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Fifty-two ileostomy patients were examined in a follow-up study and an attempt was made to evaluate the quality of life with regard to function of the ileostomy, ability to work, social adaptation, and sexual life. Forty-nine had existences considered within the normal range, whereas quality of life was considered unacceptable in three cases because of severe cutaneous or psychiatric problems. In the patients who had not adapted to ileostomy there would appear to be an indication for construction of a continent ileostomy reservoir using the technique of Kock. [ABSTRACT FROM AUTHOR]

This is the second of two papers which involve a "triangulation" on medical performance in an effort to test the proposition that organizational stratification is related to hospital care. The triangulation consists of the measurement of performance from the subjective, reputational, and objective points of view. The present paper presents evidence based upon the objective medical records. The evidence is organized around a conception of the hospital as an institution performing seven key functions. Criterion measures related to these seven functions are examined, and it is shown that units which differ in their degree of stratification also differ in their performance with respect to a number of these criteria (e.g., the length of patient stay, and the use of the consultation process). Taken together, the two papers show that when performance is independently measured in three fundamental ways, there is a basic congruence which supports the proposition that the degree of stratification of organizational units is related to variations in task performance. [ABSTRACT FROM AUTHOR]

The advantage of a multi-center clinical investigation lies in the possibility of obtaining conclusive results on the basis of relatively few numbers of patients from each of the participating institutions. It has the disadvantage of a lack of uniformity of methods among centers, which must be overcome by careful advance planning, including the institution of a central coordinating unit, the biometrical unit. Its functions include (1) participation in the planning of all phases of the investigation, (2) editing and processing of the data, and (3) analysis of the data and evaluation of results. Three devices for promoting uniformity of methods are: (1) the protocal, (2) specially designed record forms, and (3) visits to participating centers by a team of observers, including the statistician. The protocol is the document which contains all important specification for the conduct of the investigation, including statement of purpose of the study, definition of the study population, and explicit instructions on methods of patient assessment. In a clinical trial, the biometrical unit prepares the random allocation of treatments to patients. Stratification may be used to make comparisons between strata, and/or increase the sensitivity of the experiment. Stratification by exclusion may increase sensitivity at the cost of restricting the generality of results. A well-planned multi-center study, in which the members really cooperate, may achieve objectives exceeding the scope of single-center studies and provide a setting for the fruitful exchange of knowledge and ideas.