Customer satisfaction and self-reported treatment outcomes among psychiatric inpatients

OBJECTIVE: Relationships among different dimensions of patient satisfaction and selected demographic, clinical, and outcome variables were explored in a sample of severely ill people receiving inpatient psychiatric services. METHOD: The sample consisted of 81 patients admitted to and discharged from an inpatient psychiatric unit at a midwestern Veterans Affairs medical center. Stepwise multiple regression was used to examine the relationship between patient satisfaction and self-reported changes in quality of life, symptomatology, and level of functioning as measured by the Treatment Outcome Profile. Other variables such as diagnosis, length of stay, employment, living situation, and prior psychiatric and substance abuse treatment were also considered. A subsample of the most satisfied and dissatisfied patients was chosen to further explore variables contributing to satisfaction with services. RESULTS: Patient satisfaction was related to initial level of functioning, certain diagnoses, and treatment gains. Clinicians were highly accurate in identifying patients who were satisfied, based on blind chart reviews. CONCLUSIONS: This study underscores the significant relationships between patient satisfaction, psychiatric diagnosis, and other outcome measures, and argues for the validity and utility of patient satisfaction measures in assessing the efficacy of inpatient care.     

Use of the suture anchor in open Bankart reconstruction. A follow-up report

We previously reported early results of a new technique using a suture anchor to perform a modified Bankart reconstruction. That study included patients from two medical centers and had an average followup of only 1 year. This report includes patients from a single center with followup extended to a mean of 42 months (range, 33 to 61). Between April 1988 and August 1991, 53 patients with recurrent anterior glenohumeral instability underwent modified Bankart reconstruction with the use of a suture anchor. Thirty-two patients met inclusion criteria (identifiable Bankart lesion, open repair with suture anchors, and minimum followup of 2 years); 4 patients were lost to followup. There have been no complications as a result of this technique. Ninety-three percent of the patients in the study had objectively excellent or good results. There were 2 failures with recurrent anterior dislocation. The use of a suture anchor can simplify the Bankart reconstruction. At average followup of 3 years, 26 patients have returned to presurgery activity levels without recurrent dislocation or subluxation. However, careful attention to anchor placement at the junction of articular cartilage and the glenoid neck is necessary to avoid technical failure.     

Stereochemical requirements for intercalation of platinum complexes into double-stranded DNA's

The complexes 1,10-phenanthrolineethylenediamineplatinum(II) and 2,2'-bipyridineethylenediamineplatinum(II) have a planar, aromatic ligand system that facilitates intercalation, as shown by their ability to unwind closed circular duplex DNA. Nonbonded steric interactions can rotate the pryidine ligands out of the coordination plane in bis(pyridine)ethylenediamineplatinum(II), thus preventing intercalation. Fiber x-ray diffraction patterns of the two metallointeracalators indicate that the binding is governed by the neighbor exclusion principle.     

Sialic acid-depleted red cells following acute myocardial infarction

A reduction of red cell SA in patients following acute myocardial infarction is reported and the effects of SA-depleted red cells on cardiac index and alveolar capillary blood flow in the dog are described. The mean red cell SA in 26 patients following acute myocardial infarction was 0.021 +/- 0.001 compared with a mean of 0.031 +/- 0.002 mumol./0.1 ml RBC in 12 normal subjects (p less than 0.01). In five dogs injected with neuraminidase, an enzyme which removes SA from the red cell membrane, a 43% decrease in mean cardiac index from 2.3 +/- 0.22 to 1.3 +/- 0.16 (p less than 0.01) occurred. In films of the pulmonary microcircuation the mean widths of typical alveolar capillary beds decreased 42.6% +/- 5% (p less than 0.01). In three other dogs, autotransfusion with SA-depleted stored blood resulted in a 25% decrease in mean cardiac index from 2.0 +/- 0.21 to 1.5 +/- 0.21 (p less than 0.2), and a 21.7% +/- 0.9% (p less than 0.01) decrease in mean widths of typical alveolar capillary beds. We conclude that a reduction of red cell SA follows acute myocardial infarction and that SA-depleted red cells decrease cardiac index and alveolar capillary blood flow in the dogs.     

A comparative analysis of pulmonary perfusion scans with pulmonary angiograms

Pulmonary angiograms and pulmonary lung perfusion scans on 162 patients with pulmonary embolism were comparatively analyzed. Among the expert angiographic panel members who independently evaluated the studies there was consistent agreement on the diagnosis, size of the emboli, and severity. Consistency of agreement among the expert pulmonary lung perfusion scan panelists was considerably less. These data demonstrate that, in addition to the lack of specificity of the lung perfusion scan for the diagnosis of pulmonary thromboemboli, there is a considerable problem of interpretation in this patient population.