bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Ethics and Organization Ethics
Authors: Spencer Edward M , Mills Ann E , Rorty Mary V , Werhane Patricia H
Published: November 2023

It is in the clinical units that the fundamental work of an HCO occurs. However extensive the administrative and support system which grows up around those units, it is here that the excellence or inadequacies of the HCO are most often judged by HCO stakeholders, including patients, staff, and the larger society. The ethics of the clinical enterprise has received a great deal of attention in the last few decades. The public is increasingly aware of ethical issues in health care, and medical innovations constantly force us to rethink issues that seemed settled only yesterday. The shift from individual to team medicine has changed the parameters within which we think of ethical issues in clinical practice, and institutional ethics committees (IECs) have developed as the forum in which competing values are negotiated between team members, or between the medical team and families.

The clinical setting will not decline in importance as a focus for ethical activity in HCOs, but the interpenetration of organizational and clinical ethical decisions is becoming increasingly obvious. All clinical decisions have organizational implications, and the converse is often the case as well. Cases brought to IECs frequently focus on organizational problems that created them, and organizational changes are sometimes suggested in order that the same problem not recur. This tendency has been accelerated by the recent addition of “organization” ethics standards to the JCAHO accreditation procedure and by initiatives from other directions as well.
The Relationship of Social Climate to the Historical Development of the Healthcare Organization and Its Ethical Climate
Authors: Spencer Edward M , Mills Ann E , Rorty Mary V , Werhane Patricia H
Published: November 2023

Our healthcare organizations owe much of their form and function, as well as their publicly perceived mission, to their particular history in the United States and the social, economic, and political conditions under which they operate.

The organization of health and hospital services has always reflected changing societal values and interests. These societal interests shape the ethical climate within which healthcare organizations operate. They help determine how their income is derived, who has the power to affect their direction and everyday operation, and how their mission is perceived and judged. The changing relationships within an HCO itself (involving the board of directors, administrators, medical staff, other clinical staff, ancillary staff, hourly employees, and, most importantly, patients) as well as the relationships between individuals or groups representing the HCO and interested persons outside the organization are also important factors when attempting to analyze its ethical climate.
Compliance, Risk-Management, and Quality-Improvement Programs
Authors: Spencer Edward M , Mills Ann E , Rorty Mary V , Werhane Patricia H
Published: November 2023

The public’s negative perceptions of the healthcare system have led to calls for regulation and will likely lead to further, possibly expensive changes. These in tum will increase the need for HCOs to develop mechanisms to protect their position in the marketplace. Programs addressing compliance, risk management, and continuous quality improvement are already part of the HCO’s administrative structure or soon will be. If these programs are seen as mechanisms that help protect or strengthen the HCO in the market, then these programs and their influence in the HCO will certainly grow.

At first glance, these three activities may appear to either duplicate the healthcare organization ethics program or offer a framework that can easily be expanded to encompass the goals of such a program. In this chapter we argue otherwise. To make this argument we will first consider the role in the current HCO structure of these three programs. We will then consider whether one or more of these programs should be expanded to include the organization ethics program.
Organization Ethics Activities and Their Evaluation
Authors: Spencer Edward M , Mills Ann E , Rorty Mary V , Werhane Patricia H
Published: November 2023

Any activity undertaken by an organization should be consistent with the mission and goals of that organization. If it is important to an organization that it have a positive ethical climate, the effective functioning of the organization’s ethical processes will not only influence but also, at times, direct activities critical to the fulfillment of the organization’s mission.

An organization ethics program engages in various activities, including policy review and development, communication activities, education, and in some instances, consultation. To strengthen an organization’s ethical climate, the activities that are designed to affect it must be evaluated to determine whether the organization ethics program is fulfilling its purposes.
Emergence of “Ba”: A Conceptual Framework for the Continuous and Self-transcending Process of Knowledge Creation
Authors: Nonaka Ikujiro , Konno Noboru , Toyama Ryoko
Published: November 2023

In recent years, the importance of knowledge as a source of sustainable competitive advantage has been discussed by a myriad of authors (Drucker, 1993; Leonard-Barton, 1992; Nelson, 1991; Prahalad and Hamel, 1990; Quinn, 1992; Sveiby, 1997; Teece, Pisano, and Shuen, 1990; Toffler, 1990). Knowledge is undoubtedly an indispensable resource to create value for the next generation of society, industries, and companies.
The Influence of New 3-D CAD Systems on Knowledge Creation in Product Development
Authors: Nobeoka Kentaro , Baba Yasunori
Published: November 2023

The management of knowledge creation is considered one of the key factors in the management of new product development. In the past, differences in knowledge creation capabilities at the organizational level were primarily attributed to the quantity and quality of human interactions that were facilitated by the appropri- ate organizational management (Nonaka, 1994; Kogut and Zander, 1992). Although organizational interactions continue to be important, the use of information technologies (ITs), including design, engineering, and manufacturing (CAD/ CAE/CAM), is becoming a much more critical factor for organizational knowledge creation in product development.
Conclusion: Social, Technical, and Evolutionary Dimensions of Knowledge Creation
Authors: Nonaka Ikujiro , Nishiguchi Toshihiro
Published: November 2023

