Institutional expansion, community relations, and the hospital next door

Thesis (M.C.P.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 2005.Includes bibliographical references (p. 115-119).Hospitals play many roles in a city: alternately, they may be caretakers of the sick, economic engines, intellectual hubs, major employers, and neighbors. This last role has evolved greatly over the last 45 years. The relationship between hospitals and the communities in which they are located has been affected by constantly changing economic, political, and social factors. During the early days of urban renewal in the 1950s and early 1960s, large teaching hospitals in Boston experienced a surge of political and economic power that allowed them to expand with few constraints, often to the detriment of their residential neighbors. Today, the same hospitals must broker complex deals with their neighbors if they wish to expand, offering up a host of community benefits. The process by which the hospital-community power dynamic has evolved has been shaped by the mediating entity of the Boston Redevelopment Agency, which is in turn influenced by the Mayor's Office in Boston. Despite their many roles in the city, it is their sheer physical presence that drives hospitals' relationships with their neighbors. The health care and employment benefits they can provide are not major bargaining chips in disputes over expansion; the important considerations are the tangible elements of power - money and land. The primacy of physical presence as a relationship driver can be illustrated by the differences in the negotiation process that hospitals directly bordering residential communities and extending into them experience, as opposed to hospitals that are not directly on the residential fringe.by Karla Nyreen Solheim.M.C.P

Treatment of Hailey-Hailey Disease of the vulva: a retrospective case series

Background: Hailey-Hailey disease (familial benign chronic pemphigus) of the vulva is a rare autosomal dominant dermatosis characterized by malformation of desmosomes and bullae, particularly in intertriginous areas. Cases: We reviewed the cases of 5 women followed at a single academic institution over a period of 17 years. Of the 5 patients, 4 carried a diagnosis of Hailey-Hailey at the time of presentation to our institution, and one was diagnosed on biopsy. 3 were members of a family group. Initial treatment of choice was a topical steroid (betamethasone in 3, fluocinonide and hydrocortisone in 1 each), vulvar skin guidelines, tepid soaks, a skin protectant (A&D; ointment, zinc oxide) and additional treatment (crotamiton in 1, clotrimazole in 2, and Polysporin in 1). Final treatment regimens in 3 patients followed long term were zinc oxide/A&D; and betamethasone-clotrimazole ointment in all 3, nystatin-triamcinolone ointment in 2, oral minocycline in 1, oral fluconazole prn in 1, and topical tacrolimus in 1. Treatment courses were complicated by superimposed fungal infections, superimposed bacterial infections, and lichen simplex chronicus flares. These were treated with antifungals, topical clindamycin and metronidazole, and steroid-antifungal bursts, respectively. Three of five patients followed long term achieved successful remission with occasional flares. Discussion: Treatment of Hailey-Hailey disease must be tailored to the individual patient. Adherence to vulvar skin care guidelines is critical for the remission of Hailey-Hailey disease. Treatment is long-term and may be complicated by episodes of fungal and bacterial superinfection and lichen simplex chronicus

Global fetal DNA methylation and birth outcomes in obese women

Pregnant women who are obese are more likely to have gestational diabetes, gestational hypertension, pre-eclampsia, macrosomia, operative vaginal delivery, and cesarean delivery. Obesity also has adverse implications for the neonate. Congenital anomalies are more common in children born to obese women. These include neural tube defects, gastroschisis, cardiovascular anomalies, and others. Although the connection between maternal obesity and chronic health conditions has been described, the mechanism by which this occurs is less well understood. Changes to the epigenetic structure of offspring DNA have been proposed as one such mechanism

Quality of life in adults with brain tumors: Current knowledge and future directions

Quality of life is an important area of clinical neurooncology that is increasingly relevant as survivorship increases and as patients experience potential morbidities associated with new therapies. This review of quality-of-life studies in the brain tumor population aims to summarize what is currently known about quality of life in patients with both low-grade and high-grade tumors and suggest how we may use this knowledge to direct future research. To date, reports on quality of life have been primarily qualitative and focused on specific symptoms such as fatigue, sleep disorders, and cognitive dysfunction, as well as some symptom clusters. However, the increasing interest in exploring quality of life as a primary end point for cancer therapy has established a need for prospective, controlled studies to assess baseline and serial quality-of-life parameters in brain tumor patients in order to plan and evaluate appropriate and timely interventions for their symptoms

Quality of life in low-grade glioma patients receiving temozolomide

The purpose of this study was to describe the quality of life (QOL) of low-grade glioma (LGG) patients at baseline prior to chemotherapy and through 12 cycles of temozolomide (TMZ) chemotherapy. Patients with histologically confirmed LGG with only prior surgery were given TMZ for 12 cycles. QOL assessments by the Functional Assessment of Cancer Therapy–Brain (FACT-Br) were obtained at baseline prior to chemotherapy and at 2-month intervals while receiving TMZ. Patients with LGG at baseline prior to chemotherapy had higher reported social well-being scores (mean difference = 5.0; p < 0.01) but had lower reported emotional well-being scores (mean difference = 2.2; p < 0.01) compared to a normal population. Compared to patients with left hemisphere tumors, patients with right hemisphere tumors reported higher physical well-being scores (p = 0.01): 44% could not drive, 26% did not feel independent, and 26% were afraid of having a seizure. Difficulty with work was noted in 24%. Mean change scores at each chemotherapy cycle compared to baseline for all QOL subscales showed either no significant change or were significantly positive (p < 0.01). Patients with LGG on TMZ at baseline prior to chemotherapy reported QOL comparable to a normal population with the exception of social and emotional well-being, and those with right hemisphere tumors reported higher physical well-being scores compared to those with left hemisphere tumors. While remaining on therapy, LGG patients were able to maintain their QOL in all realms. LGG patients’ QOL may be further improved by addressing their emotional well-being and their loss of independence in terms of driving or working