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PubMedDate not supplied

Comparison of tumour blood flow changes induced by step-up and step-down heating.

The changes in the blood flow in SCC-VII tumours after step-down and step-up heating (SDH and SUH) were compared. SDH was carried out by initial treatment of tumours in a water bath at 44.5 degrees C for 10 min, immediately followed by heating at 41.5 degrees C for 60 min. For SUH, the sequence of these high- and low-temperature treatments was reversed. Tumour perfusion was evaluated by laser Doppler flowmetry (LDF) at 1, 2, and 24h after finishing the hyperthermia. It was shown that the decrease in the blood flow in tumours was more substantial after SDH than after SUH; in the former case, the drop in LDF values was both faster and larger than in the latter. It is concluded that such a "physiological' component may be involved in the difference in the antitumour effect between SDH and SUH.

Animals↗
PubMed1990

Managing change. A step-by-step process helps sponsors implement change smoothly.

During the past six years the Catholic Health Association (CHA) has developed and modified a process to help leaders evaluate and implement merger, cosponsorship, and sponsorship transfer decisions. CHA's highest priority in these efforts has been to keep Catholic healthcare facilities under Catholic sponsorship, control, and management. Proposals to change sponsorship arrangements usually originate with sponsoring institutes, whereas local boards generally initiate merger proposals. In either case, it is critical that all interested parties--such as sponsors, boards, administrators, medical staff, employees, and the local Church--be involved in the decision-making process at some point. Once leaders have decided on a course of action, they should appoint a task force to implement the proposal. The board, administration, and medical staff will all have important roles to play in the implementation process. Another important step is to establish criteria for evaluating candidates for a proposed merger or sponsorship transfer. Leaders should ensure that people affected by the transaction have an opportunity to give input and to grieve their loss. After leaders have selected a candidate, they must negotiate the details of the agreement and take the necessary legal steps to complete the transaction. It is imperative that a facility secure outside legal counsel to help it through this stage.

Catholicism↗
PubMedDate not supplied

Ensuring accountability in decision making. A step-by-step approach applies common sense to complex issues.

All institutions must routinely make decisions that may have a profound impact on their organizations and communities. The process used to reach those decisions defines an organization's commitment to its mission, values, and corporate ethics. At Sisters of Mercy Health System in St. Louis (SMHS), a corporate decision-making process was developed over the course of a year and introduced systemwide in 1994. The process establishes a disciplined and accountable technique for evaluating initiatives, discussing options, and arriving at clear, values-based decisions. The process begins with two questions: Is the proposed action compatible with the organization's mission? Will the proposed action advance the mission in any significant manner? Next, a step-by-step approach enables members of the decision-making group to consider the proposed action in light of the SMHS mission and values. Participants explore the implications of the decision from three perspectives: social vision, responsibility, and self-interest. They also consider the potential consequences of the decision on all affected parties, particularly poor and powerless people. SMHS leaders have found the decision-making process brings clarity and comprehension to the task of making decisions.

Decision Making, Organizational↗
PubMed1999

Effective step-by-step technique for the surgical treatment of protruding ears.

OBJECTIVE: Techniques of otoplasty may be arbitrarily divided into cartilage-molding or cartilage-splitting categories. In this article, we describe our personal experience in over 100 otoplasties using a combination of these two methods. We highlight the step-by-step approach, as well as a number of previously unreported techniques, that have enabled us to consistently achieve permanent, esthetically pleasing results in both younger patients, as well as in older adults.

Adult↗
PubMed1987

Conducting the storeroom inventory: a step-by-step approach.

At least once each year, it is necessary to perform a physical count of every item in the hospital's official inventory. The author contends that this often dreaded task needn't be difficult and should actually be somewhat pleasant for those involved. To ensure this, he provides a step-by-step instructions for how to prepare for and conduct the actual inventory. If followed, this should yield an accurate and efficient inventory while simplifying an often distasteful task.

Equipment and Supplies, Hospital↗
PubMed1999

[Recent progress on the therapy for chronic obstructive pulmonary disease (COPD)--usefulness and practice of the step-by-step pharmacologic therapy].

Recently, a step-by-step pharmacologic therapy for chronic obstructive pulmonary disease (COPD) has been recommended by several principal organizations. The characteristic of this therapy is that it is a stepwise approach organized according to the severity of disease and is mainly composed of bronchodilators including beta 2-agonists and anticholinergic agents, theophylline, and oral corticosteroids, and the goal of this therapy is to induce bronchodilation, decrease the inflammatory reaction, and facilitate expectoration. Since the effectiveness of one of the inhaled corticosteroids has been also indicated by the multicentre randomised trial in a few years, they may have an important role in the long-term treatment of COPD.

Administration, Inhalation↗
PubMed1999

Pressure-laminated athletic mouth guards: a step-by-step process.

Of the variety of mouth guards available to the conscientious athlete for protection of oral structures, the pressure-laminated appliance provides the best fit and most protection. The pressure-lamination technique, however, is not widely known among dentists. This article contains a step-by-step description of making pressure-laminated athletic mouth guards.

