The family experience of deinstitutionalization: Insights from the closing of Central State Hospital

Since the early 1970s, policy makers and researchers have expressed concern about the potential negative consequences of deinstitutionalization on families. This article summarizes results of a survey of family and lay caregivers of patients discharged from Central State Hospital, which closed in June 1994. The survey was designed to assess the impact of the closing on family members, including their attitudes, caregiving responsibilities, and involvement in the treatment of the patients. Results indicate that family members have mixed feelings about the closure. Family caregivers also reported that they have not been asked to take on significant amounts of the caregiving responsibilities since the clients were moved from the hospital. Family members described a significant reduction in the frequency of contact they had with their loved ones and with professional caregivers since the closure. Implications for behavioral health policy makers considering or planning closing or downsizing long-term care facilities are discussed.An earlier version of this article was presented at the 1997 American Public Health Association Annual Meeting in Indianapolis, Indiana. The analyses and conclusions reported here are the sole responsibility of the authors and do not necessarily reflect the position or opinions of the funding institutions or Indiana University.He is also with the Indiana Consortium for Mental Health Services Research in Bloomington.     

Radical prostatectomy. The surgical complications

Study of 165 patients with prostate adenocarcinoma who underwent radical prostatectomy using a retropubic approach. Mean PSA is 19 ng/ml, mean age 63 years and median follow-up 26 months. 22 patients (13.2%) reported complications during the first month post-surgery, primarily urinary fistula of more than 5 days long in 5 patients and rectal injury in 3.49 patients (29%) reported complications after the first month, mainly urinary incontinence in 26 cases and stenosis of the urethrovesical juncture in 15. The group with early complications showed no significant differences compared to those who had none, neither in PSA (p = 0.3) or a worse pathological stage (p = 0.1), and no evidence is shown in terms of biochemical progression or in disease free progression (p = 1). Patients with urethrovesical juncture stenosis have higher mean PSA (p = 0.01), greater biochemical progression (p = 0.006), worse Gleason (p = 0.03 = and worse progression free survival (p = 0.01). Patients with stress incontinence showed no differences compared to the other groups relative to the studied factors.     

Interferon-β inhibits proliferation and progression through S phase of the cell cycle in five glioma cell lines

Summary The growth inhibitory effect of IFN- was evaluated in 5 human glioma cell lines (AO2V4, GJC, GJR, NN and NNR) and in normal astrocyte cultures (SC and TM). All 5 glioma cell lines showed an anti-proliferative response to IFN- whereas normal glial cells were non-responsive. IFN- at 10, 100 and 500 U/ml lead to a 30%,70% and 80% relative decrease in cell number after 12 days, respectively in AO2V4 cells. GJC and GJR cell lines also responded significantly to the lowest concentration of IFN- tested and at 500 U/ml the relative cell number decreased 55%. The NN and NNR cells were the least responsive to IFN- with maximum growth inhibition of 30% at 500 U IFN-/ml. Following treatment with IFN-, AO2V4, GJC, GJR and normal astrocytes all expressed mRNA encoding the anti-viral protein, 2-5A synthetase demonstrating that IFN- bound to receptors on all four cell lines and activated signal transduction pathways required for induction of an anti-viral protein. A determination of the relative number of viable cells showed that none of these cells exhibited a significant decrease in cell viability. Since the antiproliferative response to IFN- was not primarily due to cell death, the effect of IFN- on cell cycle progression was evaluated by flow cytometry. All treated glioma cell lines showed a relative increase in proportion of cells in S phase. AO2V4 cells had a 50%–80% increase in the percentage of cells in S phase, whereas GJC, GJR and NNR had percentage increases of 20%–40%. IFN- treatment of normal astrocytes did not significantly alter their cell cycle profile. These data suggest that IFN- exerts its antiproliferative effect on glioma cells by arresting the ordered progression through S phase or decreasing entry into G₂/M phase of the cell cycle.     

