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Results of conservative treatment of benign esophageal strictures: a follow-up study in 100 patients.
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The results of a conservative treatment of benign esophageal strictures (68 peptic, 21 postsurgical, 2 caustic stenoses, 8 Schatzki rings, 1 esophageal web) were evaluated in 100 patients. Treatment consisted of dilatation either with Eder-Puestove olives or with mercury bougies up to 18-20 mm, or with both. In addition, all patients received antireflux therapy when indicated. The follow-up study lasted from 1-6 yr. The results show that 88 patients became symptom-free. In 4 patients the results were moderate (intermittent dilatation necessary), while there were three failures: all in patients with a severe ulcerating peptic reflux esophagitis with stenosis. They were treated by antireflux surgery. There were eight perforations; all patients survived after surgical (4) and conservative (4) treatment; 3 patients received further dilatation. Conservative dilatory treatment (up to 18-20 mm), combined with antireflux therapy when indicated, offers in general an adequate result in patients with benign esophageal strictures.
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10,001,502
Familial juvenile polyposis coli. A clinical and pathologic study of a large kindred.
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10,001,503
A kindred with familial juvenile polyposis coli is described. Of 92 family members, 26 have had symptoms consistent with polyposis, and a definite diagnosis of polyposis has been made in 19. Two family members have developed colorectal carcinoma before age 40 yr. The lesion of juvenile polyposis is a characteristic nonneoplastic polyp that is distinct from the neoplastic lesion of adenomatous polyposis. Patients with this disorder develop symptoms at an earlier age than those with adenomatous polyposis. Both variants of polyposis appear to have a dominant pattern of inheritance. Patients with juvenile polyposis who present in infancy are likely to have severe symptoms and complications. Although the premalignant potential of the juvenile polyp remains in doubt, there may be an increase risk of gastrointestinal cancer in these patients and their families.
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10,001,504
Development of intrahepatic cholestasis by alpha-naphthylisothiocyanate in rats.
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10,001,505
Development of intrahepatic cholestasis induced by alpha-naphthylisothiocyanate was studied in rats. At various times after alpha-naphthylisothiocyanate application, livers were isolated from treated rats and perfused hemoglobin-free to assess cholestatic parameters. Unstimulated bile flow was found to only slightly decrease up to 10 h after alpha-naphthylisothiocyanate administration. In contrast, secretion into bile of sulfobromophthalein and taurocholate declined markedly between 4 and 7 h as their concentrations in the perfusate increased, and stimulation of bile flow by taurocholate decreased. The permeability of the bile-to-perfusate barrier to [14C]sucrose and [32P]orthophosphate increased in parallel with the changes in sulfobromophthalein and taurocholate distributions. This correlation of changes in the distribution of cholephilic substances with biliary accessibility for extracellular markers suggests that, in alpha-naphthylisothiocyanate-induced cholestasis, increased leakage of tight junctions may contribute to regurgitation of bile constituents into the vascular system.
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10,001,506
Effects of acute bile acid administration on biliary lipid secretion in healthy volunteers.
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10,001,507
Collagenous colitis: an ultrastructural study of a case.
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10,001,508
A case of so-called collagenous colitis is described. This entity, featured clinically by watery diarrhea, is characterized histologically by a 50-60 micrometer fibrous layer immediately beneath the surface epithelium. Ultrastructural changes in the endothelial cells and the basement membranes of the superficial capillaries of the colonic lamina propria, as well as concentric collagenous encasement of these capillaries, are described.
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10,001,509
Ox bile treatment of severe steatorrhea in an ileectomy-ileostomy patient.
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10,001,510
Bile salt therapy is not used in patients with steatorrhea due to bile salt deficiency because of fear that severe diarrhea would be caused or exacerbated. We report a patient who previously had had colectomy, partial ileectomy, and ileostomy for Crohn's disease. She had severe steatorrhea due to bile salt deficiency and severe diarrhea (the latter apparently due to fatty acid inhibition of electrolyte and water absorption). The diarrhea was improved by loperamide, but severe steatorrhea and malnutrition persisted. The steatorrhea and malnutrition were corrected by ox bile, without an increase in diarrhea. Presumably, the deleterious effect of bile salts per se on small bowel absorption of water and electrolytes was mitigated by correction of fat malabsorption. At least in this patient, bile salt therapy was highly beneficial.