Athletic Injuries↗
PubMed1999

[The overall and step-by-step duration of cesarean section].

The purpose of this study is to define the time for different steps of Caesarean section from the moment the women lays on the operating table to the last stitch on the skin. The study is prospective and include 82 elective and emergent CS. The traditional surgical technique is used without omitting any step. The mean stay of the women in the operating theater is 90 min. The preparation for the anesthesia/analgesia is 23 min (range 8-41). The proper time of the operation is 44.3 min. The laparotomy by Pannenstiel incision takes 3 min. The opening time of the uterus is 37 sec (10-190) and the closer on two layers is 17 min (10-35). The extraction of the foetus takes 53 sec (15-180). The exteriorization of the uterus doesn't affect the repair time. Leaving the visceral and parietal peritoneum unsutured can spare 5.5 min. The elective CS takes more time than the emergent one. The time from the beginning of the operation to the extraction of the foetus is longer in resection (7 min) than in first CS (5 min).

Anesthesia, Spinal↗
PubMed2002

Steps to soulful living (steps): a weight loss program for African-American women.

BACKGROUND: The disproportionate disease burden experienced by African-American women can be explained partially by the higher rates of obesity in this population. African-American women who can benefit from weight loss may be less likely to attempt it and may have relatively less success in using traditional weight loss programs compared to White women. Steps to Soulful Living (Steps) was a pilot study to test the effects of a culturally adapted weight loss program on weight loss in African-American women. METHODS: Sixty-six African-American women participated in a 6-month weight loss program that included weekly group meetings and supervised exercise sessions. Mean baseline body mass index was 39 kg/m2, and mean baseline weight was 107 kg. Cultural adaptations, defined as program adjustments, made in response to women's preferences as expressed in focus group interviews included changes in intervention format, the content of the group meetings, and the location and format of the exercise sessions. RESULTS: Seventy-six percent of the participants attended at least 50% of the 26 weekly sessions, and 56% attended at least 75% of the sessions. Average hours of exercise per week approximately doubled during the program in comparison to baseline levels. Mean weight loss at 26 weeks was 3.7 kg, categorizing those who were lost to follow-up as having zero weight loss. Participants who attended at least 75% of the group meetings lost a mean of 6.2 kg at six months. Those who attended fewer meetings lost a mean of 0.9 kg. CONCLUSIONS: This 6-month program was associated with relatively larger weight losses, particularly among participants with high attendance, than have usually been observed in culturally adapted programs for African-American women.

Adult↗
PubMed2003

Factors contributing to the incompatibility between simplified-step adhesives and chemically-cured or dual-cured composites. Part I. Single-step self-etching adhesive.

PURPOSE: To determine if adverse chemical interaction and adhesive permeability are both responsible for the incompatibility between a single-step, self-etching adhesive and chemically-cured or dual-cured composites. MATERIALS AND METHODS: Bonding was performed with Xeno CF Bond (Dentsply-Sankin), on either hydrated (H) or dehydrated (DH) human dentin. For microtensile bond strength evaluation, a dual-cured hybrid composite (Bis-Core) was activated using: (1) the light-cured (L) mode (base syringe only), (2) delayed light activation (DL) (base syringe left on top of cured adhesive in the dark for 20 min before activation), and (3) the chemically-cured (C) mode (base and catalyst syringes in the dark). A chemical co-initiator (B; BondLink) was also applied to the cured adhesive before coupling with the composite in chemically-cured mode. This resulted in seven experimental groups: (1) L-H (control); (2) DL-H; (3) DL-DH; (4) C-H; (5) C-DH; (6) C-B-H; and (7) C-B-DH. For transmission electron microscopy, the dual-cured composite in the seven groups was replaced with a light-cured microfilled composite (Metafil CX) and an experimental chemically-cured microfilled composite of the same composition. Specimens were immersed in ammoniacal silver nitrate for 24 h. After reduction of the diamine silver ions to silver, undemineralized and unstained sections were examined for nanoleakage within the resin-dentin interfaces of the seven groups. RESULTS: For the light-cured modes, bond strengths fell substantially in DL-H but not in DL-DH. For the chemically-cured modes, bond strengths were lowest in C-H and only increased slightly in C-DH. The use of a chemical co-initiator with the adhesive further improved the bond strength in C-B-H. Only C-B-DH was not significantly different from the control light-cured mode L-H. Two abnormal modes of silver deposition were observed in resin-dentin interfaces. A continuous layer of silver was observed when the chemically-cured composite was applied to the cured adhesive in the absence of the chemical co-initiator (C-H; C-DH). Silver-impregnated water blisters were identified when the chemically-cured composite was coupled to bonded hydrated dentin (C-H; C-B-H). Similar water blisters were seen in DL-H in which adverse chemical interaction should not occur. CONCLUSION: Adverse chemical interaction between catalytic components of chemically-cured composite and the tested single-step, self-etching adhesive was the major cause of reductions in bond strength, while adhesive permeability was a minor cause of bond strength reduction. The combination of these two factors accounts for the substantial reduction in bond strength when chemically-cured or dual-cured composites were coupled to bonded hydrated dentin.

