive surgery.

Newer craniofacial operative techniques produce rapid changes in objective appearance and permit the study of body-image change. In 21 patients with either Crouzon's disease or Alpert's syndrome, a four-factor model of body-image development was applied that emphasizes cognitive growth, perception of body stimuli, stimuli from the environment in the form of comparison, and the response from others. Before a child is of school age, he has substantially defined his body image, therefore corrective surgery must be considered earlier. Although surgical intervention may produce significant objective physical change, there is not a correspondingly rapid change in body image. Four phases in the modification of body image are (1) the decision to undergo surgery, (2) the operative experience, (3) the immediate postoperative period, and (4) the reintegration stage. Recognition of this phasic process will help integrate care of these patients.

Acrocephalosyndactylia

Mixed Methods Findings from a Stepped Wedge Hybrid Implementation Trial of ATTAIN NAV: A Mental Health Family Navigation Intervention for Autistic Youth.

ATTAIN NAV (Access to Tailored Autism Integrated Care through Family Navigation) was delivered by family navigators to promote access to and engagement with mental health services for school-age autistic youth. This study used a mixed method, stepped wedge design to test the effects of family navigation on service and clinical outcomes while gathering information on implementation. Primary care providers from six clinics in California and 56 caregiver-child dyads enrolled in and completed the study. Clinics were randomized to either a technology-enhanced or standard family navigation condition. Caregivers completed assessments at baseline and post about child, family and services outcomes, and a subset participated in a post qualitative interview. Quantitative findings demonstrated improvements in child challenging behavior and parent activation across conditions although these improvements were more pronounced for families in the standard FN condition. At post-intervention, families in the standard FN condition reported higher levels of navigation satisfaction, a shorter time to attend their first mental health appointment, and higher engagement with their navigator. Qualitative findings complemented and expanded the quantitative survey findings. The ATTAIN NAV model of family navigation for autistic children with co-occurring mental health needs demonstrates promising implementation, service, and clinical benefits. Clinical Trials Registration. NCT05344378.

Humans

Loss of Methylthioadenosine Phosphorylase (MTAP) Expression: A Potentially Useful Tool for Distinguishing Sarcomatoid Urothelial Carcinoma From Inflammatory Myofibroblastic Tumor.

Inflammatory myofibroblastic tumor (IMT) and sarcomatoid urothelial carcinoma (SarUC) can have striking histologic overlap but have significantly different prognoses and clinical management paradigms. Loss of methylthioadenosine phosphorylase (MTAP) protein expression by immunohistochemistry (IHC) serves as a useful surrogate for homozygous 9p21 deletion, a recurrent genomic alteration in urothelial carcinoma (UC). We analyzed MTAP expression by IHC in 65 SarUCs and 27 urinary tract IMTs to evaluate its utility in navigating this challenging differential diagnosis. Overall, MTAP loss was significantly more frequent in SarUC (55%) compared with IMT (4%) (P < .0001). Among 46 biphasic SarUCs with independently evaluable epithelial and mesenchymal components, divergent expression patterns were frequent. The most common pattern was retention of MTAP staining in both epithelial and mesenchymal components (19/46; 41% of cases), followed by selective retention of MTAP in the epithelial component and loss in the mesenchymal component (16/46; 35% of cases). MTAP loss was observed in both the epithelial and mesenchymal components in 11 out of 46 (24%) SarUC cases. None of the 46 biphasic SarUC cases showed selective MTAP loss in the epithelial component but retention in the mesenchymal component. MTAP IHC was also particularly valuable in assessing clonal relationships in 2 challenging biphasic cases in which the differential diagnosis included a collision between a noninvasive low-grade papillary UC and an IMT versus a subtle IMT-like SarUC arising in association with an overlying noninvasive low-grade papillary UC. Next-generation sequencing on a subset of cases (n = 11) was useful for confirming 9p deletion in cases with MTAP loss by IHC, and for demonstrating molecular hallmarks of urothelial neoplasia thereby providing additional diagnostic support for morphologically challenging SarUC cases with IMT-like morphology. Therefore, MTAP IHC can be useful in evaluating spindle cell lesions of the urinary tract, as loss is significantly more common in SarUC than in IMT, and enriched in the mesenchymal component of biphasic SarUC. However, MTAP loss can be seen in both entities, and the diagnosis of IMT-like spindle cell tumors in the urinary tract requires careful integration of morphologic, immunohistochemical, and molecular data.

