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Customer satisfaction in the emergency department.

Patient satisfaction is not merely a "smile and be nice" set of behaviors. It is a philosophy that is founded in the concept that the patient's experience of care is important and ultimately translates into their actual response to care. The improved response to care that patients exhibit makes patient satisfaction important from a clinical vantage point. That point alone is enough to justify implementation of and commitment to a customer satisfaction program. There are, however, other compelling reasons also. Customer satisfaction has profound ramifications for the financial status of the institution and for its professional reputation in the community. The caregivers who participate in a system of good customer satisfaction experience fewer malpractice suits than their counterparts. And they enjoy a work environment that is more stable and pleasant than other institutions. The implementation of a meaningful customer service program is a huge task. It is a fundamental culture change that requires vision, long-term commitment, and constant surveillance. The single most critical factor in the successful implementation of a program that produces all the gains that it promises is leadership. Leadership must set the stage, create the atmosphere,demand that staff meet expectations, reward success, provide an example,and shape the new culture. Without strong, clear leadership, any customer service initiative will be simply a hospital-wide exercise, and those staff members who harbor a cynical viewpoint will be proved right in the end.One major difference between a successful customer service initiative and an unsuccessful one is the level of sincerity the hospital and its staff have about the care they express for their patients. If the whole process is merely an exercise to improve scores, the success will be limited and without deep roots. If the push is to establish an atmosphere of genuine care and interest for patients, however, the results are more meaningful, longer lasting, and more appreciated by patients and staff.

Emergency Service, Hospital↗

Maternal responsiveness of socially high-risk mothers to the elicitation cues of their 7-month-old infants.

This descriptive study of 19 socially high-risk mother-infant dyads in naturalistic interaction focused on maternal response to infant elicitation cues. Maternal response behavior was coded on a continuum from underresponsive to adequate to overresponsive. Maternal affect was rated separately using selected items from an existing scale. As a whole, the maternal sample was emotionally depressed and largely underresponsive to infant cues. When placed by maternal response into adequate, overresponsive, and underresponsive subgroups, adequate mothers more often responded appropriately to infant cues, were never physically unavailable to their infants, showed no anxiety, and were more positively responsive to their infants' smiles and cries. Adequate mothers scored higher in all affective areas. Maternal depression was associated with both overresponse and underresponse. Angry maternal mood was significantly related to underresponse. Considerable maternal strength lies in this high-risk sample and could be the basis for therapeutic intervention to normalize parenting.

Adult↗

Treatment of a Class I bimaxillary protrusive malocclusion with a high mandibular plane angle: An American Board of Orthodontics case report.

A case report of the orthodontic treatment of a male adolescent with a Class I bimaxillary protrusive malocclusion, complicated by a vertical growth pattern and high mandibular plane angle. Treatment consisted of extraction of maxillary second premolars, mandibular first premolars, use of a transpalatal bar, occipital pull headgear, and light wire mechanics. An acceptable result was achieved, with a decrease in the facial axis, decrease in lip strain, and an attractive full smile. This case report was presented to the American Board of Orthodontics in partial fulfillment of the requirements for the certification process conducted by the Board.

Bicuspid↗

Class II, Division 1 malocclusion treated with molar distalization therapy.

A case report of an 11-year-old black girl with a Class II, Division 1 malocclusion is presented. There was associated lip incompetence and excessive display of gingiva on smiling. Nonextraction treatment was undertaken with distalization of maxillary molars to correct the Class II relationship. [This case was presented at the annual session of the American Association of Orthodontists held in Orlando, 1994. This was part of the University of Oklahoma, Department of Orthodontics participation in the display of patients treated by graduate students sponsored by the College of Diplomates, American Board of Orthodontics.]

Cephalometry↗

Impacted maxillary central incisor in mixed dentition treatment.

The impacted maxillary central incisor in a child poses a disturbing esthetic dilemma to parents, by virtue of its location. Neither the orthodontist nor the parents prefer to wait for the fully erupted permanent dentition and comprehensive orthodontics to resolve this problem. This challenge can be met in the early mixed dentition stage, as described with these two cases. The response to the technique was excellent. The patients now possess confidence to smile and have enhanced self-esteem, which is critical even in early life. Just as important is that the newly positioned maxillary central incisor is the natural tooth, not a temporary prosthesis that can loosen or break. Gingival contour is a consideration, however.

Child↗

The use of oral midazolam in accident and emergency to reduce anxiety in children.

