PSYCHIATRIC EVALUATION OF HUMAN IMMUNODEFICIENCY VIRUS SEROPOSITIVES IN ARMED FORCES

Fifty five Armed Forces personnel detected to be seropositives for human immunodeficiency virus were the subjects of the study. After baseline clinical evaluation, laboratory investigations and Centre for Disease Control classification, through a semistructured interview, their sexual orientation, behaviour and psychiatric morbidity were assessed. Sixtynine percent had another sexually transmitted disease as comorbidity. Heterosexual contact was responsible for the infection in 54 out of 55 subjects. Seven patients were freshly diagnosed to have psychiatric illness.KEY WORDS: Human immunodeficiency virus, Psychiatric morbidity, Sexual orientation     

Increasing the value of cardiac care: the Dartmouth approach

A cardiac services team at Dartmouth-Hitchcock Medical Center (DHMC) launched multiple efforts to improve the quality and value of their services. The team developed a critical path for coronary artery bypass grafting (CABG) and tracked important clinical outcomes, such as mortality rates and wound complications. The team also studied the patient's view of the process. Staff used focus groups and surveys to distill the "voice of the customer" into six quality characteristics and developed methods to better involve patients in clinical decision making and evaluation of treatment efficacy. Results: CABG mortality declined from 5.7 percent in 1992 to 2.7 percent in 1994, 16 months after the critical path was developed. Mean total intubation time for patients following open-heart surgery was reduced from 22 hours to 14 hours. Median postoperative length of stay decreased from seven days to six for elective CABG patients. The number of patients discharged in five days or less increased from 20 percent to 40 percent. Readmission to the hospital following discharge remained stable, despite the shorter length of stay.     

Prevalence of Hearing Impairment and Hearing Complaints in Older Adults: A Study in General Practice

In one general practice, 660 people aged 60 years or over werescreened by means of pure tone audiometry and a specific questionnaireto assess the prevalence of hearing impairment and hearing complaints.Hearing impairment was defined as an average loss of 35 dB ormore in the 1, 2 and 4 kHz frequencies in one or both ears.In total, 37.4% (95% Cl, 33.3–41.1%) of the participantswas hearing impaired. The prevalence was higher in men (55.1%)than in women (44.9%) and clearly increased with age in bothsexes. The prevalence of hearing complaints in terms of hearingdifficulties and/or tinnitus, was 37.3% (95% Cl, 33.6–41.0%),and increased with age, especially in women. Of the subjectswith hearing impairment, 64.4% reported hearing complaints.Of the subjects without hearing impairment, 21.1% experiencedhearing complaints. This study suggests that screening olderadults with relatively simple methods, may identify a largeproportion of men and women in general practice with hearingproblems. Providing information to both patients and generalpractitioners about the possibilities of hearing improvementis a crucial step in making people become more aware of hearingproblems. This could ultimately lead to improvement of the qualityof life of older men and women with hearing problems.     

Posterior Interosseous Artery Flap for Hand Defects

Background

Reconstruction of soft tissue defects in the hand need an early, single stage and well vascularised cover to achieve the best functional result. Usually a full thickness graft is required since vital structures like tendons, bones and joints are exposed and often there is need for secondary reconstruction.

Methods

We managed 12 cases of complex defects over the hand in the last 2 years with the posterior interosseous artery flap.

Results

In 5 cases the defect was due to blast injury and in 4 because of crush injury. Males predominated in the ratio of 5:1. The defect was most often in the 1^st web space and the largest flap was 11×8 cm. In all but one case the donor site was covered by split skin graft, which settled well. 2 patients had superficial flap necrosis needing debridement and skin graft.

