A summary of recommendations for the management of alcohol problems: the quality assurance in the treatment of drug dependence project

This report presents outlines for approaches to intervening with excessive drinkers and problem/dependent drinkers. These recommendations are based on a meta-analysis of the treatment-outcome literature, a survey of treatment practices used in Australia and the views of a panel of experts. Recommendations for assessment, detoxification and intervention for excessive, problem and dependent drinkers are made. A number of interventions that are deemed unsuitable for use in this area, or that hold promise but require more evidence before they can be advocated for use are set out.     

Vitamin A status of socio-economically backward children

A comprehensive survey was carried out to asses the Vitamin A status of pre-school (0–6 yrs.) and school age (6–12 yrs.) children of socio-economically backward families from slums of Bombay and its suburbs. The Vitamin A, protein, calories and iron from the rice and dal based diet was found to be below recommended dietary allowances (RDA). Among the 1956 children surveyed 20% of the children showed low (<20 μg/dl) serum vitamin A levels. 4.8% of the children were suffering from one or the other signs of Vitamin A deficiency. Rose Bengal stain test (RBST) and conjuctival impression cytology (CIC) indicted the signs of mild conjuctival xerosis and of early epithelial changes which were correlated with serum vitamin A levels. Serum iron, PCV, Hb and RBC levels were below normal. The anthropometric measurements of these children were below 50th percentile of Indian Council of Medical Research (ICMR) standards. Due to lack of proper nutrition, the overall growth of children is either retarded or not upto the standard levels as was noted in majority of the children.     

Patient,Provider, and Treatment Factors Associated with Poor-Quality Care for Schizophrenia

Interventions are needed to improve the quality of care for schizophrenia. However, in designing these interventions it would be helpful to understand better which patients are at highest risk for poor-quality care and why care for this disorder is often of poor quality. We study the extent to which patient and treatment factors are associated with poor-quality care in 224 patients randomly sampled from two mental health clinics. Quality of medication management is evaluated using an established method based on national treatment recommendations. Multivariate regression is used to study the effect of patient and treatment factors on treatment quality, controlling for provider. Risk for poor-quality care was greater for patients who were more severely ill, older, and less compliant with treatment recommendations. There were trends toward poor management of symptoms in men and substance abusers, and poor management of side effects in Black patients. Provision of poor-quality care was associated with failure to document symptoms and side effects in the medical record. Interventions to improve care for schizophrenia should attend to the need for accurate clinical assessment and strategies for managing challenging clinical situations.     

Clinical indicators and other complications in the recovery room or postanaesthetic care unit

Clinical indicators and complications occurring in the recovery room or post anaesthetic care unit were recorded for patients who had an anaesthetic procedure during 1995, 1996 and 1997 (n = 13 266). Clinical indicators measured were those developed by the Australian Council on Healthcare Standards in conjunction with the Australian and New Zealand College of Anaesthetists, and three other indicators. All patients were assessed and positive data were collected by nursing staff on a standardised form which was checked and collated by the anaesthetist responsible for the recovery room (the author). The rates for some indicators were higher than the Australian Council on Healthcare Standards 1997 rates, but the overall rates of complications were comparable with, or lower than, those in published series. Clinical indicator data are seen as a valuable quantitative tool for quality assurance, particularly if collected as part of a more comprehensive programme.     

p53 Accumulation Is a Prognostic Factor in Intestinal-Type Gastric Carcinoma but Not in the Diffuse Type

Background: The prognostic value of p53 nuclear accumulation in gastric cancer is still unclear, as shown by the discordant results still reported in the literature. In this study, we evaluated the correlation between p53 accumulation and long-term survival of patients resected for intestinal and diffuse-type gastric cancer.Methods: Eighty-three patients with carcinoma of the intestinal type and 53 patients with carcinoma of the diffuse type were included in the study. Immunohistochemical staining of the paraffin sections was performed by using monoclonal antibody DO1; cases were considered positive when nuclear immunostaining was observed in 10% or more of the tumor cells. Prognostic significance of different variables was investigated by univariate and multivariate analysis.Results: p53 positivity was found in 51.8% of intestinal-type and 50.9% of diffuse-type cases. No significant correlation between the rate of p53 overexpression and age, sex, tumor location, tumor size, depth of invasion, lymph node involvement, distant metastases, and surgical radicality was found in the two groups of patients. A statistically significant difference in survival rate was observed between p53-negative and p53-positive cases in the intestinal type (P < .05), confirmed by multivariate analysis (P < .005; relative risk = 3.09). On the contrary, no correlation with survival was found in diffuse-type cases according to p53 overexpression.Conclusions: These results suggest that the immunohistochemical detection of p53 accumulation is a useful indicator of poor prognosis in the intestinal but not in the diffuse type of gastric cancer, and are indicative of distinct molecular pathways and pattern of progression in the two histotypes.     

