摘要:

Abstract:This paper offers an analysis and evaluation of obstacles to the continuing medical education of physician‐practitioners associated with private community hospitals, as delineated in a study of the use of the educational keys (publications, lectures, exhibits, chart audits, consultation, house‐staff teaching, and research). It is concluded that obstacles may result from lack of understanding of the professional interests and needs of the physician‐practitioner and the improper and unskillful employment of educationl keys; and that these obstacles affect his continuing medical education according to the following groups: 1) those that affect the physician when he participates indirectly, 2) those that affect him when he participates directly, and 3) those that affect his motivation to participate. Recommendations are offered for the alleviation or removal of these bar

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02819.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

摘要:

Abstract:Adult preventive medicine is the presently emerging phase of scientifically based medicine. This article: 1) traces the necessity for the development of adult preventive medicine because of many social mutations that have taken place in this century, and 2) outlines its theoretical foundations, involving such matters as health education and adult preventive medicine programs (medical weight control, anti‐smoking, preventive endocrinology, health education in human physiology and how to cope with stress, potential and motivational analysis, and predictive physico‐chemical programs).The role of the physician will change from that of a supervisor of detection‐treatment medicine to that of an advisor and consultant in adult preventive medicine. Computerized pre‐disease diagnosis and health education (including knowledge concerning the use and abuse of stress) will be emphasized, to improve upon the present history‐and‐physical‐examination method.The total program will require a tremendous increase in professionals trained to manage its va

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02820.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

摘要:

Abstract:For many decades the theory and practice of cross‐linking (bonding that ties two or more large molecules together side to side) have been developed in industry, but only since the 1940's has the theory been considered in the field of medicine as a primary reaction underlying age‐dependent changes.Crosslinking is damaging to the tissues and involves loss of elasticity, reduced swelling capacity, increased resistance to hydrolases and probably enzymes generally, and thus an increase in molecular weight and a tendency toward embrittlement. There is a growing amount of direct evidence and much indirect evidence for postulating the relationship between crosslinking and aging.Crosslinking agents present in the living organism include aldehydes, lipid oxidation products, sulfur, alkylating agents, quinones, free radicals induced by ionizing radiation, antibodies, polybasic acids, polyhalo derivatives and polyvalent metals. The latter four types of compound are slow‐acting but can also accumulate in the body to form a frozen metabolic pool. Sufficient amounts of all these potential crosslinking materials are present in the body to make the changes of aging unavoi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02821.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

摘要:

Abstract:Over a nine‐year period, 1,223 patients with cerebrovascular accidents were admitted to Montebello State Hospital, a chronic disease institution.The findings of this study consistently reflect an adverse influence of rising age on the response of CVA patients to rehabilitation. The older patients (over 65) were more disabled on admission, improved less often while in the hospital and died more often than the younger patients. However, the better response of the younger patients did not reduce their length of stay in the hospital (21–23 weeks).It would be unfair for clinicians to reject for rehabilitation all older patients because of these disadvantages, since our adjustment analysis has shown one way (number of hospital‐weeks of care required to obtain a living and improved patient) in which priorities can be balanced for different age groups. It would be premature, however, to apply these figures widely until larger groups of patients are studied in different rehabilitation centers. This can be done quickly if it is agreed that scientific rather than intuitive guidelines for selecting patients deserve urgent atte

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02822.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

摘要:

Abstract:A study was made of the nurses' perception of nursing‐care factors related to the successful adjustment of patients to nursing homes. Three groups of 20 nurses each—one group consisting of registered nurses, another of licensed practical nurses, and the third of nurse's aides—were compared with each other for differences in response to questions concerning 5 categories of patients' behavior: adjustment to transfer, interactions, observance of rules, nurse‐patient relationships, and the patient's personality.Each of the 60 nurses was given an open‐ended interview involving 26 questions about the foregoing 5 categories of behavior. Each nurse was also asked to characterize the patients from mental hospitals, the patients from general hospitals, and the patients from the community by checking the adjectives appropriately descriptive for each group. Interview responses were scored and classified for fourfold chi‐square analysis.For registered nurses versus licensed practical nurses, no significant differences were found. However, there were significant differences between these two groups of trained nurses and the nurse's aides, reflecting in part the training and experience of the skilled nurses and their corresponding levels of authority and responsibility. Trained nurses were somewhat more distant from patients, largely because of record‐keeping and administrative work which kept them from talking to the patients as often as they wanted to. The trained nurses dealt with the patients' personal problems and illnesses directly, whereas the aides left these functions to the trained nurses.Nurses characteristically regarded patients as holding negative attitudes toward nursing homes at the time of admission. Adjustment to the home was felt to be easier for lonely and dependent patients, because of their increased need for care and companionship. According to the nurses, the adjustment of former mental‐hospital patients was facilitated by their prior exposure to institutional care.According to the information obtained by using the adjective list for the patients' behaviors, the nurses perceived the mental‐hospital patients as being more disturbed than the other two groups, as manifested by these symptoms: confusion, disorientation, destructiveness, assaultiveness, and withdrawal. The general‐hospital patients were regarded as less able to perform self‐care functions. The patients admitted directly from the community were perceived as lonely, depressed, and overly dependent.An earlier study of the patients' responses indicated that successfully adjusted mental‐hospital patients were at least as well, if not better, adjusted than their counterparts admitted directly from their homes or from general hospitals. The nurses' description of mental‐hospital patients implies that the nurses' perceptions of such patients are distorted by over‐generalizations based on the behavior of poorly adjusted patients. These distortions may result in restrictive, fearful attitudes toward the mentally ill and may lead, at critical times, to dispositional decisions unfavorable to the patients and disastrous to programs of aftercare in which nursing homes are

