养阴清热活血中药对大鼠离体灌流颌下腺唾液分泌的作用

目的:中草药能通过增加唾液的分泌而缓解口腔干燥症状。本试验研究临床常用养阴清热中药促唾液分泌功能。方法:成年wistar大鼠用苯巴比妥钠麻醉后,外科分离颌下腺,转移至37℃恒温浴槽。使用蠕动泵(Cole-Palmer)进行灌流。氯化氨甲酰胆碱(CCh)对照灌流后,用缓冲液洗脱,后单独用含中药的缓冲液灌流及中药与CCh联合灌流,观察中药对颌下腺唾液分泌的影响。结果:养阴清热活血中药单独灌流,大多不能或仅能促进唾液少量分泌,而其灌流时加入CCh,则能明显促进唾液的分泌(唾液分泌曲线呈持续升高平台)。只有丹参在在不加入CCh的情况下也能促进唾液分泌。结论:养阴清热中药对离体颌下腺具有促分泌作用。中药促唾液分泌实验研究将为中药治疗口干症状及相关疾病的临床应用提供理论依据。     

Review of acute cancer beds

A review of admissions to cancer services at University Hospital Galway (UHG) was undertaken to assess the appropriateness of hospital usage. All cancer specialty patients admitted from 26-28 May 2009 were reviewed (n = 82). Chi square tests, Exact tests, and One-way ANOVA were utilised to analyse key issues emerging from the data. Fifty (61%) were classified as emergencies. Twenty three (67%) occupied a designated cancer bed with 24 (30%) in outlying non-oncology wards. The mean length of stay was 29.3 days. Possible alternatives to admission were identified for 15 (19%) patients. There was no evidence of discharge planning for 50 (60%) admissions. There is considerable potential to make more appropriate utilisation of UHG for cancer patients, particularly in terms of reducing bed days and length of stay and the proportion of emergency cancer admissions, and further developing integrated systems of discharge planning.     

Outcomes of emergency room visits for asthma. II. Relationship to admission criteria

To learn how the outcomes of emergency room (ER) care relate to the decision-making process, criteria for the disposition of asthma in the ER were incorporated into a formal protocol in the form of an algorithm for use by pediatric resident physicians. We compared the application of those criteria with the consequences of 199 decisions to admit patients to the hospital for asthma and of 293 decisions to discharge patients from the ER. For most patients the chance of relapse was significantly raised if they were discharged from the ER when the protocol had specified admission. This was not true, however, for a group of "frequent visitors" (12.7% of all patients) who accounted for 66.3% of all relapses. This finding offers an explanation for previous difficulties in identifying characteristics of visits destined to be followed by relapse. Patients were placed in jeopardy by inappropriate ER discharges only if they were high-risk patients who had experienced prior episodes of respiratory failure. Nearly all admissions involving severe episodes of asthma were also limited to high-risk patients. A variety of criteria supported such admissions. At the other extreme, "avoidable" admissions, in which obstruction resolved within a few hours of admission, occurred equally among all patient strata, and no particular admission criterion could be held at fault for admission of such rapidly remitting cases. The results support the use of explicit, quantitative criteria for guiding ER disposition of asthma, especially specific arrangements for management of ER visits by high-risk patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Variance in practice emergency medical admission rates: can it be explained?

BACKGROUND: Emergency admission rates have been rising steadily in recent years, with the majority of the increase owing to emergency medical admissions. Possible causative factors include changing demography, incidence of disease, admission thresholds, multiple admissions, and appropriateness of admission. AIM: To investigate the impact of patient and practice factors on variance in general practices' emergency medical admissions rates. DESIGN OF STUDY: Multiple regression analysis relating emergency medical admission rates of general practices to patient and practice characteristics. SETTING: The study was conducted between 1996 and 1997 in the acute hospital trust serving the study area, Dundee, Scotland. METHOD: Scottish Morbidity Record 1 (SMR1) data, which contains details of all hospital consultant episodes, was used to calculate individual practices emergency medical admission rates. These rates were then standardised to an expected value of 100. Forward selection was used to find a suitable multiple regression model to predict each practice's emergency medical admission rate from practice and patient variables. RESULTS: Crude emergency medical admission rates for general practices showed a 1.8-fold variation between the top and bottom deciles. The deprivation status and age of patients explained 42% of the variance in admission rates (64% with the exclusion of one practice that had a poor fit to the model). After correcting for age and deprivation there was a 1.2-fold variation in general practices' emergency medical admission rates. CONCLUSION: The most important factors in explaining variance in general practices' emergency medical admission rates are socio-demographic, with age and deprivation explaining a large proportion of the variation. We found no evidence to support the contention that general practice factors were linked with admission rates.     

