Evolving Concepts In Management Research Articles

Head and neck sarcomas in adulthood: current trends and evolving management concepts.

Sarcomas are rare, malignant bone and soft-tissue tumours of mesenchymal origin, and their overall incidence accounts for 1% and 0.2%, respectively, of all malignancies. The aim of this article is to provide a reference on the evolving management concepts and trends of treatment of adult sarcomas of the head and neck in a major head and neck sarcoma centre. Early diagnosis remains a challenge due to non-specific symptomatology. Imaging such as ultrasound (US), magnetic resonance (MRI), computed tomography (CT), and positron emission tomography (PET) CT assist with diagnosis and staging, and biopsy is essential for diagnosis, tumour differentiation, and grading. Staging is dependent on histological grade, size of tumour, and metastasis. Sarcomas spread via the haematogenous route. Adequate clearance of locoregional disease and prevention of distant micrometastases are key to improved disease-free survival outcomes so multimodal treatment at a sarcoma reference centre is imperative. In the head and neck, the treatment for most bone sarcomas is neoadjuvant chemotherapy followed by compartmental resection. The interim tumour response to neoadjuvant chemotherapy is evaluated by PET CT and MRI. Heavy-particle therapy (proton beam) in combination with surgery is increasingly being used to treat otherwise unresectable disease, particularly in children. For soft tissue sarcomas of the head and neck, treatment is complex and depends on grade. Surgery is the principle mode of treatment in low-grade tumours that are amenable to resection. High-grade tumours can be treated with neoadjuvant chemotherapy followed by surgery and radiotherapy. In such cases, the response to the chemotherapy might be used as a guide of potential biological aggressiveness, and has an impact on the planning of the operation and the type and extent of radiotherapy. As a general rule, radiotherapy is reserved for high-grade, advanced soft-tissue sarcomas of the head and neck. Those of bone are radioresistant, and radiotherapy is only administered for palliative purposes when no surgical option exists, an exception being Ewing sarcoma. The role of proton beam therapy is promising, but to our knowledge no long-term data currently exist. The survival advantage of innate immune-modulation remains uncertain for disease in the head and neck.

Current Concepts in the Treatment of Lateral Condyle Fractures in Children.

Lateral condyle fractures of the humerus are the second most common fracture about the elbow in children. The injury typically occurs as a result of a varus- or valgus-applied force to the forearm with the elbow in extension. Plain radiographs are sufficient in making the diagnosis; however, an elbow arthrogram permits optimal visualization of the articular surface in minimally displaced fractures. Traditionally, nonsurgical management is indicated for fractures with ≤2 mm of displacement and a congruent articular surface. Closed reduction and percutaneous pinning is performed for fractures with >2 mm of displacement with an intact cartilaginous hinge at the articular surface. Open reduction and internal fixation is often necessary for fractures with ≥4 mm of displacement or if there is articular incongruity. Complications include malunion, delayed presentation, fishtail deformity, lateral spurring, and growth arrest. Evolving management concepts include relative indications for surgical management, the optimal pin configuration, and the use of cannulated screw and bioresorbable fixation.

Evolving Concepts in the Management of Retinopathy of Prematurity

The introduction of anti-vascular endothelial growth factor (VEGF) agents has stimulated considerable reexamination of treatment strategies for the management of retinopathy of prematurity (ROP). Herein we summarize and review evolving concepts and provide a personal perspective on clinical management today and future directions of treatment. Literature review. To synthesize the evolving management concepts for diagnosis and treatment of retinopathy of prematurity and to provide interpretation and perspective on current emerging therapies. Although initial treatment strategies focused on ablative therapy for threshold ROP, earlier treatment for type 1 or pre-threshold disease has been found to decrease unfavorable visual and structural outcomes. Vascular endothelial growth factor has emerged as a significant contributor to retinal-vascular diseases in the previous 2 decades. The potential role of anti-VEGF treatment for type 1 ROP has become a focus in recent years, but the protracted recurrence of disease and unknown adverse ocular and systemic effects have caused concern from some clinicians. In addition, the use of telemedicine technologies may provide the ability to screen remote areas with a shortage of ROP providers, thereby reducing the burden of disease. The diagnosis and management of ROP has changed over the past 40 years; the role of anti-VEGF therapy remains to be established in current treatment strategies. Screening for initial disease and progression will likely be impacted by the increasing prevalence of telemedicine and relative shortage of clinicians.

Management of Supracondylar Humerus Fractures in Children: Current Concepts

Supracondylar humerus fractures are the most common elbow fractures in the pediatric population. Type I fractures are managed nonsurgically, but most displaced injuries (types II, III, and IV) require surgical intervention. Closed reduction and percutaneous pinning remains the mainstay of surgical management. Numerous studies have reported recent alterations in important aspects of managing these fractures. Currently, many surgeons wait until 12 to 18 hours after injury to perform surgery provided the child's neurovascular and soft-tissue statuses permit. Increasingly, type II fractures are managed surgically; cast management is reserved for fractures with extension displacement only. Two to three lateral pins are adequate for stabilizing most fractures. Evolving management concepts include those regarding pin placement, the problems of a pulseless hand, compartment syndrome, and posterolateral rotatory instability.

