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Fulfilling the sisters' promise. The heritage of healthcare's early days.

Members of religious orders--the sisters--built not just Catholic healthcare, but healthcare in America. A good 50 years before Henry and Edgar Kaiser got the idea, prepaid capitated health insurance was being offered by sisters who looked at what was needed and realized this was simply the best way to get it done. The sisters also created the integrated healthcare system at a time when the emerging medical elite wanted nothing to do with any patient who was not socially acceptable and potentially curable. They arranged a continuum of care for the aging sisters within their own communities. And they understood the concept of social medicine, of population-based healthcare, of healthy communities, long before these ideas became commonplace. But the sisters are gone, most of them. The question today is, How do we preserve the sisters' heritage and transfer it to a new millennium, a new healthcare system, and a new set of rules? First, it is important to understand that much of what we remember the sisters for--courage, compassion, vision-was not unique. They created many of the structures that today are the new models; but they were not alone. However, three aspects of how they expressed their vision and their faith were unique to the sisters and must be understood by those who wish to treat the path the sisters blazed. The purity of their commitment and its underlying philosophy--that the helpless and the sick must always be the point of the exercise--should pervade Catholic healthcare to its soul. These women, living in poverty, represented, and still represent, a singular group: a group of women who, having told the world that their only wish is to serve others, humble became CEOs of vast systems and trustees of huge enterprises, without ever abandoning that simple, original pledge. Although they bowed to the rule of obedience, and they were humble, the were fighters. They spoke out against poverty, bigotry, the shunning of those with certain diseases, lack of access to healthcare, stupidity, ignorance, and hate.

Altruism↗

[The importance of the guide dog--does the guide dog still have a place in the next century?].

The guide dog is the sole living sensory aid recognized by Germany's statutory health insurance and medical rehabilitation system to help a blind person to compensate for the loss of eyesight. The guide dog is also the only recognized mobility aid that enables a blind person to reach destinations with greater speed and confidence by locating obstacles such as steps and ditches and avoiding them. Leading a person through traffic is not a dog's natural trait. Therefore, training and safety standards are essential to ensure smooth teamwork and communication between handler and dog. The guide dog offers much more than a simple technical aid such as a walking stick but not as much as a seeing human companion. To make up for this deficit, the blind person must also learn how to orientate him or herself and not just depend on the dog. For people blinded later in life a reliable guide dog can be an "aid with soul" that provides pet-facilitated therapy and companionship. On the other hand, a guide dog with character disturbances, physical deficiencies or insufficient training can become an additional burden and social hindrance--even a danger for the person it is supposed to be protecting and others such as motorists. The puppy chosen to become a guide dog requires expert trainers and host families to rear and socialize it to interact appropriately with other dogs and other human beings. This stable upbringing is particularly important for the dog as it grows up and is confronted with negative influences. The blind person too learns to conceptualize the animal's own "dog world" so that he or she can build a firmer bond of trust.

Animal Rights↗

Performance appraisal and career development: a shotgun marriage.

Both performance and career development have potential for developing human resources--potential that can be increased by linking them together, says author Beverly L. Kaye, organization consultant. This marriage of convenience--and common sense--not only produces synergy, but also strengthens each process individually. Stressing a win/win approach designed to meet the needs of both individual employees and the organization, Kaye first examines the preparation required--preparation in terms of communication, especially listening and giving feedback; awareness of employees as individuals; the recognition that developmental moves are not always upward ones; and time assigned to soul-searching and self-assessment. However well the processes are integrated, the manager is still primarily responsible for performance appraisal and the employee for career development. Kaye offers a checklist of questions designed to help each.

Career Mobility↗

Products and presentations thereof. New and novel services and their promotions.