A comparison of two different services treating schizophrenia: a cost-benefit approach

This study compares the clinical and social outcome for 2 cohorts of patients who had a first admission for schizophrenia 4 years earlier. One cohort was treated in a psychiatric unit attached to a teaching district general hospital (DGH)(T)), while the other was treated at an area mental hospital (AMH) with modern rehabilitation facilities. The clinical outcome for the 2 cohorts was broadly similar, but the DGH(T) imposed less of a strain on relatives, and was associated with less unmet need. The DGH unit tended to have significantly shorter durations of stay for its patients, so that its total hospital costs were less than those for the AMH despite higher unit costs. The cost-benefit analysis shows that, where these particular patients are concerned, the DGH(T) unit is economically superior to the AMH despite the fact that it supports a large teaching staff, and that these economic advantages are accompanied by various non-monetary advantages.     

Cuticular Hydrocarbons: Their Evolution and Roles in <Emphasis Type="Italic">Drosophila</Emphasis> Pheromonal Communication

I review the recent literature on cuticular hydrocarbons (CHs) in Drosophila. First, the major structural features of CHs are examined in a variety of species with regard to phylogeny. The genetic bases of the CH variation between and within species have been investigated with some of the genes involved characterized and manipulated. The effect of non-genetic factors as temperature, food and development is also examined with regard to CH production. Using a model involving the stimulating or the inhibiting role of CHs, it is possible to speculate on the mechanisms of CH perception and on the role(s) that these substances could play on sexual isolation and on the evolution of pheromonal communication.     

A study of Gleason score interpretation in different groups of UK pathologists; techniques for improving reproducibility

AIMS: To test the effectiveness of a teaching resource (a decision tree with diagnostic criteria based on published literature) in improving the proficiency of Gleason grading of prostatic cancer by general pathologists. METHODS: A decision tree with diagnostic criteria was developed by a panel of urological pathologists during a reproducibility study. Twenty-four general histopathologists tested this teaching resource. Twenty slides were selected to include a range of Gleason score groups 2-4, 5-6, 7 and 8-10. Interobserver agreement was studied before and after a presentation of the decision tree and criteria. The results were compared with those of the panel of urological pathologists. RESULTS: Before the teaching session, 83% of readings agreed within +/- 1 of the panel's consensus scores. Interobserver agreement was low (kappa = 0.33) compared with that for the panel (kappa = 0.62). After the presentation, 90% of readings agreed within +/- 1 of the panel's consensus scores and interobserver agreement amongst the pathologists increased to kappa = 0.41. Most improvement in agreement was seen for the Gleason score group 5-6. CONCLUSIONS: The lower level of agreement among general pathologists highlights the need to improve observer reproducibility. Improvement associated with a single training session is likely to be limited. Additional strategies include external quality assurance and second opinion within cancer networks.     

Age, sex, geographical and socio-economic variations in admissions for anaphylaxis: analysis of four years of English hospital data.

BACKGROUND: Although the most severe of the allergic disorders, the epidemiology of anaphylaxis remains poorly described. Hospital admissions for anaphylaxis in England more than doubled during the 1990s. OBJECTIVE: To provide baseline data for assessing future trends, and to assess whether there is sufficient regional variation in incidence to allow efficient testing of aetiological hypotheses, we sought to identify any age, sex, geographical and socio-economic variations in hospital inpatient admissions for anaphylaxis. METHODS: We studied all emergency admissions for anaphylaxis to English NHS hospitals between 1991 and 1995. Poisson regression modelling was used to calculate rates of anaphylaxis admission per 100 000 emergency admissions by age, sex, deprivation and by residence in urban/rural, North/South and East/West England. RESULTS: Of the 13.5 million emergency inpatient admissions, 2323 patients had a primary diagnosis of anaphylaxis. Poisson regression analyses showed significant age, gender, geographical and socio-economic variations in emergency admissions for anaphylaxis: adjusted Female rate ratio 1.19 (95% CI 1.09-1.29), South rate ratio 1.35 (95% CI 1.25-1.47), Rural rate ratio 1.35 (95% CI 1.17, 1.59), and Non-deprived rate ratio 1.32 (95% CI 1.19, 1.46). CONCLUSION: This study identifies striking national age, sex, geographical and socio-economic variations in the incidence of inpatient admissions for anaphylaxis in England, affording important opportunities to generate and test aetiological hypotheses. Risk of anaphylaxis admission is considerably increased in females of child-bearing age and those residing in southern, rural, and affluent areas are independent risk factors for anaphylaxis admission.     