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10,001,511
Evidence that hepatic crystalline deposits in a patient with protoporphyria are composed of protoporphyrin.
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10,001,512
The livers of patients with protoporphyria and hepatic disease typically contain pigment crystals which may be a factor in the pathogenesis of liver injury. We isolated and characterized these crystals from a patient who developed hepatic failure and underwent liver transplantation. The prophyrin concentration in the liver was 516 micrograms/g wet weight (normal is a trace amount), over 99% of which was protoporphyrin. Through a discontinuous sucrose density gradient, followed by tissue digestion with deoxycholate, pigment crystals were obtained that had ultrastructural features like those in the whole liver section. After the crystals were dissolved in perchloric acid-methanol, their fluorescence emission and excitation spectra were identical to those of an extract of whole liver tissue and to a protoporphyrin standard. This provides evidence that the pigment crystals in livers of patients with protoporphyria and hepatic disease are composed of protoporphyrin.
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10,001,513
Serum and cerebrospinal fluid immune complexes containing hepatitis B surface antigen in Guillain-Barré syndrome.
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10,001,514
A 76-yr-old male presented with Guillain-Barré syndrome after acute hepatitis B virus infection. Main immunologic features were: (a) high levels of circulating hepatitis B surface antigen-containing immune complexes in serum and cerebrospinal fluid during the acute neurologic syndrome, and (b) clearance of immune-complex material with recovery. Our data indicate that these immune complexes in cerebrospinal fluid reflect leakage from the systemic circulation via a deranged blood-brain barrier and are not generated in the cerebrospinal compartment. Possibly deposition of such immune complexes along nerve structures is important in the immunopathogenesis of some cases of Guillain-Barré syndrome.
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10,001,515
Pancreatic insufficiency associated with ulcerative colitis and pericholangitis.
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10,001,516
A 19-yr-old woman developed pancreatic insufficiency and pericholangitis associated with ulcerative colitis. Recognized causes of pancreatic insufficiency were excluded. Pancreatic insufficiency has not previously been reported in patients with ulcerative colitis, although interstitial pancreatitis at postmortem examination and pancreatic duct abnormalities by endoscopic pancreatography have been described. Pancreatic insufficiency and ulcerative colitis may have occurred together by chance in this patient, but the time sequence and exclusion of known causes of pancreatitis suggest an association between these two conditions. The literature concerning pancreatic disease in ulcerative colitis is reviewed.
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10,001,517
Diabetes: new systems for classification and diagnosis.
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10,001,518
Testing your older patient's thyroid function.
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10,001,519
Thyroid disease cannot be diagnosed through any single test. Normal aging does affect the values of some test parameters in the elderly. When interpreting laboratory test results in the elderly, careful consideration should be given to gender, concurrent acute or chronic illness, nutritional and mental status, as well as possible recent administration of iodinated radiocontrast media and drug therapy. When these factors have been excluded and preliminary routine thyroid function are abnormal or marginally suspect, the usual standards for younger adults, slightly modified, should suffice for diagnosing both hypo-and hyperthyroidism. Patients with complications may require special measurements of serum FT4 and FT3 levels as well as the TSH and T3 response to TRH. These tests will provide additional supportive diagnostic assistance.
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10,001,520
Misdiagnosis of Alzheimer's disease.
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10,001,521
Pneumonia in the elderly: the fatal complication.
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10,001,522
Diagnosis and treatment of occlusive peripheral arterial disease.
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10,001,523
DDx for abdominal infections: heading off peritoneal emergencies.
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10,001,524
Hypothermia in the elderly: the cold facts.
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10,001,525
Timely detection: key to optimal management of breast cancer.