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02823.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

摘要:

Abstract:Follow‐studies were conducted on unselected groups of patients discharged from a chronic disease hospital to private homes or to domiciliary facilities. Most of these patients were between the ages of 70 and 72. Reports are presented on 105 patients discharged in 1965 to such facilities—at the end of one year from the time of discharge, at the end of one and a half years, and at the end of two years. Additional data are presented regarding the main diagnosis and length of hospital stay in relation to results after one year in 75 patients discharged during the first eight months of 1966.The 1965 data indicate that 45 per cent of those discharged were still functioning adequately at the end of one year, 39 per cent after one and a half years, and 32 per cent after two years, with an additional percentage (18 per cent at one year, 15 per cent at one and a half years and 17 per cent at two years) showing minor or gross deterioration but still able to be maintained outside of a hospital.In view of the advanced age, the multiplicity of diseases and the average life expectancy of these aged patients, the results represent a reasonable degree of success in the rehabilitation of long‐term patients, and also tend to refute a common belief that the chronically ill geriatric patient will inevitably deteriorate rapidly after discharge from the hospital.The numbers of patients are too small for drawing definite conclusions, but may indicate areas worthy of further

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02824.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

摘要:

Abstract:Thirty‐nine elderly patients were treated surgically for chronic subdural hematoma. Of the 34 who survived the postoperative period, 30 were restored to their pre‐illness states of activity and function; the remaining 4 had paraplegia or hemiparesis.Chronic subdural hematoma in patients past 60 years of age presents many difficulties in diagnosis. However, clues often may be elicited by careful inquiry into the history, thorough physical examination, echo‐encephalography, plain roentgenograms of the skull, and analysis of the cerebrospinal fluid. Subdural hematoma must be seriously considered in any person older than 60 with a history of recent personality changes, rapidly progressing senility, headaches, or neurological deficits, whether or not there has been any known trauma to the head.It is important to recognize that the lesion is often curable. The better results in our series were obtained in those cases in which diagnosis and surgical intervention were carried out early in the course of the il

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02825.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

摘要:

Abstract:Micrometer measurements in the chest roentgenograms of 197 males and 168 females whose ages ranged from 10 to 80 years, showed that the relative cortical thickness of the clavicles decreased with advancing age. When the linear regression slopes of decrease for the clavicles, metacarpals and femur were compared, the steepest slope was for the clavicles, especially in females.The use of clavicular cortical thickness as a criterion might offer a practical method of assessing skeletal age from routine posterior‐anterior chest x‐ray fi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02826.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

摘要:

Abstract:Twenty‐three elderly males in Egypt, whose ages ranged from 60 to 72 years, underwent a study of their exocrine pancreatic functions by means of the intravenous secretin test.The results showed a reduction of the volume of pancreatic secretions (mean, 55.2 ml) to one third of the normal mean for adults, and a selective reduction in enzyme activity. Amylase and trypsin activities (554 units and 1/102 dilution respectively) were decreased to two thirds of the normal values. Lipase activity was normal (mean, 1.1 unit per ml).This reduced volume and enzyme production might be attributed to three factors acting singly or in combination: 1) the aging process itself, 2) the frequency of chronic fibrosing pancreatitis in the aged, favoured by the high incidence of gall stones, and 3) impairment of the vascular supply to the pancreas.Therapeutic supplementation of pancreatic enzymes is recommended, to prevent these clinical or latent deficiencies which may have a great bearing on the health of the age

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02827.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY

摘要:

Abstract:Stereotactic thalamotomy has been performed to date on 370 patients with extrapyramidal disorders; 287 of these patients had Parkinson's disease.The proper selection of candidates for this operation, among elderly persons just as among younger ones, is essential for success. The criteria for selection of parkinsonian patients are listed, as are the contraindications for the operation in this disease.When properly selected elderly parkinsonian patients undergo accurately performed stereotactic thalamotomy, good results (complete or marked relief of tremor and/or rigidity) can be expected in about 75 per cent of the cases. Two representative case reports are included.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1968.tb02828.x

出版商:Blackwell Publishing Ltd    

年代:1968

数据来源: WILEY