A computer protocol to predict myocardial infarction in emergency department patients with chest pain

To achieve more appropriate triage to the coronary care unit of patients presenting with acute chest pain, we used clinical data on 1379 patients at two hospitals to construct a simple computer protocol to predict the presence of myocardial infarction. When we tested this protocol prospectively in 4770 patients at two university hospitals and four community hospitals, the computer-derived protocol had a significantly higher specificity (74 vs. 71 percent) in predicting the absence of infarction than physicians deciding whether to admit patients to the coronary care unit, and it had a similar sensitivity in detecting the presence of infarction (88.0 vs. 87.8 percent). Decisions based solely on the computer protocol would have reduced the admission of patients without infarction to the coronary care unit by 11.5 percent without adversely affecting the admission of patients in whom emergent complications developed that required intensive care. Although this protocol should not be used to override careful clinical judgment in individual cases, the computer protocol for the most part yields accurate estimates of the probability of myocardial infarction. Decisions about admission to the coronary care unit based on the protocol would have been as effective as those actually made by the unaided physicians who cared for the patients, and less costly. Whether physicians who are aided by the protocol perform better than unaided physicians cannot be determined without further study.     

Antibiotic prescribing and admissions with major suppurative complications of respiratory tract infections: a data linkage study.

BACKGROUND: Systematic reviews of antibiotic treatment of common acute respiratory tract infections (RTIs) suggest modest symptomatic benefit, but provide limited evidence that prescribing prevents complications. AIM: To assess the relationship between penicillin prescribing (the most commonly used group of antibiotics for RTIs) and hospital admission with complications. DESIGN OF STUDY: Data linkage study. SETTING: Ninety-six health authorities of England for the year 1997-1998. METHOD: Hospital admissions related to RTIs were linked with prescribing analysis and cost (PACT) data. RESULTS: There was close correlation between items of penicillin use and total antibiotic use (r = 0.96). After controlling for SMR, age, sex, and Townsend score, a one-unit increase in penicillin use (items dispensed per capita) was associated with a reduction in annual incidence per 10,000 of admissions for quinsy (-3.55 admissions, 95% confidence interval [CI] = -6.85 to -0.26), and mastoiditis (square root of incidence of admissions = -1.05, 95% CI = -1.82 to -0.27). This does not represent lower referral thresholds among higher prescribers as higher prescribing was associated with more admissions for tonsillectomy and overall admissions. Increasing prescribing by 2000 items of penicillin for a practice of 10,000 patients could possibly prevent one admission for either mastoiditis or quinsy. CONCLUSION: Higher antibiotic prescribing is associated with significantly fewer admissions with major complications. However, the overall size of the effect is modest and it is difficult to advocate an overall increase in prescribing to prevent complications. Future research should concentrate on finding better methods of targeting antibiotics to individuals at risk of poor outcome.     

A structured interview for medical school admission, Phase 1: initial procedures and results.

PURPOSE: Despite their widespread use, medical school admission interviews often are unstructured and lack reliability. This report describes the development of a structured admission interview designed to eliminate bias and provide valid information for selecting medical students, with preliminary information about the interview's reliability and validity. METHOD: After screening applications, 490 applicants to a public medical school residency program were interviewed by two faculty members using a structured interview format. Interview scores were compiled and correlated with undergraduate grade-point averages (GPAs); Medical College Admission Test (MCAT) scores; Iowa Evaluation Form (IEF) scores, an in-house evaluation of applicants' noncognitive abilities; and eventual admissions status. RESULTS: Interrater agreement was good; the percentages of rater pairs whose scores differed by one point or less ranged from 87% to 98%. Scores on the structured interview revealed low to moderate correlations with other admission criteria: 10 (p < 0.05) for cumulative GPA, 0.18 (p < 0.01) for MCAT Biological Science, 0.08 (p > 0.05) MCAT Physical Science, and 0.10 (p < 0.05) MCAT Verbal Reasoning. None of the correlations between the overall interview scores and the IEF scores reached statistical significance (p = 0.05). Higher overall scores on the structured interview did predict a greater likelihood of being accepted into the medical school and the interview score accounted for 20% of the incremental variance in admission status beyond GPA, MCAT, and IEF scores. CONCLUSIONS: The moderate-to-low correlations with other admission criteria suggest that the interview provided information about candidate credentials not obtained from other sources and accounted for a substantial proportion of the variance in admission status. This finding supports the considerable time and resources required to develop a structured interview for medical student admissions. Final judgment on the validity and utility of this interview should be made after follow-up performance data have been obtained and analyzed.     