The injured child can react to a visit to the Accident and Emergency (A & E) department in many ways. The strange noise, people, environment or their frightened parents may be overwhelming for the child. The screaming, uncooperative child can be as hard to manage as the silent unpredictable child, and there are also the smiling, laughing 'you can do anything to me within reason' children. As all these children present at our triage stations, the vast majority can be assessed quickly and efficiently with regard to their anxiety. As experienced A & E nurses we know which child will probably have to endure a painful procedure, which ones will cope well and which will not. This article aims to discuss one method of reducing anxiety for our paediatric clientele, oral midazolam. There is a need for sedation in some children; this will be further explained. The pharmacology of midazolam will be briefly looked at, within this article further detail is not necessary. The main discussion will be the introduction and the current use of oral midazolam in A & E at Leeds General Infirmary (LGI, UK). Some concerns and worries will be considered.

Administration, Oral↗

[An anthropological study of radiotherapy care experience].

An anthropological study has been carried out in order to evaluate the need expressed by patients undergoing radiotherapy treatment. The study was mostly qualitative and based on the radiotherapy experiences of 13 women with breast cancer and six men with head and neck cancer. A 24-year-old female anthropologist spent one year in the department of radiotherapy at the Bergonié Institute in Bordeaux. She collected data on patients' needs through the observation of their experience of treatment and personal interviews. These were put in context, analyzed both by qualitative and quantitative methods. The results point out the need for more information on the different steps of treatment and the patient's need 'for a smile' from the medical team; in other words, emphatic support.

Adult↗

[The patient care experience in radiotherapy: perspectives for better patient support].

This paper reports the patient care experience during the course of the radiotherapy. Plights are multiple. Patients are confronted with a complex and unknown distressing space, an irrelavant information, a banalization of side effects, an isolation with a frequent inadequate support of their family or the caregivers team, with the fear of a definitive abandonment at the end of the treatment without comforting follow-up. It is imperative to state a real policy in order to improve the patient support. Sensibilization and training of the caregivers, in spite of a frequent overbooking technical work, is required in a pluridisciplinary approach to provide a relevant reception with the collaboration of psychologists, social workers and self care groups and associations. The personal implication of the physicians and technologists is also essential. The simple smile is the intangible proof of the reliable emotional support.

Attitude of Health Personnel↗

Visual clues to emotional states: Rodin's "Burghers of Calais".

In the well-known, recorded Gsell-Rodin conversations of 1911, Gsell summarized Rodin's theory of the expressiveness of the human image: "Generally the face alone is considered to be the mirror of the soul: the mobility of the features of the face seems to us the unique exteriorization of the spiritual life. In reality, there is not one muscle of the body that does not express variations within. Each speaks of joy or sadness, enthusiasm or despair, calm or rage. Out-stretched arms, an unrestrained torso can smile with as much sweetness as eyes or lips. But in order to be able to interpret all aspects of the flesh, one must be trained patiently in the spelling and reading of the pages of this beautiful book" (Art: Conversations With Paul Gsell. Translated by deCaso J, Sanders PB. Berkeley, CA, University of California Press, 1984, p 10). The question thus arises, how can we as students of the human condition undertake this necessary training? How might we develop the aesthetic senses to appreciate the legibility of the human face and form more fully? For assistance in this undertaking we naturally turn to the artist. For the artist "sees" the world through eyes trained to acutely appreciate color, light and shadow, surface and volume, and inner truth. In particular, the education and training of Rodin, and the development of his artistic technique and insight, offer the health care professional rich intellectual material for this study. A closer look at the conception and evolution of Rodin's masterpiece, "The Burghers of Calais," amply illustrates this vision.

Altruism↗

Neuropsychological and neuropsychiatric perspectives on maternal cradling preferences.

OBJECTIVE: To assess competing explanations for the universal preference of mothers to cradle infants on their left side and to propose a relation to hemispheric asymmetry for social attachment and communication behaviour. METHODS: A review of observational, experimental, physiological, psychological, neuro-physiological, and neuro-psychological studies, including new findings on the cradling behaviour of mothers with auditory or visual impairments. RESULTS: A significant left-cradling bias is observed in both right- and left-handed mothers which cannot adequately be explained by arguments based on handedness or closer contact to the soothing sound of the maternal heartbeat. Observations of primate behaviour have led to the suggestion that the left-cradling bias may be related to a left visual field (right hemisphere) advantage for monitoring an infant's facial expressions of distress. However, more than just monitoring, cradling subserves the mother's connection with the infant. For that reason, we have suggested that left cradling might be related to a right hemisphere specialisation for emotional communication, i.e. the speech melody, smiles, signals, and stroking which mothers use to interact with their infants. Studies of mother-infant interaction show that the sound of the mother's voice is more soothing when cradling on the left, more stimulating when cradling on the right. Cradling laterality may thus be related to emotional state and behavioural intent. There is also evidence to suggest that left cradling is linked to a special role of the right hemisphere in social attachment behaviour. This function may be disturbed in mothers with post-natal depression who show abnormal right hemisphere activity. CONCLUSION: Cradling embodies the symbiotic relationship between mother and infant; various lines of evidence support the suggestion that the universal preference of mothers to cradle infants on their left side is related to a right hemisphere dominance for social attachment and communication behaviour.