How firms create, convert, transfer, and absorb knowledge to gain competitive advantage has been the focus of this book, with thirteen chapters each offering a part of the answer. Knowledge and knowledge creation are by nature complex and multifaceted phenomena, requiring a variety of concepts and approaches to explain and understand them. Nevertheless, we believe that the field of knowledge creation would benefit from increased unity of concepts and coordination of research efforts. In this concluding chapter we therefore briefly attempt to discern common threads uniting these chapters and research on knowledge creation in general. This will lead us to suggest a number of avenues that future research could take to advance this still emerging field.
Introduction
Authors: Perdue Theda
Published: November 2023

“Is it a bow or a sifter?” inquired nineteenth-century Cherokees upon the birth of a child.1 A bow, the weapon of war and implement of hunting for centuries, epitomized masculinity; the sifter, essential to making bread, was a woman’s most important tool. While Cherokee women used sifters in a variety of ways, from seeding fruit to straining the oil they made from crushed nuts, the primary function of these loosely woven baskets was processing com. Women were intimately associated with corn—the same Cherokee word, selu, means both woman and corn—which they planted, tended, and harvested. Sifters sorted out the largest kernels of com for seed, guaranteeing next year’s crop. To make dried com palatable, women soaked kernels in a mixture of wood ashes sifted into water. Sifters drained off the liquid, and when the dried kernels had been pounded into meal, sifters separated large pieces from finer meal. Each went into different dishes that the women prepared. For the Cherokees, sifters, like women, represented both production and sustenance.2
Mary Musgrove: Creating a New World
Authors: Green Michael D
Published: November 2023

Coosaponakeesa, the child who would become Mary Musgrove, was born about 1700 in Coweta, Creek Nation.1 She was the niece of Brims, chief of Coweta and the most prominent and influential town king of the Lower Creeks. Her father, Edward Griffin, was a Charles Town trader. When she was about seven years old, Griffin took Coosaponakeesa and her brother to Pon Pon, a tiny community built around a ferry over the Edisto River in South Carolina not far from Charles Town. Until 1716, Coosaponakeesa lived in Pon Pon with an English family, perhaps related through her father.
Mourning Dove: Gender and Cultural Mediation
Authors: Garceau Dee
Published: November 2023

Since I have to raise $65.00 I decided either to rob some bank or start stealing cayuses. But an after thought and our Deer Lodge the State school for crooks came to my mind and I decided to go to work and earn honest money to pay for my first books and here I am … working for a family, 6 children all of the school age but the baby … and their old dad to cook for and keep house. … I am getting $1.50 a day and when he threshes I will no doubt reap $2.50 or three dollars a day, room and board.1
Maria Montoya Martinez: Crafting a Life, Transforming a Community
Authors: Reynolds Terry R
Published: November 2023

When Maria was born in 18871 her parents could not have foreseen that she would be a major catalyst in changing their centuries-old village. They could not have known her future would bring her fame, fortune, travel, and powerful friends. They would teach her to care for others in the village, not because she was a female, but because they wanted her to become a good community member. They would have been satisfied for her to concentrate on her family, relatives, and neighbors with little thought to or activity beyond these spheres of village life. Maria, however, was caught up in the winds of change blowing throughout the southwestern United States at the turn of the twentieth century. With talent and skill in a traditional craft of women in her village, pottery making, and her thoughtful approach to living a good life in village terms, she, along with her husband, brought the village to the nation’s attention. She also helped to create an economic strategy through which her family, as well as other villagers, could enter the national economy and prosper. At the same time, Maria crafted a life based upon her ancestors’ traditions and service to others.1
Alice Lee Jemison: A Modern “Mother of the Nation”
Authors: Hauptman Laurence M
Published: November 2023

No woman in the twentieth century was as bold, courageous, strident, or fanatical in her defense of the Seneca Nation of Indians as Alice Mae Lee Jemison, the most prominent American Indian journalist in the United States from the early 1930s to her death in 1964.1 Although she was viewed by the Interior Department and the FBI as a dangerous subversive and put under surveillance because of her unyielding criticism of U.S. government Indian policies, Jemison’s political activism was well rooted in Seneca culture and history. Despite being falsely labeled at various times as an unrepresentative “mixed-blood;” a Nazi, a fascist, and a communist, Jemison was a much more representative voice of Seneca women than her enemies ever acknowledged.
Understanding TIAA-CREF
Authors: Schloss Irving S , Abildsoe Deborah V
Published: November 2023

