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Closed ruptures of flexor tendons in the hands of patients without rheumatoid arthritis are rare. We report a case of closed rupture of the flexor digitorum profundus of the middle finger in zone II, secondary to acute florid synovitis forming a tumour-like mass. No similar case has been reported to our knowledge. The management of this unexpected finding at surgical exploration is discussed.
Fiberoptic bronchoscopy remains the gold standard to establish the presence or absence of acute pulmonary allograft rejection or infection after lung transplantation (LT). Performance of clinically mandated transbronchial lung biopsy enhances diagnostic precision and has a satisfactory risk:benefit ratio in experienced hands. Surveillance transbronchial biopsies have a lower yield but may provide longitudinal insight into immunological events in the allograft that can assist long-term management. Moreover, knowledge about the structural integrity of the bronchial anastomosis is critical to achieve optimum outcomes. Obliterative bronchiolitis (OB) is the most common cause of late graft dysfunction and mortality after LT. Significant OB is invariably associated with reduced graft function, denoted physiologically by the bronchiolitis obliterans syndrome (BOS). Importantly, not all BOS is due to OB. The major risk factor for BOS is thought to be acute cellular rejection but new data support an important role for lymphocytic bronchiolitis. This review examines the role of fiberoptic bronchoscopy after LT as a surveillance tool and discusses indications, risk:benefit, and outcomes, with emphasis on two specific findings on biopsy; namely, minimal acute cellular rejection and lymphocytic bronchiolitis. Findings on follow-up biopsies to assess the outcome of therapies and the natural history of untreated "minimal" rejection events are also discussed.
Microorganisms maintain the biosphere by catalyzing biogeochemical processes, including biodegradation of organic chemical pollutants. Yet seldom have the responsible agents and their respective genes been identified. Here we used field-based stable isotopic probing (SIP) to discover a group of bacteria responsible for in situ metabolism of an environmental pollutant, naphthalene. We released 13C-labeled naphthalene in a contaminated study site to trace the flow of pollutant carbon into the naturally occurring microbial community. Using GC/MS, molecular biology, and classical microbiological techniques we documented 13CO2 evolution (2.3% of the dose in 8 h), created a library of 16S rRNA gene clones from 13C labeled sediment DNA, identified a taxonomic cluster (92 of 95 clones) from the microbial community involved in metabolism of the added naphthalene, and isolated a previously undescribed bacterium (strain CJ2) from site sediment whose 16S rRNA gene matched that of the dominant member (48%) of the clone library. Strain CJ2 is a beta proteobacterium closely related to Polaromonas vacuolata. Moreover, strain CJ2 hosts the sequence of a naphthalene dioxygenase gene, prevalent in site sediment, detected before only in environmental DNA. This investigative strategy may have general application for elucidating the bases of many biogeochemical processes, hence for advancing knowledge and management of ecological and industrial systems that rely on microorganisms.
Many Korean women living in North America interact with the health care system for a variety of reasons. Frequently, lack of understanding regarding cultural health practices results in misunderstandings and the provision of care that may be culturally inappropriate. The purpose of this critical ethnographic study is to examine how menopause is experienced by a sample of Korean-Canadian women. Data were collected through semistructured interviews with a purposive sample of 7 Korean women who have experienced menopause. Interviews were dialogic in nature and meaning was derived through collaboration with the participants. Findings revealed that the women viewed menopause as a natural process and they used facets of both Korean and Western health practices to manage menopause. Knowledge gained from this research has the potential to contribute to the provision of culturally relevant health care for Korean women during menopause.
Providing efficacious, compassionate, and efficient medical care to persons with HIV infection is one of the greatest challenges that will face US hospitals this decade. Unfortunately, there have been almost no studies of how organizational arrangements are related to the quality of care. We developed an interview protocol and conducted a pilot study to evaluate the instrument's ability to detect differences in selected interpersonal aspects of care provided to persons with AIDS. We evaluated the care received in two different treatment models in a major teaching hospital: a designated AIDS unit and general medical beds. We assessed several areas of patient care that are clinically important and that patients can evaluate: communication between patients and providers, patient education, respect for patient preferences, emotional support, involvement of family and friends, trust and confidence, physical care, pain management, AIDS knowledge, perceived segregation, confidentiality, and financial information. Patients generally were very satisfied with their hospital care, but many reported problems with certain aspects of their care. The instrument used detected differences between the care reported by patients treated in general hospital beds and in a designated AIDS unit in several specific aspects of care.