Brain↗

Spontaneous and posed facial expression in Parkinson's disease.

Spontaneous and posed emotional facial expressions in individuals with Parkinson's disease (PD, n = 12) were compared with those of healthy age-matched controls (n = 12). The intensity and amount of facial expression in PD patients were expected to be reduced for spontaneous but not posed expressions. Emotional stimuli were video clips selected from films, 2-5 min in duration, designed to elicit feelings of happiness, sadness, fear, disgust, or anger. Facial movements were coded using Ekman and Friesen's (1978) Facial Action Coding System (FACS). In addition, participants rated their emotional experience on 9-point Likert scales. The PD group showed significantly less overall facial reactivity than did controls when viewing the films. The predicted Group X Condition (spontaneous vs. posed) interaction effect on smile intensity was found when PD participants with more severe disease were compared with those with milder disease and with controls. In contrast, ratings of emotional experience were similar for both groups. Depression was positively associated with emotion rating but not with measures of facial activity. Spontaneous facial expression appears to be selectively affected in PD, whereas posed expression and emotional experience remain relatively intact.

Aged↗

Affective facial and lexical expression in aprosodic versus aphasic stroke patients.

Past research has shown that lesions in the left cerebral hemisphere often result in aphasia, while lesions in the right hemisphere frequently impair the production of emotional prosody and facial expression. At least 3 processing deficits might account for these affective symptoms: (1) failure to understand the conditions that evoke emotional response; (2) inability to experience emotions; (3) disruption in the capacity to encode non-verbal signals. To better understand these disorders and their underlying mechanisms, we investigated spontaneous affective communication in right hemisphere damaged (RHD) stroke patients with aprosody and left hemisphere damaged (LHD) stroke patients with aphasia. Nine aprosodic RHD patients and 14 aphasic LHD patients participated in a videotaped interview within a larger treatment protocol. Two naïve raters viewed segments of videotape and rated facial expressivity. Verbal affect production was tabulated using specialized software. Results indicated that RHD patients smiled and laughed significantly less than LHD patients. In contrast, RHD patients produced a greater percentage of emotion words relative to total words than did LHD patients. These findings suggest that impairments in emotional prosodic production and facial expressivity associated with RHD are not induced by affective-conceptual deficits or an inability to experience emotions. Rather, they likely represent channel-specific nonverbal encoding abnormalities.

Affect↗

Preliminary investigation of proton and helium ion radiation effects on fluorescent dyes for use in astrobiology applications.

The Specific Molecular Identification of Life Experiment (SMILE) instrument (Sims et al. Planet. Space Science 2005, 53, 781-791) proposes to use specific molecular receptors for the detection of organic biomarkers on future astrobiology missions (e.g., to Mars). Such receptors will be used in assays with fluorescently labeled assay reagents. A key uncertainty of this approach is whether the fluorescent labels used in the system will survive exposure to levels of solar and galactic particle radiation encountered during a flight to Mars. Therefore, two fluorescent dyes (fluorescein and Alexa Fluor 633) have been exposed to low-energy proton and alpha radiation with total fluences comparable or exceeding that expected during an unshielded cruise to Mars. The results of these initial experiments are presented, which show that both dyes retain their fluorescent properties after irradiation. No significant alteration in the absorption and emission wavelengths or the quantum yields of the dyes with either radiation exposure was found. These results suggest other structurally similar fluorophores will likely retain their fluorescent properties after exposure to similar levels of proton and alpha radiation. However, more extensive radiation fluorophore testing is needed before their suitability for astrobiology missions to Mars can be fully confirmed.

Absorption↗

Identification of selenocysteine in glutathione peroxidase by mass spectroscopy.