TIAA-CREF is the largest private pension plan in the world, with more than $260 billion under management, including an estimated 1% of all shares traded on the New York Stock Exchange. And yet, while there is a wealth of information on IRAs, 401(k)s and other investment vehicles, until now there has been little guidance for the millions of TIAA-CREF plan participants and their advisors. The TIAA-CREF Book offers the definitive guide to TIAA-CREF for participants, estate planners, and financial advisors. Simply and clearly--and with a droll sense of humor--the authors explain the often complex legal and financial aspects of how the TIAA-CREF plan works, how the investment choices new participants make can affect the funds available at retirement, what the distribution options are for withdrawing money either before or after retirement, and how to leave the fund as an inheritance. For participants in the accumulation stage of their careers, the authors explain the important differences between fixed income securities (TIAA) and equity securities (CREF), and examine the investment choices for both. They address such important issues as how to allocate contributions, how portable an account really is, and how plans differ from employer to employer. In addition to the valuable primer on estate planning--from how to quantify assets, needs, and income to how the Federal Estate Tax affects TIAA-CREF accounts--the authors explore in detail the distribution options available and help weigh the pros and cons of each choice. Drawing on their extensive work in the field of estate planning, the authors cover the gamut of what it takes to make the most out of a TIAA-CREF plan.
Atherosclerotic Cerebrovascular Disease
Authors: Adams Harold P , Bachinski Vladimir , Norris John W
Published: November 2023

Atherosclerosis is the leading cause of ischemic stroke in North America and most countries around the world. It affects major intracranial and extracranial arteries and is a leading cause of occlusions of penetrating arteries that perfuse the deep portions of the brain. The most common locations for symptomatic cerebrovascular atherosclerosis are the origin of the internal carotid artery, the intracavernous portion of the internal carotid artery, the first segment of the middle cerebral artery, the origin of and the distal portion of the vertebral artery, and the mid portion of the basilar artery. Atherosclerosis also involves the aorta and major cervical arteries. The origin of the internal carotid artery is the most frequent site for severe atherosclerosis in persons of European ancestry, whereas intracranial arteries are more commonly affected among persons of African or Asian heritage. Diabetic persons also have a high rate of intracranial atherosclerosis.
Stroke in Children and Young Adults and Genetic Causes of Stroke
Authors: Adams Harold P , Bachinski Vladimir , Norris John W
Published: November 2023

Although most ischemic strokes occur in persons older than 65, approximately 3% of events occur in those under 45. The number of young persons having stroke may be increasing. This increase may be a true increase in incidence, or it may be secondary to a greater awareness that stroke does occur in this patient population. Because children and young adults have a long life expectancy, a stroke that leads to death or prolonged disability has a huge economic impact. The economic and societal effects of stroke are exacerbated by the absence of other serious medical illnesses in this population.
Management of Acute Ischemic Stroke
Authors: Adams Harold P , Bachinski Vladimir , Norris John W
Published: November 2023

Acute ischemic stroke is a neurological emergency. The first hours after onset are critical for initiation of treatment that can limit the neurological consequences of ischemic stroke. Time limits to define acute ischemic stroke are evolving but, for any effective therapy to ameliorate stroke, it probably must occur within a few hours. Although the first 24 hours might be considered an upper boundary in defining acute ischemic stroke, in reality, the first 3-6 hours are the most crucial.
Clues to Diagnosis of Peripheral Neuropathy: History and Examination of the Patient
Authors: Mendell Jerry R , Kissel John T , Cornblath David R
Published: November 2023

The importance of the initial history and physical examination in the evaluation of patients with suspected peripheral neuropathy cannot be overemphasized. As discussed in Chapter 1, a complete history and thorough examination usually provide sufficient information to address the first challenge presented by the patient with suspected neuropathy; namely, whether the symptoms are due to peripheral nerve disease or result from involvement of some other area of the nervous system. In addition, the data gathered from the history and examination permit the generation of diagnostic hypotheses that can then be assessed through subsequent electrophysiological and laboratory studies.
Evaluation of the Peripheral Neuropathy Patient Using Quantitative Sensory Testing
Authors: Mendell Jerry R , Cornblath David R
Published: November 2023

Sensory thresholds for modalities of touch, temperature, vibration, and pain have been characterized and quantified by a variety of instruments to establish an accurate baseline for future comparisons. These measures have become an important element in controlled clinical trials and epidemiological studies. In fact, some clinical trials have used instrument measured sensory thresholds as primary endpoint meaures. Certain devices have also been incorporated into routine clinical practice. Instruments available for clinical use range in size from hand-held appliances to complex computer-driven machines and in cost from hundreds to tens of thousands of dollars. The requirements for adequate systems, from design to testing algorithms, to standardization, including the recommendations for controls, have been delineated in a consensus statement by the Peripheral Nerve Association. These principles are relevant to the application of instrument-measured sensory thresholds in clinical practice and are emphasized in this discussion (Table 4-1).
Evaluation of the Peripheral Neuropathy Patient Using Autonomic Reflex Tests
Authors: Novak Vera , Mendell Jerry R
Published: November 2023