Taxonomic indexing refers to a new array of taxonomically intelligent network services that use nomenclatural principles and elements of expert taxonomic knowledge to manage information about organisms. Taxonomic indexing was introduced to help manage the increasing amounts of digital information about biology. It has been designed to form a near basal layer in a layered cyberinfrastructure that deals with biological information. Taxonomic Indexing accommodates the special problems of using names of organisms to index biological material. It links alternative names for the same entity (reconciliation), and distinguishes between uses of the same name for different entities (disambiguation), and names are placed within an indefinite number of hierarchical schemes. In order to access all information on all organisms, Taxonomic indexing must be able to call on a registry of all names in all forms for all organisms. NameBank has been developed to meet that need. Taxonomic indexing is an area of informatics that overlaps with taxonomy, is dependent on the expert input of taxonomists, and reveals the relevance of the discipline to a wide audience.
We report a case of an unusual uroepithelial cyst arising from a renal calix in an African-American man with sickle cell trait. The lesion was incised and decompressed using a 7.5F flexible ureteroscope in conjunction with the holmium:YAG laser and a 200-microm quartz laser fiber. To our knowledge, endourologic management of this type of lesion has not been described in the literature.
Laser lithotripsy has become an effective and low-morbidity procedure for the treatment of ureteral calculi. Nevertheless, ureteral endoscopy is not free of side effects and complications. Lithiasis extrusion is one of the early complications of this procedure, and usually, the diagnosis is carried out by means of urographic findings because it is not easily recognized during ureteroscopy. Between January 1990 and May 1996, a total of 1047 endoscopic lithotripsies with the pulsed-dye laser were performed in our department. The 3-month stone-free rate as a single treatment was 76.5%. We found 11 cases (1.05%) of calculi extrusion after ureteral endoscopic treatment. Only one case was diagnosed intraoperatively. The evolution after a mean follow-up period of 18 months (range 6-34 months) was satisfactory in all cases. No urinary extravasation, infection, or secondary ureteral strictures were found. According to the absence of side effects, it was considered unnecessary to remove the extruded calculi. Extrusion of noninfected calculi into the periureteral tissues after laser lithotripsy causes no significant consequences and can be successfully managed conservatively. Knowledge of this possible complication is the best way to avoid it. A careful technique and a low irrigant flow will be very helpful.
MOTIVATION: A critical element of the computational infrastructure required for functional genomics is a shared language for communicating biological data and knowledge. The Gene Ontology (GO; http://www.geneontology.org) provides a taxonomy of concepts and their attributes for annotating gene products. As GO increases in size, its ongoing construction and maintenance becomes more challenging. In this paper, we assess the applicability of a Knowledge Base Management System (KBMS), Protégé-2000, to the maintenance and development of GO. RESULTS: We transferred GO to Protégé-2000 in order to evaluate its suitability for GO. The graphical user interface supported browsing and editing of GO. Tools for consistency checking identified minor inconsistencies in GO and opportunities to reduce redundancy in its representation. The Protégé Axiom Language proved useful for checking ontological consistency. The PROMPT tool allowed us to track changes to GO. Using Protégé-2000, we tested our ability to make changes and extensions to GO to refine the semantics of attributes and classify more concepts. AVAILABILITY: Gene Ontology in Protégé-2000 and the associated code are located at http://smi.stanford.edu/projects/helix/gokbms/. Protégé-2000 is available from http://protege.stanford.edu.
As in other developed countries with an ageing population, there is a growing perception in Australia that urinary symptoms are a major cause of morbidity among older men. This study aimed to determine the prevalence of urinary symptoms amongst male patients in general practice, their presentation, investigation and management. Randomly selected general practitioners' (GPs') surgeries in five mainland state capital cities in Australia were involved. A consecutive sample of male patients aged 50 years and over was asked to complete a self-administered questionnaire about urinary symptoms, allowing a symptom score to be calculated. For each participating patient, GPs completed a checklist about symptoms, investigation and management without knowledge of the patient's answers. Sixty-eight per cent of GPs agreed to participate in the study and 95% of patients participated, resulting in 4268 patient questionnaires and 4255 GP checklists. Men bothered by severe symptom scores were significantly more likely than men with mild symptoms to be presenting with a urinary problem. For no city did the proportion of men with severe symptom scores who were not presenting for a urinary problem exceed 7%. Other measures of morbidity were similarly low in this group. GPs investigated 61% of urological symptoms presenting on the day and initiated treatment for less than a third. Approximately 10% of the total sample had had a transurethral resection of the prostate: 9% of these had severe symptom scores. It was concluded that almost all older men in general practice who are sufficiently troubled by urinary symptoms will see their GP for advice at some time.(ABSTRACT TRUNCATED AT 250 WORDS)
Donor funding for family planning and reproductive health (FP/RH) has declined in Latin America over the past decade, obliging providers to consider other financing mechanisms, including cost recovery through user fees. Pricing decisions are often difficult for providers, who fear that increased fees will cripple demand and create barriers to access for poor clients. Providers need information on how changes in price can affect utilization of services, and how to resolve trade-offs between generating income and serving poor clients. This paper reports on an experiment that measured the impact of higher client fees on utilization, revenue and client socioeconomic characteristics at 15 clinics operated by CEMOPLAF, an Ecuadoran not-for-profit FP/RH agency. The study improves on previous research by comparing effects of different price levels on demand for services. We conclude that demand was inelastic for three of CEMOPLAF's four main FP/RH services, and we found no evidence that the price increases had a disproportionate impact on utilization by poorer clients. The study therefore provided CEMOPLAF managers with knowledge that price increases at the levels tested would help to achieve sustainability goals (by increasing locally generated income) without undermining CEMOPLAF's social mission.
