Indicating Care Process Quality: A Multidimensional Scaling Analysis.

Background and Purpose: Resident assessments are analyzed by multidimensional scaling. Methods: We analyzed observer-based real care and support time in four facilities with 209 residents during two working days; resident, organizational data and pairs of residents were assessed by registered and assistant nurses regarding the dissimilarity of resident pairs. Registered- and assistant nurses dissimilarity assessments are compared to criteria-based nursing management assessment. Results: The fits of management criteria matrices as external restrictions are higher in registered nurses' than in assistant nurses' assessments. These differences disappear with low staffing. Conclusion: The influence of qualification levels on assessment is affected by staffing. Low complexity of Assistant Nurses assessments is connected to higher nursing care and support time in groups of demanding residents.

Pathologic nipple discharge: surgery is imperative in postmenopausal women.

BACKGROUND: A total of 10% to 15% of pathologic nipple discharge in women is due to malignant lesions of the breast. The purpose of this study was to discover the rate of breast cancer in women who present with this symptom and undergo ductal excision, to evaluate the different diagnostic methods used before surgery, and to discover whether there are specific factors with regard to dignity. METHODS: We analyzed 118 ductal excisions in 116 patients performed at the women's hospital of the University of Rostock, Germany, between 1995 and 2002. The discharging duct was identified by preoperative galactography. RESULTS: The rate of cancer in these patients was 9.3% (n = 11). The most frequent benign lesion was intraductal papillomatous proliferation (36.4%; n = 43). Solitary papillomas were shown in 21.2% (n = 25), and other specific benign histologic findings were shown in 27.1% (n = 32). Women with malignancies were significantly older (P = .009) and were more often postmenopausal (P = .095) compared with patients with benign histology. Galactography was the method that reached the highest sensitivity (73%), and clinical examination showed the highest specificity (85%) in distinguishing between benign and malignant lesions. CONCLUSIONS: Because 94.1% of all cases presented with specific histological findings causing pathologic nipple discharge, ductal excision combined with preoperative galactography was proven to be a sufficient method for diagnosis and therapy. This procedure should be performed in all postmenopausal women with this symptom because of a cancer rate of 12.7% among this age group and the unsatisfactory quality of other diagnostic methods.