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10,001,526
The psychodynamics of the presidential assassin and an examination of the theme/graphic variables of his threatening correspondence.
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10,001,527
Many document examiners recognize the importance of an individuals 'state of mind' and its effect on handwriting but historically have steered clear of working closely with psychiatrists, linguists, or psychologists in understanding the interaction of nervous impulses and motor responses on the final handwritten product. In an attempt to better understand and evaluate those fears and motivational influences which should exist within the writings of the mentally disturbed in his threatening correspondence, research was conducted to ascertain whether there are consistently reappearing delusional value systems/hostilities which characterize the writings of the paranoid schizophrenic assassin subject. The results of this preliminary investigation revealed substantial evidence to suggest that most U.S. assassins have been psychotic at the time they attempted to kill their victims and that the most frequently rendered diagnosis was 'paranoid schizophrenia'. It was also reported that many of the assassin subjects had either sent threatening correspondence to their victims prior to the assassination attempt or had recanted the justifiable nature of their 'heroic deed' in letters or personal diaries which were recovered shortly after the assault. It is also apparent that over the years, the Secret Service has investigated a number of threatening letter writers who were later diagnosed as suffering from some sort of schizophrenic reaction and characterized as 'potentially dangerous' to the President. Most of the insight to be gained from an examination of what researchers have discovered regarding those unique graphic traits found in 'schizophrenic writing' can be gleaned from those published papers contributed by graphologists/document examiners and that offered by the behavioral science/medical community in the form of psychiatrists, neurologists, psychologists and psycholinguists. The results of bonafide scientific and forensic literature research strongly suggest that the threatening writings of the paranoid schizophrenic and/or potential assassin will probably reveal distinctive graphic 'abnormalities' which are found to act in combination with certain combinations of reoccurring delusional value systems, frustrations, and hostilities.
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10,001,528
A survey of the psycho-social aspects of murderers in Iran.
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10,001,529
The psycho-social aspects of 72 murderers (one female, 71 males) were studied. The murderers came from the Khoozestan and the Lorestan provinces of Iran. One of them had been transferred from the north of Iran (probably on exile). The murderers were mostly from lower social classes and crowded homes. The majority of them had worked as unskilled labourers or farmers. A great number of them regretted their action but a few were proud of what they had done. They believed that they had saved the chastity of their family which is very important in Islam. None of them were epileptic nor had any history of it. Four claimed to be nervous. Eight were alcoholics and three were addicted to drugs. One of them was suspected of having manic-depressive psychosis and only one had paranoid schizophrenia. The female and four of the males were psychopaths.
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10,001,530
The determination of Ck, LDH and its isoenzymes in pericardial fluid and its application to the post-mortem diagnosis of myocardial infarction.
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10,001,531
After having studied 144 pericardial fluids, from the same number of judicial corpses, we propose the measurement of CK for the postmortem diagnosis of myocardial infarction, since it is a reliable, exact and easy technique available to an ordinary laboratory. Providing that contaminated samples be disregarded, the fluids are centrifuged early, and the cadavers be under 48 hours old, the study of CK enzymatic levels in the pericardial fluid allows the postmortem differentiation of myocardial infarction from other causes of death.
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10,001,532
A simple method for calculating the probability of excluding paternity with any number of codominant alleles.
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10,001,533
Evaluation of ethanol analysis on brain and liver by head-space gas chromatography.
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10,001,534
An evaluation of the reliability of ethanol analysis in brain by the head-space gas chromatographic method has shown the following. (a) This method may be used directly, without prior distillation, with homogenized brain tissue; (b) a good correlation exists with values obtained on blood (blood/brain ratio of 0.97 and 1.32 for blood ethanol concentrations of 0.1 and 0.2 g/dl respectively); (c) in non-preserved blood, there is a 15% deviance in the correlation resulting from changes in ethanol concentration; (d) the same evaluation applied to ethanol analysis in liver reveals a poor correlation between the results in liver and blood; this is believed to result mainly from natural oxidative losses of ethanol in liver, and also from the variable fat content of the liver samples analyzed. Caution is emphasized with regard to interpretations of blood/brain and blood/liver ethanol concentration ratios for the purpose of determining pre- and post absorption stages of intoxication where samples involved are not properly preserved.