Guidelines for use access to compuuterized medical records

Computerization of the medical record allows the unique capability to provide differential access to various components of the record by users outsid of the immediate provider/patient health care setting Guidelines for designers, programmers, and users of computerizeid medical records have been defined in order to clarify which data elements or categories are appropriate for communication to various parties involved in utilizing patients information.     

Reading, Demographic, Social and Psychological Factors Related to Pre-adolescent Smoking and Non-smoking Behaviors and Attitudes

The purpose of this study was to examine reading, demographic, social and psychological factors related to pre-adolescent smoking and non-smoking behaviors and attitudes. The school-home humanistic education program was implemented in a large, urban public school system. It stressed responsible decision-making, increased self-esteem and the inter-relationships among the acquisition of knowledge of the consequences of smoking, personal feelings, family relationships and behavior. The results showed that family involvement was necessary to affect smoking attitudes and behaviors. Of all the variables studied, reading had a most pervasive relationship. Peer influence and self-esteem also were related to smoking knowledge, smoking attitude, future smoking intentions and the "purchase" of cigarettes. Two of several conclusions drawn from the results are: 1. Family involvement is necessary to affect attitudes and behaviors. 2. Health education research that does not investigate the relationship between program outcomes and reading achievement may be misleading.     

Phase I and pharmacologic evaluation of intraperitoneal 5-fluoro-2′-deoxyuridine

Summary Intraperitoneal (i.p.) 5-fluoro-2-deoxyuridine (Floxuridine, FUdR, FdUrd) was evaluated in a phase I study at a starting level of 500 mg given on 1 day in 2 I 1.5% dialysate. Escalations within patients were allowed every other cycle. A total of 23 patients (age, 32–78 years) received 108 treatment courses. Local tolerance at all dose levels was excellent, with no cases of drug-related peritonitis being observed. Nausea and vomiting increased in severity in relation to dose and was universal at >3,000 mg ×3 days. One patient each developed grade 1 mucositis as well as diarrhea at a dose of 3,000 mg×3 days and leukopenia and thrombocytopenia at 5,000 mg×3 days. Peritoneal fluid (PF) and plasma (PL) FdUrd profiles were monitored by an HPLC method in 13 subjects, with 7 being studied serially at 2–4 increment doses for up to 6 h. Profiles that exhibited apparent linear pharmacokinetics gave PF drug levels 2–4 logs higher than the PL counterparts, with the latter essentially declining in parallel to the former, indicating that the disposition of FdUrd from the peritoneal compartment is rate-determining. The mean terminal half-life for PF FdUrd was found to be 115 min and mean peritoneal clearance was 25 ml/min. The vast differences in drug levels and AUC found between the PF and the PL profiles suggests a high systemic clearance of FdUrd, which was confirmed in two patients receiving 2 g FdUrd by short i.v. infusion. A disproportionate increase in the plasma FdUrd levels and the corresponding AUC values was found with increasing dose, suggesting a disproportionate increase in the systemic partitioning of FdUrd when doses were escalated within a patient. Substantial levels of peritoneal 5-fluorouracil (FUra) were also detected in most of the subjects. Thus, FdUrd was found to have several desirable properties for i.p. administration: (1) a 2- to 4-log pharmacologic advantage, (2) the absence of local toxicities, and (3) a favorable antitumor spectrum and some evidence of antitumor effects in this phase I and pharmacology study. A 3,000-mg dose given in 2 l 1.5% dialysate for 3 consecutive days exhibited antitumor activity and produced no systemic toxicity except nausea and vomiting, which was controlled by antiemetics. This dose schedule is therefore recommended for phase II trials directed against small-volume disease in the peritoneal cavity, such as may be found in some stages of ovarian and gastrointestinal cancers. In addition, it is suitable for further exploration as a part of regimens including systemic therapy or drugs that modulate the action of fluoropyrimidines.Supported in part by Cancer Center Core Grant CA 14089, by ROI CA 50 412, by an ACS Institutional Grant (IN21Z, to C. R.) and by the Italian-American Foundation award (to N. C.)Deceased