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PubMed1999

Organize for success: seven steps to a successful building project.

Intended for ambulatory care administrators considering a building project, the article discusses seven key steps to a successful project: Avoid common pitfalls: allow enough time, avoid over-delegation, focus staff on issues rather than egos, require staff "buy-ins" to project concepts and design, and understand the realties of construction. Select the right team: how to interview, assess qualifications, and make a sound decision. Understand all the project costs; construction cost is only one of many. Understand the various construction methods and pricing alternatives; become a sophisticated consumer. Understand the nature and scope of the risks inherent in building projects. Understand all the management issues. Start your project off right through producing. Identify strategic goals and needs, then quantify and qualify your project's intent, scope, and basic financial assumptions.

Ambulatory Care Facilities↗
PubMed1995

How do GPs discuss subjects other than illness? Formulating and evaluating a theoretical model to explain successful and less successful approaches to discussing psychosocial issues.

A theoretical model was formed, according to grounded theory, to understand how discussions about psychosocial problems might be designed. It was used in 19 videotaped consultations where it was considered relevant for the physician to take up psychosocial issues. 'Concern' i.e. that the patient could express that which was most pressing, was used as an indicator of outcome. A uniform pattern was observed in those cases where the patients expressed 'concern', in that the physician encouraged the patient by using open-ended questions, by following up the information received, and by having an empathic approach. On the other hand, in consultations where 'concern' was not expressed, it was noticed that the physician often asked close-ended, leading or negative questions, thus putting an end to the dialogue and, as a consequence, to the follow-up phase. Important therapeutic skills would appear to be the ability to reassure and support the patient as well as to be able to explain the connection between the patient's symptoms and psychosocial problems, rather than to solve these problems.

Adult↗
PubMedDate not supplied

Dress for success. A nurse's knowledge of simple clothing adaptations and dressing aids may make the difference between rehabilitation success and failure.

Typical chronic diseases that affect older people often result in the loss of independence in daily activities, such as dressing. Losses of functional independence in such basic areas are factors in the institutionalization of elderly persons. The nurse's challenge? Help your clients remain independent. Simple clothing adaptations and dressing aids will help elderly people preserve self-esteem, social contacts, and control of their personal environment.

Aged↗
PubMed2000

Successful and not so successful chemoprevention of tobacco smoke-induced lung tumors.

Strain A/J mice underwent whole body exposure for 6 hours a day, 5 days a week, for 5 months to a mixture of cigarette sidestream and mainstream smoke (89%-11%; total suspended particulates 80-150 mg/m3), then were kept for another 4 months in air before being killed for scoring of lung tumors. In 7 independent experiments, lung tumor multiplicity was significantly increased in all 7 trials and lung tumor incidence in 5. When animals were kept for 9 months in smoke, lung tumor multiplicity was not significantly higher than in controls, although lung tumor incidence was. The following chemopreventive agents were evaluated: green tea, phenethyl isothiocyanate (PEITC), acetylsalicylic acid (ASA), N-acetylcysteine (NAC), p-XSC (1,4-phenylenebis[methylene]selenocyanate), d-limonene (DL), and a mixture of PEITC and BITC (benzyl isothiocyanate). In animals exposed to tobacco smoke, none of these agents reduced lung tumor multiplicity or incidence. As a control, the effects of the same agents were examined in A/J mice initiated with 4-(methylnitrosamino)-1-(3pyridyl)-1-butanone (NNK) or urethane. In mice injected with NNK, green tea and ASA did not reduce lung tumor multiplicities and NAC had no effect on urethane-induced lung tumors, whereas PEITC, p-XSC and DL reduced NNK-induced tumor multiplicities to 20% to 50% of control values. On the other hand, dietary mixture of myoinositol and dexamethasone was not only highly protective against NNK, but reduced lung tumor multiplicities and incidence in smoke-exposed animals to control values. This effect was also seen when the animals were fed the myo-inositol-dexamethasone mixture once they were removed from smoke. It is concluded that in animal studies it might be preferable to evaluate the effectiveness of putative chemopreventive agents against full tobacco smoke rather than against selected model compounds. The observations made with myo-inositol-dexamethasone suggest that people who have recently quit smoking might benefit the most from active chemoprevention.

Animals↗
PubMed2004

What is the most relevant standard of success in assisted reproduction? Redefining success in the context of elective single embryo transfer: evidence, intuition and financial reality.

Treatment-related multiple pregnancy poses the biggest threat to the safety of IVF. Despite a double embryo transfer (DET) policy in most European centres, twin rates continue to be unacceptably high, at 20-35%. Elective single embryo transfer (SET) is an effective way to minimize twin pregnancies, but the debate surrounding its routine clinical use continues. A review of the literature was undertaken in order to seek evidence about the effectiveness of SET, and identify barriers to its acceptance in clinical practice. Data from randomized controlled trials (RCTs) indicate that SET results in lower live birth rates per fresh IVF cycle (odds ratio 0.53; 95% confidence interval 0.31-0.89; P = 0.02) in comparison with DET. Data on cumulative live birth rates are unavailable from RCTs, although the expectation is that these are comparable in the two groups. SET is unlikely to be suitable for all women undergoing IVF and outcomes may be sensitive to different laboratory protocols. The perceived effectiveness of SET is influenced by the way existing evidence is interpreted. Other factors affecting the routine use of SET include laboratory techniques, individual preferences and funding issues.

Embryo Transfer↗
PubMed2005

Successful reintroduction of a different erythropoiesis-stimulating agent after pure red cell aplasia: relapse after successful therapy with prednisone.

We report a 3-year case history that describes a 78-year-old woman with recurrent transfusion-dependent pure red cell aplasia (PRCA) secondary to recombinant epoetin use that was responsive to immunosuppressant therapy. The patient had kidney disease of unknown aetiology (estimated glomerular filtration rate of 13 ml/min/1.73 m2) and was not on dialysis. After 16 months of therapy with subcutaneous Eprex, she developed anti-erythropoietin antibody-confirmed PRCA and was started on high dose prednisone (50 mg per day). Within 5 months, the patient's serum was clear of antibodies and, under the cover of low dose prednisone (5-7.5 mg per day), therapy with a different erythropoiesis-stimulating compound (Aranesp) was initiated due to persistent fatigue and anaemia. At 3 months of therapy, the serum anti-erythropoietin antibodies remained negative and, due to the patient's requests, and after discussion, prednisone therapy was discontinued. Unfortunately, 3 months after cessation of prednisone, a recurrence of PRCA was confirmed by the development of profound anaemia and reappearance of anti-erythropoietin antibodies in the patient's serum. High dose prednisone (50 mg per day) was reinstituted, whereupon, 2 months later, antibodies were again confirmed to be negative. This case report demonstrates the responsiveness of PRCA to simple immunosuppressive therapy, and the ability to introduce different erythropoiesis-stimulating agents in the presence of such therapy. It appears that there may be problems associated with discontinuation of immunosuppressive therapy in the presence of sustained erythropoiesis-stimulating agent therapy in those in whom the condition has occurred previously.

Aged↗