摘要:

AbstractA tool for the assessment of physician practices was developed by means of hospital record review for two cardiovascular syndromes—acute myocardial infarction and congestive heart failure. The application of this method to a review of the records of three community hospitals identified deficiencies in medical practice and indicated that such review could be useful in the design as well as in the evaluation of postgraduate educatio

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb02343.x

年代:1969

数据来源: WILEY

摘要:

AbstractThe terminal stages of life were observed in 300 patients whose ages ranged between 65 and 104 years. The clinical syndromes found to be associated with the final deterioration were classified into four groups: 1) ischaemia in 31 per cent; 2) toxaemia in 15 per cent; 3) unexpected complications in 25 per cent; and 4) incomplete or unsatisfactory diagnosis in 29 per cent.In geriatrics the direction and speed of the patient's course are more important than the patient's exact position at any given time.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb02344.x

年代:1969

数据来源: WILEY

摘要:

AbstractThe interesting findings of many studies on aging are outlined. These indicate the importance of large‐scale research on the biology of senescence as an integral part of health maintenance and disease prevention. The Research on Aging Act (Bill 870), now before the Senate Committee on Labor and Public Welfare, deserves active evidence of the support of all physicians, since on its passage will depend many programs for the improvement of health in the later years of lif

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb02345.x

年代:1969

数据来源: WILEY

摘要:

AbstractDevelopment of an organism from a fertilised egg, entails growth and differentiation in structure and function, classic genetics and molecular biology.Ageing and death are forms of differentiation. Development and growth, differentiation and ageing, proceed according to a definite predestined programme in the nucleus. The nucleus contains DNA molecules (genes), in which information is coded governing all biochemical cellular activities which are catalysed by enzymes formed according to a messenger RNA. The nucleus contains a mechanism of repression and derepression of genes which regulates the production and suppression of enzymes, and therefore the type of growth, differentiation, ageing and death.Ageing and death, as aspects of differentiation are inherited characters controlled by DNA molecules (genes). They can be affected, as are other inherited characters, by external factors which have an impact on the DNA molecules.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb02346.x

年代:1969

数据来源: WILEY

摘要:

AbstractThis report concerns the findings in 3 fatal cases of third‐degree prolapse of the uterus with pronounced hydronephrosis. The cause of the urinary obstruction in patients with prolapsus uteri seems to be compression of the ureters by the plexus of thickened uterine vessels which are stretched abnormally by the prolapsed cervix. This compression usually occurs at the point where the ureters and the blood vessels lie athwart one another in the base of the broad ligament.Early correction of uterine prolapse is advocated because, even in longstanding cases, it may result in regression of the ureteral dilatation and thus prevent pyelonephrosis or uremi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb02347.x

年代:1969

数据来源: WILEY

摘要:

AbstractA review of the literature on criminality among the aged discloses a paucity of research in this important area. The few studies reported have focused on offenses associated with the psychological or psychopathological aspects of aging. Since there are scarcely any data on older men with a history of chronic delinquency, the present study was designed to meet this deficiency. It involved an investigation of offenders chronologically aged beyond 60 years, but whose crimes were committed in various periods of their lives, some even in childhood or adolescence.The sample consisted of 36 males drawn at random from the population of aged parolees in the New York State Division of Parole. Data were chiefly obtained by means of a social‐data form developed by the writers and completed by the parole officers of the aged parolees. This form elicited information about personal identifying data, family history, criminal background and present life adjustment. A psychiatric examination also was made in half the cases. The findings led to the following conclusions: These aged parolees do not appear to be especially influenced by any religious, ethnic or familial factors. As a group they are relatively active, self‐supporting, and fairly well adjusted to their work and parole. Pathological disturbances are not as common or as severe as in Hay's study of elderly offenders drawn from a Mental Hygiene Unit population. The basic loneliness of aged offenders was strongly confirmed in regard to marital status (most had no spouse) and living arrangements. A subsidiary study of men who had committed less than three offenses showed a tendency to better mental health and a greater likelihood of marriage and employment as compared with men who had committed more than three offen

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb02348.x

年代:1969

数据来源: WILEY

摘要:

AbstractHomes and other institutions for the aged should be places for living, not just dying. The characteristics of such a facility include stress on the individual identity of each patient, provision for individual preferences, no deprivations unless strictly necessary, and encouragement of patients in fulfilling their aspirations. The staff members should have a deep understanding of their patients. Psychiatrically trained nurses and social workers are a great asset. The psychiatrist as a consultant to the administration is a valuable additional to the staff. The job of caring for geriatric long‐term patients can be a challenge to provide ways for helping them to accomplish the tasks of the later years, so that their lives may have meaning until the very en

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb02349.x

年代:1969

数据来源: WILEY

摘要:

AbstractThe study group comprised 60 indigent patients (average age, 70) in a public hospital who had undergone amputations of the lower extremity, chiefly because of gangrene. These patients sought aid only in the last stages of disease, and meanwhile they neglected personal hygiene. There were 10 deaths. The most common contraindications for the use of a prosthesis were chronic brain syndrome (dementia) and muscle weakness or contractures. Of the 60 patients, 22 were considered to be candidates for prostheses, and 5 of these were lost to follow‐up. Thus only 17 potential candidates underwent preprosthetic training, for maximal ability. Eight of the 17 ultimately, because of contraindications, had to be content with crutches or a wheelchair. In the other 9 cases, however, prostheses were successful.Recommendations regarding the management of such patients in a large public hospital include: 1) continuity of management by having the amputee under the supervision of the same physician(s) throughout his course; 2) a series of lectures for the house staff on the rehabilitation of amputees; and 3) a definite protocol for the immediate fitting of a prosthesis in suitable case

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb02350.x

年代:1969

数据来源: WILEY

摘要:

AbstractState hospitals are still being used as a dumping ground (the End of the Road) for geriatric patients who present serious nursing problems. The Geriatric Service at Bronx State Hospital, affiliated with the Albert Einstein College of Medicine, underwent a marked metamorphosis from the traditional custodial service to a community‐oriented unit with emphasis on treatment. This was accomplished only when the admission criteria were changed.The community can be educated to accept such a modern admission policy for geriatric patients in a state hospital by: 1) having definite criteria for admission; 2) explaining to the referring agency the reasons why patients may or may not be suitable for admission; 3) answering all complaints of public officials who intervene for their constituents; 4) advising the family what procedure should be followed to have the patient admitted to an old age home or nursing facility, or for obtaining a homemaker; 5) providing an out‐patient department (preferably to include a day hospital) for those patients who are not sufficiently ill to be admitted to the state hospital for 24‐hour maintenance; 6) providing a speaker to explain especially to hospital staffs the criteria for admission; and 7) providing a mobile psychiatric team to visit the patient in his home, hospital, nursing home or old age home, and also to consult with the family phys

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb02351.x

年代:1969

数据来源: WILEY

摘要:

AbstractAt Bronx State Hospital, active treatment modalities—psychotherapeutic, social and psychopharmacological—are offered from the time of admission. Families are dealt with energetically from the start, with particular attention to preventing extrusion of the patient from the family unit. For retraining patients whose social and psychological skills have atrophied from prolonged hospitalization, there is an intensive treatment ward. A “hotel ward” without staff has been established for those who are able to live in a minimally structured environment but have no homes to go to. A work‐for‐pay program, specially tailored to the needs of geriatric patients, also has been organized. For regressed patients there are special programs, including reality orientation and sensory training. A major factor in maintaining staff morale in this difficult work is their active involvement at all staff levels in the regular teaching conferences.After release of the patient, hospital responsibility continues. Supportive services—psychiatric, social, psychological and recreational—are supplied when necessary, but emphasis is placed on the ex‐patients becoming involved with local community organizations such as community houses and Golden Age clubs.In the future we hope to place more emphasis on prevention by helping to establish or maintain supportive services in the community for the elderlybeforethey become ill, and by starting therapeutic activities in the earliest stages of illness so that disability and hospital admission can be minimized if not averted. Much can be done for geriatric psy

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1969.tb02352.x

年代:1969

数据来源: WILEY