When we emerged from our last print ad review (our printable name for our collective "sitting-on-the-floor-to-discuss-and -cull-from-thousands-of-print-ads-sent-by-our-clipping-service-and -getting-absolutely-filthy-in-the-process"), we had seen something strikingly interesting. We had found hospitals offering a wide range of programs--from all sorts of psychiatric services ... to headache management ... to special women's events ... to impotence treatment and much more--in volume we had not seen before. The variety of new programs, as demonstrated by print advertisements, is truly remarkable. Our plan, then, became to investigate the print ads and their response, with special emphasis on the programs that are the foundation for the ads. We found hospitals listening to their communities, then developing programs that match institutional resources to consumer needs. In most cases, the ad campaigns followed careful research and considerable institutional soul-searching. Also, in most cases, when research and consideration followed study but preceded ad development, the campaigns worked. We hope that you enjoy seeing, and learning from, what your colleagues (and maybe your competition) are doing.

Advertising↗

Neurosciences - A neurosurgeon's perspective.

The advancements in the field of science in the past fifty years have highlighted the need to integrate all fields of human endeavours and have emphasised interdependency of various disciplines. The separation of humanities, therefore, from neurosciences is a preposterous practical joke on all thinking men. With the human genome project on the anvil, biotechnology is making significant headway holding out promise for organ regeneration. Macro evolution is over, but micro-evolution continues in the brain. Neural Darwinism thus, continues to evolve as long as individual remains conscious and has memory. In the milieu of widely varying internal physiological mechanisms and external stimuli, an alternative theory to preprogrammed directionalism is proposed by three mechanisms namely developmental variation and selection, experiential selections and reentrant signalling. Reentrant signalling reorients and correlates the external inputs leading to psychic development preceding the development of consciousness. The cholinergic and aminergic neuro-modelling systems are well suited to serve as value systems. The main achievement of consciousness is to bring together the many categorizations involved in perceptions into a SCENE. Another part of evolution involved capacity of reentrant signalling to be guided by a value system where it is provided with a lot of choices. With 10(13) neurons and 10(16) connections, freedom of choice may manifest into a 'Buddha' or a 'Hitler'. As part of the evolutionary process, it was interesting how capacity to categorize the need to worship by referring to environment outside evolved into a search within our minds. As the next stage of evolution, neuroscience may, thus, serve as the next gateway to understanding the mind and soul.

Buddhism↗

Fragments of tradition: revisiting the virtues of wine.

Wine is a characteristic example of how difficult it is to make a clear-cut distinction between products that are good for man's health and those that damage it. Over the centuries wine has not only been used as a foodstuff, a luxury item and a poison, but also a drug, a carrier for preparing medicines, a cure-all for the ills of the body and soul, and has even assumed an aura of holiness and mysticism. All of these can fall into the categories of treatment and prevention. In taking an historic look at the various opportunities wine has provided over the centuries--especially in the history of pharmacy--the aim is not to reject the product, but rather to reconfirm its qualities in the light of recent discoveries, and above all, highlight how these qualities are inherent to the product as a whole, not just in terms of its individual components. Wine has many characteristics that could classify it as a plant compound. This could serve as a reevaluation of tradition and traditional medicines, not by dissecting them, but by reconsidering them in their historical, medical and even religious entireties. Finally, but no less importantly, some active ingredients of wine with acknowledged therapeutic properties have been used for millennia in traditional Chinese plant therapy. Ingredients contained in other plants have been used for the same purposes and have recently been "scientifically" discovered.

Health↗

[The human being from the point of view of animals or, "Who knows whether the breath of men goes upwards?" (Ecclesiastes 3:21)].

The question of whether animals have souls has been asked since as early as the Old Testament. Where this is believed to be true, fiction has provided interesting models in literature: The human being as seen by animals has been a popular subject since Apuleius' 'Asinus aureus' and how man appears from the perspective of a donkey or a beetle, that is to say the perspective from below, becomes controversial. Examples may be found in all languages and centuries in Jonathan Swift, Miguel Cervantes, E. T. A. Hoffmann, Ludwig Tieck, Heinrich Heine, Viktor von Scheffel, Franz Kafka and others. Résumé at the end: How does man answer this question or his own self-questioning?

