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Background: Placental site trophoblastic tumor is a rare subtype of gestational trophoblastic neoplasia affecting women of reproductive age. The preferred method of treatment is surgical resection.Case: A 33-year-old woman, gravida 3 para 1111, was incidentally diagnosed with placental site trophoblastic tumor during an evaluation for infertility. As a result of persistent pathologic evidence of disease, she underwent a hysterectomy. The site of disease on pathologic review of the hysterectomy specimen was widely discordant from the preoperative imaging and hysteroscopic evaluations.Conclusion: Wedge resection of the uterus has been suggested as an acceptable alternative to hysterectomy in women with placental site trophoblastic tumor who wish to preserve future fertility. However, this case demonstrated that preoperative imaging may not correlate with the tumor site, making wedge resection treatment ineffective. [ABSTRACT FROM AUTHOR]

Adolescent obesity has become a major health concern in the United States. An increased frequency of fast food restaurant dining is associated with higher intake of calories and calories from fat. The purpose of this study was to gain insight as to how food choices in a ''simulated'' fast food environment might be influenced by nutrition education in a group of adolescents. Ten adolescents were asked to choose food items from a fast food restaurant menu. Their chosen meals' nutrition make-up (calories, fat, cholesterol, sodium, carbohydrates, protein, and fiber) was calculated. Following a 30-minute nutrition education session, participants were asked again to choose a meal from the same fast food menu. The nutrition make-up of the meal chosen postintervention was compared with the meal chosen before the education session. There was a statistically significant (p < .05) difference in calories, fat, carbohydrate, and fiber content of the meals chosen postintervention. This short nutrition education intervention resulted in healthier fast food choices in this group of adolescents. [ABSTRACT FROM AUTHOR]

A large-scale pilot study was carried out to evaluate the impacts of changes in water source and treatment process on iron and copper release in water distribution systems. Finished surface waters, ground-waters, and desalinated waters were produced with seven different treatment systems and supplied to 18 pipe distribution systems (PDSs). The major water treatment processes included lime softening, ferric sulfate coagulation, reverse osmosis, nanofiltration, and integrated membrane systems. PDSs were constructed from PVC, lined cast iron, unlined cast iron, and galvanized pipes. Copper pipe loops were set up for corrosion monitoring. Results showed that surface water after ferric sulfate coagulation had low alkalinity and high sulfates, and consequently caused the highest iron release. Finished groundwater treated by conventional method produced the lowest iron release but the highest copper release. The iron release of desalinated water was relatively high because of the water's high chloride level and low alkalinity. Both iron and copper release behaviors were influenced by temperature. [ABSTRACT FROM AUTHOR]

We interviewed 71 surrogate decision makers of older, chronically ill veterans to explore their knowledge of hospice and their role in helping loved ones access hospice services. We asked them to describe hospice and any previous hospice experiences. Of the group, 24 percent with hospice experience and 14 percent without hospice experience correctly described three key aspects of hospice: who hospice cares for, where the care is provided, and the goal of the care. Additionally, we found evidence that surrogates who correctly described the three key aspects of hospice were inclined to pursue hospice care for loved ones in the future, and surrogates who provided less complete descriptions of hospice might not access it. Since surrogates often help dying patients access care, incomplete knowledge of hospice may be an important barrier to hospice services. We advocate that clinicians discuss the three key aspects of hospice during routine advance care planning sessions with patients and their future surrogate decision makers. [ABSTRACT FROM AUTHOR]

Patient safety and medical errors in ambulatory primary care are receiving increasing attention from policy makers, accreditation bodies and researchers, as well as by practising family physicians and their patients. While a great deal of progress has been made in understanding errors in hospital settings, it is important to recognise that ambulatory settings pose a very large and different set of challenges and that the types of hazards that exist and the strategies required to reduce them are very different.What is needed is a logical theoretical model for understanding the causes of errors in primary care, the role of healthcare systems in contributing to errors, the propagation of errors through complex systems and, importantly, for understanding ambulatory primary care in the context of the larger healthcare system. The authors have developed such a model using a formal 'systems engineering' approach borrowed from the management sciences and engineering. This approach has not previously been formally described in the medical literature.This paper outlines the formal systems approach, presents our visual model of the system, and describes some experiences with and potential applications of the model for monitoring and improving safety. Applications include providing a framework to help focus research efforts, creation of new (visual) error reporting and taxonomy systems, furnishing a common and unambiguous vision for the healthcare team, and facilitating retrospective and prospective analyses of errors and adverse events. It is aimed at system redesign for safety improvement through a computer-based patient-centred safety enhancement and monitoring instrument (SEMI-P). This model can be integrated with electronic medical records (EMRs). [ABSTRACT FROM AUTHOR]