Autonomic nervous system involvement is an important feature of many acute and chronic peripheral neuropathies (Table 5-1). Neuropathies may affect both somatic and autonomic nerves, or less often, autonomic nervous system failure may be the major or sole manifestation of the condition. In either case, autonomic reflex testing has emerged as an important diagnostic tool. Examples where autonomic reflex tests are valuable include acute panautonomia (Chapter 9), pure autonomic failure, and paraneoplastic intestinal pseudoobstruction. In patients with small cell carcinoma of the lung, autonomic failure may precede other manifestations of the disease. In other patients, such as those with small-fiber sensory neuropathies, loss of a particular autonomic nervous system function, like sudomotor function of the distal extremity; can provide objective evidence of nerve fiber damage that may be difficult to substantiate by other means (see Case Report 1: Idiopathic Painful Sensory Neuropathy).
The Role of Peripheral Nerve and Skin Biopsies
Authors: Mendell Jerry R , Erdem Sevim , Agamanolis Dimitris P
Published: November 2023

It is important to emphasize that the nerve biopsy is not a screening test for neuropathy. We have other methods of screening that are less invasive, less expensive, and less likely to produce discomfort that persists for weeks to months. Therefore, the nerve biopsy should be strategic and well planned, not a routine part of the evaluation of every neuropathy patient. The nerve biopsy is used to address specific questions, with the realization that there are limitations of interpretation imposed by the narrow range of pathological responses to a variety of insults. It is also an expensive test, employing multiple means of analysis, including paraffin, frozen and plastic (epoxy resin) embedding techniques, along with teased nerve fiber preparations; preparing the latter, in particular, takes considerable time and skill. Each of the processing methods targets different potentially affected components of the nerve. In some cases, explicit diagnostic information can be derived, in others only supportive diagnostic information can be expected.
Vasculitic Neuropathy
Authors: Kissel John T , Collins Michael P , Mendell Jerry R
Published: November 2023

The term vasculitis incorporated a large group of clinically heterogeneous conditions that have the following characteristic pathologic features in common: inflammation and structural damage to blood vessel walls that leads to ischemic, hemorrhagic, and thrombotic damage to the tissues supplied by those vessels. Peripheral neuropathy is common in conjunction with most of these vasculitic syndromes, irrespective of whether vasculitis is the primary disease process, as in polyarteritis nodosa or Wegener’s granulomatosis, or is secondary to some other connective tissue disorder, such as rheumatoid arthritis or systemic lupus erythematosus. In patients with secondary vasculitides, it can occasionally be difficult to distinguish vasculitic neuropathy from other types of neuropathy (discussed in Chapter 13). The clinical and pathologic features of vasculitic neuropathy, however, are distinctive enough to merit separate discussion, particularly since neuropathy may be the first, and sometimes only, manifestation of vasculitis. Prompt diagnosis by the neuromuscular clinician is therefore crucial because of the significant potential for improvement with immunosuppressive treatment. In fact, vasculitic neuropathy represents one of the most treatable neuropathies encountered by clinicians.
Peripheral Neuropathies Associated with Connective Tissue Diseases
Authors: Robert P Lisak , Mendell Jerry R
Published: November 2023

Connective tissue diseases represent a varied and challenging group of disorders, and the peripheral nerves are highly susceptible targets for damage in these conditions.1-•3 The pathogenic mechanisms are varied and often ill defined. An immune-mediated or inflammatory process is usually invoked, but the precise role played by many of the components of the inflammatory process awaits more knowledge. A necrotizing vasculitis can be demonstrated in some cases, as described in this review and in Chapter 12. Compressive and entrapment neuropathies are common, especially in association with rheumatoid arthritis. The peripheral nerves can also be damaged by organ system failure, especially renal damage, and also as a consequence of pulmonary and hepatic failure. Drugs used in the treatment of these disorders can also affect the peripheral nervous system.
Critical Illness Polyneuropathy and Related Conditions
Authors: Mendell Jerry R
Published: November 2023

A neuropathy associated with critical illness was described by Bolton in 1984, but similar reports date back many decades. Although initially controversial because of the complexity of the clinical setting in which it occurs, critical illness polyneuropathy has gradually gained acceptance. Recognizing disorders affecting the motor unit in the critically ill patient is an important endeavor for the clinician. The motor unit is vulnerable at all levels, including the motor neuron (Hopkins Critical illness polyneuropathy is not a single entity. The condition described by Bolton and colleagues in a series of reports is the best recognized variant and by definition occurs in the setting of sepsis and multiple organ system failure (dysfunction in at least two organs). Bolton emphasizes that the neuropathy is one of the manifestations of the “systemic inflammatory response syndrome,” a term coined in 1992 by the Society of Critical Care Medicine and the American College of Chest Physicians. Other conditions considered to be variants of critical illness neuropathy and falling under its umbrella include “acute respiratory failure neuropathy” and “acute motor neuropathy associated with neuromuscular blocking agents”.
Hereditary Sensory and Autonomic Neuropathies
Authors: Mendell Jerry R
Published: November 2023