Conclusion

Flap based on reverse flow in the posterior interosseous artery is a versatile and reliable source for full thickness cover of complex soft tissue defects in the hand.Key Words: Soft tissue defect of hand, Posterior interosseous artery flap     

Positional cloning of a gene involved in hereditary multiple exostoses

Hereditary multiple exostosis (EXT) is an autosomal dominant condition mainly characterized by the presence of multiple exostoses on the long bones. These exostoses are benign cartilaginous tumors (enchondromata). Three different EXT loci on chromosomes 8q (EXT1), 11p (EXT2) and 19p (EXT3) have been reported, and recently the EXT1 gene was identified by positional cloning. To isolate the EXT2 gene, we constructed a contig of yeast artificial chromosomes (YAC) and P1 clones covering the complete EXT2 candidate region on chromosome 11p11-p12. One of the transcribed sequences isolated from this region corresponds to a novel gene with homology to the EXT1 gene, and harbours inactivating mutations in different patients with hereditary multiple exostoses. This indicates that this gene is the EXT2 gene. EXT2 has an open reading frame encoding 718 amino acids with an overall homology of 30.9% with EXT1, suggesting that a family of related genes might be responsible for the development of EXT.      

A comprehensive evaluation of language for early behavioral intervention programs: The reliability of the SKILLS Language Index

Early intensive behavioral intervention (EIBI) is a well-established treatment for children with autism spectrum disorders (ASD) and is thus widely recommended. However, the content of EIBI programs presumably varies considerably and may not always be tailored to the individual strengths and deficits of each child. Few assessment tools exist (and none have been psychometrically evaluated) which attempt to identify appropriate targets for treatment in EIBI programs. The current study evaluated the reliability of the subscales of the SKILLS Language Index, an assessment tool for EIBI programs. Results demonstrated excellent internal consistency, inter-rater, and test-retest reliability.     

Specificity of Incident Diagnostic Outcomes in Patients at Clinical High Risk for Psychosis

It is not well established whether the incident outcomes of the clinical high-risk (CHR) syndrome for psychosis are diagnostically specific for psychosis or whether CHR patients also are at elevated risk for a variety of nonpsychotic disorders. We collected 2 samples (NAPLS-1, PREDICT) that contained CHR patients and a control group who responded to CHR recruitment efforts but did not meet CHR criteria on interview (help-seeking comparison patients [HSC]). Incident diagnostic outcomes were defined as the occurrence of a SIPS-defined psychosis or a structured interview diagnosis from 1 of 3 nonpsychotic Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) groups (anxiety, bipolar, or nonbipolar mood disorder), when no diagnosis in that group was present at baseline. Logistic regression revealed that the CHR vs HSC effect did not vary significantly across study for any emergent diagnostic outcome; data from the 2 studies were therefore combined. CHR (n = 271) vs HSC (n = 171) emergent outcomes were: psychosis 19.6% vs 1.8%, bipolar disorders 1.1% vs 1.2%, nonbipolar mood disorders 4.4% vs 5.3%, and anxiety disorders 5.2% vs 5.3%. The main effect of CHR vs HSC was statistically significant (OR = 13.8, 95% CI 4.2–45.0, df = 1, P < .001) for emergent psychosis but not for any emergent nonpsychotic disorder. Sensitivity analyses confirmed these findings. Within the CHR group emergent psychosis was significantly more likely than each nonpsychotic DSM-IV emergent disorder, and within the HSC group emergent psychosis was significantly less likely than most emergent nonpsychotic disorders. The CHR syndrome is specific as a marker for research on predictors and mechanisms of developing psychosis.     

Teaching children with autism to detect and respond to deceptive statements

Previous research has shown that children with autism often have deficits in deception, both in the ability to lie to others and in the ability to detect when they are being lied to. Additionally, children with autism are frequently the victims of bullying and difficulty with understanding deception likely makes the population more vulnerable to bullying. The purpose of this study was to teach individuals with autism to identify when others were lying to them, specifically to exclude them or to take their possessions. The treatment package consisted of multiple exemplar training, including rules, modeling, role-play, and immediate feedback. The results indicated that the procedure was effective for all three participants. Additionally, generalization was demonstrated to novel, untrained lies and to same-age peer confederates who were not involved in training.