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.     

Effects of acute and chronic morphine on rotational behavior in nigral-lesioned rats

Stimulation of mu-opioid receptors located on dopaminergic neurons in the striatum and the nucleus accumbens increases dopamine release, which may account for some of the behavioral effects of morphine. In this study, we examined the effects of acute and chronic morphine treatment on rotational behavior in rats with unilateral 6-hydroxydopamine dopamine (6-OHDA)-induced lesions of the nigrostriatal pathway. Rats receiving morphine acutely (0.3-10 mg/kg) did not show a significant bias toward contralateral or ipsilateral turning. Mini osmotic pumps dispensing morphine continuously (20-24 mg/kg/day) were implanted s.c. in these animals. This treatment induced tolerance to the behavioral depression produced by the highest dose of morphine (10 mg/kg) when it was given acutely. A slight but significant increase in ipsilateral turning occurred over the range of morphine doses examined. The effects of morphine on rotational behavior are slight, and do not correlate well with the reported increase in locomotor activity or extraneural dopamine in the striatum that are produced by doses of morphine similar to the ones tested in this study.     

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.     

Diol diricinoleates from dihaloalkanes

A series of alkanediol diricinoleates was prepared by heating ricinoleic acid with triethylamine and dibromo- or dichloroalkanes containing 2 to 10 carbon atoms. As expected, the dibromides react more rapidly than the dichlorides. This method of esterification avoids the side reaction of estolide formation which occurs when ricinoleates are prepared by direct esterification or transesterification. The products are high molecular weight diols which should be useful in the preparation of polyurethanes. Presented at the AOCS Meeting, San Francisco April 1969. W. Utiliz. Res. Dev. Div., ARS, USDA.     

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.