[Primary hemiarthroplasty after complex fracture of the humeral head--functional late results]. / Primäre Hemiprothetik nach komplexem Oberarmkopfbruch--Funktionelle Spätergebnisse.

UNLABELLED: Treatment of complex fractures of the humeral head remains an obviously unsolved problem. Under consideration of the problems of head preserving methods, the development of the last years tended towards the hemiprosthetic replacement. As the discussion about the methods and implants continues to be controversial, long-term results of Neer-II-replacement of humeral head in own trauma cases are presented here. PATIENTS AND METHODS: 46 patients were investigated, in whom a cemented Neer II hemiprosthesis was implanted between 1983 and 1996 due to complex fracture patterns. Median age was 60.2 years, 74 % of patients were female. 59 % had a luxation fracture type Neer VI, 22 % presented a concomitant nerval lesion. Follow up was performed 5 years on average after the operation. 38 patients were investigated clinically according the score of Constant and Murley, 36 had a x- ray control. Additionally an individual questionnaire was completed by 46 patients. RESULTS: Average Constant-score was 66.2 points, whereas in 76.3 % a satisfactory or better result was achieved. In 23.9 % the outcome was poor. In one patient (2.2 %) explantation of the hemiprosthesis and shoulder fusion due to pain was necessary. Conditions for a good result were a patient aged 50 years and younger (75.9 pts. versus 64.2 pts.), an early hemiprosthetic replacement within 4 weeks after the trauma (71.7 pts. versus 55.3 pts.) and a patient without an earlier operation and nerval lesion (76.8 pts. versus 53.9 pts.). No correlation was found between the date of the follow-up and the interval of time since the operation. CONCLUSION: After complex fractures of the humeral head satisfactory long-term results can be obtained by the cemented Neer II hemiprosthesis. Thus, implants of the newer generation can not yet whitness their superiority under consideration of functional aspects. Refixation and reintegration of both the tubercula after trauma still seems to be an unsolved problem and requires further development.

COPE (client-oriented, provider-efficient), a model for building community partnerships that improve care in East Africa.

This article describes how a mission hospital in East Africa expanded its quality improvement (QI) process by promoting partnership with the community in order to better meet the community's needs. The partnership evolved from the hospital's existing COPE (client-oriented, provider-efficient) self-assessment approach. In addition to seeking the views of clients, the hospital embarked on a process to engage community members in a dialogue, implement improvements suggested by the community, and gradually ensure community representation on its QI committee. The importance of considering the cultural diversity of the community was reinforced by the outcome of the COPE initiative.

Using practical quality improvement approaches and tools in reproductive health services in east Africa.

BACKGROUND: A nonprofit, nongovernment organization, AVSC International provides technical assistance worldwide, including a range of reproductive health services and quality improvement (QI) approaches and tools. Current activities in East Africa involve several hundred sites, including referral hospitals, district-level hospitals, and individual family planning clinics. THE QI PACKAGE: AVSC and its local partners developed Client-Oriented, Provider-Efficient Services (COPE), a problem-solving process and set of tools to involve all levels of site staff members in assessing and improving the services. The COPE tools--self-assessment guides, client interview guides, client flow analyses, and action plans--promote involvement, ownership, and commitment to the QI process. Facilitative supervision and whole-site training complemented AVSC's traditional approaches of medical monitoring and informed choice. Facilitative supervision encourages supervisors and managers to consider staff members as internal customers, whose needs they must meet for staff to be able to meet the needs of external customers (clients). Whole-site training was developed to meet the needs of staff members and providers, who needed to function as a team responsible for providing high-quality services. CASE STUDY: A government hospital that has adopted the entire package of QI approaches, has used the Quality Improvement Quotient self-assessment surveys to track its progress in several elements of high-quality care, including management and supervision, safety, and information and client--provider interactions. For example, maternity ward staff learned how to pass on to their clients information about clients' rights and family planning methods through posters, pamphlets, sample contraceptives, and health talks. LESSONS LEARNED: AVSC's work with local organizations suggests a number of lessons learned, including the following: easy-to-use tools that promote staff involvement and ownership are essential in the QI process, QI requires considerable staff development and capacity building at all levels, and although the QI approaches were initially introduced for a relatively narrow field of services, they are applicable to and have increasingly been used in other departments and wards. (It is difficult, may be impossible, and certainly undesirable, to limit QI activities to one ward or service.) CONCLUSION: Activities in East Africa have shown that QI is possible even in very resource-poor settings. The same principles have guided the process in all the different programs, with some adaptation of the tools used. AVSC program activities are to continue to disseminate the experiences of sites implementing the package of tools and approaches, to advocate for investment in supervision and management capacity building as a means to support continuous quality improvement, and to further study the impact of the QI approaches on service quality.