Continuously Evolving Management Concepts for Diabetic CKD and ESRD

During the past 50 years, a global pandemic of kidney failure attributed to diabetes mellitus provoked continuously changing treatment strategies based in the belief that micro- and macrovascular complications of diabetes may be preventable. Both patient and physician have revised, and sometimes reversed drug regimens based on inferences extracted from prospective, controlled, properly populated trials. Illustrating this dilemma is a newly relaxed target for glycosylated hemoglobin (HbA1c) of 7%, introduced because of the greater rate of cardiovascular complications noted when striving to reduce attained HbA1c to < or = 6.5%. Our concept of the natural history of kidney disease in diabetes has repeatedly been modified by a rising mean age of those developing uremia (now 64.5 years). Underscoring the reality that the majority of diabetic kidney failure patients fall within the geriatric age group. An encouraging finding first reported in 2005 and continuing through 2009 is a declining incidence rate of irreversible advanced kidney failure in individuals known to have diabetes. That this "good news" results from appropriate renoprotective treatment is as yet unsubstantiated wishful thinking.

Why PART? The Institutional Politics of Presidential Budget Reform

The George W. Bush administration’s Program Assessment Rating Tool (PART) follows a sequence of president-initiated budget reforms. The pattern is puzzling in that past reforms have tended to drain staff resources, failed to take hold, and yielded little or no political advantage. Given the track record of past initiatives, why has the Bush administration chosen to invest Office of Management and Budget (OMB) and agency resources in PART? This article briefly traces PART’s development and, placing the initiative in the context of contemporary research on the institutional presidency, attempts to make sense of the sustained appeal that rationalizing reforms have held across administrations. An account of reform as problem solving is developed. Set against the changing architecture of budget and administrative politics, reform is prompted by the interplay of evolving management concepts and two persistent problem types: Reform holds at least the potential for enhanced budget control where any leverage is valued and responds to the dilemmas of managing policy competence in the modern institutional presidency. The article concludes with a plea on behalf of institutional theories built on realistic models of how actors interpret and respond to the conditions prevailing in administrative politics. The George W. Bush administration’s Program Assessment Rating Tool, or PART, is ambitious, carefully crafted, and if history is a guide, probably doomed. Since its initiation in 2002, PART’s worksheets have guided Office of Management and Budget (OMB) and agency staff through assessments of the design and performance of hundreds of federal programs, ‘‘PARTing’’ about 20 percent of programs each year. The president’s fiscal year (FY) 2006 budget, the first of Bush’s second term, demonstrated a commitment to use PART to target program reductions, as the administration endeavors to rein in a budget deficit that exceeded $400 billion in 2004. ‘‘My budget,’’ President Bush announced in his 2005 State of the Union address, ‘‘substantially reduces or eliminates more than 150 government programs that are not getting results, or duplicate current efforts, or do not fulfill essential priorities. The principle here is clear: Taxpayer dollars must be spent wisely, or not at all’’ (Bush 2005). Evidence regarding PART’s leverage as a tool for The author is grateful to Peri Arnold, Donald Kettl, Patrick Roberts, Rachel Girshick, and Clinton Brass for valuable guidance and feedback; and to Sarah Binder and members of the Governance Studies program of the Brookings Institution for their hospitality and encouragement while this project (slowly) took its current form. Address correspondence to the author at mdull@polisci.wisc.edu doi:10.1093/jopart/muj004 Advance Access publication on January 12, 2006 a The Author 2006. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org. JPART 16:187–215

Rosen's Breast PathologyRosen's Breast Pathology Edited by RosenPaul P., MD. Lippincott-Raven Publishers, Philadelphia, PA, 1996. ISBN 92 4 1561 84X

Book ReviewsRosen's Breast Pathology Walid A. MouradMD, FRCPC Walid A. Mourad Department of Pathology and Laboratory Medicine (MBC-10), King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia Search for more papers by this author Published Online:1 May 1998https://doi.org/10.5144/0256-4947.1998.278SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionThe book not only covers all aspects of benign and malignant diseases of the breast in an encyclopedic fashion, but also discusses these diseases in an impartial and objective way, with the inclusion of all points of view, especially on controversial issues such as atypical ductal hyperplasia. The book also attempts to dispel many myths deeply entrenched in the practice of surgical pathology of the breast. This is nicely illustrated in the discussion of the cell of origin of Paget's disease.The book has several unique features, including a detailed clinical description of almost every disease mentioned. It also describes evolving management concepts with a nice historical perspective. One feature which I liked in particular was the elaborate discussion of difficult and controversial issues. An example is the discussion of precancerous lesions of the breast in Chapter 10. Diagnostic pitfalls and fine-needle aspiration findings are mentioned whenever appropriate.The book consists of 50 chapters divided into six parts. The first part (Chapters 1-4) covers the anatomy and embryology of the breast, as well as specific infections. The second part (Chapters 5-8) covers benign breast diseases, including fibrocystic diseases and benign neoplasms. The third part (Chapters 9-12) discusses precancerous lesions, including hyperplasia and carcinoma in situ and the controversies associated with them. The fourth and largest part (Chapters 13-41) discusses all aspects of breast carcinoma. The fifth part (Chapters 42-43) discusses benign and malignant mesenchymal tumors of the breast. The final part (Chapters 44-50) covers several miscellaneous issues related to the breast, including a chapter on fine-needle aspiration of the breast. This section also includes a chapter covering the proper methods of handling breast specimens.The book is very well written with up-to-date references and appropriate sections discussing molecular techniques and their implication in breast cancer. One additional unique feature of the book is the inclusion of many low-power photomicrographs denoting the importance of recognizing histological patterns.If there is any flaw in the book at all, it would be the sometimes long discussion of very rare pathological entities of the breast. But this is not to belittle the great deal of effort and expertise put into this book. I strongly recommend it for every pathology department's library. Previous article Next article FiguresReferencesRelatedDetails Volume 18, Issue 3May 1998 Metrics History Published online1 May 1998 InformationCopyright © 1998, Annals of Saudi MedicinePDF download