Outpatient geriatric evaluation and management. Results of a randomized trial

The effectiveness and efficiency of outpatient geriatric evaluation and management (GEM) was compared with usual outpatient primary care (UPC). One hundred sixty frail elderly outpatients were assigned randomly to GEM or UPC and assessed at baseline and at 8 months on measures of (1) health and functional status, (2) psychosocial well-being, (3) quality of health and social care, (4) use of inpatient and outpatient services, and (5) cost of care. The results indicate that GEM was significantly more effective than UPC in reducing mortality, increasing patient satisfaction, and improving the quality of health and social care. However, it was not effective in reducing health care use or the cost of care.     

Results of stationary management of patients with hypertension with reference to previous ambulatory care]

The case histories of 100 patients who were hospitalised in the Department of Internal Medicine of St. George's Hospital in the period from January 1975 to March 1976 are analysed mainly to study their treatment as outpatients (information of the patient, previous diagnoses and treatment, and diagnosis at the time of hospitalisation) and the results of their in-hospital treatment. Most of the patients were admitted to hospital at an advanced stage, usually when out-patient treatment had failed to produce results, but in 80% of the cases the result of in-hospital treatment was satisfactory or good. Besides improvement in drug combination and treatment of cardiac insufficiency, the most frequent complication, observation of general therapeutic principles under conditions of in-hospital treatment was found to be of special importance. Over and above this, we regard close cooperation of hospital and out-patient clinic as essential in the optimisation of the treatment of hypertension.     

Pharmacist as a provider of oncology ambulatory care services

The services provided by a pharmacist to ambulatory oncology patients is described. The pharmacist takes drug histories, monitors drug therapy, gives patient discharge consultations and acts in cooperation with local physicians and the medical staff in providing chemotherapy to cancer patients for home administration. The pharmacist also provides inservice education and acts as a consultant to the medical, nursing and pharmacy staffs.     

Quality management for psychology services in health care facilities.

Describes a model of quality management, designed by a task force of the Canadian Psychological Association, to meet revised standards of the Canadian Council on Health Facilities Accreditation for psychology services. The incorporation of aspects of Continuous Quality Improvement, Total Quality Management, Indicators, and Benchmarking are discussed in relation to their application to psychology services in health care facilities. The Quality Management Model is based on the assumptions that everyone wants to do their job well and improve in their job performance; that the improvement in the quality of services is everyone's responsibility; and that psychological service provision in a health care facility involves complex linkages between providers, suppliers, and customers. The model also assumes that the major problems affecting quality of service are usually those same linkages, or the customers themselves; and that identifying and monitoring these linkages is crucial to understanding how to improve quality. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pilot experience with the use of an ambulatory geriatric assessment instrument

BACKGROUND: Ten percent of the Chilean population is over 60 years old and general practitioners need an instrument to assess the degree of disability and multiple ailments of elders. AIM: To develop and use an instrument to assess elders consulting in primary care outpatient clinics. PATIENTS AND METHODS: An instrument to be used by general practitioners, aimed to assess bio-psico-social risk of elders was devised by the Geriatrics Program at the Faculty of Medicine of the Catholic University of Chile. The instrument was used in 100 elders (82 female) aged 71 +/- 8 years old consulting in a primary care outpatient clinic. RESULTS: The instrument took less than 5 minutes to be used. The most frequent risk factors found were living alone in 62% of subjects, falls in the last year in 47%, memory disturbances in 62%, overweight in 76%, visual impairment in 76%, urinary incontinence in 26% and depression in 76%. Thirty percent had difficulties to climb stairs and 4% had no support in case of severe disability. CONCLUSIONS: The applied instrument is fast to apply, easily understood by patients and detects problems associated with old age, that will help to plan primary care health programs.     

