RESUMO
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.
Assuntos
Síndrome do Compartimento Anterior/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Miosite/microbiologia , Infecções Estafilocócicas/microbiologia , Tíbia/microbiologia , Adulto , Aeromonas hydrophila/isolamento & purificação , Idoso , Síndrome do Compartimento Anterior/complicações , Síndrome do Compartimento Anterior/patologia , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/patologia , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/patologia , Humanos , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/patologia , Leucemia Plasmocitária/complicações , Linfoma de Células T/complicações , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Miosite/complicações , Miosite/tratamento farmacológico , Miosite/patologia , Defeitos do Tubo Neural/complicações , Neoplasias da Próstata/complicações , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/patologia , Tíbia/patologia , Tomógrafos ComputadorizadosRESUMO
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.
Assuntos
Pesquisa sobre Serviços de Saúde/métodos , Satisfação do Paciente , Qualidade da Assistência à Saúde , Análise Custo-Benefício , Competição Econômica , Grupos Focais , Guias como Assunto , Humanos , Participação nas Decisões , Projetos de Pesquisa , Inquéritos e QuestionáriosRESUMO
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.
Assuntos
Pesquisa sobre Serviços de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Satisfação do Paciente , Projetos de Pesquisa , Grupos Focais , Pesquisas sobre Atenção à Saúde/métodos , Humanos , Participação nas Decisões , Inquéritos e Questionários , Estados UnidosRESUMO
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.