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10,001,535
Collagen production by rat hepatocytes and sinusoidal cells in primary monolayer culture.
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10,001,536
The cellular sources of collagen in normal rat liver have been examined. Hepatocytes and nonparenchymal (sinusoidal) cells were isolated and established in primary monolayer culture. These cells were incubated with radiolabeled proline in the presence of l-ascorbate and beta-aminopropionitrile. Nondialyzable material was prepared from the cell layer and the medium from each type of culture. The level of collagen accumulation was determined by measuring labeled hydroxyproline and sensitivity to purified bacterial collagenase. In hepatocytes, collagen represented 0.2% of both secreted and cell-associated labeled protein. In sinusoidal cells, collagen was 3.2% of secreted and 1.1% of cell-associated proteins. The total secreted labeled collagen, expressed per microgram of DNA, was similar in hepatocytes and sinusoidal cells. However cell-associated collagen in hepatocyte culture was approximately 10-fold that present in sinusoidal cells. These findings indicate that, while collagen formation is a relatively important function of sinusoidal cells, in normal liver the contribution of hepatocytes to total hepatic collagen accumulation may be substantial.
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10,001,537
The insanity defense: new calls for reform.
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10,001,538
A comparison of acute reversible pre- and postsinusoidal portal hypertension on salt and water retention in the dog.
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10,001,539
To define the relationship between portal hypertension and renal excretion of salt and water, two acute animal models of portal hypertension were investigated. In both models, it was necessary for systemic and renal hemodynamics to remain unchanged during the creation of portal hypertension so as to eliminate the effects of change in these parameters on renal excretion. In eight dogs, portal hypertension was induced by controlled tightening of a ligature around the superior hepatic vein and changes in hemodynamics were prevented by controlled i.v. titration with canine plasma. Rises in portal pressure 9.3 +/- 2.6 to 15.6 +/- 2.3 cm H2O were associated with significant decreases in urine volume 1.57 +/- 0.53 to 0.66 +/- 0.21 ml per min (p less than 0.05) and urinary sodium excretion [340 +/- 82 to 145 +/- 75 mEq per min (p less than 0.05)]. In contrast, similar experiments in five dogs in which the portal vein was partially ligated with increases in portal pressure from 8.3 +/- 0.6 to 18.6 +/- 0.5 cm H2O resulted in no change in urinary volume or sodium excretion. Acute reversible portal hypertension induced by hepatic vein constriction is associated with acute reversible retention of water and salt in the absence of changes in renal blood flow and creatinine clearance which only occur when the liver is involved and not with portal vein constriction.
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10,001,540
Filling the need for emergency psychiatrists: is better education the answer?
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Although the need for specialists in emergency psychiatry is increasing, little attention is given to this field by American psychiatric residency programs, and few psychiatrists choose emergency psychiatry as a career. Like their American counterparts, few Canadian psychiatric residents also choose this specialty. To determine Canadian patterns of emergency education and Canadian residents' opinions of their emergency psychiatry experience, the authors distributed a 41-item questionnaire to 190 psychiatric residents across Canada. The results showed that most residents worked long hours alone, with little complementary education or evaluation. Residents in programs with formal education and evaluation components and on-call assignments no more than once a week found the emergency psychiatry experience most rewarding. The authors make a series of recommendations to strengthen the educational aspects of the emergency psychiatry experience.
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10,001,542
Encouraging third-party coverage of partial hospitals.
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10,001,543
Despite the proven clinical effectiveness and cost-effectiveness of partial hospitals programs, any third-party insurers still refuse to offer coverage of their services. A number of clinical, administrative, and fiscal issues involving current partial hospital programming and the health care system in general have led to this difficulty. The author outlines these barriers, which include concerns about lack of cost accountability, lack of financial incentive to third parties, and lack of consumer interest, and makes specific recommendations on pursuing coverage of partial hospital programs. He urges a redefinition of the scope of partial hospital services and the development of detailed standards of treatment as prerequisites to pursuing third-party coverage.
