ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb01326.x

年代:1969

数据来源: WILEY

摘要:

AbstractChronic postoperative cystitis in the elderly patient is a difficult problem, and is especially annoying if all obvious anatomic abnormalities have been corrected. This study of 20 such patients who underwent bladder surgery indicates that several local resistance factors may be related to this continued urinary infection. In elderly postoperative patients with chronic cystitis the bladder defense mechanisms have reached such a state of imbalance that they cannot cope with the invading organisms either by the mechanism of voiding or by vesical‐wall defense factors. The relative importance of the various cellular and serologic local defense mechanisms in resisting bacteria in bladder urine and the bladder mucus layer, mucosa or submucosa is not known.There is no apparent quantitative histologic defect in the local bladder cellular response of the elderly patient. Therefore, a decreased quality of response is implied. In addition, trauma created by indwelling catheterization or by surgery destroys the anatomic integrity of the bladder wall and may thereby encourage the development of deep‐seated infection by permitting tissue invasion. Foci of tissue infestation by E. coli were demonstrated in 1 of 2 patients in whom it was possible to make such a study. These foci are not subject to the normal voiding defense mechanism and the antibacterial factors within the bladder or urine; they can be eliminated only by inflammatory cells, antibodies, or antibacterial agents capable of attaining bactericidal tissue levels.Two axioms were confirmed by this study: 1) any period of preoperative indwelling catheterization should be as brief as possible, and 2) specific antimicrobial therapy should be planned preoperatively so that surgery takes place at a time when the urine and tissues are sterile; this sterility should be maintained until all foreign bodies, such as catheters, are removed from the urinary tr

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb01313.x

年代:1969

数据来源: WILEY

摘要:

AbstractA study of 100 consecutive admissions of elderly persons to a county psychiatric screening ward revealed that functional assessment of such persons is a highly complex procedure. Our experience confirmed the belief that such patients have a combination of social, medical and psychological problems; evaluation requires the services of persons qualified in several disciplines. In this instance, a multidisciplinary team examined each patient, consensually agreed on a treatment plan, and then used existing community resources to implement the program. This report describes some of the methodological and philosophical aspects of screening procedures, and some of the pitfalls encountered unless a comprehensive examination is performed.The team consisted of a psychiatrist, internist, social worker, nurse and psychologist. Each discipline obtained information in a more or less traditional manner. The “art” of assessment begins with the understanding of the interrelatedness of specific functions. Adequate assessment of a patient required an exchange of information among the team members; no single discipline could rely completely on its findings. A comprehensive treatment plan could evolve only after the data were integrated. In making judgments about patients, an examiner must not overlook the limitations of partial examinations and the intrusion of personal values and other subtlet

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb01314.x

年代:1969

数据来源: WILEY

摘要:

AbstractThe analyses in this study—from the Rehabilitation Center at Montebello State Hospital, Maryland—indicate that physicians have been slow to accept as a legitimate activity the rehabilitation of their stroke patients. The physicians who are more likely to send patients for such care tend to be more recent graduates, to belong to hospital staffs and medical societies, and possibly to graduate from schools in which the faculty has more interest in rehabilitation. From the experience with their first patients, physicians may learn how to refer more suitable patients.The situation is complex, however; the available data concerned only indirectly those factors which are probably most crucial to the degree of innovation. To avoid upsetting Montebello's program, this study did not include personal interviews with the 294 general practitioners involved, thus leaving some crucial questions dangling in mid‐air, and possibly overlooking some valid reasons for nonreferral for rehabilitation during this period.The findings are tentative but they seem to indicate that the norms for physicians may not favor the use of outside sources of help nor encourage the energetic treatment of stroke patients. Cultural norms change only slowly, and this may partly explain the slow referral for rehabilitation. However, we should strive to ensure that the concepts and scientific basis of rehabilitation be as clear and as strong as possible, and that the concepts be communicated accurately, intensively and repeatedly. This will prepare a more fertile field for the seeds of c

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb01315.x

年代:1969

数据来源: WILEY

摘要:

AbstractThe significance of the intracytoplasmic hyalin neuronal inclusions first described by Lewy over fifty years ago is discussed on the basis of an analysis of 50 autopsy cases in which Lewy bodies were an incidental finding. Lewy bodies were not found in any person younger than 62 in this series. The distribution of the inclusions was similar to that in 21 cases of idiopathic parkinsonism, and in half the cases there was similar although less severe, nerve‐cell loss in the substantia nigra. Twenty‐two per cent of the incidental cases eventually proved to have had some mild clinical symptomatology that might indicate parkinsonism.It is suggested that Lewy bodies are related to a specific abnormality of nerve‐cell metabolism, affecting the neuromelanin‐containing nerve cells in particular, and related to idiopathic parkinsonism rather than to age alone. Incidental cases may represent mild, early and preclinical cases of parki