Use of olanzapine in dysphoric mania

BACKGROUND: The simultaneous presentation of both manic and depressive symptoms has long been recognized. Nevertheless, a variable prevalence of dysphoric mania has been reported. The aim of this study was to estimate the prevalence of dysphoric mania among hospitalized patients and to assess the effectiveness of olanzapine in this type of patients. METHODS: Eighty-six patients who met DSM-IV criteria for mania were evaluated at admission with a protocol that included McElroy's criteria for dysphoric mania [Am. J. Psychiatry 149 (1992) 1633]. Treatment was administered according to clinical need, using mood stabilizers combined with antipsychotics. Sequential assessments were conducted throughout the study. RESULTS: Forty-four patients (51.2%) fulfilled McElroy's criteria for dysphoric mania. Fourteen of these dysphoric patients were treated with olanzapine in combination with mood-stabilizers. All patients improved in manic symptoms but patients treated with olanzapine improved significantly more than those treated with other antipsychotics in depressive symptoms. LIMITATIONS: The lack of randomization is a methodological limitation of this study, so these findings should be considered as preliminary. CONCLUSIONS: Dysphoric symptoms are common in this population of manic patients. Olanzapine in combination with mood-stabilizers may be effective in these patients. Additional controlled studies are needed to replicate these results.     

A simple and rapid protocol for the sequence determination of functional kappa light chain cDNAs from aberrant-chain-positive murine hybridomas

This protocol describes the application of a polymerase chain reaction to allow the cloning and sequencing of new functional kappa light chain cDNAs from murine hybridomas co-expressing aberrant endogenous kappa chain mRNAs. The presence of kappa light chain aberrant mRNAs can hinder or even prevent determination of the sequence of functional murine kappa light chain cDNAs amplified by PCR from hybridomas. The method described here employs a panel of kappa primers in the presence of molar excess of a primer complementary to the complementary determining region (CDR) 3 of the known aberrant chain sequence. Analysis of the PCR products reveals two bands for some reactions: one the functional, full-length kappa chain cDNA (approximately 400 bp) and another shorter (approximately 100 bp) band corresponding to short aberrant chain kappa CDR3-constant region. The full-length product is gel purified and cloned prior to sequencing and aligned with V-region germline sequences available in NCBI and GenBank databases. This method is used routinely in our laboratory and demonstrates consistency and reliability for sequence determination of kappa light chain V-gene cDNA of mAbs to diverse antigens. This protocol is a rapid and convenient method for determining the sequence of murine V kappa region genes from hybridomas expressing aberrant kappa chain mRNAs.     

Increased appropriateness of customized alert acknowledgement reasons for overridden medication alerts in a computerized provider order entry system

ObjectiveComputerized provider order entry systems commonly contain alerting mechanisms for patient allergies, incorrect doses, or drug–drug interactions when ordering medications. Providers have the option to override (bypass) these alerts and continue with the order unchanged. This study examines the effect of customizing medication alert override options on the appropriateness of override selection related to patient allergies, drug dosing, and drug–drug interactions when ordering medications in an electronic medical record.Materials and methodsIn this prospective, randomized crossover study, providers were randomized into cohorts that required a reason for overriding a medication alert from a customized or non-customized list of override reasons and/or by free-text entry. The primary outcome was to compare override responses that appropriately correlate with the alert type between the customized and non-customized configurations. The appropriateness of a subset of free-text responses that represented an affirmative and active acknowledgement of the alert without further explanation was classified as “indeterminate.” Results were analyzed in three different ways by classifying indeterminate answers as either appropriate, inappropriate, or excluded entirely. Secondary outcomes included the appropriateness of override reasons when comparing cohorts and individual providers, reason selection based on order within the override list, and the determination of the frequency of free-text use, nonsensical responses, and multiple selection responses.ResultsTwenty-two clinicians were randomized into 2 cohorts and a total of 1829 alerts with a required response were generated during the study period. The customized configuration had a higher rate of appropriateness when compared to the non-customized configuration regardless of how indeterminate responses were classified (p < 0.001). When comparing cohorts, appropriateness was significantly higher in the customized configuration regardless of the classification of indeterminate responses (p < 0.001) with one exception: when indeterminate responses were considered inappropriate for the cohort of providers that were first exposed to the non-customized list (p = 0.103). Free-text use was higher in the customized configuration overall (p < 0.001), and there was no difference in nonsensical response between configurations (p = 0.39).ConclusionThere is a benefit realized by using a customized list for medication override reasons. Poor application design or configuration can negatively affect provider behavior when responding to important medication alerts.     