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10,001,544
A mitochondrial antigen-antibody system in cholestatic liver disease detected by radioimmunoassay.
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10,001,545
A radioimmunoassay (RIA) was established for the detection of antimitochondrial autoantibodies (AMAs) in patient sera. AMAs were detected by RIA in 12 of 14 patients with primary biliary cirrhosis and in 3 of 29 patients with chronic active hepatitis. AMAs were detected by indirect immunofluorescence in all sera positive by RIA. In addition, two patients with primary biliary cirrhosis and one patient with chronic active hepatitis were AMA positive when tested by indirect immunofluorescence, but negative when tested by RIA. AMAs were not detected by RIA or indirect immunofluorescence in 121 further patients with various hepatic and nonhepatic diseases, including healthy controls. The RIA detects an AMA directed against one determinant of a mitochondrial antigen which bears the characteristics of the previously described primary biliary cirrhosis antigen (M2 antigen). The RIA described is a sensitive and specific test for the detection of one mitochondrial autoantibody associated with chronic cholestatic liver diseases displaying the morphology of primary biliary cirrhosis in chronic active hepatitis or liver biopsy specimens. Antibodies against other mitochondrial antigens do not react in this assay system.
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10,001,546
Using epidemiologic survey data to plan geriatric mental health services.
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10,001,547
A university medical center and a community mental health center undertook an epidemiologic survey of elderly residents of a county in North Carolina and used the data to plan a geriatric mental health program. The survey team assessed the rate and distribution of county residents 65 years and older with mental health impairment; defined the services necessary to treat the target population; identified the perceived need for services of these mentally impaired elderly; identified their current utilization of existing services; identified factors that affect utilization; and determined the type of personnel required to staff the new program. Among the elderly, mental health impairment was usually accompanied by functional impairment in other areas (social and economic resources, physical health, and activities of daily living); this finding suggests that a geriatric mental health program should not be limited to the treatment of mental illness but should be prepared to help elderly patients with other types of problems as well. A preliminary evaluation of the clinic's first year of operation indicates that the survey data were most useful in the planning process.
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10,001,548
A comparison of AMA and non-AMA patients on a short-term crisis unit.
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10,001,549
Nineteen patients who left a short-term psychiatric crisis unit against medical advice were compared with 109 patients who received a regular discharge during a six-month period. Demographic, historic, assessment, and diagnostic variables of both groups were examined. Results indicated that patients diagnosed as having personality or substance use disorders and patients judges abnormal on a mental status examination were more likely to be AMA patients. However, AMA patients indicated fewer social problems as rated on Linn's Social Dysfunction Scale. It was concluded that diagnostic variables best differentiated patients leaving the treatment unit against medical advice from those who completed treatment.
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10,001,550
A study of referral failures for potentially suicidal patients: a method of medical care evaluation.
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10,001,551
To learn more about the methodological problems inherent in medical care evaluation studies, a quality assurance committee conducted a study of rates of referral failure for potentially suicidal patients seen in the psychiatry division of a university hospital's emergency room. A simple 5-point scale was used to identify for study a similarly ill patient group: 296 patients with moderately to extremely severe suicide potential. The rates of referral failure for the emergency room's psychiatry division were 24 per cent for referrals within the university hospital system and 33 per cent outside the system, which compared favorably with other facilities. Outlier analysis-a statistical procedure that holds promise for medical care evaluation studies-was used to identify clinicians whose rates of referral failure differed significantly from their peer's rates of. As a result, an instance of substandard performance was identified and corrected through the transfer of information about exceptionally good performance.
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10,001,552
Visits by volunteers to chronic mute patients.
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10,001,553
Drugs as indicators of hepatic function.
