The changing role of the state hospital director: Restructuring the top management team

This article analyzes turnover in the position of state hospital director. It examines the relationship between role structure, job stress and burnout. Based on this analysis, recommendations are made for the restructuring of a top management team. Buffalo Psychiatric Center, a 750-bed facility operated by the New York State Office of Mental Health, provides the setting for this case study.Diane M. Pinchoff, M.A., is Associate Director of the Buffalo Psychiatric Center, 400 Forest Avenue, Buffalo, N.Y. 14213. Mahmud Mirza, M.D., is Director of the Buffalo Psychiatric Center. Reprint requests should be directed to Diane M. Pinchoff at the above address.     

Diverse effects of the CARD15 and IBD5 loci on clinical phenotype in 630 patients with Crohn's disease

OBJECTIVES: Genetic variants at the CARD15 and IBD5 loci are strongly associated with Crohn's disease (CD), but evidence of the effect of these variants on the clinical expression of CD is conflicting and has often been hampered by small sample sizes. We studied 630 well-characterized patients to clarify the genotype/phenotype relationship in CD. METHODS: Patients and healthy controls were genotyped for three common mutations in CARD15 and a marker of the IBD5 risk haplotype. Allele frequencies were compared between phenotypic subgroups using chi2 or Fisher's exact tests. Genotype/phenotype analysis was carried out using multinomial logistic regression modelling allowing for adjustment for correlated or confounding factors. RESULTS: The mean age at diagnosis was significantly lower in carriers of the CARD15 or IBD5 risk alleles. After correction for age and smoking, CARD15 mutations were strongly associated with both ileal disease (P=8.8 x 10(-6)) and stenotic disease (P=0.003), but the association with stenotic disease appeared to be due to a confounding effect with ileal disease. CARD15 mutations were also associated with the presence of granulomas (P=5.7 x 10(-5)), which remained significant after adjustment for age at diagnosis and disease location (P=0.0047). The IBD5 risk haplotype frequency was significantly elevated in cases with perianal disease (P=0.028) and axial spondyloarthropathy (P=0.012). CONCLUSION: Genetic variants at the CARD15 and IBD5 loci have diverse effects on clinical expression in CD. CARD15 mutations are significantly correlated with the presence of granulomas.     

Effect of linkage variation on pharmacokinetics of ricin A chain-antibody conjugates in normal rats

We have investigated the pharmacokinetics of three ricin A chain-antibody conjugates having different bridging structures. Conjugate 1 has a disulphide linkage and was prepared with the N-succinimidyl-3-(2-pyridyldithio)propionate cross-linking reagent. Conjugate 2 has a protected disulphide linkage with a methyl group substituted on the carbon atom of the bridging structure adjacent to the disulphide linkage. Its preparation necessitated the synthesis of a new cross-linking reagent N-succinimidyl 3-(2-pyridyldithio)-butyrate. Conjugate 3 has a sulphide linkage and was prepared with the cross-linking reagent N-succinimidyl 4-(iodoacetylamino)benzoate which was synthesized by a novel route. Conjugate 1 is reducible, conjugate 2 less easily reducible and conjugate 3 nonreducible. On administration to animals all three conjugates displayed biphasic kinetics. The reducibility of the bond had no significant effect on the early disappearance of the conjugate from the circulation. However, at the later time points ease of reduction of the bond was associated with a more rapid disappearance of conjugate.     

Bone marrow biopsy and bone scan to detect skeletal metastases.

This study correlates the findings of bone marrow biopsy with those of bone scan in patients with common cancers and highlights the comparable sensitivities of the two methods at the authors' institution. The results show that bone scintigraphy may be slightly more sensitive than bone marrow examination for the detection of carcinomatous metastases. This experience suggests that institutions should devise clinical pathways based on their testing sensitivities and patient characteristics. These considerations will ultimately result in better and more cost-effective treatment of these patients.     

Validation of the Hospital Anxiety and Depression Scale in Arab patients.

The Hospital Anxiety and Depression Scale (HADS) was administered to psychiatric outpatients with various diagnoses to assess its validity. The study was also designed to find out whether HADS can differentiate between diagnostic groups based on depression and anxiety symptoms. HADS was able to discriminate patients from controls at a sensitivity of 79% and specificity of 87%. HADS was much less sensitive, specific and diagnostically accurate in identifying anxiety and depressive disorders in the experimental group at a cut-off point of 13 and 10 respectively for both conditions. Possible psychological, social and psychiatric reasons for the results are discussed.     

Some characteristics of the psychiatric population attending a primary care centre in Kuwait

This study examined the sociodemographic correlates of psychiatric illness in a primary care centre in Kuwait. A total of 164 psychiatric patients seen over a 3-year period formed the experimental group while 165 nonpsychiatric patients attending the same centre formed the control group. Results showed significant differences in basic demographic variables of the 2 groups. The psychiatric patients were significantly more likely to be single, unskilled, young, less educated and living alone or in an overcrowded household and to report more recent life events than controls. The absence of family and social support, lacking a meaningful job and chronicity of illness were significantly correlated with poor treatment response. Possible interpretations of the results were discussed in the cultural context of our patients. The fact that 57% of the psychiatric patients had been ill for more than 6 months prior to consultation highlights the importance of orientation of primary care practitioners to the psychiatric aetiology of somatic presentation of many of their patients.     

Endoscopic removal of retained bile duct calculi via T-tube tract

A simple and safe technique for removal of retained bile duct calculi using a flexible fibreoptic choledochoscope and rigid nephroscope via the T-tube tract has been described. The technique allowed removal of large impacted calculi under direct vision without damage to the bile duct.