The pediatric medical-psychiatric unit in a psychiatric hospital

Interest in the development of pediatric medical-psychiatric units continues to grow, driven by clinical, financial, and interdisciplinary considerations. While virtually all of the pediatric medical-psychiatric units reported in the literature to date have arisen in the pediatric setting, there are considerations that may encourage the development of such programs in the psychiatric setting. The authors report on the development and characteristics of a pediatric medical-psychiatric specialty inpatient unit developed in a psychiatric hospital. Advantages and disadvantages of the psychiatric hospital setting are considered in light of cumulative experience.     

Implementation of guidelines for No-CPR orders by a general medicine unit in a teaching hospital

Improvements in reconstruction of the skull base have made craniofacial surgery safe. Reconstruction of the anterior skull base must provide a seal between the cranial cavity and upper respiratory tract, as well as offer structural support for the brain. A wide variety of local flaps have been designed. The choice of flap in individual cases depends on the location and size of the defect. We report a reconstructive technique for the anterior skull base with vertical median forehead flaps which we used to treat two patients, one patient with adenocarcinoma and the other with leiomyosarcoma. Both were lesions of the ethmoid sinuses and nasal cavity.     

Developing a research unit within a hospital social work department

This article describes the establishment of a research unit as an integral part of a hospital social work department on the basis of the authors' experience in a cancer center over a 13-year period. Methods are described for building support within the institution, for the process of initiating the unit, for deciding on study topics, and finally for bridging the gap between clinical and research staff. The evolution of the relationship between clinical and research staff was characterized by four different phases: curiosity, competitiveness, cooperation, and collaboration. A childhood bereavement project is used to exemplify the developmental processes and the ongoing interaction of research and clinical staff. The professional practice of all staff benefited from the increased academic rigor and productivity, although some staff remained unconvinced of the value of such a major research effort. The benefits and costs of the unit are also discussed.     

Effects of hospital closure on mortality rates of the over-65 long-stay psychiatric population

We describe a girl with a brain-stem tumour and symptoms very similar to those of Rett syndrome (RS). Her early history was uneventful and development was normal (except for hypotonia). At the age of 6 months her development slowed. Subsequently, deterioration occurred and the features characteristic of RS were seen: loss of purposeful hand use, stereotypic hand movements, impaired social contact, decelerated head growth, and ataxia. Cerebral CT at the age of 3 years and 4 months revealed a tumour in the region of the pons and hydrocephalus. We suggest that a pons/midbrain tumour appearing at an early age may affect the developing CNS and cause symptoms similar to those of RS. A possible causal connection between midbrain pathology and RS is supported by this case.     

The place of the high dependency unit in a modern New Zealand hospital

AIM: To describe the concept of, and the benefits which come from having, a high dependency unit (HDU), based on the 24 years experience of Waikato Hospital. DESCRIPTION: The HDU (9 beds/1600 patients per year) is part of the Critical Care Unit which also contains an adult intensive care unit (ICU) (11 beds/1000 patients per year), and a paediatric ICU/HDU (3 beds/250 patients per year). The regular care in the HDU is given by the specialist teams, aided by input from the ICU team. Over three years, 4390 patients were admitted having an average stay of 34 hours (61% < 24 hours). Forty eight percent of patients were over 60 years of age. The main sources of admissions were the theatre (66%), emergency department (18%), ICU (14%) and wards (11%). The main destinations were the wards (92%) and ICU (4%), with a mortality of 0.6%. The reasons for admission, specialist teams and post-operative diagnoses are described. Clinicians value the area highly, and have used it extensively. The average cost was $NZ800 per day. CONCLUSIONS: Large hospitals in New Zealand should be planning an HDU to allow adequate care for those patients too complicated for the ward but not needing the ICU. Smaller hospitals can usefully combine the functions of ICU and HDU within one area.     

Withdrawal in opiate addicts in an internal medicine hospital unit

Withdrawal of opiates drug addicts in Internal Medicine is unusual in France. Four main preliminary conditions are requested: 1--Drug addict preparation and self motivation, 2--Inter and intra institution team collaboration, 3--Opening the hospital towards community agencies, 4--Hospital staff recruited on volunteer basis. Within two years (1992-1993), 210 opiates drug addicts were hospitalized for withdrawal. Two third were males, median age was 27, median years of addiction was 7. Thirty percent were seropositive for HIV, 70% for HCV. Hospitalisation lasted 7 days for heroin addicts and 10 days for morphin, codein or buprenorphin addicts. Successful withdrawn was observed for 70% patients but six months after withdrawal, only 15% remained abstinent.     

基层医院科护士长素质要求

基层医院护理工作繁重,护理管理难度大,要求可护士长具备扎实的业务技术及良好的管理水平,才能有效保障护理工作安全,保证护理质量及时提高基层医院的服务对象主要是广大的农民患者,由于病人的文化层次参差不齐,病人对护理服务的需求千差万别,这就给护理工作的顺利开展带来了很多挑战,良好的护理队伍是医院做好医院医疗服务工作的主体,作为承担管理角色的护士长的素质要求至关重要,对医院医疗及护理服务质量起着举足轻重的作用.     

Use of a general surgical high dependency unit in a district general hospital: the first 10 years

The chemotherapy regimen of paclitaxel and carboplatin produces an objective response in 30%-60% of patients with non-small-cell lung cancer (NSCLC). In a prospective study, we administered paclitaxel 200 mg/m2 (by 1-3-hr infusion) and carboplatin at an area under the plasma concentration curve (AUC) of 5 (by the Calvert formula) every 3 weeks to 21 patients who had previously received predominantly platinum-based chemotherapy for NSCLC. We observed no objective responses. Patients received a median of 2 cycles before disease progression. Three of 5 patients who had received only single-agent treatment with a relatively inactive agent may have had modest clinical benefit. We conclude that the paclitaxel/carboplatin regimen has minimal activity in previously treated patients with NSCLC.