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10,001,554
It is well recognized that liver disease may influence the disposition of many drugs. Conversely, it has been suggested that knowledge of the disposition of a model drug might provide an index of certain aspects of hepatic function. This review discusses the physiology of drug disposition and indicates how recent progress in understanding the determinants of drug disposition has provided useful indices of individual aspects of hepatic function. Topics which are discussed are the interpretation of pharmacokinetic parameters as indices of hepatic function, including half-life clearance, and intrinsic clearance. Utilizing the "intact hepatocyte hypothesis" as an operational model, an approach is described that uses the pharmacokinetic disposition of high and low intrinsic clearance drugs following p.o. and i.v. administration to provide quantitative estimates of hepatic function, flow to functioning hepatocytes, and the extent of portasystemic shunting through the liver. Thus, the theoretical basis for quantitation of certain aspects of hepatic function are available. It remains to be determined whether these indices will provide clinically useful measures to follow the natural history of hepatic disease.
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10,001,555
Bile acid metabolism in cirrhosis. VIII. Quantitative evaluation of bile acid synthesis from [7 beta-3H]7 alpha-hydroxycholesterol and [G-3H]26-hydroxycholesterol.
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10,001,556
In order to evaluate more definitively the observed aberrations in the synthesis of cholic and chenodeoxycholic acids in patients with advanced cirrhosis, two bile acid biosynthesis pathways were examined by determining the efficiency of conversion of [3H]7 alpha-hydroxycholesterol and [3H] 26-hydroxycholesterol to primary bile acids. Bile acid kinetics were determined by administration of [14C]cholic and [14C]chenodeoxycholic acids. Cholic acid synthesis in cirrhotic patients was markedly depressed (170 vs. 927 mumoles per day)( while chenodeoxycholic acid synthesis was reduced to a much lesser degree (227 vs. 550 mumoles per day). The administration of [3H]7 alpha-hydroxycholesterol allowed for an evaluation of the major pathway of bile acid synthesis via the 7 alpha-hydroxylation of cholesterol. This compound was efficiently incorporated into primary bile acids by the two normal subjects (88 and 100%) and two cirrhotic patients (77 and 91%). However, the recovery of the label in cholic acid was slightly less in cirrhotic patients than in normal subjects. [3H]26-hydroxycholesterol was administered to ascertain the contribution of the 26-hydroxylation pathway to bile acid synthesis. All study subjects showed poor conversion (9 to 22%) of this intermediate into bile acids. The results of this study suggest that a major block in the bile acid synthesis pathway in cirrhosis is at the level of 7 alpha-hydroxylation of cholesterol (impairment of 7 alpha-hydroxylase) and /or in the feedback triggering mechanism regulating bile acid synthesis. The data also suggest that the 26-hydroxylation pathway in normal subjects and patients with cirrhosis is a minor contributor to synthesis of the primary bile acids. Therefore, the relative sparing of chenodeoxycholic acid synthesis observed in cirrhotic patients is not due to preferential synthesis of this bile acid via the 26-hydroxylation pathway.
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10,001,557
Irregular discharges from psychiatric wards in a VA medical center.
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10,001,558
The effectiveness of childbirth education as an early intervention program.
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10,001,559
A transcultural observation of posttraumatic stress disorder.
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10,001,560
The effect of portal diversion on the early stages of liver carcinogenesis in the rat.
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10,001,561
The effect of portal diversion by ameroid constriction was studied in the carcinogenic process in the rat after initiation of foci by diethylnitrosamine and after the establishment of putative preneoplastic nodules. Portal diversion or portal diversion plus partial hepatectomy did not act to promote or select for the development of nodules. Furthermore, portal diversion did not alter the natural history of established nodules. These results suggest that vascular factors are not important at these early stages of the carcinogenic process in the rat liver.
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10,001,562
The enigma of intrahepatic cholestasis of pregnancy: lessons from Chile.
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10,001,563
Toxic doses of acetaminophen suppress hepatic glutathione synthesis in rats.