A convenient procedure was developed for identifying selenocysteine in selenoproteins by mass spectroscopy, based on formation of the 2,4-dinitrophenyl (DNP) derivative. Pure ovine erythrocyte glutathione peroxidase was reduced with sodium borohydride and reacted with 1-fluoro-2,4-dinitrobenzene at neutral pH under anaerobic conditions in 4 M guanidine. The inactivated enzyme was hydrolyzed with 6 N HCl for 20 h at 110 degrees C under anaerobic conditions. Following extraction of the hydrolysate with benzene, Se-(2,4-dinitrophenyl)selenocysteine in the aqueous phase was separated from non-DNP-amino acids by gel-filtration chromatography and then separated from other water-soluble DNP-amino acids by reversed-phase high-performance liquid chromatography. The Se-(2,4-dinitrophenyl)selenocysteine was converted to Se-methyl-N-(2,4-dinitrophenyl)selenocysteine by the addition of sodium barbital to induce an intramolecular Se leads to N shift (Smiles rearrangement) under anaerobic conditions, in the presence of methyl iodide to trap the liberated selenol group. Following esterification of the product's carboxyl group with methanol and hydrochloric acid, it was subjected to direct probe mass spectroscopy and identified as the methyl ester of Se-methyl-N-(2,4-dinitrophenyl)selenocysteine. This procedure allows selenocysteine to be isolated quite easily as a readily identifiable derivative and has permitted the first identification of a seleno amino acid in a protein by mass spectroscopy.

2,4-Dinitrophenol↗

JChemTidy: a tool for converting chemical Web document collections to an XHTML representation.

A robot-based procedure is described for traversing a collection of hyperlinked documents written in HTML and converting these to the XML-compliant and well-formed XHTML representation. Transcluded chemical content invoked using or HTML calls are converted to the XHTML recommended form. Additional attributes such as title or derived chemical attributes such as a SMILES descriptor are added to improve the indexing of the resulting document collection. Conformance tests for the popular Web browsers are reported.

Journal Article↗

The Chemistry Development Kit (CDK): an open-source Java library for Chemo- and Bioinformatics.

The Chemistry Development Kit (CDK) is a freely available open-source Java library for Structural Chemo- and Bioinformatics. Its architecture and capabilities as well as the development as an open-source project by a team of international collaborators from academic and industrial institutions is described. The CDK provides methods for many common tasks in molecular informatics, including 2D and 3D rendering of chemical structures, I/O routines, SMILES parsing and generation, ring searches, isomorphism checking, structure diagram generation, etc. Application scenarios as well as access information for interested users and potential contributors are given.

Journal Article↗

Artificial neural networks and linear discriminant analysis: a valuable combination in the selection of new antibacterial compounds.

A set of topological descriptors has been used to discriminate between antibacterial and nonantibacterial drugs. Topological descriptors are simple integers calculated from the molecular structure represented in SMILES format. The methods used for antibacterial activity discrimination were linear discriminant analysis (LDA) and artificial neural networks of a multilayer perceptron (MLP) type. The following plot frequency distribution diagrams were used: a function of the number of drugs within a value interval of the discriminant function and the output value of the neural network versus these values. Pharmacological distribution diagrams (PDD) were used as a visualizing technique for the identification of antibacterial agents. The results confirmed the discriminative capacity of the topological descriptors proposed. The combined use of LDA and MLP in the guided search and the selection of new structures with theoretical antibacterial activity proved highly effective, as shown by the in vitro activity and toxicity assays conducted.

Anti-Bacterial Agents↗

ZINC--a free database of commercially available compounds for virtual screening.

A critical barrier to entry into structure-based virtual screening is the lack of a suitable, easy to access database of purchasable compounds. We have therefore prepared a library of 727,842 molecules, each with 3D structure, using catalogs of compounds from vendors (the size of this library continues to grow). The molecules have been assigned biologically relevant protonation states and are annotated with properties such as molecular weight, calculated LogP, and number of rotatable bonds. Each molecule in the library contains vendor and purchasing information and is ready for docking using a number of popular docking programs. Within certain limits, the molecules are prepared in multiple protonation states and multiple tautomeric forms. In one format, multiple conformations are available for the molecules. This database is available for free download (http://zinc.docking.org) in several common file formats including SMILES, mol2, 3D SDF, and DOCK flexibase format. A Web-based query tool incorporating a molecular drawing interface enables the database to be searched and browsed and subsets to be created. Users can process their own molecules by uploading them to a server. Our hope is that this database will bring virtual screening libraries to a wide community of structural biologists and medicinal chemists.

Databases, Factual↗