ABSTRACT
Five oncology patients developed bacterial pyomyositis involving the anterior tibial compartment and resulting in compartment syndrome with ischemia and abnormalities of neuromuscular function. All patients were neutropenic and thrombocytopenic, and four were receiving or had recently received cancer chemotherapy. Three infections were due to gram-negative bacilli and two to Staphylococcus aureus. Appropriate antimicrobial therapy and surgical drainage in four patients resulted in the resolution of these infections with good residual muscle function. To our knowledge, primary pyomyositis has never previously been known to cause compartment syndrome.
Subject(s)
Anterior Compartment Syndrome/microbiology , Gram-Negative Bacterial Infections/microbiology , Myositis/microbiology , Staphylococcal Infections/microbiology , Tibia/microbiology , Adult , Aeromonas hydrophila/isolation & purification , Aged , Anterior Compartment Syndrome/complications , Anterior Compartment Syndrome/pathology , Escherichia coli Infections/drug therapy , Escherichia coli Infections/microbiology , Escherichia coli Infections/pathology , Gram-Negative Bacterial Infections/complications , Gram-Negative Bacterial Infections/pathology , Humans , Klebsiella Infections/drug therapy , Klebsiella Infections/microbiology , Klebsiella Infections/pathology , Leukemia, Plasma Cell/complications , Lymphoma, T-Cell/complications , Magnetic Resonance Imaging , Male , Middle Aged , Multiple Myeloma/complications , Myositis/complications , Myositis/drug therapy , Myositis/pathology , Neural Tube Defects/complications , Prostatic Neoplasms/complications , Staphylococcal Infections/drug therapy , Staphylococcal Infections/pathology , Tibia/pathology , Tomography Scanners, X-Ray ComputedABSTRACT
Patient perceptions of the quality of services provided is a key factor (along with cost effectiveness) in determining a health care organization's competitive advantage and survival. This article examines the advantages, disadvantages, and problems associated with nine different methods of measuring patient satisfaction with service quality. The appropriateness of each of these techniques under different organizational conditions is also discussed. The article concludes with guidelines for measurement of patient satisfaction and implementation of managerial follow-up.
Subject(s)
Health Services Research/methods , Patient Satisfaction , Quality of Health Care , Cost-Benefit Analysis , Economic Competition , Focus Groups , Guidelines as Topic , Humans , Management Quality Circles , Research Design , Surveys and QuestionnairesABSTRACT
Patient perceptions of the quality of services provided are a key factor in determining a healthcare organization's competitive advantage and survival. This article examines the advantages, disadvantages, and problems associated with nine different qualitative and quantitative methods of measuring patient satisfaction with service quality and concludes with guidelines for measurement of patient satisfaction and implementation of managerial follow-up.
Subject(s)
Health Services Research/methods , Outcome Assessment, Health Care/methods , Patient Satisfaction , Research Design , Focus Groups , Health Care Surveys/methods , Humans , Management Quality Circles , Surveys and Questionnaires , United StatesABSTRACT
The interaction of several synthetic analogues of d-ApA with Poly U and Poly dT was examined to explore the effects of substituents at phosphorus on binding properties of oligonucleotides. These analogues contained a bulky, lipophilic group (2,2,2-trichloroethoxy or 2,2,2-trichloro-1,1-dimethylethoxy) a small, uncharged hydrogen-bonding group (amido), or a cationic phosphoramidate (2-aminoethylamido, protonated in neutral aqueous media) in place of the anionic oxygen of the internucleotide phosphate. As determined by "melting curves" each formed a complex with Poly U more stable than the Poly U.d-ApA complex. Binding to Poly dT was comparable or in some cases stronger. Checks on composition (mixing curves) revealed the expected stoichiometry of ldA:2U (or 2dT). Stereochemistry at phosphorus influenced stability of the complexes, but the effect was not a major one. These results suggest that oligonucleotides containing large, lipophilic groups, as well as small non-ionic groups (e.g., the methyl phosphonates) or polar groups, could be useful as probes in hybridization experiments.