40所军队医院病种病例分型质量评价结果分析

应用病例分型质量费用监控管理软件和ＳＡＳ６．１２统计软件包,对４０所军队医院５０万份病例样本资料进行深入分析,结果显示：病例分型组合数据稳定,分析结果合理。     

Patients' and doctors' perception of long-term morbidity in patients with testicular cancer clinical stage I

Patient-based questionnaires were designed with the aim to identify and rank long-term somatic and psychosocial morbidity in patients with low-stage testicular cancer. A further intention was to compare patients' assessments with experienced doctors' general opinion on quality of life items in cured testicular cancer patients. In pilot study I, 103 tumour-free patients ranked items of physical and psychosocial morbidity after having had various kinds of treatment. Though the ranking procedure appeared to cause some difficulties amongst the patients and subsequently was abandoned, the results indicated considerable differences between the patients' and doctors' evaluations. In pilot study II patients were asked to score the different items. The questionnaire of pilot study II was completed by 107 patients from the Norwegian Radium Hospital (NRH) and 99 relapse-free patients from the Royal Marsden Hospital (RMH) with testicular cancer stage I at least 1 year after infradiaphragmatic radiotherapy (n = 94) or adjuvant chemotherapy (2 cycles,n=26), or patients who had been followed on the surveillance program (n = 86). A total of 93 doctors completed a similar questionnaire, thereby expressing their general opinion on long-term morbidity in comparable testicular cancer patients as seen during routine clinical follow-up. Both the irradiated patients and those on the surveillance program reported slight degrees of Raynaud-like phenomena, neurotoxicity and ototoxicity, most probably representing background morbidity in an age-matched general male population. Doctors tended to underestimate their patients' somatic morbidity, but often overestimated the degree of psychological distress, in particular in patients on the surveillance program. Significant differences between RMH and NRH patients with regard to sexual problems and to leisure time activity may be explained by cultural differences in the two countries. The items presented in the questionnaire used identify important issues for patients cured of testicular cancer which may be used in future multicentre trans-cultural studies assessing these patients' quality of life. This will provide sufficient data for psychometric testing and, together with the findings from patients' free comments, support the final design of a testicular cancer quality of life module.     

Prognostic Significance of Proliferating Cell Nuclear Antigen (PCNA) in Squamous Cell Carcinoma of the Esophagus

Proliferating cell nuclear antigen (PCNA) has been shown tobe of prognostic significance in some gastrointestinal tumors.Immunohistochemical analysis was performed to determine whetherPCNA is useful for predicting the outcome of patients with squamouscell carcinoma of the esophagus. Using a mouse monoclonal antibody,PC 10, the expression of PCNA was studied in resected squamouscell carcinomas of the esophagus from 59 patients who had undergonecurative esophagectomy. None had received any preceding therapy.The proliferation rate was assessed in terms of the percentageof the PCNA-positive nuclear area relative to the total areaof cancer nuclei using a cell analysis system (CAS). Clinicopathologicalvariables including PCNA staining were assessed in relationto prognosis. Survival rate was obtained by the Kaplan-Meiermethod. The PCNA indices (percentage of the positive nucleararea) of the tumors varied from 4.4% to 96.2%. Among the clinicopathologicalvariables, only tumor size (5 cm) and depth of invasion werecorrelated significantly with PCNA index (P<0.05). Microscopically,PCNA was stained in non-keratinized cells but not in keratinizedcells. However the histological grade was not correlated withPCNA index. The survival rate was significantly worse in patientswith high PCNA indices (40%) than in those with low indices(<40%) (P<0.05). However, multivariate analysis revealedthat PCNA index was not an independent prognostic factor.     

Matching pain coping strategies to the individual: A prospective validation of the Cognitive Coping Strategy Inventory

The validity of the Cognitive Coping Strategy Inventory (CCSI; Butler et al., 1989) was tested in a prospective fashion. Subjects were randomly assigned to one of three conditions. Some were matched to a strategy for which they received a high CCSI score, some were mismatched to a strategy for which they received a low CCSI score, and some were given a choice of strategies. Those subjects using a matched strategy obtained better threshold and tolerance times on the cold pressor than subjects who used a mismatched strategy. Despite clear differences in exposure to the cold pressor these conditions did not differ from each other in self-reported levels of pain. It was concluded that the CCSI appears to be a valid and useful tool for selecting a coping strategy to help particular individuals manage acute pain. Though the CCSI is relatively easy to administer and score, the comparative costs and benefits of using it must be weighed against the somewhat more efficient approach of simply offering the subject a choice of treatments. Subjects given a choice of strategies performed as well as subjects matched to a strategy on the basis of CCSI scores.     

Assessment issues involving the families of trauma victims

This paper reviews the empirical literature on the clinically significant problems found within families containing a member with post-traumatic stress disorder. Recommendations are made regarding specific instruments that can be useful for evaluating marital and familial adjustment. Assessment issues concerning the need to weigh historical relationship factors vis-á-vis the influences of a traumatized family member are discussed. A multiple-gating model is presented for assessing different aspects of family dysfunction, and suggestions for future research and clinical directions are offered.