The trauma patient: open hospital choice?

Mental-health service utilization among elderly people has been shown to be low relative to younger age groups. This study was done to determine the current proportion of elderly persons served in a university-affiliated psychiatry outpatient clinic, and to better characterize elderly patients who receive specialized mental-health care in this setting. The proportion of visits from elderly patients (aged 60 and over) was found to be 16%. Demographic and clinical characteristics of a sample of 140 consecutive geriatric patients evaluated at the clinic were obtained. The data revealed that the patients had a mean age of 74.7+/-7.5 (SD) years, and were mostly female (72.1%) and white (78.6%). Surprisingly, the age distribution was found to be bell shaped, with a small upper tail. The three most prevalent psychiatric diagnoses were depression (56.4%), dementia (35.7%), and substance use disorder (20%). Overall, 59.3% of geriatric patients had a history of prior psychiatric treatment. Females were significantly more likely than males to have a psychiatric history (69.3% vs. 33.3%, P = .0001). Among patients with a psychiatric history, females were more likely to have a current diagnosis of major depression (P = .0006), while males were more likely to have a current substance use disorder (P = .03). The prevalence of dementia increased with each successive decade above 60, while the occurrence of bipolar and adjustment disorders was confined to younger geriatric patients. Elderly patients receiving psychiatric treatment in the clinic thus formed a heterogeneous group. Gender, age, and presence of a psychiatric history were all associated with differences in prevalence and distribution of various mental disorders in this geriatric psychiatry outpatient clinic.     

Chronic geriatric patient in the hospital

The cost explosion in the health system, especially in the hospital field, and the prolongation of life, i.e. the increase of the proportion of old people in the total population, oblige us to ask the question as to the part of geriatric patients in the present and future hospital treatment. By means of statistically relevant material, i.e. 25,342 female and 20,189 male in-patients in the Municipal Hospitals Nuremberg during the year 1974, compared with investigations of the year 1964, the growing significance of the geriatric patients for the total health system is demonstrated. Particular interest is paid to the old chronically ill persons, as is shown in an estimate of the internal in-patients. 50% of the internal in-patients are chronically ill persons. The present structure of hospitals is by no means complying with this situation. As an improvement, a ward system with different aims instead of the one complex acute hospital is presented. Apart from the existing acute stations there should be provided geriatric rehabilitation wards, social stations and day-hospitals. Humanitarian and financial advantages to be expected of these new wards are outlined. Particular emphasis is given to the active rehabilitation in the sense of a comprising social-medical help.     

Pulmonary tuberculosis: diagnostic delay in Ghanaian adults

Pica (pica = magpie) is an eating disorder that is manifested by a craving for oral ingestion of a given substance that is unusual in kind (nonfood items) or quantity (food items). Pica has been described as a world wide phenomenon, but there are more frequent occurrences of selected substances among selected groups--especially young children and black pregnant and nonpregnant women in the southern part of the USA. In Central Europe and Germany this syndrome has not been described in the moderne literature. For this reason, we report a case of pica for starch associated with severe iron deficiency anemia in Germany. Iron deficiency anemia and--less often-potassium and zinc deficiency are the main complications of an excessive starch or clay ingestion, followed by gastrointestinal obstructions due to gastroliths or impaction. Additionally, naphtalene poisoning (in pica for toilet air-freshener blocks), phosphorus poisoning (in matches pica), mercury poisoning (in paper pica), and lead poisoning (in dried paint pica) have been described.     

The community hospital: a three-year study

In a three-year period a community hospital of 40 beds discharged 2086 patients, their mean length of stay being 14.8 days. Some 68% of the patients treated were over 65, and 8.9% died in hospital. While the most common diagnosis on admission was disease of the respiratory tract, this does not indicate the actual cause of admission. For 142 patients from one practice this was acute illness in 44% of the cases, assessment in 20%, and a need for nursing care in 36%. If the community hospital had not been available about half these patients would have been admitted to the general hospital.     

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.     

Thyroxine, thyrotropin, and age in a euthyroid hospital patient population

The diagnosis of thyroid disease now often can be achieved reliably by measuring thyrotropin (TSH) alone. Thyroxine (T4), triiodothyronine, and other analytes are only needed if TSH and the accompanying clinical condition are discordant. We describe here work that confirms the age independence of TSH in both inpatient and outpatient euthyroid hospital populations between ages 20 and at least 80 years, and demonstrates that although free T4 does vary with age, the range of variation remains within the T4 reference interval. On this basis, TSH-based thyroid diagnostic algorithms can be used reliably in adults without reference to age-related reference intervals.     

Non-smoking policy in the hospital: insight into policy-relevant social research

This article reports on long-term activities of the social research group SALSS which have been supported by the Federal German Health Education Authority. Work started in 1989/90 with a representative survey among hospital managers in West Germany which--soon after reunification--was completed by similar action in East Germany. In both cases, the subjects were regulations and actual situation of non-smokers' protection in hospitals as well as plans for improvement. Based on the data gathered, handy information material and campaign aids were developed for "frontline" activists. Professional support has been given to persons engaged in devising and implementing measures to improve the situation. This includes assisting concerned hospitals in patient and staff surveys (design and data processing) which are meant to detect the weak spots of non-smokers' protection as well as the demands for changes. This contribution contains the findings of patient and staff surveys conducted in four establishments which may be regarded as typical of German hospitals. There is clear evidence that the rate of smokers is higher among staff members than among patients, and that conflicts about smoking are most likely to occur within the group of hospital employees. Especially non-smoking staff members demand that the hospital management shows more commitment to smoking restrictions. The findings support the notion that only a broad, careful step-by-step approach has reasonable chances to reduce smoking and improve non-smokers' protection in hospitals by combining structural measures (better separating smokers from non-smokers) with optimized regulations and health education.     