The hereditary sensory and autonomic neuropathies (HSAN) represent a rare group of disorders. A classification of the conditions belonging to this group has been in evolution for decades. At present, the categorization of patients is based on the mode of inheritance, clinical manifestations, and electrodiagnostic and neuropathological observations. The frailty of such a pure phenotypic approach has been demonstrated with other inherited neuropathies (see Chapters 21 and 23 on hereditary motor and sensory neuropathies and familial amyloid polyneuropathies, respectively), where molecular genetic findings continue to have a major impact on our understanding and nosological classification. The precise number of accepted subtypes of HSAN is somewhat arbitrary. Five subtypes of HSAN are reasonably well defined, and a case has been made to accept HSAN VI as an additional subtype. A more accurate classification will grow out of genetic studies demonstrating chromosomal localization and specific gene defects. This is beginning to happen with these disorders as demonstrated by the finding of a molecular defect in the TRKA tyrosine kinase receptor gene for nerve growth factor (NGF) in HSAN IV.
Lipoprotein Disorders: Tangier Disease and AbetaIipoproteinemia/FamiIial Hypobetalipoproteinemia
Authors: Mendell Jerry R
Published: November 2023

Three neurologic disorders involve abnormalities in lipoproteins and their constituents. Tangier disease predominantly affects the peripheral nerves without significant central nervous system involvement. Abetalipoproteinemia, or Bassen-Komzweig disease, and familial hypobetalipoproteinemia are phenotypically identical, predominantly spinocerebellar syndromes with a peripheral neuropathy, much like Friedreich ataxia.
Cryptococcal meningitis
Authors: Brew Bruce James
Published: November 2023

Cryptococcal meningitis is a relatively frequent complication of human immunodeficiency virus (HIV) disease. It can present subtly with only mild headache, but if the diagnosis is missed the patient can rapidly deteriorate to death within hours to days. In most patients, it is easily treatable so that all clinicians involved with HIV-infected patients should be fully aware of the condition. Indeed, a good clinical aphorism is that headache in a patient with advanced HIV disease is cryptococcal meningitis until proved otherwise.
Prevention and Screening Principles Relevant to Gastrointestinal Malignancies
Authors: Shureiqi Imad , Reddy Pavan , Ruffin Mack T , Brenner Dean E
Published: November 2023

Strategies for the prevention of any disease can be categorized as primary, secondary, or tertiary. Primary prevention strategies aim to reduce the incidence of disease and generally target the entire population without symptoms or disease. For gastrointestinal cancers, primary prevention strategies include diet or dietary supplements, smoking cessation, hepatitis B vaccine, avoidance or elimination of environmental carcinogens, and risk reduction.
Therapeutic Principles of Gastrointestinal Neoplasia: Emerging Therapies: Vaccines
Authors: Jessup J Milburn
Published: November 2023

By 1990, several reports indicated that adjuvant chemotherapy for stage III colon cancer1,2 or adjuvant multimodality therapy for stage II or stage III rectal cancer3 successfully decreased recurrence rates and improved survival rates. A National Institutes of Health (NIH) Consensus Conference4 reviewed the available data and recommended that patients with stage II colon carcinoma or stage II or III rectal cancer receive adjuvant therapy, which in 1990 was 5-fluorouracil plus levamisole for colon cancer or 5-fluorouracil and leucovorin with radiation therapy for rectal cancer.
Molecular Biology of Esophageal Cancer
Authors: Tselepis Chris , Jankowski Janusz
Published: November 2023

Esophageal cancer remains the third most frequent gastrointestinal (GI) cancer in the world. It was responsible for over 500,000 new cases in 1994, more than 90% of which were fatal. Esophageal cancer has the widest regional variation in incidence of any GI cancer and has a greater than 100-fold difference in incidence between high-and-low risk areas of the world. The histological type of cancer also shows regional variation, with predisposition to adenocarcinomas in the Western world and squamous cell carcinomas (SCC) in third-world countries.
Epidemiology and Molecular Epidemiology of Gastric Cancer
Authors: Moss Steven F , Shirin Haim
Published: November 2023

Gastric adenocarcinoma is by far the most common malignant gastric neoplasm and worldwide remains the second most common cause of cancer mortality after lung cancer. The much rarer non-Hodgkin’s lymphomas and leiomyosarcomas, which account for fewer than 5% of all gastric tumors, are discussed in Chapters 66–70 of this book.
Molecular Biology of Gastric Cancer
Authors: Tahara Eiichi
Published: November 2023

Striking advances in molecular dissection of precancerous and cancerous lesions of the stomach indicate that genetic and epigenetic alterations in oncogenes, tumor suppressor genes, DNA-repair genes, cell-cycle regulators, telomeres, and telomerase, as well as genetic instability at microsatellite foci, are involved in the multistep process of human stomach carcinogenesis.1–3 The scenario of these changes found in gastric carcinoma differs depending on the histologic type of gastric cancer, indicating that different carcinogenetic pathways exist for well-differentiated or intestinal-type carcinomas and poorly differentiated or diffusetype carcinomas.
Clinical Aspects and Management of Gastric Carcinoma: Management Options: Potentially Resectable Gastric Cancer
Authors: Mansfield Paul F
Published: November 2023

Since the 1930s, when gastric cancer was the most common type of cancer in the United States, the incidence of this type of cancer has declined dramatically. Although it is now not even one of the 10 most common cancers, it is the eighth leading cause of cancer death. In 2001, approximately 21,700 patients were diagnosed in the United States, of whom more than half are expected to die from the disease.
Locally Advanced Unresectable Gastric Cancer
Authors: Clark Jeffrey W
Published: November 2023

