Suicidal hanging. An association with the adult respiratory distress syndrome.

This study of two victims of suicidal hanging describes a previously unknown association between near-fatal hanging and the adult respiratory distress syndrome. We report on the pathophysiologic results of this pulmonary complication and the implications of this finding regarding the treatment of these patients.

Identification of radiation-induced thymine derivatives in DNA.

A methodology for the separation of radiation-induced thymine derivatives in DNA using high pressure liquid chromatography is presented. DNA was subjected to enzymatic hydrolysis yielding 2'-deoxyribonucleosides and the hydrolysate cochromatographed with marker compounds. Confirmation of the presence of derivatives was accomplished by chromatography on Sephadex LH-20 and microderivatization. The method separates free bases from nucleosides allowing for identification of spontaneously released bases or those released through the action of repair enzymes. The results indicate that most of the thymine derivatives formed in irradiated cellular DNA were the same as those found in DNA irradiated in solution. However, the major cellular derivative was not present in the latter. This derivative was identified as 5-hydroxymethyl-2'-deoxyuridine (HMdU). HMdU has previously been shown to be cytotoxic to cells in culture and caused diarrhea and bone marrow failure when administered to mice. Thus, the presence of this radiation-induced thymine derivative in cellular DNA correlates with the known effects of ionizing radiation on cells and animals.

Joining a healing community for cancer: who and why?

This paper provides a description and evaluation of selected aspects of The Wellness California. Based upon participant observation, TWC's philosophy and program are described. The ways in which charismatic leadership is used to create a sense of 'healing charisma' is specified. Interviews were conducted at 3 points over a 10 month period with 65 individuals who initiated contact with TWC. Thirty-seven eventually became participants at TWC, while the 28 who did not were used as a comparison group. Participants were healthier, more oriented toward self-care and less satisfied with their existing social support networks. The findings indicate the role, and limitations, of healing communities for people with chronic physical illness.

Holistic physicians and family practitioners: similarities, differences and implications for health policy.

Although loosely defined, holistic or alternative medicine has been viewed by most observers as fundamentally at odds with mainstream biomedical approaches. Convergence or integration of the two are seen as highly unlikely. We attempt to assess the potential for such integration empirically through a survey of physicians, members of the American Holistic Medical Association (N = 340) and a comparison group of family practitioners (N = 142). Although social origins of the two groups are similar, they differ in their completion of residency training and a variety of practice characteristics. While the groups differ in the predicted directions in their evaluation and utilization of holistic techniques and in their attitudes toward the nature of medical practice, there is a good deal of overlap. Personal experiences, especially those in the area of religion/spirituality and psychotherapy differ sharply between the groups. Policy concerned with fostering cooperation or convergence between holistic and mainstream medicine should differentiate between clinical attitudes and behaviors (which appear to be more compatible than has been suggested), and the personal world views of physicians (which appear to be much further apart).

Cystometric evaluation of vesical endometriosis before and after hormonal or surgical treatment.

Subjective patient complaints as they relate to bladder endometriosis have been well reported. Objective findings have been lacking. The case reported on demonstrates the cystometric finding of a small-capacity irritable bladder in a patient with vesical endometriosis. It further demonstrates the improvement of these findings following surgical resection of endometriosises and hormonal therapy using danazol.

The development of an instrument to measure satisfaction with physical therapy.

BACKGROUND AND PURPOSE: Patient satisfaction continues to receive attention as a measure of the outcome of physical therapy intervention. However, a great deal more attention has been paid to the topic outside of, rather than within, physical therapy. This article describes the development of an instrument that measures patient satisfaction among physical therapists' patients and clients. METHOD: A 26-item instrument designed to measure the domains of patient satisfaction among patients was developed by the authors in preparation for this study and field tested on patients from several sites comprising a large clinical operation. Descriptive statistics and estimates of reliability of measurements obtained with the instrument were computed. Reliability and validity were assessed. A total of 289 individuals completed the instrument. RESULTS: The coefficient for reliability (Cronbach alpha=.99) obtained for the instrument was clearly within a desired range. Different types of validity were established as well. CONCLUSION AND DISCUSSION: Instruments typically used by physical therapists to measure patient satisfaction have undergone little psychometric analysis. This instrument appears to meet the criteria required to make it a useful tool for measuring patient satisfaction.

Gender and physical therapy career success factors.