Informed consent: research and the psychotic patient

During the past few decades, western societies seem to have placed a particularly high premium on the individual's personal integrity and right to self-determination. Presently, obtaining a patient's consent is accepted as a prerequisite for the performance of any form of medical treatment, whether diagnostic or therapeutic in nature. A study was undertaken in various centres involved with clinical trials to compare the procedures used for obtaining informed consent from a psychotic patient. Although the study did not investigate the legal aspects related to consent and informed consent, it is necessary that one must be aware of these aspects when doing clinical trials.     

An approach to defining a patient population in psychotherapy research.

The utility of employing elevated scores on the Depression and Psychasthenia scales of the MMPI as an indicator of a genuine, enduring clinical problem in need of remediation was investigated for a male college student population. The personal, academic, and occupational histories of 54 entering students with elevated scores (T > 60) on these scales were compared with those of a comparable random group of 54 males over an 81/2-yr period. Based on university records and self-report questionnaire data, the high scorers exhibited greater difficulty with personal adjustment, in graduating from college, and in finding a job and deciding on a career; they were earning lower salaries and fewer had married. Nearly half had sought professional help for an emotional problem. Pilot data further suggest that MMPI scale scores for this population decrease following psychotherapy but not with the passage of time. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The care programme approach: a patient perspective

This study explores the attitudes and experiences of one group of patients on the care programme approach living in an outer London borough. There was evidence to suggest that patients were unfamiliar with their treatment programmes and lacked knowledge regarding their care. Further research into patient attitudes to the CPA would be beneficial, since it was not possible to make precise conclusions based on this study.     

Pediatric malingering: The capacity of children to fake believable deficits on neuropsychological testing.

A direct test was performed of neuropsychologists' capacity to detect malingering. Children were instructed to "fake bad" on comprehensive neuropsychological testing but were given minimal guidance on how to proceed. Of the 42 clinical neuropsychologists who reviewed cases, 93% diagnosed abnormality, 87% of these 93% attributed the results to cortical dysfunction, and no clinician detected malingering. The results are consistent with other studies that have examined the capacity of adolescents and adults to fake believable deficits on neuropsychological testing. These studies, and consideration of our current knowledge and methods for the detection of malingering, suggest the need to qualify our confident statements about accurate detection. The current lack of a definitive means for determining whether identifications are correct in actual cases of malingering precludes the objective separation of valid from invalid clinical guidelines. Psychologists' increased involvement in third-party arrangements, particularly in the forensic area, has created a growing need to develop methods for detecting simulation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enterprise Architect在实验预约管理系统的建模研究

介绍了应用EA建立实验预约管理系统数据模型的开发过程,侧重于该系统结构的设计与实现,并期望能提炼出一种适合一般管理系统的框架。在整个项目的设计和实施过程中,始终采用UML图等作为描述文档,并将其和统一过程结合,实现项目的迭代和增量式开发。     

The effectiveness of hospital at home compared with in-patient hospital care: a systematic review

As nitric oxide (NO) may be a particularly important vasodilator in early life, we investigated its role in the regulation of the gastrointestinal (GI) circulation at mid-gestation. Cardiac output and GI blood flow were measured by the radioactive microsphere technique in eight chronically instrumented and unanesthetized mid-gestation fetal sheep. Mean arterial pressure (MAP), heart rate, blood flow, oxygen delivery, and vascular resistance were determined before and after infusion of the specific NO synthase inhibitor, Nomega-nitro-L-arginine (L-NNA) at doses of 10 and 25 mg/kg. In response to L-NNA infusion, MAP increased (p < 0.01) and combined ventricular output decreased (p < 0.001). GI blood flow and oxygen delivery decreased and vascular resistance increased in the stomach and all segments of the small and large intestine (all p < 0.001). The greatest reduction in blood flow was in the small intestine (p < 0.01) and the basal differential pattern of small intestinal blood flow exceeding large intestinal flow was completely abolished. These changes were much greater than those previously described in late-gestation fetuses. Our results suggest that, at mid-gestation, NO plays a major role in the regulation of blood flow and vascular tone across all segments of the fetal GI tract, with its effects being more pronounced than later in development.     

Case Study: Hydraulic Modeling of Runoff Processes in Ghanaian Inland Valleys

The inland valleys of West Africa are strategic in terms of food security and poverty alleviation, but scientific studies on hydrologic processes happening in these environments have not been well documented. Modeling approaches presented in this paper are an attempt to better comprehend hydraulic phenomena occurring in inland valleys. An inland valley situated in the Northern Region of Ghana is set as the study site. The inland valley comprises well-drained uplands and hydromorphic valley bottoms. There are several earthen dams across the valley bottoms, which are at the same time seasonal wetlands cultivated to rice during the rainy season. A finite volume model for the shallow water equations is developed to numerically simulate surface runoff flows in the valley bottoms during flood events. Innovation is necessitated to handle a series of different hydraulic phenomena. Flux-splitting and data reconstruction techniques are used to achieve stable computation in the complex topography of the valley bottoms. Standard problems of oblique hydraulic jump and dam break flows are used to test the accuracy of the numerical model. The Manning’s roughness coefficient is determined from calibration in another Ghanaian watershed located in the Eastern Region. Using actually observed time series data of rainfall intensity, surface flows during the rainfall events are simulated in the computational domain representing the valley bottoms of the study area. Observed data of water levels in the dams are compared to predictions, and discrepancies between them are examined from the hydrological point of view. In the case of a hypothetical flood event, cascading collapses of the dams and flooding of cultivated fields are reproduced.