Attempted curative resection is the treatment of choice for gastric adenocarcinoma. However, it is not always possible. In Western countries, less than 50% of patients can have potentially curative resections at the time of initial presentation. In Asian countries where the higher incidence of gastric cancer has led to earlier screening and detection of gastric cancer in high-risk individuals and in those with early symptoms, a greater percentage of patients have their disease diagnosed earlier and thus can have potentially curative resections.
Molecular Biology of Pancreatic Adenocarcinoma
Authors: Jean Marina E , Lowy Andrew M , Evans Douglas B , Chiao Paul J
Published: November 2023

Pancreatic adenocarcinoma is the fifth leading cause of adult cancer mortality in the United States.1 On the basis of population data and cancer incidence rates collected by the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, it is estimated that 30,700 new cases of cancer of the pancreas will be diagnosed in the United States in 2003, and 30,000 cancer deaths will result from pancreatic cancer.
Pathology and Natural History of Pancreatic Cancer
Authors: Mutema George , Fenoglio-Preiser Cecilia
Published: November 2023

Pancreatic cancer is now the 5th most common cause of death from cancer in the United States, preceded by only lung, colon, breast, and prostate cancers. Each year, 28,000 new patients are identified, of whom only 1000 are expected to survive 5 years. The pancreas is functionally divided into exocrine and endocrine components, and most pancreatic cancers arise in the exocrine pancreas and are carcinomas. This chapter will cover the pathologic features of these tumors. (Cancers of the endocrine pancreas are neuroendocrine tumors). Secondary involvement of the pancreas by other tumors can occur either by direct extension or through metastasis. Metastatic tumors will be covered briefly here.
Clinical Aspects and Management of Pancreatic Adenocarcinoma Management Options: Locally Advanced Unresectable Pancreatic Cancer
Authors: Tempero Margaret A , Termuhlen Paula , Brand Randall E , Mcginn Cornelius
Published: November 2023

Current multimodality therapy for patients with pancreatic adenocarcinoma consists of surgery, chemotherapy, and radiation therapy. Unfortunately, more than one-half of patients present with distant metastatic disease and more than two-fifths of patients have locally advanced but unresectable disease.1 The management of patients with pancreatic adenocarcinoma must include palliation of the symptoms associated with the disease, such as gastric outlet obstruction, biliary obstruction and pain.
Epidemiology, Molecular Epidemiology, and Biomarkers of Biliary Tract Cancers
Authors: Soloway Roger D , Rego Rayburn
Published: November 2023

Malignant tumors of the biliary tract are rare, accounting for less than 2% of all malignant neoplasms in the United States. Knowledge concerning the etiology of these cancers has come from clinical observations, animal experiments, autopsy series, and descriptive epidemiologic studies. The exact pathogenesis of these tumors, however, still needs to be established, and more sensitive and specific markers need to be developed to screen for these uncommon tumors.
Molecular Biology of Cholangiocarcinoma and Gallbladder Carcinoma
Authors: Goggins Michael
Published: November 2023

Neoplasia arises in a cell as a result of damage to multiple cancerpredisposing genes, each providing selection of progressively more autonomous clone(s) until characteristic features of cancer such as invasion and metastasis have been achieved. Many classes of cancer-causing genes are involved in cancer formation. Furthermore, in addition to defects in growth regulatory genes, increasingly, cancers are characterized by defects in genome maintenance.
Clinical Aspects and Management of Cholangiocarcinoma and Gallbladder Carcinoma Management Options: Unresectable Gallbladder Carcinoma and Cholangiocarcinoma
Authors: Johnnides Christopher , Roh Mark S
Published: November 2023

Carcinoma of the gallbladder tends to be a disease of elderly women. The mean age at diagnosis is 65 years and the female-to-male ratio is approximately 3 to 1. 4– 6 Certain ethnic groups carry a higher risk, with American Indian, Japanese, Hispanic (especially Mexican and Chilean), and persons of Jewish ancestry having a higher prevalence of the disease than the population of the United States as a whole.
Clinical Aspects and Management of Hepatocellular Cancer: Diagnostic and Staging Procedures
Authors: Choti Michael A
Published: November 2023

Hepatocellular carcinoma (HCC) is among the most common malignancies worldwide, accounting for more than 1,000,000 new cases per year.1,2 Surgical therapy of early-stage disease provides the only hope for curative therapy. Therefore, early diagnosis and appropriate determination of extent of disease and hepatic function are critical in optimizing treatment planning and improving survival rates.
Molecular Biology of Colorectal Cancer
Authors: Su Li-Kuo
Published: November 2023

The development of colorectal cancer from normal epithelial cells is a multistep process. A molecular genetic model proposed more than a decade ago has been proven to be a major genetic pathway for colorectal tumorigenesis.1,2 It is clear that the alteration of many genes, including both proto-oncogenes and tumor suppressor genes, is involved in this complex process of tumorigenesis. Several of these genes have been identified and their functions elucidated. In addition, other molecular alterations that may contribute to the development of colorectal cancer have been discovered.
Clinical Aspects and Management of Rectal Adenocarcinoma Management Options: Unresectable Rectal Carcinoma
Authors: Minsky Bruce D
Published: November 2023

