摘要:

ABSTRACTRest is essential, even though its exact physiologic functions and quantitative requirements are far from clear. Sleep appears to be the primary and most imperative form of rest. The nature, the role, and the necessity for rest as simple relaxation and leisure are elusive and poorly defined. The rejuvenating effects of leisure and diversion are apparent, over and above the pleasure and enjoyment they bring to life. Absolute rest has in the past been an important component of therapy for disease and injury. Relatively recent evidence that bed rest may prolong invalidism and contribute to complications, combined with the development of more specific therapies, has reduced both the necessity and prescription for bed rest. However, it should be emphasized that the data are incomplete, and in some situations such as myocardial disease or hepatitis, there is no final proof that early activity does not have late effects. This article presents a perspective and a classification that can serve as a more precise and restrictive context in which the concept of rest can be used and prescribed. Further study is necessary to establish whether rest which is not sleep, not diversion, nor a discredited prescription of immobility, is physiologically or psychologically valid, and to determine a more precise measure of required “dosage

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1977.tb00801.x

年代:1977

数据来源: WILEY

摘要:

ABSTRACTA three‐year follow‐up study was made of 45 elderly subjects with left anterior hemiblock, either alone or associated with right bundle‐branch block. In the LAH + RBBB group, there was a higher mortality rate and frequent evolution toward complete A‐V block. The prognostic significance of left fascicular hemiblocks is di

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1977.tb00802.x

年代:1977

数据来源: WILEY

摘要:

ABSTRACTAn experimental design was used to compare the delivery of primary care by two health manpower patterns—the Physician Only (PO) and the Adult Health Nurse Practitioner/Physician (NP/P) Team. The study group consisted of 167 patients in three subgroups (Ambulatory, Homebound, and Nursing Home). The dependent variables were effectiveness and efficiency. Effectiveness was measured by the Goal Attainment Scale. Efficiency was determined by measuring the operational use and cost of the primary and supportive systems for health care delivery. A cost‐effectiveness model was used to facilitate the comparison between the two approaches to primary care. Scientific hypotheses related the measures of the dependent variables to the levels of the independent variable. The conclusions of the study were: 1) The NP/P Team is as effective as the PO but substantially more efficient in its operational use of the systems for health care delivery; 2) Ambulatory patients can make a positive change in the achievement of their health care goals with efficient use of the health care system, if they receive their care on a PO basis; 3) Homebound patients can make a positive change in such achievement if they receive their care from a NP/P Team; and 4) Nursing Home patients can make a positive change in such achievement whether they receive their care from the POorfrom the NP/P T

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1977.tb00803.x

年代:1977

数据来源: WILEY

摘要:

ABSTRACTThe etiology of depression in the aged is discussed from the viewpoint of biologic, psychodynamic, genetic and sociocultural concepts. The chronic neurotic depression of the aged seems to differ from that of younger age groups. The understanding of geriatric depression requires a multidisciplinary approach.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1977.tb00804.x

年代:1977

数据来源: WILEY

摘要:

ABSTRACTTemporal arteritis (granulomatous inflammation) usually involves the temporal and and ophthalmic arteries, but may be part of a more widespread inflammation of the medium and large vessels. The patient usually presents with an associated group of constitutional symptoms (fever, malaise, anorexia, weight loss, anemia) and rheumatic complaints (polymyalgia rheumatica). The diagnosis should be considered in any patient over 55 years old in whom these symptoms develop or in whom there is evidence of recent onset of headache, visual loss or localized arterial involvement. The diagnosis is also to be considered when the erythrocyte sedimentation rate is over 50 mm/hr, and the presence of arteritis is confirmed by temporal‐artery biopsy findings. Visual loss may occur in 50 percent of affected patients; other serious complications are less common. A strong clinical suspicion of temporal arteritis will permit diagnosis of the more uncommon and atypical presentations of the syndrome. Although cases of temporal arteritis may be self‐limited, treatment is imperative because of the threat of blindness. Patients respond well to steroid (prednisone) therapy, which should be maintained for a prolonged per

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1977.tb00805.x

年代:1977

数据来源: WILEY

摘要:

ABSTRACTA 71‐year‐old woman had massive pulmonary metastases from a right hypernephroma, as shown by a chest roentgenogram. Nine days after nephrectomy, there was no roentgenographic evidence of such metastases. This represents the most rapid regression of clear‐cell pulmonary metastases ever reported. Metastases reappeared six months postoperatively and the patient died of widespread metastatic disease 18 months after nephrectomy. The unpredictable behavior of metastatic hypernephroma is disc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1977.tb00806.x

年代:1977

数据来源: WILEY

摘要:

ABSTRACTTwo groups of geriatric patients were treated with either 300 mg/day of papaverine hydrochloride (Pavabid) or placebo in a double‐blind study of two months’ duration. All patients (25 in each group initially) had mild to moderate senile organic brain syndrome but were ambulatory and treated on an outpatient basis. Neuropsychologic evaluations were made by means of the following six tests: Electroencephalographic Analysis (EEG), Profile of Mood States (POMS), Subject Paced Digit Symbol Substitution Test (SPDT), Continuous Performance Test (CPT), Peterson and Peterson Test (P&P) for Short‐Term Memory, and Clinical Global Impression (CGI). The tests were comparative with a baseline period and between treatment groups. There were positive responses from baseline to active‐drug treatment in four of the six evaluations—EEG, POMS, SPDT and CPT. Some side effects were noted in both drug and placebo groups, but these were not disabling and did not interrupt therapy. Positive responses were also observed between treatment groups. By the EEG criterion, the papaverine patients responded positively. By the P&P test for short‐term memory, the placebo group responded better than did the papaverine group. It is suggested that the pharmacodynamic action of papaverine in ameliorating the symptoms of senile organic brain syndrome may not be due to vasodilation but to dopamine recept

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1977.tb00807.x

年代:1977

数据来源: WILEY

摘要:

ABSTRACTIn 6 patients with vertebrobasilar insufficiency (VBI), precordialgia and autonomic‐nervous‐system manifestations such as diaphoresis and tachycardia were associated with the symptoms of VBI. Investigation ruled out cardiac and gastrointestinal causes. Possible mechanisms are discussed on the basis of intermittent ischemia of the central autonomic centers supplied by the posterior circulat

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1977.tb00808.x

年代:1977

数据来源: WILEY

摘要:

ABSTRACTSix elderly persons with a diagnosis of “chronic brain syndrome,” who resided in a home for the aged, received bi‐weekly sensory stimulation and group therapy for three months. This pilot project demonstrated that the symptoms used to classify “chronic brain syndrome” are flexible and can improve with such treatment. Not only does this cast doubt on the accuracy of this diagnosis as used, but it provides further evidence of the utility of such treatment for this type of patient. Since group therapy and sensory stimulation over a relatively short period can result in clinical and testable improvement, the diagnosis of “chronic brain syndrome” in the elderly should not be allowed to preclude the provision of appropriate psychi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1977.tb00809.x

年代:1977

数据来源: WILEY

摘要:

ABSTRACTThis follow‐up survey of physicians’ attitudes and practices reveals a changing approach toward the care of terminal patients. It shows that: 1) communication with dying patients is becoming more open, 2) support for the omission of life‐prolonging treatments is increasing, and 3) opposition to the use of death‐hastening measures remains strong. It indicates that the physician's experience with terminal patients and the setting of his practice influence his attitude towards these patients and the approach to tr

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1977.tb00810.x

年代:1977

数据来源: WILEY