Toward a new philosophy of care: Perspectives on prevention

The history of medical care in America and the present practice of mental health professionals generally reflect the economic structure of the country and of supply and demand. Revision is seriously needed in the areas of service delivery and training to give emphasis to primary prevention, and this requires social action on two levels: redirection of national priorities and development of a new philosophy of care founded in service and committed to prevention. Prevention is a form of response that can be made to existing and anticipated societal difficulties, to attempts to resolve them, and thus to planning properly for the future. Such plans must involve specific goals, purposes, attainable relevant programs, and the ability of providers and consumers to plan and act collaboratively; education of both providers and consumers: and making use of the political process to support this new philosophy of care both morally and financially. The tools of modern technology can be adapted and brought to bear on the problem of mental health care and mental illness prevention so that society can move beyond past failures to a system of care for the mentally ill that can keep pace with our complex modern society.     

Correlates of consumer satisfaction with outpatient therapy assessed by postcards

This paper presents research findings on the effect of numerous psychotherapy variables on clients' satisfaction with psychotherapy in an outpatient unit of a community mental health center. The surprising result is that so few variables had any significant impact. Those that did have an impact raise some questions about the value of certain kinds of therapy.     

Percutaneous procedures for the repair of iatrogenic occlusion or stenosis of peripheral vessels in children--report of 5 cases

Invasive percutaneous diagnostic or therapeutic procedures are associated with the risk of thrombosis and occlusion of peripheral vessels which are used for vascular access. Data on the transcatheter therapy of vascular complications in children are scarce. We described five children in four of whom percutaneous transluminal balloon angioplasty of occluded peripheral vessels was successfully performed. Technical aspects of this treatment and indications are discussed.     

Two novel mutations in mitochondrial acetoacetyl-CoA thiolase deficiency

Summary We report a new patient with acetoacetyl-CoA thiolase deficiency in whom we found two new missense mutations.     

Surgical strategies in the removal of malignant tumors and benign lesions of the anterior skull base

The choice of surgical approaches to the tumors of the anterior skull base is determined by the location, dimensions of such lesions and their relations to the surrounding structures. Furthermore, the need for the reconstruction of the dura and skull base structures has an important influence on the decision about the surgical procedure. Transfacial approaches provide limited exposure, especially when tumors damage the floor of the anterior cranial fossa and involve the frontobasal dura and brain. Transcranial, craniofacial and subcranial approaches in particular may aid a surgeon in the removal of such lesions, and often these surgical procedures are the only beneficial methods. Our study comprised 15 patients. Transcranial approaches were used in ten cases. In five further cases, we adopted craniofacial or subcranial approaches. Total removal of these lesions was possible in 13 cases. Neither important complications nor death after surgery was observed except for two cases (craniofacial/subcranial approach) where the CSF leak and CNS infection were reported. We deem that the transcranial approach creates a good possibility for total removal of anterior skull base tumors, particularly of the benign lesions, and permits reconstruction of the skull base damaged by the tumor. However, in patients with large malignant tumors, the en bloc resection via the combined craniofacial/subcranial approach achieved better outcome.Parts of the materials of this research were presented at the 12th European Congress of Neurosurgery—EANS 2003, 7–12 September, Lisboa, Portugal     

Comparing utility scores before and after hearing-aid provision

Utility scores were estimated for 609 hearing-impaired adults who completed EQ-5D, Health Utilities Index Mark III (HUI3) and SF-6D survey instruments both before and after being provided with a hearing aid. Pre-intervention, the mean utility scores for EQ-5D (0.80) and SF-6D (0.78) were significantly higher than the mean HUI3 utility score (0.58). Post-intervention, the mean improvement in the HUI3 (0.06 change) was significantly higher than the mean improvement according to the EQ-5D (0.01 change) or SF-6D (0.01 change). The estimated cost effectiveness of hearing-aid provision is therefore likely to be dependent on which instrument is used to measure utility.     

MRI appearance of lumbar epidural abscesses: report of three cases

The authors report three cases of non-tuberculous epidural abscess. Presenting symptoms included lumbar back pain, muscle spasms, soft tIssue swelling, and neurological deficits in all three cases. MR imaging was helpful for diagnosis and showed involvement of perivertebral soft tissues and an epidural abscess of variable size. There was no significant involvement of intervertebral disks or vertebrae. Diagnosis was confirmed by bacteriologic exam. Clinical outcome was favourable with antibiotic treatment.