In patients with primary, respectable (T3) rectal cancer, a significant improvement in local control and survival can be achieved with the use of radiation therapy plus 5-fluorouracil (5-FU)– based chemotherapy (combined-modality therapy).1–3 It is more difficult to obtain these same results for patients with more advanced disease. For locally advanced or unrespectable rectal cancers, collectively defined as T4 disease, there is no uniform way to determine respectability.
Management Options: Metastatic Colorectal Carcinoma
Authors: Vauthey Jean-Nicolas , Medgyesy Diana , Goffin John R , Royce Melanie , Ayoub Jean-Pierre , Hoff Paulo M
Published: November 2023

Despite the remarkable advances seen in the understanding of the development and treatment of colorectal cancer, it is estimated that approximately 150,000 individuals are diagnosed annually with this disease in the United States. Forty percent of patients with colorectal cancer will die from metastatic disease, and the liver is the main site of metastasis. Approximately 20% of patients will present with or develop metastasis confined to the liver during the course of the disease.
Low- and High-Grade Lymphomas
Authors: Cabanillas Fernando , Pro Barbara
Published: November 2023

Non-Hodgkin’s lymphomas (NHLs) comprise a heterogeneous group of malignant neoplasms arising mostly in lymph node tissue but sometimes at extranodal sites. These extranodal NHLs are referred to as primary extranodal lymphomas. The incidence of NHLs has been rising steadily over the last two to three decades. According to Surveillance, Epidemiology, and End Results (SEER) data for the period from 1974 to 1988, the incidence of nodal NHL increased 1.7% to 2.5% per year and the incidence of extranodal NHL, 3.0% to 6.9% per year.1,2
Clinical Aspects and Management of Gastrointestinal Sarcomas: Management Options: Potentially Resectable Gastrointestinal Sarcomas
Authors: Cormier Janice N , Pisters Peter W T
Published: November 2023

Gastrointestinal (GI) stromal tumors (GISTs), of which leiomyosarcomas represent a subset, have presented a diagnostic and therapeutic dilemma for decades. The complexity of defining these tumors is magnified by the rarity of their occurrence (accounting for only 0.1% to 3% of all GI malignancies) and by their anatomic heterogeneity (esophagus to anorectum). Most of the available data come from retrospective single-institution analyses of small series of patients treated over long periods.
Style and Presentation in the 17th Century
Authors: Bruce Steve
Published: November 2023

When we watch an old Max Sennett short, we may be amused not only by the antics of the Keystone Kops, but also by their rapid, jerky motions; if so, we are indulging in the pleasures of anachronism. The Keystone jerkiness is a consequence, not of Sennett’s desire to please, but of his technical limitations. Only informed hindsight allows us to enjoy exactly what its original audiences enjoyed.
Argument in the 17th Century
Authors: Bruce Steve
Published: November 2023

On 15 May 1693, in the Memoire de Mathematique et de Physique of Two there appeared an article by Jean Mery entitled “Observations of Two Fetuses Enclosed in the Same Membrane.” The two fetuses were dead, and Mery reflects on the cause of their mortality: For if they are separated [each in his own membrane], their umbilical cords cannot interlace; instead, when two lei uses are enclosed in a common membrane, they easily interwine their cords by their movements and consequently suffocate; as actually happened to these fetuses represented here whose cords hindered each other’s functions and formed a knot that, having prevented I lie blood from circulating from the placenta Io their vessels, caused their death.
Evolutionary Dynamics of Organizational Populations and Communities
Authors: Baum Joel A C , Rao Hayagreeva
Published: November 2023

The ability of societies to respond to social problems may hinge crucially on the diversity of organizational forms, and in the long run, in a dynamic environment, diversity can be maintained or increased by the rise of new forms. Moreover, new forms are vital engines of organizational evolution. Indeed, an important component of organizational change, at the macro level, consists of the selection and replacement of existing organizational forms by new organizational forms. Furthermore, since new organizational forms are structural incarnations of technologies, beliefs, values, and norms, they emerge in tandem with social movements, new institutions, and new technologies and help to foster and reflect cultural and technical change in societies. For these reasons, where new organizational forms come from is a central question for organization theorists.
Introduction: Medical Ethics and Organizational Ethics
Authors: Hall Robert T
Published: November 2023

The field of medical ethics is relatively new, but it has already become a well­ established enterprise both in university health centers and in smaller hospitals. Hospice programs, nursing homes, and home health agencies are now developing ethics committees as well (DeVries and Subedi, 1998). Issues like informed consent, the withdrawal of life-sustaining treatment, abortion, the use of experimental drugs, and the confidentiality of medical information have been dis­ cussed widely in the professional literature and the popular press. Definite progress has been made: ethics consultations are widely available to patients and physicians, state laws have been passed assuring patients the ability to issue advance directives for their care and to appoint surrogate decision makers, and the automatic use of extraordinary measures to extend life has been curbed (Jonsen, 1998). Debates continue about physician-assisted suicide, the right to care that is considered medically futile, and the obligation to care for patients who refuse to adopt healthier lifestyles, among other issues.
Advertising and Marketing
Authors: Hall Robert T
Published: November 2023

