Circulating thyroid hormone levels and adequacy of dialysis.

In vitro thyroid function tests were performed in three groups of patients with chronic renal failure who were receiving, on average, 15, 18 and 27 hours of maintenance hemodialysis per week. Total thyroxine levels were low and total triiodothyronine levels low to normal in those receiving the least dialysis (15 hours), and were significantly higher in those receiving longer dialysis. Free thyroxine levels, as measured by the effective thyroxine ratio, were normal and similar in all three groups, as were serum thyrotrophin levels. All patients were clinically euthyroid. As total hormone levels showed a significant inverse relationship to both urea and creatinine, this study suggests that there is a dialyzable metabolite retained in uremia which competes with thyroid hormones for protein-binding sites.     

Community care of the mentally ill: Implementation of the Saskatchewan Plan

There has been partial implementation of the Saskatchewan Plan to replace the large centralized public mental hospital with small regional centers stressing community care. Intensive treatment of new patients together with intensive rehabilitation of old patients has greatly reduced the accumulation of chronic patients in the Saskatchewan Hospital, Weyburn. As a result there has been a significant fall in the population of the hospital from 1,478 in January 1963 to 443 at the end of 1966. Follow-up studies indicate that patients are doing well in community care and that there are no undue strains on community tolerance. This experience challenges justification of the continued existence of large isolated mental hospitals.Dr. Lafave, a psychiatrist, formerly superintendent of Saskatchewan Hospital, Weyburn, Saskatchewan, CanadaDr. Grunberg, formerly Director of the Psychiatric Services Branch, Saskatchewan Department of Public Health, Regina, SaskatchewanWe are deeply indebted to Dr. R. C. Hunt for his help with the preparation of this paper. Part of the material was originally presented under the title Halving the Population of a Large Psychiatric Hospital Within Two Years at the APA Meeting in Atlantic City in May 1966.