Consistent patient care: the secret to long-term relationships

Consistent patient care is vitally important. While first impressions may appear to be the most important, they merely act as a bridge to get patients over to your side. Once they have crossed over, you must shift your focus to sustaining their loyalty by cultivating a desire for them to continue doing business with you. Practices who are committed to consistently meeting their patients' needs, and take the time to understand their patients as people--before, during and after patient care--ultimately keep their patients returning and referring for many years to come.

Update on TB, waterlines, ventilation and ergonomics

As the study of diseases changes, the focus must remain the same: To provide the highest quality of care in the safest healthcare environment. It is absolutely necessary to continue a relentless pursuit to keep current with new emerging diseases and adapt solutions that eliminate waterline contamination, support ventilation standards, and ergonomic practices as they apply to dentistry. It's not enough to eliminate the symptom, we must prevent the cause. The standard of care must be constantly challenged with an awareness and acceptance to improve modes of operation as they become necessary. This commitment, in and of itself, allows us to take a proactive approach in ensuring not only our own futures, but also those of whom we serve.

Health reform: what to expect from the coming debate. Interview by Jeannie Mankelker, Dan Wise, and Steven Findlay

Health care reform is in limbo as 1994 draws to a close. Last month's Republican sweep puts the issue in a starkly new political environment. The new Congressional leadership said last month it will put forth a reform plan in 1995. Also, the Clinton administration is working on a scaled-back proposal. To get an idea of what might happen next year, we invited 20 informed persons to give us their opinions and to tell us what action they'd prefer. Because of B&H's production schedule, the interviews took place before the election. We don't think that diminishes their insights and analyses.

Maternal malignancy involving the products of conception: a report of malignant melanoma and medulloblastoma

PURPOSE

Cancer in pregnancy is not uncommon, but cases of maternal malignancy involving the placenta or the fetus are much more rare. We report two additional cases.

PATIENTS AND METHODS

We report one case of malignant melanoma discovered during pregnancy and found to have metastasized to the placenta. We also describe a case of maternal medulloblastoma involving the placenta at delivery.

CONCLUSIONS

Although maternal malignancy during pregnancy occurs in as many as one in 1,000 pregnancies, involvement of the products of conception is rare. Subsequent malignancy in the fetus is even more rare. We report two cases, one of melanoma and another of medulloblastoma (the first such case described). Both infants are alive and well.

Voices of reform. The AHA: policy, advocacy and the tools for reform

In three thoughtful essays, with an introduction by president Dick Davidson, executives at the AHA discuss the policy and political aspects of the reform process, and the organization's reform vision, including the development of tools for its membership.

Cultivating a winning team

Retaining loyal, highly skilled employees is a challenge in today's competitive market. A strong balance of intrinsic and extrinsic motivators creates an attractive work environment.

Health care for all: long-term care, the missing piece. A roundtable discussion: Part 3

Long-term care has been described as the "missing piece" in many healthcare reform proposals. Yet the cost of nursing home care often exceeds that of acute care, especially for the elderly with Alzheimer's disease. In this final installment of a three-part roundtable discussion, panelists discuss the options for providing long-term care, such as social insurance, a single-payer system, play or pay, or private insurance models. Alternatives to nursing home care, such as community service centers and home care, are discussed. The panelists conclude with an examination of how these proposed reforms might affect the practices of physicians and the U.S. economy.

Health care for all: comparing proposals for reform. A roundtable discussion: Part 2

Part 1 of this roundtable discussion [Geriatrics 1992; 47(Sept):34-48] examined the flaws in our current healthcare system and factors that are interfering with our nation's ability to achieve reforms. This month, the panelists discuss the benefits and drawbacks of the major healthcare reform proposals, including managed care, single-payer systems, and so-called "play or pay." The practical aspects of any redistribution of healthcare resources are considered as each panelist outlines a favored approach. The influence of special interests, such as the insurance industry, is also discussed.

Perineal endometriosis. A case report

Perineal endometriosis was found unexpectedly in a 32-year-old woman with primary infertility. Since there had been no prior perineal trauma, the transport of endometrium through a venous or lymphatic route could have accounted for the location of the endometriosis.

Multiple insertions and tandem repeats of origin-minus simian virus 40 DNA in transformed rat and mouse cells

Stable simian virus 40 (SV40) transformation requires integration and expression of the early region of the SV40 genome. We have examined the amount and state of integrated viral DNA of SV40-transformed NIH 3T3 mouse and F2408 rat fibroblast lines generated by transfection with either wild-type or origin-defective SV40 DNA. A functional SV40 replication origin was not required for multiple inserts and partial-repeat structures to form in NIH 3T3 mouse transformants. In contrast, partial repeats in F2408 rat transformants were rare when the SV40 replication origin was intact and not detected at all when it was defective.