BACKGROUND AND PURPOSE: Gender and profession are thought to affect how career success is perceived as well as how it is achieved. This study investigated items considered important in defining career success for male and female physical therapists. The study also explored the relationship among gender, beliefs about career success, and career experiences. SUBJECTS AND METHODS: Data were obtained through an investigator-developed survey. The self-report questionnaire consisted of 78 items in 4 areas: descriptive information, items important in characterizing career success, items perceived to enhance or inhibit career success, and items assessing self-esteem. Questionnaires were mailed to a random sample of active physical therapist members of the American Physical Therapy Association (N = 5,000). The response rate was 38.1% (n = 1,906). RESULTS: Both men and women selected indicators such as practicing ethically, improving patient health, and feeling satisfied over high income or status when describing career success. All respondents agreed that clinical competency and motivation are key factors related to achieving career success. Family issues, full-time employment, and flexibility of practice conditions emerged as primary gender differences. CONCLUSION AND DISCUSSION: A unique set of indicators describe physical therapy career success. Gender differences in its description and factors that influence its achievement are related primarily to family issues. Career success for women depends to a greater degree on the ability to manage family responsibilities in conjunction with employment opportunities.

Mixed models of alcoholism. Definitions, etiology, treatment and prognosis in health education textbooks.

The information on alcoholism presented in college-level health education textbooks was compared with eight models of alcoholism. No model was cited consistently; diverse knowledge bases, models of alcoholism and moral views were implicit in the texts. The utility of the models is also discussed.

Use of and satisfaction with homeopathy in a patient population.

BACKGROUND: This article describes a survey of new clients entering care with nine practicing classical homeopaths in the Los Angeles metropolitan area between January 1994 and July 1995. METHODS: Participants completed a self-administered questionnaire before undergoing diagnosis by the homeopath. Follow-up interviews were conducted by phone 1 month after diagnosis and face to face 4 months after diagnosis, along with a self-administered questionnaire before the final interview. A total of 104 participants entered the study; 77 completed all data collection. RESULTS: Clients sought homeopathic care for a wide array of largely chronic conditions. Respiratory, gastrointestinal, and female reproductive problems were the most common primary complaints. Most clients were highly educated, but had limited knowledge about homeopathy before entering treatment. Approximately 80% reported earlier, unsuccessful attempts to get relief from mainstream care. Four months after treatment, general measures of health status showed improvement, and only 29% of participants reported no improvement for the primary complaint leading to treatment. Satisfaction with homeopathic treatment was high regardless of outcome. Three outcome measures of perceived change--overall health status, primary condition for which treatment was sought, and outlook on life--were predicted by different combinations of study variables. CONCLUSIONS: Homeopathy does not divert people from seeking mainstream care. The use of alternative modes of care such as homeopathy can be understood as attractive and satisfying to educated individuals with chronic problems.

Holistic physicians and family practitioners: an empirical comparison.

We report on a survey of 340 self-identified, holistic physicians (members of the American Holistic Medical Association) and a group of 142 California family practitioners (FPs). The groups are quite similar in age, gender, socioeconomic origin, and marital status. Holistic physicians are more likely to be from rural origins, not board certified, in private practice, see fewer patients, and use hospitals less. Holistic physicians also evaluate and utilize a number of "holistic" medical techniques and interactional styles with patients quite differently than FPs. In addition, the two groups are differentiated by the importance they attribute to religious and/or spiritual factors, as well as their own experiences in psychotherapeutic situations, that influence their views of health, illness, and healing.

Dental health: what is being taught to college students.

An analysis of the dental health material in all college-level, health education textbooks published between 1966 and 1973 showed a deficiency in the amount, the thoroughness, and the quality of the dental health information given. Realibility of information from one source to another is low, and some information is inaccurate. On the basis of information in these textbooks, serious questions are raised concerning the adequacy of dental health education in college-level health education courses. The dentist is advised to review and to examine the dental health information that is being taught in these courses.

An organizational approach to the hospital pharmacist shortage.

A Task Force was formed by the Pennsylvania Society of Hospital Pharmacists to review the shortage of hospital pharmacists and to recommend ways to deal with it. Recommendations by the Task Force to PSHP are discussed. These recommendations should place hospitals and their departments of pharmacy in a better position to recruit and retain pharmacists.

A method for monitoring medication omission error rates.

A study was conducted of the number of doses omitted on eight patient care units in a hospital which employs a decentralized unit dose system. Omitted doses were doses of drugs that were returned to the pharmacy and that, as subsequently determined, should have been administered to patients. The number of omitted doses was 0.048 per patient day. The number of omitted doses per patient day varied among the patient care units. The results were reported to the Medication Practices Review Committee, a subcommittee of the Pharmacy & Therapeutics Committee. Subsequently, educational efforts by the Departments of Nursing and Pharmacy were directed towards reducing the omitted-dose rate. The study was repeated five months later. The number of omitted doses had fallen to 0.011 doses per day, a significant difference from the previous study. All patient care units but one had significantly fewer omitted doses, with the other patient care unit showing no change. This study showed that the rate of omitted doses can be estimated without the use of trained observers. Additionally, this method can be used to determine the changes in the omitted dose rate within a hospital.