Pharmacist-patient relationship development in an ambulatory clinic setting.

We investigated the pharmacist-patient relationship, conceptualizing its interpersonal constructs and dynamics using social exchange principles. The constructs of felt indebtedness (FI), collaborative willingness (CW), interpersonal relationship quality (IRQ), medication use beliefs (MUBs), and critical interpersonal incidents (CII) between pharmacist and patient were proposed, measured, and modeled. Patient responses were collected using interviews and mail surveys in 2 pharmacist-managed anticoagulation clinics. Higher IRQ levels predicted greater FI toward and CW with pharmacists (p < .01). MUBs predicted CW with IRQ mediating the association (p < .01). Patients reporting positive CII gave higher IRQ ratings and expressed greater FI (p < .05). Findings suggested that patients' perceptions of their pharmacists, and not their therapy, may lead to increased interpersonal exchange and patient collaboration in care.

The use of conjoint analysis to study patient satisfaction.

Previous research has identified aspects of the outpatient interactions between patients and physicians that are important for patient satisfaction. In this study, conjoint analysis was used to determine the relative importance of these factors to patients. This study found the perceived skill of the physician to be the most important factor and waiting time in the office the least important. The use of conjoint analysis should help both patients and physicians to maximize patient satisfaction while minimizing costs as much as possible.

Diagnostic reliability of combined physical examination, mammography, and fine-needle puncture ("triple-test") in breast tumors. A prospective study.

A prospective study of 622 consecutively registered patients with 650 breast tumors was performed to appraise the reliability of combined physical examination, mammography, and fine-needle puncture (triple test) in the preoperative diagnosis of such tumors. All malignant as well as benign test results were confirmed by subsequent histologic examination. The diagnostic accuracy of the triple test at benign changes is comparable to that of histologic examination, but participation of experienced radiologists and cytologists as well as persons skilled in fine-needle puncture is required. Twenty-eight percent of the planned excisional biopsies were made superfluous by the fine-needle puncture, which immediately revealed the tumor as a cyst, abscess, or hematoma. For this reason, too, fine-needle puncture is recommended as a routine procedure.

Gynecomasty: estrogen and androgen receptors. A clinical-pathological investigation.

The histology, estrogen (ER)- and androgen (AR)- receptor content, s-FSH, s-LH, s-17-beta-estradiol, U-17-ketosteroid and U-17-ketogenic steroid patterns were measured in a consecutive series of 20 patients operated on for gynecomasty. Two out of 22 specimens were ER-positive, and 4 out of 22 were AR-positive. No relationship was demonstrated between the histopathologic features, ie. active-intermediate-inactive gynecomasty, and the steroid receptor content in the present limited number of cases. In addition, there was no marked relationship between the histopathologic features and the hormone values.

Palpable breast tumours: "triple diagnosis" and operative strategy. Results of a prospective study.

A prospective study of 292 consecutive patients with 303 tumours was performed to appraise the combination of physical examination, mammography and fine-needle puncture (triple test) in the diagnosis of breast tumours. The diagnostic accuracy of the triple test was 100%. Because of its relative smallness, however, the series does not permit the conclusion that a benign result of triple test makes excisional biopsy unnecessary. It is emphasized that a follow-up regimen with participation of radiologists and cytologists is required. Fine-needle puncture with cytologic examination of the aspirate is recommended as a routine procedure in the diagnosis of breast tumours.

Human breast cancer: heterogeneity of estrogen binding sites.

A patient who had two primary tumors in the same breast is described. Both tumors were infiltrating duct carcinomas, but they differed as far as histologic malignancy and estrogen-receptor-positivity are concerned. One tumor was estrogen-receptor-positive the other was estrogen-receptor-negative. The case illustrates the multicentric origin of breast cancer as well as its cellular heterogeneity. Problems of treatment are discussed.

Ion and transmitter movements during spreading cortical depression.

A reaction--diffusion system of equations whose components are the extracellular concentrations of K+, Ca++, Na+, Cl-, an excitatory neurotransmitter and an inhibitory neurotransmitter, is developed in order to model the movements of these substances through various kinds of membrane in brain structures. Expressions are derived from probabilistic arguments for the conductances induced in subsynaptic membrane by transmitter substances at various concentrations, for one-way active transport rates and for an exchange pump rate. These expressions are employed in the reaction terms of the system. The meaning of the many constants is explained and, with appropriate choices for their values, the model predicts subthreshold responses to small enough local elevations of KCl or glutamate and stable propagating SD waves if the local elevations of these chemicals is sufficient. The SD waves consist of elevated K+ and transmitter substances and diminished Ca++, Na+ and Cl-, the velocity of propagation in cortex being about 0.6 mm/min. This is in the experimental range, the K+-amplitude being 17 mM relative to a baseline of 3 mM, as the model developed ignores the effects of action potentials. There is no SD response to either NaCl or GABA. The effects of no K+ and no glutamate diffusion are investigated, both being manifest as a failure in propagation of the stable SD waves. The wave solutions are analysed in terms of phase portraits. The roles of various amino acid uptake and release processes by neurons and glia are discussed, as are the complications with regard to their incorporation in a model for SD. The roles of neurons and glia are analysed and the six basic fluxes of K+ are outlined. It is postulated that under some circumstances, in cortex treated with TTX, there may be practically no transmitter release, but SD may propagate if TTX does not completely abolish gNa for nonsynaptic membrane, a corresponding system of model equations being developed. The data and ideas of K+-based and glutamate-based SD of Van Harreveld are discussed and interpreted in terms of which reaction terms are operative in the K+ equation. An appendix contains the values of the parameters used in the numerical calculations.

Primary malignant lymphoma of the duodenum. Case report.

Primary malignant lymphoma located in the duodenum is a rarity. A case where such a tumor made its debut with massive gastro-intestinal bleeding is reported here. Treatment consisted of emergency subtotal pancreaticoduodenectomy followed by antineoplastic chemotherapy for one year. At one year follow-up examination there were no signs of recurrence.

Influence of porosity on the viability of the neointima. A histological investigation on implanted synthetic vascular prostheses.

The influence of porosity on the viability of the neointima was evaluated in two types of Dacron vascular prostheses with quite different porosities. It could be concluded that the observed parietal thrombus formation in functioning prostheses, and the dislodgement of the neointima in several of these, might well be attributed to the low porosity of the investigated prostheses, as compared to the recommended value. At the same time it is remarkable that no pronounced difference in the histological picture was observed in the two types of prostheses, despite large differences in their mutual porosities.