Animal Population Groups↗

The renewal of aristocratic principles.

The term of "aristocracy" has always risen various questions, such as its real meaning, its role, its types, its purposes, who composes aristocracy, etc. In this text, I have tried to give my point of view to those questions, not only in a historical and traditional line of development, but also applied to present systems, relations and sets of values. I have differentiated two types of aristocracy, so called "aristocracy of soul" and "aristocracy of property" and decsribed main features. Furthermore, there is a view to traditional role of aristocracy, its principles and laws of existence, together with its dangers. Based on those categories, further direction of development leads to the questions of aristocracy in democratic societies with all the contemporary "specificum". The last part deals with the matter of aristocracy in regard to politics and its wide range of application.

Hierarchy, Social↗

Informed consent, parental permission, and assent in pediatric practice. Committee on Bioethics.

The statement on informed consent, parental permission, and patient assent has a long and extraordinary history. The first draft of this document, prepared by William G. Bartholome, MD, was presented to the original American Academy of Pediatrics (AAP) Committee on Bioethics in 1985. Bill put his soul into the manuscript and has watched over it carefully ever since. Now, a decade later, those who have worked on its continued development and urged its adoption as Academy policy applaud its publication. No one is more gratified than its primary author and champion. Those who have had the privilege to know Dr. Bartholome share his sense of accomplishment, but cannot help but experience a cruel sense of irony. Just as the work Bill considers his most important contribution has become available for public appreciation, Dr. Bartholome suffers from a serious illness that threatens his life. Bill always wanted "the experience, perspective, and power of children" to be taken most seriously. Through the years of the statement's revisions and re-presentation within the Academy, Bill "had faith in the power of the text and the ideas it contained, ... that its time would come." The statement embodies Bill Bartholome's dedication to children. Throughout his career, he worked to make medicine and medical research safer and more friendly for children. The AAP and its Committee on Bioethics, on behalf of all our colleagues, extend heartfelt thanks to Dr. William G. Bartholome for helping us more fully appreciate that children are in the process of becoming, in his words, "intelligent, observant, capable, and responsible persons" who deserve our utmost respect.

Child↗

[Spiritual needs at the end of life].

All human beings have been dieting since two million of years, and since 100,000 years they have surrounded death with rites and religious considerations, which reflect a basic need to assume the end of life with spirituality. Religion helps to prepare patients spiritually in the end of their life to cope with death as something which cannot be eluded. We are all bound to die. A spiritual fullness should contribute to the serenity and to strengthening of the soul at the end of life.

Attitude to Death↗

[Is pastoral care psychotherapy?].

Whilst pastoral work is aimed at the consciousness of men, the duty of the psychotherapist is to turn the subconscious into the conscious. After clarifying the situation in his inner world the patient should be able to take free decisions. The psychotherapist is not responsible for the decision made by the person, which means that the conscious area is the responsibility of the individual. The psychotherapist must not manipulate the conscious parts just as the clergy must not manipulate the subconscious. So whilst there is a difference in both areas that must be maintained, that difference is less than the two have in common. The common aim or goal is: 1. The basis of both areas is a 'Socratic optimism' rooted in the fact that pastoral work and psychotherapy want the person to discover his or her own truth which cannot be told to him or her. However, it can be found by the person with assistance. 2. Both are characterised by a pragmatic individualism that says that it is worth listening to a single person for days, weeks, months or years until it is ascertained what the soul suffers from. 3. Both are convinced that the truth of a person cannot be described in moral categories. Social and ethical standards don't help but they may reflect the symptoms and the distress of the person. 4. Taking into consideration the dimension of the subconscious in pastoral duty as well, human decisions and activity can be understood much better.

Consciousness↗

Leadership: the elusive search for fit.

