Educational approaches for preparing social work students for interdisciplinary teamwork on geriatric health care teams.

Interest in teamwork has fluctuated over the last several decades, with recent renewed interest. As social workers become more involved in working with older people in the coming years, their success will hinge on collaboration with other health providers. Schools of social work and clinical sites must address this through the development of educational curricula and clinical programs which prepare social workers to work on interdisciplinary geriatric health care teams. Based on the experience of the national Geriatric Interdisciplinary Team Training (GITT) Program, this article presents an overview of the necessary team skills for social workers, educational methods for teach ing teamwork developed at the GITT sites, and some teaching challenges.     

Identification of X-linked severe combined immunodeficiency by mutation analysis of blood and hair roots

Severe combined immunodeficiency is a heterogenous syndrome of varied genetic origins of which the X-linked type is the commonest (XSCID). The most sensitive method for diagnosis of XSCID in the absence of X-linked inheritance pattern is by mutation analysis. In this report we have performed mutation analysis in 13 unrelated boys transplanted (BMT) for SCID without a known cause to determine the frequency of XSCID. Five boys had an affected male relative. We also assessed the utility of hair roots for children without pre-transplant blood stored for mutation analysis since donor genotype was expressed in peripheral blood post BMT. Screening was performed by analysis of single-strand conformational polymorphism (SSCP) followed by sequencing of candidate exons. Mutations were found in 11 cases, of which six were sporadic, and maternal mosaicism was found in one family. Three mothers of the six sporadic cases were identified as carriers. The majority (6/8) of boys with SCID had gammac deficiency despite the absence of X-linked inheritance pattern. The significant frequency of de novo mutations and the occurrence of maternal germline mosaicism highlights the importance of mutation analysis. The strategy of using DNA from hair roots was particularly valuable where no pre-transplant blood was stored. Characterization of the mutations will also enable research into the correction of these genetic defects.     

Trace minerals and the kidney: an overview

The deviations from normal health produced by abnormalities in trace mineral metabolism in patients with renal disease and renal disorders produced by deficiencies or excesses of these trace minerals serve as the focus for this symposium on trace minerals and the kidney. Zinc, the trace mineral of most interest of the nephrologist, and aluminum, the nonessential (toxic) trace element of most interest, are treated in separate reviews. Iron, copper, selenium, and silicon (essential trace elements) and cadmium, lead, mercury, and lithium (nonessential or toxic elements) are covered in this review.     

Survival after surgical treatment in maxillary neoplasms of epithelial origin

During 1968-1979, 55 cases of epithelial neoplasms originating from the maxillary antrum were diagnosed and treated within the referral area of 1.5 million inhabitants. A majority of the patients were operated upon after pre-operative irradiation therapy (40-50 Gy). No significant difference in survival rate was found between patients operated on by total maxillectomy, including orbital exenteration, and patients subjected to partial maxillectomy. Patients with tumours not completely removed during primary surgery and patients with glandular involvement had a poor prognosis despite additional surgery and radiotherapy. The prognosis for the remaining patients was considerably better, with a 5-year survival rate of 60 per cent.     

Adventitial adipogenic degeneration is an unidentified contributor to aortic wall weakening in the abdominal aortic aneurysm

Objective

The processes driving human abdominal aortic aneurysm (AAA) progression are not fully understood. Although antiinflammatory and proteolytic strategies effectively quench aneurysm progression in preclinical models, so far all clinical interventions failed. These observations hint at an incomplete understanding of the processes involved in AAA progression and rupture. Interestingly, strong clinical and molecular associations exist between popliteal artery aneurysms (PAAs) and AAAs; however, PAAs have an extremely low propensity to rupture. We thus reasoned that differences between these aneurysms may provide clues toward (auxiliary) processes involved in AAA-related wall debilitation. A better understanding of the pathophysiologic processes driving AAA growth can contribute to pharmaceutical treatments in the future.

Prediction of social activity 1 year poststroke

OBJECTIVE: To develop an easy-to-use prediction rule for social activity 1 year poststroke that can identify patients at risk for social inactivity. DESIGN: Inception cohort. SETTING: Rehabilitation center. PARTICIPANTS: Patients with a first-ever supratentorial stroke were selected in 4 Dutch rehabilitation centers. Data of 250 patients were available for analysis. Potential prognostic factors measured at admission were sex, age, marital status, prestroke employment status, educational level, type of stroke, hemisphere, motor impairment, trunk control, communication, and activities of daily living (ADL) dependency. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Social activity measured by the Frenchay Activities Index (FAI) at 1 year poststroke. RESULTS: Multivariate backward linear regression analysis identified sex, age, marital status, motor impairment, communication, and ADL dependency as important predictors of the FAI score 1 year poststroke. An easy-to-use score chart was constructed that could identify patients at risk for social inactivity. The score chart proved to be well able to discriminate poor social functioning from moderate to good social functioning (area under the curve = .85). CONCLUSIONS: Identifying patients at risk enables health care professionals to focus on the social activity of this patient subgroup at an early stage in the care process.     

Comparing Effectiveness of Treatments for Borderline Personality Disorder in Communal Mental Health Care: The Oulu BPD Study

The implementation of effective psychotherapies in community mental health care is challenging. This study aimed to create a well-structured and easily applicable treatment model for patients with severe borderline personality disorder (BPD). We integrated a schema therapy based psycho-educational group into an available individual therapy. Two groups were formed: (1) community treatment by experts (CTBE) patients (n = 24) receiving new treatment and (2) treatment as usual (TAU) patients (n = 47). Changes in symptoms were measured by Borderline Personality Disorder Severity Index-IV interview and quality of life by the 15D health-related quality of life questionnaire. After 1 year the CTBE patients showed a significant reduction in a wider range of BPD symptoms and better quality of life than TAU patients. The results of this study are encouraging. A well-structured treatment model was successfully implemented into community mental health care with improved patient adherence to treatment and superior treatment outcomes compared to TAU patients.