Survivors of traumatic brain injury frequently develop respiratory complications that require specialized knowledge and management skills in both acute and postacute environments. This article discusses the pathophysiology of and treatment options for ventilatory failure, neurogenic pulmonary edema, and aspiration. Management of tracheostomies is also discussed, with particular attention paid to decision making regarding the removal of a tracheal appliance. Long-term tracheal complications are also outlined.
PURPOSE OF REVIEW: Fortunately, gynecologists are enthusiastically embracing diagnostic and operative hysteroscopy as a means to evaluate women with menstrual disorders, infertility, post-menopausal bleeding, recurrent pregnancy loss, and for ultrasound images. In general, operative hysteroscopy is a safe procedure, is easily learned, and has excellent surgical outcomes. As more obstetricians/gynecologists perform hysteroscopy, they must remain cognizant about the salient complications. The recognition of complications and prompt intervention will prevent adverse sequelae as well as minimizing undesirable patient outcomes and reducing legal risks. RECENT FINDINGS: Hysteroscopy remains a relatively safe procedure. Diagnostic hysteroscopy has the fewest risks, followed by operative hysteroscopic adhesiolysis, metroplasty, and myomectomy. Fluid management is critical for intraoperative safety. Meticulous detail should be paid to fluid management, and consultation sought with a critical care specialist when fluid overload or hyponatremia is suspected. Lingering pain, fever, or pelvic discomfort after surgery requires prompt evaluation. Women becoming pregnant after operative hysteroscopic procedures need careful antepartum and intrapartum care. Special attention to unusual pain complaints during pregnancy or with fetal distress in labor need prompt intervention. SUMMARY: The preoperative use of misoprostol or laminara decreases the risk of uterine perforation. Expert preoperative evaluation is essential in determining the surgical skill and expertise needed, surgical time, and the likelihood of completing the operative procedure. Overall, complications in operative hysteroscopy are infrequent and are usually easy to manage. This knowledge should help physicians perform more procedures.
Nurses have become increasingly interested and involved in the area of outcomes to assure that the patient is represented as more than a composite of physiological variables. The use of outcome measures has helped nurses articulate their unique value and contribution to the well being of patients. Nevertheless, many measures presently used to evaluate an outcome do not identify or acknowledge the unique contribution of nurses. Clinical nurse specialists and other advanced practice nurses must use their "ways of knowing" to develop appropriate measures and outcomes. Through this careful inquiry, nurses will then be equipped to ask "nurse-driven" questions regarding the development of appropriate outcomes and outcome measures and to analyze the models in which care is presently delivered.
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Although they are responsible for the operation of business units, nurse managers are often less well prepared to manage the business activities than the clinical activities. Perceptions of nurse managers and nurse executives regarding competencies required for nursing management roles and the educational preparation required to attain them were examined. Results indicate the groups are in basic agreement about required competencies, though nurse managers appear less clear about nurse executive role responsibilities. Nurse executives value the acquisition of a master's degree as essential for nurse manager performance, while fewer nurse managers agree. Strategies nurse executives may employ to develop nurse manager business knowledge include traditional undergraduate and graduate degree programs, online programs, certificate programs, continuing education, inservice education offerings, seminars, and mentoring activities.
This article presents historical research into the origins of the Henry Street Settlement on the lower East Side of New York City. It is about Lillian D. Wald and her contributions. Wald used techniques and approaches to deal with problems that exist today: health care equity and financial support from public and private sources. Keys to her success include effective leadership, assertive management, and knowledge of the power structure. The Henry Street Settlement, from its humble origins, set precedents for innovations in public health nursing that have profoundly affected health care in the United States.
Care of patients who have sustained a mild traumatic brain injury (MTBI) requires collaboration between the case manager, other disciplines, the patients, and their significant other. The case manager's knowledge of the evaluation tools that may be used to assess patient status in various phases of care is essential in planning and dealing with possible variances of care, which could affect outcomes of care. An overview of the etiology of MTBI, diagnosis, recovery, evaluation at various stages, outcome measurement, and examples of valid and reliable tools are presented.