AIM: The aim of this paper is to demonstrate the usefulness of salutogenesis in work relating to child protection. METHODS: A systematic review to explore the links between parenting, social factors and failure to thrive was carried out using 17 CD ROM and online databases using keywords in appropriate medical subject headings (MeSH terms) and Boolean operators refined for the studies. The salutogenic framework was then used as a way of clarifying what benefit particular research findings may have in identifying and using factors which can be associated with protection, safety and well being of children. Cross-referencing the evidence from the systematic review against Antonovsky's generalized resistance resources created a salutogenic matrix. FINDINGS: Four factors in the systematic review were found crucially important: parent factors; parenting factors; child factors; and social factors. However, it is probable that these are useful within all child protection research and the evidence gathered in particular cases (here failure to thrive) could be plotted against each factor. Application of a salutogenic framework to the results was further illuminating and has utility for both systematic review methodology and other child protection explorations. The matrix created a warp and weft effect that identified gaps in current evidence and practice and was able to disentangle some of the complexities inherent within failure to thrive situations. By beginning to shed understanding on such processes, the concept of salutogenesis added further depth and rigour to the analysis. CONCLUSIONS: The concept of salutogenesis is widely used in some areas of nursing practice and research, and can also be regarded as a theoretical tool that has potential in child care and protection research, development and practice. The paper also illustrates the importance of a sound theoretical framework in ensuring depth and rigour in analyses of literature review findings. [ABSTRACT FROM AUTHOR]

Here are step-by-step methodologies to help you select the right clinical policies and actually change practice with them. [ABSTRACT FROM AUTHOR]

Doctors increasingly need to know how to find, evaluate and implement clinical policies. Our primer begins with this first of two articles. [ABSTRACT FROM AUTHOR]

Nursing is undergoing radical change and with this has come the emergence of a 'new' nursing. However, in struggling to define ourselves, it is imperative that we identify a nursing ideology. Whilst ideology can begin to be clarified within a historical context, the threads of beliefs, values, power, and politics must also be respected. In attempting to explore the ideology of nursing, this paper considers the pluralistic nature of nursing and the modes of operation utilised in legitimizing its ideology. In particular, a uniquely nursing strategy has been identified -- that of patientization. Nursing has more than one ideology and whilst all may be criticized, self-knowledge is seen as imperative in enhancing any future this occupation might have. [ABSTRACT FROM AUTHOR]

In this paper, the author seeks to address issues of personal and professional development that may occur during the research process. Whilst research reports now abound in the nursing literature, this personal aspect is often neglected. As we seek to encourage research awareness within the profession, many student and qualified nurses now produce a small research project, and this often concentrates on measurable outcomes. By examining her own perceived learning in resolving epistemological pluralism whilst undertaking such a project as a tutor student, the author has attempted to resolve the problem of ignoring the personal. Indeed, she believes that increased self-awareness can only enhance nursing professionalism. [ABSTRACT FROM AUTHOR]

In 'Three Arguments Against Prescription Requirements', Jessica Flanigan argues that 'prescription drug laws violate patients' rights to self-medication' and that patients 'have rights to self-medication for the same reasons they have rights to refuse medical treatment according to the doctrine of informed consent (DIC), claiming that the strongest of these reasons is grounded on the value of autonomy. However, close examination of the moral value of autonomy shows that rather than being the strongest justification for the DIC, respect for the value of autonomy is actually the weakest, and it is dependent upon the first two well-being-based justifications for the DIC. Recognising this has important implications for Flanigan's argument against prescription requirements. [ABSTRACT FROM AUTHOR]