We report a case of Mirizzi syndrome due to a cystic duct stone occurring in a 66-year-old man in the presence of multiple debilitating medical conditions which precluded surgery. The patient was successfully treated by percutaneous stone removal and made a swift and uneventful recovery. This is the first report of Mirizzi syndrome due to a ductal stone being treated in this manner.

Aged↗

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Stent graft in managing juxta-renal aortoiliac occlusion.

Endovascular procedures are frequently used as an alternative to surgical bypass in aortic and iliac occlusion. Stents have revolutionized the scope of such endovascular procedures, but there are few reports of stents or stent grafts in occlusive juxta-renal aortic occlusion. We present a case where such occlusion was managed by use of a stent graft with successful outcome.

Aged↗

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Bobber: a cervical ataxic mutant in the domestic turkey responsive to sunlight.

Bobber is a genetic disorder in the domestic turkey that is usually expressed between two and four weeks of age. The condition is permanent and is characterized by ventrocaudad bending of the neck accompanied by a lateral pendulumlike motion of the head between the legs. Expressivity of the defect is variable and may be exhibited in some turkeys as a stargazing posture or a rapid clockwise twirling motion. When suspended by the legs in a head-down orientation, afflicted turkeys exhibit an inward turning of the neck and head toward the breast as opposed to an outward turning in normal turkeys. The disorder is inherited as a sex-linked recessive trait. The symbol bo is used for the gene. The defect can be corrected by exposure to intense light in the visible spectrum.

Animals↗

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The risk of hepatitis B infection among health professionals in the United States: a review.

Many physicians, dentists, and allied health personnel sustain occupational exposures to blood and other body fluids that increase their risk of contracting type B viral hepatitis. Overall, the risk of hepatitis B among persons employed in health-related fields is estimated to be approximately four times that in the general adult population. Studies on the incidence of infection and the prevalence of hepatitis B serologic markers have further defined risk in specific occupational categories and work activities. Physicians and dentists are five to ten times more likely than the general adult population to experience hepatitis B infection. Infection rates ten or more times above the average have often been characteristic of surgeons, patient care personnel in dialysis units and institutions for the mentally handicapped, and clinical laboratory workers having frequent contact with blood samples.

Adolescent↗

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Critical variables in making organizational change a reality.

Daniel J. West Jr., Ph.D., FACHE, FACMPE, director of the graduate health administration program at the University of Scranton, Pennsylvania, writes that any change to part of the health care delivery system impacts the total system. Therefore, expertise is needed in a wide variety of functional areas to ensure that change occurs smoothly.

Consultants↗

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Practice compliance programs: reducing therapeutic misadventures and adverse outcomes.

Contemporary medical group practice administrators navigate a complex world of challenges, questions, and ambiguous circumstances. Adverse outcomes and therapeutic misadventures have significant implications within this world. Practice compliance programs must be developed to reduce risk and liability. As with any negative behavior, event or disruptive action, therapeutic misadventure is easily identified; however, determining a strategy to correct physician behavior, attitude, and action is sensitive and difficult, requiring administrative skill, tact, and patience. This article provides corrective action strategies that can be applied to any therapeutic misadventure encountered in a typical medical group practice. Three categories are identified: problematic behavior, problematic practice patterns, and physician impairment. Measures to correct and alter physician behavior and actions are also described.

Group Practice↗

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Measuring loss of life, health, and income due to disease and injury: a method for combining morbidity, mortality, and direct medical cost into a single measure of disease impact.

The impact of disease on a population includes illness, death, and medical care cost. Information on all three may be combined in a disease impact scale. The disease impact for a given condition can be defined as the sum of (a) the years of life lost before age 75 per 100,000 population (adjusted to reflect causes of death up to age 100); (b) the person-years of complete disability per 100,000 population, and (c) the direct medical costs in years of average annual personal income per 100,000 population.The sum of (a), (b), and (c)-disease impact in person years per 100,000 population-can be used to compare one disease with another, to estimate the potential effect of programs for risk alteration, and to measure the outcome of planned or accidental changes in society. The data necessary to calculate disease impact are becoming available in many States.In Minnesota, the total disease impact in 1978 was approximately 26,000 person-years per 100,000 population per year. The disease catgories in the International Classification of Diseases, Adapted, Eighth Revision, with the highest disease impact in the State were circulatory diseases (23.7 percent), injury and poisoning (10.9 percent), respiratory system (9.3 percent), neoplasms (9.0 percent); musculoskeletal system and connective tissue (8.8 percent), digestive system diseases (7.5 percent), and nervous system and sense organ diseases (5.8 percent). Circulatory diseases ranked first in morbidity, mortality, and cost, but the rankings for several other categories varied according to the parameter being considered.Use of a disease impact scale such as the one developed in Minnesota avoids dependence on a single parameter such as mortality or cost in making program decisions. In contrast to economic analyses of disease impact, it does not require estimates of discount rates, future rates of inflation, or salaries for homemakers, students, and children. Although the results of present calculations are only approximate, they provide a methodological framework within which correctable deficiencies in data collection methods are readily apparent. The disease impact scale is intended to be a component of a comprehensive disease surveillance system that includes measures of disease impact, the prevalence of risk factors for diseases, and the availability of health resources.

Costs and Cost Analysis↗

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Advance directives: the price of life.

Advance directives support the concepts of patient autonomy and resource allocation. Promotion of advance directives by nurse managers according to the suggested paradigm should be an economic and policy priority.

Advance Directives↗

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Incorporating digital imaging into dental hygiene practice.

The objective of this paper is to describe digital imaging technology: available modalities, scientific imaging process, advantages and limitations, and applications to dental hygiene practice. Advances in technology have created innovative imaging modalities for intraoral radiography that eliminate film as the traditional image receptor. Digital imaging generates instantaneous radiographic images on a display monitor following exposure. Advantages include lower patient exposure per image and elimination of film processing. Digital imaging enhances diagnostic capabilities and, therefore, treatment decisions by the oral healthcare provider. Utilization of digital imaging technology for intraoral radiography will advance the practice of dental hygiene. Although spatial resolution is inferior to conventional film, digital imaging provides adequate resolution to diagnose oral diseases. Dental hygienists must evaluate new technologies in radiography to continue providing quality care while reducing patient exposure to ionizing radiation.

Dental Hygienists↗