ABSTRACT
As mental health services shift from institutional to community-based care, the psychiatric caseload for home care providers has increased. To satisfy the quality measurement demands of managed care organizations, providers can implement care paths for psychiatric home care programs.
Subject(s)
Community Mental Health Services/standards , Critical Pathways , Home Care Services/standards , Budgets , Centers for Medicare and Medicaid Services, U.S. , Job Description , Managed Care Programs , Patient Care Planning , Program Evaluation , Psychiatric Nursing , United StatesSubject(s)
Home Care Services/organization & administration , Mental Health Services/organization & administration , Nurse Clinicians , Program Development , Health Services Needs and Demand , Humans , Insurance, Health, Reimbursement , Mental Health Services/economics , Program Evaluation , Psychiatric Nursing , Quality of Health Care , Referral and ConsultationABSTRACT
Stimulation of ovulation combined with the clomiphene therapy and human gonadotropins is presented. Follicular maturation was followed by changes of the cervical score and ultrasonic folliculometry from the tenth day of the stimulating cycle. Ovulation was proved by the change of quality of the cervical mucus, the increase of the BBT, the increase of the progesterone concentration in serum, then by ultrasonically proved changes inside the follicle and in endometry, and finally by pregnancy. With the combined therapy the authors stimulated ovulation in a group of 14 females, altogether 21 cycles. In all the patients, before the application of the combined therapy, induction of ovulation with clomiphane alone through at least 6 cycles proved unsuccessful. Ovulation was proved in the 20 cycles of the combined stimulation. Altogether 11 pregnancies of all induced cycles were obtained: 6 pregnancies with term delivery, 2 extrauterine pregnancies, 1 spontaneous abortion in the 24th week, 1 missed abortion, and 1 blighted ovum. Two twin pregnancies were recorded. In one patient the syndrome of hyperstimulation of the first degree occurred, while in the others there were no complications at all.
Subject(s)
Clomiphene/administration & dosage , Menotropins/administration & dosage , Ovulation Induction/methods , Adult , Drug Therapy, Combination , Female , Humans , Infertility, Female/drug therapy , PregnancySubject(s)
Dermatoglyphics , Gonadal Dysgenesis/genetics , Female , Humans , Turner Syndrome/geneticsABSTRACT
The authors put forward their own scheme of investigating possible causes of infertility. In everyday clinical routine the results of such investigations are limited. Most useful data are obtained by a detailed anamnesis, hysterosalpingography, bacteriological analysis, and cytogenetics. In the therapy of spontaneous abortion strict rest is recommended. Gestagen therapy is applied in bleeding in the first trimester only when fetal life is proved (ultrasound). Early protecting cerclage is to be performed between the 14th and the 16th gestation week. The importance of a positive psychological relation between physician and patient is emphasized.
