Surgical management of vertebral column metastatic disease

The spine is the most frequent site of skeletal metastases. Among all spinal malignancies metastatic disease is most frequent and indicative of disseminating tumor disease. Depending on primary tumor entity, estimated survival time, general health status of the patient, presence of spinal instability and neurological deficits an oncological useful and patient-specific therapeutic intervention should be performed. New anterior approaches, resections and reconstruction techniques are making surgery a preferred method over radiation therapy. For differential indication of the multiple surgical treatment modalities prognostic scores are available to assist individual decision making. Indications for surgery include survival prognosis of minimum 3 months, intractable pain, progress of myelon compression and/or neurological deficits under radiochemotherapy, spinal instability and necessity for histological diagnosis. Resulting quality of life depends on efficient decompression of the spinal cord and restoration of spinal stability. To achieve these ultimate goals there are different anterior and posterior approaches, instrumentations and vertebral body replacement implants available. Preoperative embolization should be performed in hypervascular tumors, e.g., renal cell cancer. Vertebro-/Kyphoplasty as a percutaneous intervention should be considered for painful multisegmental disease and symptomatic osteolysis without epidural tumor compression to reach analgesia and stability. A multidisciplinary approach in patient selection, decision making and management is an essential precondition for complication avoidance and acceptable quality of life.     

The Densford Clinical Scholars Program: improving patient care through research partnerships

The Densford Clinical Scholars Program at the University of Minnesota School of Nursing partners advanced practice nurses and faculty members to design and conduct clinical studies for improving patient care. Benefits have included changes in nursing practice and, on occasion, the practice of other members of the healthcare team; enhanced research skills for clinicians; an enriched professional practice environment; access to clinical facilities for faculty; funding for research; and an expanded network for professional development. The authors describe this innovative partnership.     

Quality and safety in home and ambulatory settings

Much of the work in quality and patient safety has been based in hospitals and other acute care settings, yet it has become increasingly apparent that there are errors in delivery of care in other settings, all of which require attention. This article reviews sources of errors in 3 nonacute settings: the home, children's day care, and ambulatory surgery centers. Also described are standards that have been developed to guide practice, as well as specific regulatory agencies that are involved and some of the safeguards that have been instituted in each of the settings to protect against errors.     

The quality burden

While the cost of care remains a major focus of attention in pursuing quality patient care, little recognition has been given to the costs of the quality improvement efforts themselves: the time, energy, infrastructure, and emotional stress associated with documenting, monitoring, reporting, implementing, and evaluating quality indicators and initiatives. This article describes an emerging phenomenon, the quality burden, which, though often unmeasured, is significant in size and impact and accompanies ongoing efforts to improve the quality and safety of health care. Recommendations are given to mitigate the impact of the quality burden in delivering care and improving quality and safety.     

The strategic management: the methodology applied by the "Centre Hospitalier Regional Universitaire"

This work is a general presentation of the "Démarche Stratégique", a strategic process applied by the "Centre Hospitalier Régional Universitaire" (CHRU) at Lille, France. The hospital management methodology relies on the strategic analysis of the best alternatives for rationalizing the hospital mission. It takes into account a competitive environment, in which it is necessary to structure health care networks based on the negotiation of inpatient care goals. The author presents the phases and main methodological tools of the approach, as well as a preliminary evaluation of its potentials.     

The influence of regeneration and nerve growth factor on the neuronal cell body reaction to injury

Summary The consequence of neuronal regeneration on the affected cell body has not been well documented previously. The long-term effects of either successful peripheral nerve (sciatic) regeneration or exogenously administered nerve growth factor (NGF) on dorsal root ganglion (DRG) neurons were determined. The degree of neuronal death and changes in neuronal size were measured after various injuries and treatments. The regenerative influence of the transected, distal sciatic-nerve segment on the neuronal cell body was examined under various standardized conditions (e.g. crush, transection followed by immediate epineurial anastomosis or transection with capping of the proximal nerve stump). Neuronal death was greatest in smaller neurons with diameters between 16 and 28 m. The data showed no difference in the degree of neuronal death between the crush injury and the anastomosis (both able to regenerate). However, the capped, proximal nerve (regeneration prevented) had a significantly higher incidence of neuronal death and less complete recovery from the early neuronal atrophy, which was initially observed in all three groups. The long-term effect on neuronal survival of transient NGF administration (three weeks) at the site of injury demonstrated partial protection by a decrease (55%) in the neuronal loss nine weeks after injury compared to controls. Either the distal nerve segment during regeneration or exogenously applied NGF is capable of mitigating the long-term effects of axotomy in the DRG neuronal cell body.     

三维超声心动图测定机械瓣瓣口面积初步经验

观察三维超声心动图测定机械瓣瓣口面积的可行性。方法１１例机械瓣置换病例,用任意 切面（ａｎｙｐｌａｎｅ）３ＤＥ测定机械瓣瓣口有效面积,将测定值与多普勒超声心动图（ＤＥ）测定的有效瓣口面积（包括实测值和文献报道测值）及生产厂商提供的离体瓣口面积比较。