Between 1992 and 1994 the Woodstock Theological Center convened a seminar of experts to discuss “Ethical Considerations in the Business Aspects of Health Care.” One of the major challenges faced by the healthcare system in the United States, they concluded, comes from the influence of market practices:

The expansion of health care diagnostic and treatment possibilities has also opened up significant profit opportunities to health care professionals and entrepreneurs. Professionals can choose lucrative specialties, or can target niches within their specialties, such as cosmetic plastic surgery or sports medicine, which are especially profitable because many individuals are willing to pay high prices for these services, even if they are specifically excluded from coverage by insurance policies. As a result, the health care field is increasing being influenced by “marketing” practices, and the line between attending to the health care needs of society and selling a consumer product has been increasingly blurred.
Managed Care
Authors: Hall Robert T
Published: November 2023

Conflict of interest is a key concept in business ethics (Margolis, 1979) and in healthcare organizational ethics (JCAHO, 1998:77-83). A conflict of interest exists whenever a decision maker has a motive for making a decision that is not in the interest of the organization of which he or she is an agent (an organizational conflict of interest) or of a client or patient (a professional conflict of interest). The most common conflicts of interest are those between organizational or professional obligations and the personal interests of the decision maker—for example, when a physician refers a patient to a home health agency in which he has a financial interest. But a conflict can also occur between a professional’s obligation to a client and his or her other obligations: a physician may need to spend extra time explaining a procedure to a patient, while the organization expects her to be seeing other patients.
Diversity
Authors: Hall Robert T
Published: November 2023

Race, ethnicity, and gender permeate our social interaction and our work lives. Diversity is now a major issue in organizational management and customer services. The discussion in this chapter focuses on those aspects of the subject that impinge most directly upon the normal activities of healthcare organizations: employment discrimination, sexual harassment, workplace relationships, and sexual orientation. It concludes with some comments on diversity training programs.

Discrimination in employment, according to the Civil Rights Act of 1964, takes place when a person is denied a position, promotion, or some other employment benefit, or is laid off, because of his or her race, color, religion, sex, or national origin. Age was added to the list as a protected class in 1967. In 1982 a separate bill was passed governing pregnancy discrimination; and in 1991 discrimination on the basis of disability was made illegal under the Americans with Disabilities Act. Individual states have added other categories, such as marital status and sexual orientation.
Medical Records
Authors: Hall Robert T
Published: November 2023

The new version of the principle is, in certain respects, just as out of date as the old one. Both appear to presume that medical care is a matter of one physician in a relationship with one patient, with the information limited to what the patient discloses. Today, with multiple physicians, other specialists, laboratory technicians, nurses, clerks, medical students, social workers, chaplains, researchers, medical committees, administrative committees, quality review auditors, admitting clerks, billing clerks, and a whole corps of approval officers, financial intermediaries, and insurance processors all involved, medical information seems to be anything but confidential.
Patient Services
Authors: Hall Robert T
Published: November 2023

Before the Medicare prospective payment system was introduced in the early 1980s, hospitals were not greatly concerned about the amount of uncompensated care they provided. The cost of such care was shifted from patients who could not pay to those who could. The cost reimbursement system virtually assured healthcare organizations that they would be paid for care that was given, regardless of who received it. Hospitals could literally add up their total operating costs and divide the bill among the paying patients. When Medicare started paying fixed amounts according to DRGs, however, the costs of charity care could no longer be divided among the paying patients. When other payers followed the Medicare example with provider contracts and fee schedules, the pool of patients from whom the hospital’s costs for uncompensated care could be recovered was reduced even further. Economic constraints now make it necessary for all healthcare organizations to watch very closely the amount of charity care they give.
Clinical Ethics, Medical Research, and Compliance Programs
Authors: Hall Robert T
Published: November 2023

This chapter deals with three common programs of healthcare organizations that are closely related to organizational ethics: clinical ethics committees, institutional review boards for medical research, and compliance programs. Each has a mandate that is focused on ethical considerations; but each has its own jurisdiction. Only a brief introduction to the scope of these programs can be offered here, along with consideration of the ways in which each is related to organizational ethics.
The Development of An Organizational Ethics Program
Authors: Hall Robert T
Published: November 2023

The current move toward healthcare organizational ethics involves both carrots and sticks. The carrots are the desires of many healthcare professionals to build a better healthcare system. These people take seriously the unmet needs of those who have no health insurance, the social responsibilities of businesses, the community obligations of nonprofit organizations, and the organizational problems of institutions. The sticks are the patients’ rights movement in man­ aged care, compliance with federal regulations, and the standards set by the JCAHO. This chapter reviews the JCAHO’s standards, discusses options for establishing an organizational ethics program, and proposes two practical strategies for program implementation.