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb01316.x

年代:1969

数据来源: WILEY

摘要:

AbstractInterviews were conducted with the administrators of 118 nursing homes in Minnesota. Data were collected regarding: 1) characteristics of the nursing home, 2) economic characteristics, 3) characteristics of the patients, and 4) characteristics of the administrators. Information also was collected on: 1) medical rehabilitation services, 2) psycho‐social rehabilitation services, 3) volunteer services, and 4) activity programs. Indices were developed and the data subjected to statistical analysis.Results of the study indicate that nursing homes differ in the kinds of rehabilitation services and programs provided to their elderly patients. Different nursing homes emphasize different aspects of rehabilitation. Moreover, although nursing homes differ as to kinds of rehabilitation services and programs provided, few nursing homes serve a homogeneous population, similar in terms of rehabilitation potential and rehabilitation needs. Patients with high potential are housed in nursing homes providing few, if any, medical rehabilitation services, and persons who might especially benefit from programs of nonmedical rehabilitation dwell in facilities placing little emphasis upon their psychological and social needs.An obvious conclusion is that nursing‐home patients should be classified according to rehabilitation potential and rehabilitation needs and matched with nursing homes which can best fulfill the requirements. Although both potential and needs for rehabilitation may be medically assessed, there are few criteria by which to classify nursing homes according to rehabilitation services offered. This study represents a first attempt to discover those characteristics of nursing homes which provide various kinds of rehabilitation services and programs for their aged reside

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb01317.x

年代:1969

数据来源: WILEY

摘要:

AbstractA study was made to determine whether progress in physical therapy and psychological status are related to the following factors: diagnosis, sex, age, average number of treatments per week, length of hospital stay, and aphasia. Two eight‐week cross sections of data on patients with hemiplegia, paraplegia, quadriplegia, bilateral leg amputation, and hip fracture were analyzed statistically. The first cross section involved 123 patients (age range, 17 to 89) and the second cross section, 88 patients (age range, 17 to 90).Factors related to progress in physical therapy were: the average number of treatments (improved patients received more), length of hospital stay (longer for the improved patients), psychological status (better in the improved patients), and possibly age (improved patients were younger). Younger patients also had a better psychological status, and patients having a better psychological status received more treatments and had been in the hospital longer. Aphasic patients had a poorer psychological status than did those without aphasi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb01318.x

年代:1969

数据来源: WILEY

摘要:

AbstractFourteen ischemic or stasis ulcers in 8 patients were treated by means of gold leaf overlaid with polyethylene film; a piece of foam rubber was inserted before application of a bandage. The average length of treatment was four weeks. Of the 14 ulcers, 9 were completely healed, 4 were greatly reduced in size, and only 1 (a large decubitus lesion in a terminal cancer patient) failed to respond. The length of hospital stay was reduced as compared to previous admissions for treatment by other methods, and the patients did not experience any undue allergic reactions nor discomfort.Although our sample was small, the dramatic tissue response, the simplicity of application, and the effectiveness of this therapeutic technique deserve further investigation.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb01319.x

年代:1969

数据来源: WILEY

摘要:

AbstractTo investigate the influence of environment upon the psychic (emotional) state, 150 adult subjects were studied, in three groups. One‐third consisted of married women; one‐third consisted of their husbands; and one‐third consisted of unrelated females (randomly drawn) age‐paired to the wives. Psychic state was determined by a simple self‐administered controlled association test (Cornell Word Form‐2).In the two male‐female comparisons, the psychic responses were related only in the husband‐wife group, and in this group the correlation increased with advancing age. Since the husbands and their wives presumably lived under similar conditions, this may constitute evidence for the role of environment in the psychic state, without in any way minimizing other ca

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb01320.x

年代:1969

数据来源: WILEY

摘要:

AbstractGeriatric psychiatry and social gerontology are defined. These two disciplines are comparatively new, making for wide differences of opinion owing to the great lack of fundamental data. There are also semantic problems, either related or unrelated to habit‐bound perceptions and interpretations.A case report demonstrates how, under the psychiatrist's guidance, the author assisted in the social rehabilitation of a 75‐year‐old woman. Both milieu‐ and socio‐therapy were used to help this woman move from an unsuitable large home, where she was isolated, into a retirement residence which was safer, more healthful physically and mentally, and more conducive to continuing social self‐realization.The author's work with groups is discussed. Mental stimulation and group discussion appear to help the older adult modernize his behavior and broaden his viewpoints, thus increasing his opportunities for continuing self

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb01321.x

年代:1969

数据来源: WILEY