[Meeting of the Italian Society of Chemotherapy at Milan].
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Technology is only one solution to a complex problem. Speech-language pathologists need to evaluate and apply existing service delivery systems carefully. We also need to develop innovative and creative alternatives. Rather than continuing to fit our clients into the existing systems, we need to promote systems that more adequately meet their needs, regardless of barriers. Given the diversity of rural America, no single model or strategy is enough. A model that may work in one remote/rural island or desert area may not work in a rural farm community. At times a combination model may be the most efficient and effective means for serving our clients. The problems in service delivery to the underserved populations in remote/rural areas can be solved. The solutions require flexibility and adaptability of traditional, alternate, and innovative service delivery models, depending on the unique characteristics of the community.
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Hitherto it has not been usual to talk in the German language about the therapy-oriented concept of two forms of the progress of atypical depression (Type A and Type V). The characteristic symptom of Type A is angst, together with phobias, physical complaints, etc. In Type V there are vegetative symptoms, often towards evening (Hypersomnia, difficulty in getting to sleep, increased appetite, increased weight, increased libido), accompanied by hysterical extrovert personality traits, and of intermittent occurrence. These clinical pictures are amenable to psychopharmalogical therapy. In conformity with the assumption of "somatic accommodation" treatment with antidepressives is recommended in the case neurotic depression, too, at least in the initial stages of treatment.
The Oral-Facial and Communicative Disorders Program of the University of North Carolina has provided comprehensive diagnostic evaluation and inpatient and outpatient treatment for patients with cleft lip, cleft palate, and related problems for 22 years. A major aspect of the program is the initial diagnostic evaluation of patients and long-term follow-up evaluation of the results of treatment. The Oral-Facial and Communicative Disorders Program acts as both a consultant in providing requested information to referring professionals and agencies and also as a multi- and interdisciplinary treatment center. The nature of the evaluation process and the manner in which findings and recommendations are agreed upon in order that a comprehensive and coherent treatment plan can be established has been presented. It has been stressed that the needs of the patient can best be met by representatives from disciplines important to the diagnosis and management of patients with cleft lip and cleft palate who can meet together, and after discussion and negotiation arrive at a consensus for every aspect of treatment that is required, as well as a time that is most desirable for each patient.
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