From vision to reality: strategic agility in complex times.

Health care is experiencing turbulent times. Change has become the constant. Complexity and sometimes chaos are common characteristics.

Opinion survey towards hormone replacement therapy in the prevention of coronary heart disease.

Background: Observational and experimental data underscore the cardioprotective effects of hormone replacement therapy (HRT). On the other hand, the randomised trial available, the 'Heart and Estrogen/Progestin Replacement Study (HERS)', showed no reduced risk of coronary heart disease (CHD), using HRT.

Aim: Opinion survey on the effect of HRT on CHD risk.

"Fellow gynaecologists, help your patients stop smoking!".

Background: Age-adjusted mortality from lung cancer in American women has increased dramatically and has even exceeded breast cancer mortality. Gynaecologists, are often involved as primary actors in prevention strategies but may not be aware of this epidemic. This is especially true in Europe where, lung cancer mortality for women is three times lower than in the US.

Estrogen replacement therapy in patients with endometrial cancer: prescription attitude of Belgian gynecologists.

Background: Endometrial cancer is estrogen dependent and has been considered as a contraindication for HRT. Some uncontrolled studies reported no increase in recurrence in women who received ERT after they had suffered early stage endometrium cancer and many opinion leaders have mandated that early uterus cancer should not be considered as an absolute contraindication to HRT.

Aim: We conducted a survey evaluating the prescription attitude of Belgian gynecologists (n=1363) towards a case describing a patient who presents indication for ERT (climacteric symptoms and osteoporosis) and a past history of early stage endometrium cancer.

Perception of osteoporosis by Belgian women who work in a university hospital.

Campaigns to increase 'awareness' of osteoporosis have been organized. The aim of this study was to assess how Belgian women who benefit from superior conditions favoring 'awareness' perceive osteoporosis as being an important disease. A survey sent to the private home of all the women working in a university hospital in Brussels (n = 1154).

Comparison of moxifloxacin and cefuroxime axetil in the treatment of acute maxillary sinusitis. Sinusitis Infection Study Group.

The aim of this prospective, multicenter, randomized, double-masked clinical trial was to compare the efficacy and safety of moxifloxacin with those of cefuroxime axetil for the treatment of community-acquired acute sinusitis. Five hundred forty-two adult patients with symptoms and radiographic evidence of acute maxillary sinusitis received a 10-day oral regimen of either moxifloxacin (400 mg once daily) or cefuroxime axetil (250 mg twice daily). Acute signs and symptoms at presentation had lasted >7 days but <4 weeks.

Prescription attitudes among gynecologists towards two particular risk factors of osteoporosis: the patient's age and her bone mineral density.

Objective: The present report assesses, among Belgian gynecologists, the effect of age and bone mineral density on osteoporosis prescription strategy in postmenopausal women.

Methods: Charts of postmenopausal women were summarized. We constructed cases by modifying some parameters.

Managing the climacteric.

HRT taken for a sufficient duration may reduce the occurrence of osteoporosis and of cardiovascular disease by up to 50% and possibly also reduce incidence and lessen severity of Alzheimer's disease. Nevertheless, it is often only prescribed when women request it to relieve climacteric symptoms. Furthermore, many physicians prescribe it for only limited periods of time and few are willing to prescribe it to women in their sixties.

The art of nursing: the client-nurse relationship as a therapeutic tool.

The C-N relationship is the cornerstone and essence of mental health/psychiatric nursing. However, that process has the same potential for nursing in general. The C-N relationship is an interpersonal, interactive, and ongoing relationship set up to assist clients in the continuous evolution toward quality health and well-being.

Educating patients about the benefits and drawbacks of hormone replacement therapy.

Hormone replacement therapy (HRT) influences many aspects of health: climacteric symptoms, osteoporosis, cardiovascular disease, breast and endometrial cancer, thrombosis and emboli, and Alzheimer's disease. A decision to use HRT may depend on a woman's individual views of the menopausal transition, the postmenopause and its consequences. It is therefore useful that the health provider inquiries about and discusses these issues in a cultural and family context.

Factors influencing the prescription of hormone replacement therapy.

Objective: To assess the effects of age, bone mineral density, risk of cardiovascular disease, and of breast cancer on the prevalence of hormone replacement therapy (HRT) prescriptions.

Methods: Seventeen charts of postmenopausal women were summarized. For each chart, we constructed 36 different cases by modifying the age (two levels), the bone mineral density (three levels), the cardiovascular risk (three levels), and the breast cancer risk (two levels).

The brittle bone: how to save women from osteoporosis.

For a woman, the risk of suffering an osteoporotic fracture during her lifetime is higher than the combined risk of breast, endometrial, and ovarian cancer. It is important to reduce the number of osteoporosis-related fractures. Therefore, it is necessary to emphasize various interventions and attitudes which will decrease both the risk of falling and that of breaking bones.

Power quality issues and the effects on medical equipment.

Power quality issues are becoming more important as more medical equipment utilizes microprocessor controls and switched DC power supplies. Externally and internally induced power surges and harmonics can have a dramatic effect on equipment performance. The effectiveness of a good "Equipment Management Program" can be greatly affected by poor power quality in today's hospitals.

Effect of bone density evaluation on hormone replacement therapy prescription.

Objectives: This study evaluates whether Bone Mineral Density (BMD) results influence HRT prescription.

Methods: Successive charts of 29 postmenopausal women were summarised. For each chart, 3 'simulated cases' were created by modifying the BMD result (based on the Z-score) in order to have 4 groups with the same clinical story but a wide range of BMD values (Group I = Z-score > 0, Group II = Z-score between 0 and -1, Group III = Z-score between -1 and -2 and Group IV = Z-score < -2).

Principal cancers among women: breast, lung and colorectal.

The major variations in the pattern and level of cancer throughout the world reflect for the most part differences in the environment. It is generally agreed that carcinogenesis may arise as a result of chemical, physical, biologic, and genetic insults to cells. In addition, specific external factors may initiate and/or support malignant transformation, such as smoking, occupational and environmental chemicals, radiation, dietary factors, and specific viruses.

Intracity regional demographics of major trauma.

Study Objective: To report intracity, regional trauma, geographic, and demographic factors affecting risk of major intentional versus nonintentional trauma.

Design: One-year retrospective analysis of trauma-registry and census-tract databases.

Setting: Urban trauma system with patient entry by emergency medical services personnel.

Does out-of-hospital EMS time affect trauma survival?

To determine if out-of-hospital emergency medical services (EMS) time intervals are associated with unexpected survival and death in urban major trauma, a retrospective review was conducted of major trauma cases entered into an urban trauma system by an EMS system during a one-year period. Patients with unexpected death or unexpected survival were identified using TRISS methodology. The EMS response, on-scene time, transport time, and total EMS out-of-hospital time intervals were compared for the two groups using the unpaired t test (two-tailed analysis).

Demographics of cardiac arrest: association with residence in a low-income area.

Objective: To report cardiac arrest demographics and assess whether arrest rate is associated with differences in intracity regional population densities, incomes, or race distributions.

Methods: One-year retrospective review of out-of-hospital cardiac arrests in a city with a two-tier emergency medical service (EMS) system. Associations of population density, median income, and race data with age- and gender-adjusted cardiac arrest rates for seven city regions and groupings of high- and low-income census tracts were made.