Patient data management in intensive care therapy--pro]

Interleukin 2 (IL-2) is a T-cell proliferation factor released from TH0- and TH1-type helper T-cells and is an essential cytokine for certain immune responses. We reported here cloning and sequence of IL-2 cDNA in guinea pigs, which have been used for a long time in various immunological experiments and in vivo screening tests for skin sensitization potential of chemicals. Consequently, a cDNA clone was obtained encoding guinea pig IL-2 of 520 bp in length, which contained a complete open reading frame. Alignment of the amino acid sequence with human IL-2 indicates that guinea pig IL-2 is composed of 20 amino acids (aa) of a signal peptide and 132 aa of a mature peptide with a predicted molecular weight of 15133. Guinea pig IL-2 has an amino acid homology of 62% with human IL-2, 52% with murine IL-2, and 55% with rat IL-2. In addition, guinea pig IL-2 has a possible N-linked glycosylation site as seen in bovine and porcine IL-2.     

Exploring the theatrical experience: Results from an empirical investigation.

The article aims at explaining visitors' overall judgment of a theatrical event. A questionnaire was constructed including the 4 dimensions of the theatrical experience identified by Eversmann (2004): perceptual, cognitive, emotional, and communicative. The authors investigated 125 visitors of a production in a German community theater and confirmed that both the emotional and cognitive dimensions were determinants of visitors' overall judgment of a theatrical event. Implications for further research on the theatrical experience are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient assessment in ambulatory surgery. A questionnaire study

In our department, from the beginning of December 1994 to the end of February 1995, we operated upon a selected group of 199 patients, hospitalized as day surgery patients. Each patient was given a questionnaire to fill in after discharge. We asked them to evaluate day surgery from the consumer's point of view. We did not record any data which could identify the single patient. We received 158 questionnaires (79%) of which 151 were accepted. One hundred and seven patients (71%) found day surgery acceptable and a good alternative to conventional hospitalization, 82% preferred having the same doctor and primary nursing during the treatment. One hundred and sixteen patients were discharged as planned (77%). There were no serious complications. Provided that patients are carefully selected, we find day surgery a highly satisfactory method of management which is safe and efficient.     

Treatment of anxiety and panic attacks in geriatric psychiatry

For the treatment of anxiety disorders and panic attacks in elderly patients a multidimensional approach including pharmacotherapy, psychotherapy and behavioral modification is crucial. More than in younger patients side effects of drugs have to be taken into account. For the long-term treatment only a few psychotropic drugs are recommended. Useful substances are antidepressants including tricyclics and the newer class of SSRI. Buspirone may also play a role in the long-term pharmacotherapy of anxiety disorders. Neuroleptics, benzodiazepines and betablockers should only be prescribed after careful evaluation; by and large, they are of minor significance in the long-term strategy due to significant adverse effects. The pharmacological treatment should always be accompanied by psychotherapy. In particular, behavioral therapy and behavioral modification strategies are of benefit.     

Continuity of care and delivery of ambulatory services to children in community health clinics

This study assesses how continuity of care influences receipt of preventive care and overall levels of ambulatory care among children and adolescents in community health clinics (CHCs). It is a secondary data analysis of the 1988 Child Health Supplement to the National Health Interview Survey. Of 17,110 children in the sample population, the 1465 who identified CHCs as their routine source of care formed the study population. Continuity of site was defined as identification of a CHC as a source of both routine and sick care, and continuity with a clinician was defined as identification of a specific clinician for sick visits. In bivariate analyses both continuity with the CHC and with a specific clinician were associated with increased levels of preventive care and overall ambulatory care. In logistic regression models, continuity of care was associated with nearly a two-fold increase in the odds of receiving age-appropriate preventive care. Alternatively, insurance status was a better predictor of receipt of overall levels of ambulatory care. We conclude that expanding financial access alone is unlikely to sufficiently improve low-income children's access to Community Health Clinics. Additional emphasis on localizing the delivery of both routine and sick care services in a single site or with a specific clinician may be needed to achieve higher levels of both preventive care and overall ambulatory care.     

Control of nosocomial infections by multiresistant bacteria in geriatric services]

Huntington disease (HD) is an inherited neurodegenerative disorder which is associated with CAG expansion in the coding region of the gene for huntingtin protein. Recently, a huntingtin interacting protein, HIP1, was isolated by the yeast two-hybrid system. Here we report the isolation of a cDNA clone for HIP1R (huntingtin interacting protein-1 related), which encodes a predicted protein product sharing a striking homology with HIP1. RT-PCR analysis showed that the messenger RNA was ubiquitously expressed in various human tissues. Based on PCR-assisted analysis of a radiation hybrid panel and fluorescence in situ hybridization, HIP1R was localized to the q24 region of chromosome 12.     