Variability in Postharvest Decay Among Apple Cultivars.

The level of resistance to decay caused by four fungal pathogens, the force required to break the epidermis, and the extent of open sinuses as measures of potential decay resistance were determined for the fruit of several apple cultivars. No single cultivar was the most resistant to each of the four pathogens in this study. In addition, each cultivar that was the most resistant to one pathogen also was the most susceptible to one of the other pathogens. However, Royal Gala was the most resistant to the wound pathogens Botrytis cinerea, Penicillium expansum, and Mucor piriformis. Fuji and Oregon Spur II were more resistant than other cultivars to Pezicula malicorticis. The epidermis (skin) of Fuji and Granny Smith were the most resistant to puncture, requiring an average of 81.5 and 87.0 Newtons, respectively, to break the epidermal layer. Fuji had the highest percentage of fruits with open sinuses, with a mean of 38%, whereas Braeburn had 0% of fruit with open sinuses. The cultivar information presented herein may be a valuable measure of decay resistance and may be of use to the apple industry.

An evaluation of initiatives to improve family planning use by African-American adolescents.

Teen pregnancies in the United States have reached epidemic proportions, and consequently, efforts to promote family planning among adolescents have increased. At the Orleans Parish Family Planning Clinic in New Orleans, Louisiana, adolescent-specific initiatives were implemented to improve understanding of family planning services and promote contraceptive use. Since 92% of the patients are African American, the study population was limited to this group. This study examines the efficacy of two initiatives (i.e., orientation sessions and 3-month booster visits conducted in adolescent-specific clinics) for improving initiation and continuation of family planning services among African-American adolescent women. Initiation of services was compared among those who attended the orientation session and those who did not attend. Continuation of services was determined by attendance of the annual visit for those who attended the 3-month follow-up visit and those who did not attend. Of 737 teens entering into the clinic, the mean age was 16 years, 95% were enrolled in school, 23% attended the orientation session, and 71% initiated services. Of the 507 who initiated services and who underwent follow-up for at least 12 months, 29% attended the 3-month follow-up visit and 32% attended an annual visit. Attendance of the orientation session was associated with initiation of services and attendance of the 3-month booster visits was associated with attendance of the annual visit in multivariate logistic regression. Simple and cost-effective techniques such as orientation sessions and follow-up visits conducted in adolescent clinics can improve initiation of family planning and compliance among adolescents.

PIP: The authors investigated the efficacy of orientation sessions and 3-month follow-up visits in adolescent-specific clinics in improving the initiation and continuation of family planning services among African-American adolescent women. Of 737 teens entering the Orleans Parish Family Planning Clinic in New Orleans, the mean age was 16 years, 95% were enrolled in school, 23% attended the orientation session, and 71% initiated services. Of the 507 who initiated services and who underwent follow-up for at least 12 months, 29% attended the 3-month follow-up visit and 32% attended an annual visit. Multivariate logistic regression found attendance at the orientation session to be associated with attendance of the annual visit. Simple and cost-effective techniques such as orientation sessions and follow-up visits in adolescent clinics can improve the initiation of family planning and compliance among adolescents.

Assessment of antipsychotic activity of an unique agent: SU-23397.

SU-23397 is a unique new hybrid molecule, the animal profile being characteristic of neuroleptic activity. Although the trial was uncontrolled, there appears to be no doubt that SU-23397 exerts antipsychotic activity between 20 mg and 250 mg daily in severely ill schizophrenic patients. Seven of the ten subjects required at least transient antiparkinson medication. Two patients demonstrated premature ventricular contractions. One patient had infrequent PVCs at baseline which increased in frequency with rising dosage. The other patient developed frequent premature ventricular contractions only after active and medication was initiated and was subsequently withdrawn from the study.