Acid Etching, Dental↗
PubMed1992

A practical, step-by-step approach to stress management for women.

Stress is a significant threat to the physical and emotional health of contemporary American women. Primary health care providers are an excellent resource for women in need of education about the seriousness of stress. Clinicians can work with women to prevent unnecessary exposure to stressors and to help them learn adaptive coping skills. This article offers a practical, step-by-step approach to stress management for women. Assessment processes, planning concepts and relevant intervention strategies are discussed.

Adaptation, Psychological↗
PubMed2004

[An algorithm of step-by-step pedigree drawing].

An algorithm for drawing large, complex pedigrees containing inbred loops and multiple-mate families is presented. The algorithm is based on a step-by-step approach to imaging, when the researcher determines the direction of further extension of the scheme. The algorithm is implemented as the PedigreeQuery software package written in Java. The software has a convenient graphical interface. The software package permits constructing not only whole pedigrees, but also their fragments that are particularly interesting for research. It also allows for adding new information on the phenotypes and genotypes of pedigree members. PedigreeQuery is distributed free of charge; it is available at http://mga.bionet.msc.ru/PedigreeQuery/PedigreeQuery.html and ftp://mga.bionet.msc.ru/PedigreeQuery/.

Algorithms↗
PubMedDate not supplied

[Step by step approach--a method of working in stroke rehabilitation].

UNLABELLED: Modern stroke rehabilitation should be conducted on a step by step approach towards final achievable objectives. Guidelines about how to introduce this in daily work are however missing. The aim of the present study was to create and introduce a paradigm with intermediate and final objectives in a multidisciplinary stroke team. METHOD: Over a period of eight months the staff was trained to use team conferences to evaluate and formulate intermediate and final objectives. The staff s ability to formulate correct objectives and their knowledge about previously agreed targets were evaluated monthly through a questionnaire. RESULTS: The number of objectives that were accurately formulated improved from 50% to 90% and the caring team' s awareness of these improved from 45% to >80g. CONCLUSIONS: This model can be used to improve the multidisciplinary caring team's ability to formulate objectives and keep current objectives in mind in the daily work in a stroke unit.

Hospital Units↗
PubMed2006

Replacement of a fractured upper central incisor with an implant-supported crown: a step-by-step approach to achieve acceptable esthetics.

Implant-supported restorations in the upper anterior segment need to meet biological, functional, and esthetic requirements to be successful. Bone availability and soft-tissue characteristics in the area of implant placement are crucial for achieving maximum success. This article describes the steps involved in replacing a fractured upper central incisor with an implant-supported crown. Using surgical techniques involving extraction socket preservation/augmentation and connective tissue grafting, ideal positioning of the implant was possible and gingival contours were idealized. With this multiple step treatment, the final restoration met biological and functional requirements and its esthetic results were maximized.

Bone Matrix↗
PubMed2006

Step up to the step-down method.

CFOs can use the Medicare cost report step-down method to allocate costs by service line and then develop an income matrix. With an income matrix and tiered expenses by service areas, CFOs can direct corrective action to improve financial performance. The cost data derived from the step-down method can also be used to set prices and to negotiate third-party contracts.

Accounting↗
PubMed1989

Evaluation of goblet cells in conjunctival impression cytology by multiple-step & two-step staining techniques.

Two staining techniques for conjunctival impression cytology (CIC) were evaluated in both eyes of 106 subjects with either early clinical signs of xerophthalmia (17%) or without any obvious ocular disease (83%). One technique consisted of eleven steps of staining while the other of two steps. The slides were evaluated independently in a masked fashion by two readers using three criteria for evaluation of CIC, viz., goblet cells, mucin spots and epithelial cells. By either method, both readers had greatest agreement in evaluation of the goblet cells, the percentage difference being statistically not significant. Errors in interpretation of CIC can be minimized if goblet cells alone are considered as the major criterion of evaluation.

Child, Preschool↗
PubMed1989

[Interaction of thrombocytes with immobilized collagen in the vascular wall (a model for step-by-step study of formation of parietal thrombi)].

Scanning electron microscopy was used to examine the interaction of platelets with types I, III, IV, and V human collagens (CI, CIII, CIV, and CV substrates) immobilized on the surface of cultural plates. Basic differences were found in the activity of collagen substrates against platelets. On the CV substrate, virtually all the adhesive platelets were in a non-spreading++ state, i.e. at the stage of initial attachment to the spread. The CIV substrate showed initial attachment, spreading, and attachment of platelets from the suspension to the spread platelets. In addition to the processes occurring at the CIV substrate, the CI and CIII substrates produced multilayer platelet aggregates on the strata of spreading platelets (thromboid aggregates). The surfaces covered with various types of collagens are an adequate model for quantitative step-by-step study of the formation of parietal thrombocytic thrombi and of mechanisms of this process control.

Blood Vessels↗