Neuropsychological predictors of adaptive kitchen behavior in geriatric psychiatry inpatients

This study examined the degree to which demographic variables, psychiatric diagnosis, depression rating, and neuropsychological test performance predict adaptive kitchen behavior in geriatric psychiatry patients and normal elderly volunteers. Amixed group of 27 participants including 8 normal volunteers and 19 geriatric psychiatry inpatients underwent psychiatric evaluation, neuropsychological testing, and a kitchen skills assessment conducted in a natural setting. Both depression and dementia were prevalent among patients. The kitchen skills assessment was abnormal in 69% of patients, compared to none of the normal volunteers. Estimated premorbid IQs, psychiatric diagnosis, and neuropsychological test scores significantly predicted the pass/fail status on the kitchen skills assessment, but there was no effect for age, education, gender, or depression. The discriminant function analysis classified 92% of cases, and the canonical correlation coefficient was .84. Of the neuropsychological tests employed in the study, two tests involving visuospatial processing and attention were retained in the discriminant function analysis. The results are consistent with previous studies that suggest that visuospatial tasks are more predictive of instrumental activities of daily living than are cognitive tasks emphasizing verbal and memory abilities. In addition, we conclude that neuropsychological test data are useful and valid for the purpose of guiding clinical judgments regarding activities of daily living in geriatric psychiatry patients.     

The practice of geriatric psychiatry in three countries: observations of an American in the British Isles

The author compares the practice of geriatric psychiatry among three countries: Ireland, the United Kingdom and the United States. The two main areas reviewed are how the practice of geriatric psychiatry is done, and the mental health services available in each country, including organizational characteristics. The US is the most entrepreneurial of the three, Britain's greatest strength is the uniformity and comprehensiveness of its services, and Ireland provides an excellent model for nations of comparable size. Considerable change is occurring in all three countries.     

Establishing pharmaceutical care services in an HIV clinic

OBJECTIVE: To present a brief overview of human immunodeficiency virus (HIV) infection and to describe the implementation of pharmaceutical care services for adult patients with HIV infection. SETTING: University hospital clinic. PRACTICE DESCRIPTION: A pharmacist joined a multidisciplinary team serving HIV-infected patients in January 1994. PRACTICE INNOVATION: Current pharmacy services include taking medication histories, educating patients, counseling patients on compliance, monitoring response to therapy, identifying drug-related problems, documenting all interventions, and making therapeutic decisions and formulary choices. The pharmacist also participates in research. INTERVENTIONS: The pharmacist sees patients immediately after their physician appointments. Patients with one or more of the following characteristics are targeted to receive pharmaceutical care: multiple drugs, history of noncompliance, initiation of new drug therapy, recently discharged from hospital or emergency department, identification of potential adverse effects, identification of potential drug-drug interactions, and presence of drug toxicities. CONCLUSION: Pharmacists are uniquely qualified to provide a wide range of pharmaceutical care services to HIV-positive patients. Pharmacy interventions should lead to improved outcomes and decreased costs for a chronic and very expensive disease.     

Psychologists in geriatric medicine: Results of a national survey.

51 physician directors of geriatric medicine fellowship programs were surveyed on their current and desired involvement with psychologists, perceived areas of expertise of psychologists, comparisons of psychologists with overlapping health care professions, and factors limiting involvement of psychologists in geriatric medicine. Results indicate that psychologists are quite involved in most geriatric medicine training programs and that directors of these programs welcome their greater involvement. Significantly, psychologists and psychiatrists are rated as similar in expertise in most areas of clinical practice. Neuropsychological assessment and family therapy are areas of psychologist expertise that are seen as especially valuable. Factors that may increase psychologist involvement in geriatric medical settings and the special importance of medical settings for the care of older patients are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)