When filling important jobs, a good fit now works both ways. "Recruiting is an attitude," says one executive search pro. "And it's marketing." It's also equal parts horse sense, careful interviewing, and soul-searching. No matter how down-pat your organization's recruiting process, a refresher will keep you on your toes and a bad fit from disrupting your strategy--or your sleep.

Hospital Administrators↗

9th Chapter of Surgeons' Lecture: the orthopaedic surgeon: historical perspective, ethical considerations and the future.

From a fishing village with colonial surgeons from the East India Company, Singapore is now a medical and business hub servicing the region and beyond in trade and medical education. Orthopaedic Surgery is a young specialty and is the fastest growing sub-specialty in Surgery. Orthopaedic education in Singapore has a structured syllabus and training is coordinated with the Royal Colleges and the American Academy of Orthopaedic Surgeons. Part of the training as Fellows is in the United Kingdom and USA on an HMDP Fellowship. Ethics and Continuing Medical Education need further emphasis. Sub-specialisation in Orthopaedic Surgery is now well-established in Trauma, Adult Reconstructive Surgery, Sports Medicine, Spinal Surgery, Hand Surgery and Rehabilitation Medicine. Ageing in the next millennium with osteoporosis and hip fracture problems of gait and balance need more orthopaedic surgeons to be committed to rehabilitation medicine and voluntary service in the community. There is a need for good role models and knowledge on Quality Assurance, Clinical Pathways and Administration. Appropriate use of high technology and care for the aged in the community with dignity is fundamental to good ethical practice. Selfish, pecuniary interests will destroy the very soul and fabric of medicine.

Curriculum↗

Freud and film: encounters in the Weltgeist.

Freud's antipathy toward film is striking, since film and dreams are formed by similar mechanisms. Nevertheless, Freud occasionally and unavoidably encountered film. This paper details some of these encounters. Ten years after viewing time-lapse photography, a fore-runner of moving pictures, at the Salpêtrière, he was conceptualizing a model of the mind and of the formation of dreams that in some ways parallels the film apparatus invented by the Lumière brothers in December 1895. On his visit to America in 1905, Freud saw movies in New York City. In 1925, he refused a lucrative offer to consult on a film, and he discouraged Karl Abraham and Hanns Sachs from consulting on the first psychoanalytic film, Pabst's Secrets of a Soul (1926). He was, however, once sighted viewing an American double feature in Vienna. The paper closes with a critique of his acting in home movies.

Art↗

Morphological phenotypes in neoplastic progression of human breast epithelial cells.

Neoplastic progression is a prolonged and stepwise process, while tumor growth occurs after a series of molecular alterations that culminate in tumorigenesis. The phenotypic changes of transformation in breast carcinogenesis were studied through the use of scanning and transmission electron microscopy. MCF 10F, a spontaneously immortalized human breast epithelial cell line (Soule et al., 1990), was treated with 7,12 dimethylbenz(a)anthracene (DMBA) (Calaf and Russo, 1993) and then transfected with the c-Ha-ras oncogene (Calaf et al., 1995). Treated cells showed a progression in altered morphology, anchorage independency, invasiveness and tumorigenicity in the SCID. Scanning and transmission electron microscopy illustrated that the transformed cells could be distinguished from control cells by the expression of morphological characteristics such as loss of contact inhibition, irregular size and shape, emission of long filopodia and formation of stratified layers. In contrast, control cells showed uniform, flattened and polyhedrical cells, well closely juxtaposed to each other and joined by cytoplasmic interdigitations. Control cells also did not form colonies in agar-methocel, and were not invasive or tumorigenic in SCID mice. These studies showed the progression of breast carcinogenesis by phenotypical changes induced by the carcinogen and the insertion of the c-Ha-ras oncogene.

9,10-Dimethyl-1,2-benzanthracene↗

God, mammon and the physician: medicine in England before the college.