Clinical Characteristics and Factors Influencing the Occurrence of Acute Eosinophilic Pneumonia in Korean Military Personnel

Acute eosinophilic pneumonia (AEP) is an uncommon inflammatory lung disease, and limited data exist concerning the clinical characteristics and factors that influence its occurrence. We retrospectively reviewed the records of AEP patients treated at Korean military hospitals between January 2007 and December 2013. In total, 333 patients were identified; their median age was 22 years, and all were men. All patients presented with acute respiratory symptoms (cough, sputum, dyspnea, or fever) and had elevated levels of inflammatory markers including median values of 13,185/µL for white blood cell count and 9.51 mg/dL for C-reactive protein. All patients showed diffuse ground glass opacity/consolidation, and most had pleural effusion (n = 265; 80%) or interlobular septal thickening (n = 265; 85%) on chest computed tomography. Most patients had normal body mass index (n = 255; 77%), and only 30 (9%) patients had underlying diseases including rhinitis, asthma, or atopic dermatitis. Most patients had recently changed smoking habits (n = 288; 87%) and were Army personnel (n = 297; 89%).The AEP incidence was higher in the Army group compared to the Navy or Air Force group for every year (P = 0.002). Both the number of patients and patients with high illness severity (oxygen requirement, intensive care unit admission, and pneumonia severity score class ≥ III) tended to increase as seasonal temperatures rose. We describe the clinical characteristics of AEP and demonstrate that AEP patients have recently changed smoking habits and work for the Army. There is an increasing tendency in the numbers of patients and those with higher AEP severity with rising seasonal temperatures.     

Rates and characteristics of intensive care unit admissions and intubations among asthma-related hospitalizations.

BACKGROUND: A life-threatening attack of asthma that leads to intensive care unit (ICU) admission, intubation, or both identifies patients at high risk of subsequent morbidity and mortality and represents a major cost burden. OBJECTIVE: To assess the rates, characteristics, and costs of ICU admissions and intubations among asthma-related hospitalizations. METHODS: This analysis was performed using a database of 215 hospitals representing more than 3 million annual inpatient visits. Asthma-related hospital admissions were identified by a primary diagnosis code for asthma during 2000. Logistic regression was used to estimate the odds ratios (ORs) for predictors of ICU admission, intubation, and in-hospital mortality. Ordinary least squares regression was used to estimate adjusted mean costs and length of stay. RESULTS: Of 29,430 admissions with a primary diagnosis of asthma, 10.1% were admitted to the ICU and 2.1% were intubated. The risk of in-hospital death was significantly greater in patients who were intubated but not admitted to the ICU (OR, 96.20; 95% confidence interval [CI], 50.24-184.20), those who were admitted to the ICU and intubated (OR, 62.69; 95% CI, 38.17-102.96), and patients with more severe comorbidities (OR, 1.53; 95% CI, 1.38-1.70). On average, intubated patients stayed in the hospital 4.5 days longer and incurred more than $11,000 in additional costs; patients admitted to the ICU stayed 1 day longer and accounted for $3,000 in additional costs vs standard admissions. CONCLUSIONS: The inpatient mortality, morbidity, and cost burden of life-threatening asthma in the United States is considerable. This study characterizes patients with asthma at risk of ICU admissions and intubations. Appropriate recognition and treatment are needed to prevent these severe and potentially life-threatening events.     