Humans

Complicated urinary tract infections: evolving definitions, clinical burden, and treatment landscape amid antimicrobial resistance.

INTRODUCTION: Complicated urinary tract infection (cUTI) is a common and heterogeneous infection associated with substantial morbidity, high healthcare utilization, and increasing antimicrobial resistance. Evolving definitions, increasing device use, and changing patient populations have altered its epidemiology and management. Marked variability in diagnostic criteria, clinical trial endpoints within and outside registrational settings, and treatment strategies complicates clinical decision-making and interpretation of therapeutic advances. AREAS COVERED: This review examines contemporary cUTI epidemiology, classification frameworks, and drivers of disease burden. It evaluates resistance trends and their therapeutic implications, alongside stewardship-based management strategies, including empiric antibiotic selection, intravenous-to-oral transition, treatment duration, and source control. Challenges in catheter-associated infection, recurrence, and regulatory endpoint design are discussed, together with the emerging role of novel agents targeting resistant Gram-negative pathogens. EXPERT OPINION: Rising multidrug resistance and limited oral options are reshaping cUTI management, necessitating individualized, stewardship-aligned therapy guided by illness severity and local epidemiology. Current regulatory endpoints inadequately reflect patient-centered outcomes, particularly in the context of asymptomatic bacteriuria. Expanding availability of effective oral agents may enable earlier discharge and outpatient care. Integration of rapid diagnostics and risk stratification will be essential to optimize therapy, limit resistance, and improve outcomes.

Humans

X-ray-transmission computed tomography.

The immediate goal of clinically based x-ray-transmission computed tomography (CT) is to provide a measurement of the x-ray linear attenuation coefficient in cross section with the ultimate goal of impacting on patient management and care. To do this with the accuracy needed for clinical goals requires the careful integration of x-ray physics, detector technology, and mathematical reconstruction theory. Performance evaluation and quality assurance are necessary adjuncts to a CT scanning program. A number of investigative studies are underway.

Fourier Analysis

The teaching of medical ethics at Southampton University Medical School.

For centuries medical schools in Britain and elsewhere had a fairly static curriculum based on what might be called the 'three Rs' of medicine, and consequently had to make room for new subjects as the need arose in a fashion which was sometimes makeshift. However, Southampton University has only had a medical school for six years, and therefore their course on medical ethics and legal medicine was carefully integrated into the curriculum after some preliminary experiments carried out by a subcommittee which is continually reviewing the situation. Medical ethics has now a definite place in the fourth year, preceded by an introduction to ethical problems encountered in medicine in the first year. Not only do members of the medical faculty participate in this teaching but also members of the faculties of law and the arts.

Curriculum

Gonadotropin response to luteinizing hormone releasing hormone administration in secondary amenorrhea and galactorrhea syndromes.

Luteinizing hormone releasing hormone (LHRH), 100 mug, was administered to 60 patients with secondary amenorrhea. No side effects or adverse reactions occurred. Delayed FSH and LH peak outputs were observed in patients receiving LHRH subcutaneously rather than intravenously, but responses were otherwise comparable. The majority of patients with secondary amenorrhea had responses which fell into the 95% confidence limits of responses for normal ovulating women. Responses of patients with different forms of dysfunction may be similar, and patients with similar pathology may respond quite differently. The LHRH stimulation test may assist in the diagnosis of particular hypothalamic, pituitary, or gonadal dysfunction, but it must be used clinically in the context of a carefully integrated study.

Adenoma, Chromophobe