Subject(s)
Hospital Administration/legislation & jurisprudence , Information Services/legislation & jurisprudence , Internet/legislation & jurisprudence , Liability, Legal , Organizational Policy , Risk Management/methods , Communication Aids for Disabled , Ethics, Institutional , Health Insurance Portability and Accountability Act , Hospital Administration/standards , Information Services/standards , Internet/standards , Telecommunications/legislation & jurisprudence , Telecommunications/standards , United StatesSubject(s)
Hospital-Patient Relations , Internet/organization & administration , Multi-Institutional Systems/organization & administration , Computer Communication Networks , Information Services , Marketing of Health Services , Organizational Case Studies , Organizational Objectives , Physician Executives , WashingtonSubject(s)
Internet , Patient Participation , Physician's Role , Information Services , United StatesABSTRACT
BACKGROUND: Treatment of postinflammatory hyperpigmentation in patients of Fitzpatrick skin types IV, V, and VI is difficult. Glycolic acid peels are useful for pigment dyschromias in caucasians; however, there are no controlled studies examining their safety and efficacy in dark-complexioned individuals. OBJECTIVE: To determine if serial glycolic acid peels provide additional improvement when compared with a topical regimen of hydroquinone and tretinoin. METHODS: Nineteen patients with Fitzpatrick skin type IV, V, or VI were randomized to a control or peel group. The control group applied 2% hydroquinone/10% glycolic acid gel twice daily and 0.05% tretinoin cream at night. The peel patients used the same topical regimen and, in addition, received six serial glycolic acid peels (68% maximum concentration). Patients were evaluated with photography, colorimetry, and subjectively. RESULTS: Sixteen patients completed the study. Both treatment groups demonstrated improvement, but the patients receiving the glycolic acid peels showed a trend toward more rapid and greater improvement. The peel group also experienced increased lightening of the normal skin. CONCLUSIONS: This pilot study demonstrates that serial glycolic acid peels provide an additional benefit, with minimal adverse effects, for the treatment of postinflammatory hyperpigmentation in dark-complexioned individuals.
Subject(s)
Black People , Chemexfoliation , Dermatitis/complications , Glycolates/administration & dosage , Hyperpigmentation/therapy , Administration, Topical , Adult , Drug Combinations , Female , Humans , Hydroquinones/administration & dosage , Hyperpigmentation/etiology , Keratolytic Agents/administration & dosage , Middle Aged , Pilot Projects , Tretinoin/administration & dosageABSTRACT
Organizational culture is a key ingredient in successfully managing monumental strategic change initiatives. Those who are successful in managing change are actively integrating organizational culture into their total planning process. Organizational cultures should be a forethought in the management of the change process. Managers should give the same care and thoroughness to culture that they allot to the other major aspects of a plan. The culture of any organization in the midst of rapid change will not tolerate an information vacuum. People affected by change want to be able to ask questions and be heard. Communication should be interactive. Create opportunities that allow people at all levels of the organization to close the past. Without closure, some of the best people may feel that the organization has betrayed them. Creating a process that allows people to work through the change and motivating people to reinvent their approach and role in the new ways of doing things is what healthcare leadership in the 1990s is all about. It is part of the critical skill set that is necessary to lead Catholic-sponsored health services into the future.
Subject(s)
Organizational Culture , Organizational Innovation , Personnel Administration, Hospital/standards , Anxiety , Catholicism , Communication , Group Processes , Hospitals, Religious/organization & administration , Humans , Leadership , Morale , Motivation , Personnel Administration, Hospital/methods , Personnel, Hospital/psychology , Psychology, Industrial , United StatesABSTRACT
The difficulties in quantitation of in vivo 31P spectra are exacerbated by the fact that, in general, coils with inhomogeneous B1 fields are used with in vivo samples. A general method for quantitation of in vivo 31P MRS results obtained with the ISIS localization method was developed using computer simulations. The simulation calculates the preparation of the sample magnetization throughout the sample by the ISIS pulse sequence, as well as the sensitivity of signal reception. The calculation accounts for both the B1 field and the B0 gradients applied to the sample. The sensitivity of the experiment is expressed by integration of the simulated signal over the sample, assuming a homogeneous sample. The primary advantage of this approach is that a separate localization experiment on a phantom of known concentration is not required each time parameters of the localization experiment, such as dimensions or location of the localized volume, are altered. In addition, the simulations indicate the degree of contamination (signal from outside of the localized volume) that occurs, and provide a means of comparing different executions of the ISIS experiment. Experiments were performed on phantoms to verify the simulations, and experimental results on human brain and liver are reproduced to show that this approach provides reasonable estimates of metabolite levels in terms of molar concentrations.
Subject(s)
Computer Simulation , Magnetic Resonance Spectroscopy/methods , PhosphorusABSTRACT
A simple model is presented for the calculation of relative signal-to-noise (S/N) ratios of coils of different sizes and configurations when applied to in vivo MRS. Axial symmetry is assumed, which enables rather simple expressions to be used for the calculation of coil loading by the tissue. The model is calibrated to experiments through measurement of the loaded and unloaded coil Q's. Applications of the model demonstrate that for small, superficial regions of interest (ROI), small surface coils can provide a S/N much improved over that of a larger coil. However, for very deep ROIs, larger coils or coils producing uniform B1 provide improved S/N.
