Publications

Abstract

Studies of delirium in general medical populations have used criteria for delirium different from current DSM-III or DSM-IIIR criteria of the American Psychiatric Association, or have used DSM-III or DSM-IIIR criteria without operationalizing the components of these criteria. Therefore this prospective study was conducted to establish an approach to operationalizing DSM-III criteria and to determine the incidence and prevalence of delirium. Two hundred thirty-five consecutive subjects age 70 and over admitted to general medicine underwent daily standardized screening. Patients with low scores on screening tests or clinical evidence suggestive of any psychiatric disorder and controls were seen by a psychiatrist, who determined whether delirium was present by applying explicit operational definitions to each component of the DSM-III criteria for delirium. We conclude that the syndrome of delirium as defined by the American Psychiatric Association is prevalent on admission among elderly on general medical services, but the number of cases developing in the hospital is much less than often stated in the literature.

Abstract

The use of the human immunodeficiency virus (HIV) antibody test for women of childbearing age is discussed. Serological tests used to determine HIV status are reviewed. Practitioners should be aware of the legal and ethical issues involved in testing. Psychological responses to knowledge of test results are considered. The goal of the counseling session is to provide sufficient information for the woman to make an informed decision about reproductive choices. The format and content of pre- and post-test sessions are outlined, and checklists that may assist the practitioner in post-test counseling appear in the Appendixes.

Abstract

A comparative anthropometric assessment involving 2175 measurements of 1533 children under the age of 5 was carried out in Malawi, both before and after the harvest seasons (February and May, 1985). Subjects were randomly drawn from socioeconomically similar rural environments within and outside a large-scale agricultural development project. Chronic malnutrition (height for age less than 90 per cent of the median) was found to be 36 per cent in February and 41 per cent in May. The prevalence of acute malnutrition (weight for height less than 80 per cent of the median) was 4 per cent and 5 per cent, respectively. Tests of significance found no statistical difference between the project and non-project children for a variety of nutritional status indices. It is postulated that such factors as increased female access to extension services and male access to nutrition education may have greater impact on morbidity than income increases alone, and should be part of agricultural development planning.

Abstract

We compared clinical outcomes of 65 hospitalized patients receiving clindamycin before and 59 after a sudden hospital wide shift in dosing schedules for this drug from 600 mg every 6 hours to 600 mg every 8 hours. Outcomes studied included the efficacy of antibiotic treatment, length of febrile period, and frequency of adverse effects. We also compared and controlled for patient characteristics such as age, sex, presence of multiple diagnoses, length of therapy, and concurrent use of other antibiotics. There were no differences in measured clinical outcomes between the two groups. Treatment was successful in 87% of both groups. The average number of febrile days was 5.1 in the first group and 3.9 in the second (P<.05). Patients on 6-hourly therapy experienced a 12% rate of antibioticrelated adverse effects vs. 5% for the 8-hourly group (P<.05). These data support the clinical rationale and safety of a hospitalwide reduction in the frequency of clindamycin dosing. In addition to considerable pharmacy and nursing time saved, this change also saved$40,000 annually in antibiotic costs.

Abstract

Results of this study indicate a significant positive relationship among mental disorder, length of hospital stay, and number of nursing diagnoses. The sample included 110 patients admitted to a teaching hospital and classified under DRG 210 (hip fracture with surgery).

Abstract

The current treatment of type II noninsulin dependent diabetes mellitus (NIDDM) and obesity involves complex regimens for weight reduction and improvement in metabolic control that necessitate active partici pation by the patient in estab lishing treatment goals and strategies. However, well-documented rates of nonad herence suggest that weaknesses may exist in patient-provider communications that preclude such patient participation. This study examines patient percep tions of diabetes treatment goals as established with their health care providers. Fifty-four individuals with type II NIDDM and obesity were surveyed. To determine the degree of congruence between patient and health care provider, the physi cians of study participants were also surveyed. A 53 % discrepancy rate was found to exist in the area of overall treatment goals. In addition, a 57% and 43 % rate of discrepancy was found for the specific goals of weight loss and blood glucose levels, respectively. Further findings and the implica tions for practice are discussed in this paper.