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10,001,564
The effect of a toxic dose of acetaminophen on hepatic glutathione turnover was studied in fed and fasted rats. Following the administration of 1 gm per kg of acetaminophen, the fractional rate of glutathione turnover increased from 0.19 to 0.28 hr-1 in fed rats and from 0.43 to 0.50 hr-1 in rats fasted for 48 hr. The increase in the fractional rate of turnover was proportionally much less than the decrease in hepatic glutathione concentration resulting from the toxic dose of acetaminophen. Thus, the estimated hepatic synthesis of glutathione decreased from 0.86 and 1.50 mumole per gm liver . hr to 0.59 and 0.53 mumole per gm . hr in fed and fasted rats, respectively. The excretion of acetaminophen-sulphate was significantly decreased in fasted rats. The fraction of administered acetaminophen metabolized to the mercapturic acid, however, was similar in both groups. Nevertheless, all fasted animals had massive centrilobular necrosis whereas virtually no necrosis was observed in fed animals. The administration of sulfate did not protect against liver injury in fasted rats. In view of the similar synthesis of glutathione in fed and fasted rats following a toxic dose of acetaminophen, an inability to synthesize adequate quantities of glutathione or a decreased availability of sulfate cannot account for the increased susceptibility to liver injury in the fasted state. However, a toxic dose of acetaminophen depletes the hepatic glutathione to a lower nadir before glutathione is repleted by synthesis, and a greater amount of tissue arylation occurs during this brief period of critically depleted glutathione.
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10,001,565
The appropriateness of care-only for some institutional patients.
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10,001,566
Toward a definition of staff rights.
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10,001,567
Potential for abuse of antiparkinson agents.
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10,001,568
Sterilization of incompetents: The quest for legal authority.
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10,001,569
Voluntary organization to tackle community health care problems.
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10,001,570
1981's third-quarter financial performance.
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10,001,571
Departmental input helps stabilize budget.
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10,001,572
Hospitals solve nursing shortage by arranging subsidized housing.
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10,001,573
Guaranteed services improve hospital image.
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10,001,574
Cart requisition form provides cost control for surgical suite.
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10,001,575
Unreceived meals source of malnourishment.
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10,001,576
The nurse shortage: how can we turn the exodus around?
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10,001,577
The nurse shortage can be seen as a symptom of the problems caused by the unwillingness of most hospital power groups to share their control of both resources and decision making. Nurses will continue to leave hospital work if hospitals persist in ignoring nurses' pleas for a share of the rewards and power that should be commensurate with the enormous contributions they make to patient care.
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10,001,578
Nurses as managers: acceptance problems may lie with nurses themselves. Interview by Maria R. Traska.
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10,001,579
Teaching hospitals build models for nursing organization.
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10,001,580
Boon or bane, business coalitions have entered the health care scene.
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10,001,581
What makes a medical office building competitive?
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10,001,582
Hospital clinic aids patients with permanent visual impairments.
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10,001,583
Suburban hospital imbued with"medical center' charisma.
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10,001,584
Round-the-clock child care center provides education and training for children of medical center employees.
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10,001,585
Pediatric medical center helps to overcome the problems of inadequate health care delivery in a rural area.
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10,001,586
Ambulatory care center built by and for medical school and underserved community.
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10,001,587
Nursing home design focuses on personal needs of residents.
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10,001,588
Pavilion will offer open, bright environment for alcoholic and psychiatric patients.
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10,001,589
Regional health center stresses accessibility to primary health care and health education.
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10,001,590
Marketing: a tool for measuring demand.
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10,001,591
Inner-city hospital expands to serve both urban and suburban patients.
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10,001,592
Pediatric infirmary program provides care for employees' sick children.
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10,001,593
Planning key to facility's form-follows-function design.
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10,001,594
Management company offers hospitals benefits of voluntary and investor-owned sectors.
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10,001,595
Expenses continued to moderate in October.
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10,001,596
Primary care: problem or opportunity?
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10,001,597
Administrator offers guidelines for successful decertification campaign.
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10,001,598
New changes in Life Safety Code expected to be JCAH accreditation requirements in late 1982.
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10,001,599
FDA proposes that patient package insert program be rescinded.
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