Medieval medical practice has all too often been depicted by historians as ineffective, overpriced and riddled with superstition. Yet the physician, who boasted an impressive range of academic accomplishments, exercised considerable influence in political, religious and cultural affairs. How was this achieved? The overwhelming authority of the Church, in an age of high mortality, when life was generally painful as well as short, helps to explain an apparent paradox. For the practitioner, who was often also a priest, dealt with spiritual as well as earthly diseases, plumbing the recesses of men's souls while he examined their bodies. He was a confidant and mentor, offering advice on all aspects of the human condition. Since physical suffering was often regarded as a consequence of sin, confession loomed large in treatment. Indeed, the practice of both medicine and surgery was regulated by canon law, which looked beyond mere physical fitness to the quest for eternal salvation.

Cultural Characteristics↗

The acute behavioral syndrome of anterior thalamic infarction: a prospective study of 12 cases.

Using systematic investigations, including neurological and neuropsychological examinations and computed tomography and magnetic resonance imaging analyzed on anatomical maps, we prospectively studied 12 patients (age range, 63+/-19 years) with an isolated anterior thalamic infarct. They had acute, severe, perseverative behavior, which was apparent in thinking, speech, and all memory and executive tasks, combined with increased sensitivity to interference. They also showed superimposition of mental activities normally processed sequentially (e.g., giving biographical information while working on a calculation test), which we called palipsychism (from the Greek palin [again] and the Greek psyche [soul]). In addition, all 12 patients (8 with a left-sided infarct, 4 with a right-sided infarct) had word-finding difficulties, 7 of 12 with impaired naming, 8 of 12 with dysarthria, and 5 of 12 with hypophonia. Comprehension, repetition, written abilities, and reasoning were consistently preserved, but apathy was usual. All patients had anterograde memory impairment, with a delayed recall deficit, primarily verbal in left-sided infarcts and visuospatial in right-sided infarcts. Dysexecutive features such as difficulty in programming motor sequences were always present. Visual neglect or topographic disorientation was found in 3 patients. Magnetic resonance imaging emphasized involvement of the anterior group of thalamic nuclei, the mamillothalamic tract, and the anterior part of the internal medullary lamina, with structural sparing of the dorsomedial and ventrolateral nuclei. Sequential follow-up examinations showed spectacular improvement within a few months, with the only significant persisting abnormalities being memory dysfunction and apathy. The acute behavioral syndrome of anterior thalamic infarction is dominated by palipsychism, which corresponds to an overlap of sequential cognitive processes in two or more domains. Its association with severe perseverative behavior with increased sensitivity to interference, anterograde memory retrieval deficit, intrusions, naming difficulties with dysarthria and hypophonia, and apathy is suggestive of this type of infarct.

Anterior Thalamic Nuclei↗

Comparative bioavailability study of two ketoconazole tablet preparations.

The bioavailability of a generic preparation of ketoconazole (Zorinax from Xepa-Soul Pattinson, Malaysia) was evaluated in comparison with the innovator product (Nizoral from Janssen Pharmaceutica, Switzerland). Eighteen healthy male volunteers participated in the study conducted according to a two-way crossover design. The bioavailability was compared using the parameters, total area under the plasma concentration-time curve (AUC0-infinity), peak plasma concentration (Cmax) and time to reach peak plasma concentration (Tmax). No statistically significant difference was observed between the values of the two products in all the three parameters. Moreover, the 90% confidence interval for the ratio of the logarithmic transformed AUC0-infinity and Cmax values of Zorinax over Nizoral was found to lie between 0.82-1.04 and 0.83-1.02, respectively, being within the acceptable equivalence limit of 0.80-1.25. These findings indicate that the two preparations are comparable in the extent and rate of absorption. In addition, the elimination rate constant (ke) and apparent volume of distribution (Vd) were calculated. For both parameters, there was no statistically significant difference between the values obtained from the data of the two preparations. Moreover, the values are comparable to those reported in the literature.

Adult↗