Association between air pollution and asthma admission among children in Hong Kong

OBJECTIVE: To examine the association of air pollutants with hospital admission for childhood asthma in Hong Kong. METHODS: Data on hospital admissions for asthma, influenza and total hospital admissions in children aged < or =18 years at all Hospital Authority hospitals during 1997-2002 were obtained. Data on daily mean concentrations of particles with aerodynamic diameter <10 microm (i. e. PM10) and <2.5 microm (i. e. PM2.5), nitrogen dioxide (NO2), sulphur dioxide (SO2), and ozone (O3) and data on meteorological variables were associated with asthma hospital admissions using Poisson's regression with generalized additive models for correction of yearly trend, temperature, humidity, day-of-week effect, holiday, influenza admissions and total hospital admission. The possibility of a lag effect of each pollutant and the interaction of different pollutants were also examined. RESULTS: The association between asthma admission with change of NO2, PM10, PM2.5 and O3 levels remained significant after adjustment for multi-pollutants effect and confounding variables, with increase in asthma admission rate of 5.64% (3.21-8.14) at lag 3 for NO2, 3.67% (1.52-5.86) at lag 4 for PM10, 3.24% (0.93-5.60) at lag 4 for PM2.5 and 2.63% (0.64-4.67) at lag 2 for O3. Effect of SO2 was lost after adjustment. CONCLUSION: Ambient levels of PM10, PM2.5) NO2 and O3 are associated with childhood asthma hospital admission in Hong Kong.     

Audit of nurse-led-training for epipen in a District General Hospital

BACKGROUND: A community-based study in the London Borough of Hounslow, which included patients in our District General Hospital (DGH) Paediatric Department, found that most families who had been prescribed adrenaline auto-injectors could not use them properly. This prompted the establishment of a new protocol for doctors and an Allergy Clinic where one nurse was responsible for training all patients. AIM: This audit was done to reassess this service 3 years after the changes were made. METHODS: 68 of the 81 (83%) patients followed up in our District General Hospital Nurse led Allergy Clinic agreed to participate. They were compared with the District General Hospital sub-group of the previous study. RESULTS: We found that most patients now reported they were trained to use the devise, had written instructions, were able to demonstrate competence on a dummy and would appropriately call an ambulance. This was significantly better than the previous situation. CONCLUSION: The study shows that training can be improved in a DGH setting with the strategy of protocolised prescribing and a Nurse led Allergy Clinic.     

Minor criteria of infectious disease society of america/american thoracic society for severe community-acquired pneumonia can predict delayed treatment response

The purpose of this study was to investigate the clinical aspects of patients satisfying the Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) minor severity criteria, focusing on their treatment response to empirical antibiotics. In total, 381 community-acquired pneumonia (CAP) patients who did not require mechanical ventilation or vasopressors at admission were enrolled, and 50 (13.1%) satisfied the minor severity criteria (i.e. , minor severe CAP [minor-SCAP]). The rates of new complication events and clinical treatment failure were significantly higher in the minor-SCAP group than in the control group (30.0% vs 2.1%, P < 0.001, and 42.0% vs 10.6%, P < 0.001, respectively), and the time to reach clinical stability was longer in the minor-SCAP group (8 days vs 3 days, P < 0.001). In a multivariate model, minor severity criteria (≥ 3) were significantly associated with treatment failure (odds ratio, 2.838; 95% confidence interval, 1.216 to 6.626), and for predicting treatment failure the value of the area under the receiver operating characteristic curve for minor criteria was 0.731, similar to other established scoring methods. The IDSA/ATS minor severity criteria can predict delayed treatment response and clinical treatment failure.     

Care in a mother-baby psychiatric unit: analysis of separation at discharge

Joint psychiatric admission to a Mother-Baby Unit (MBU) enables a mother to obtain care for psychiatric disorders and simultaneously receive support in developing her identity as a mother. This care is meant to prevent attachment disorders and mother-baby separation. Outcome at discharge, however, may differ according to the mother's admission diagnosis. Demographic data, clinical features of parent and child, and clinical outcome of 92 consecutive admissions of mothers and their children to a MBU in Marseille were collected over a period of eight years (1991-1998). Separations occurred in 23% of the joint admissions. Women with acute postpartum psychoses and major depressive disorders had better outcomes than those with chronic psychoses: at discharge, the latter were more often separated from their children. In those cases, however, MBU admission provided time to arrange the best placement for the child. Outcome was less predictable for non-psychotic personality disorders and depended not only on the mother's disease but also on her family and social context.