Victim control of the aggression of an institutionalized retardate

This study demonstrated that aggressive attacks on ward staff by an adult female retardate could be controlled by the victims' reactions to the attacks. The woman had daily 15-min sessions during which an experimeter (the victim) entered her seclusion room and sat beside her. Three conditions were used: (1) a social extinction condition during which the victim ignored all attacks directed at him, (2) a social reinforcement condition during which the victim verbally and physically attended to attacks, and (3) a return to the social extinction condition. All aggressive acts toward the victim were eliminated during the extinction conditions. When the victim showed attention, attacks directed at him increased. Self-aggression and object-aggression were found to be closely related to victim-aggression.     

Surgical site infection in orthopedic trauma: A case–control study evaluating risk factors and cost

Background

With the shift of our healthcare system toward a value-based system of reimbursement, complications such as surgical site infections (SSI) may not be reimbursed. The purpose of our study was to investigate the costs and risk factors of SSI for orthopedic trauma patients.

Methods

Through retrospective analysis, 1819 patients with isolated fractures were identified. Of those, 78 patients who developed SSIs were compared to 78 uninfected control patients. Patients were matched by fracture location, type of fracture, duration of surgery, and as close as possible to age, year of surgery, and type of procedure. Costs for treatment during primary hospitalization and initial readmission were determined and potential risk factors were collected from patient charts. A Wilcoxon test was used to compare the overall costs of treatment for case and control patients. Costs were further broken down into professional fees and technical charges for analysis. Risk factors for SSIs were analyzed through a chi-squared analysis.

Results

Median cost for treatment for patients with SSIs was $108,782 compared to $57,418 for uninfected patients (p < 0.001). Professional fees and technical charges were found to be significantly higher for infected patients. No significant risk factors for SSIs were determined.

Conclusions

Our findings indicate the potential for financial losses in our new healthcare system due to uncompensated care. SSIs nearly double the cost of treatment for orthopedic trauma patients. There is no single driver of these costs. Reducing postoperative stay may be one method for reducing the cost of treating SSIs, whereas quality management programs may decrease risk of infection.     

The effect of M1 muscarinic blockade on behavior and physiological responses following traumatic brain injury in the rat

Dicyclomine (1 mg/kg or 10 mg/kg), scopolamine (1 mg/kg), or saline was administered intraperitoneally to rats 15 min prior to moderate fluid percussion brain injury. A variety of reflexes and responses were measured up to 60 min following injury, and body weight and several neurological measures were taken daily up to 10 days following injury. All 3 antimuscarinic treatments reduced the duration of transient behavioral suppression as assessed by these measures. It appears that blockade of the M1 muscarinic receptor can attenuate transient behavioral suppression associated with concussive brain injury. Thus, stimulation of M1 muscarinic receptors may mediate components of reversible traumatic unconsciousness following cerebral concussion. No differences were observed between saline and antimuscarinic treatments in the incidence or duration of apnea following injury. Scopolamine pretreatment significantly elevated heart rate prior to injury, but had no significant effect on the responses of heart rate and blood pressure to experimental concussion. Both doses of dicyclomine significantly reduced resting heart rate, but unlike scopolamine, significantly enhanced the cardiovascular response to fluid percussion injury. Antimuscarinic treatment significantly reduced body weight loss and certain motor deficits, including beam balance and beam walk performance, following concussive head injury. Scopolamine and both doses of dicyclomine appeared to be equally effective in reducing long-term deficits. Data from these experiments indicate that at least some of the long-term behavioral deficits following moderate levels of brain injury may involve the binding of acetylcholine to M1 muscarinic receptors.(ABSTRACT TRUNCATED AT 250 WORDS)     

Replacing a chronic schizophrenic man's delusional speech with stimulus appropriate responses

This study attempted to extend the use of Cues, Pause, Point language training procedures (developed to treat the speech disorders of mentally handicapped persons) to delusional speech. The direct and potential generalized effects of the procedures on the delusional and socially appropriate responding of an institutionalized, chronic schizophrenic man were evaluated in a multiple baseline design across stimulus-response pairs. The procedures encouraged the subject to (a) remain quiet before, during, and after the presentation of verbal stimuli and then (b) respond on the basis of environmental cues (i.e. written word cards) that contained the correct responses. Delusional responding was rapidly replaced by appropriate responding on both sets of the trained stimuli. Across person and setting generalization occurred in assessments conducted immediately following training, and these effects were maintained for 15 months. The results suggest that Cues, Pause, Point procedures may offer some potential for replacing delusional responding with appropriate responding to social stimuli.     

Replacing the Echolalia of Children With Autism With Functional Use of Verbal Labeling

We evaluated the direct and generalized effects of cues-pause-point language training procedures on immediate echolalia and correct responding in two children with autism. The overall goal was to teach the children to remain quiet before, during, and briefly after the presentation of questions and then to verbalize on the basis of the cues (pictures) whose labels represented the correct responses. A multiple baseline design across question/response pairs demonstrated that echolalia was rapidly replaced by correct responding on the trained stimuli and there were clear improvements in one childs responding to untrained stimuli. These results replicate and extend previous research with adults with mental retardation and autism which demonstrated that cues-pause-point procedures can be effective in teaching individuals displaying echolalia to use their verbal labeling repertoires functionally.     

Age effect on dopamine and serotonin metabolite levels in cerebrospinal fluid

Homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), and 3-methoxy-4-hydroxyphenylethylene glycol (MHPG) were measured in lumbar cerebrospinal fluid from a group of patients ranging in age from 1 week to 45 years. Quantitation of these biogenic amine metabolites was achieved using a gas chromatographic/mass spectrometric technique. The subjects had various specific disorders of the nervous system, though patients with movement disorders and biochemical defects known to affect the neurotransmitter systems examined in this study were specifically avoided. The results indicated a strong inverse correlation in children between CSF HVA and 5-HIAA concentrations and age. The decline in these metabolites with age appeared to be exponential. No significant age effect was observed for MHPG. The results indicate the importance of comparing CSF metabolite levels in children with values in age-matched controls.     

Potential clients' beliefs about the relative competency and caring of psychologists: implications for the profession.

To assess the extent to which the results reported by Warner and Bradley (1991) can be generalized beyond the population of undergraduate psychology students, 132 adults in the metropolitan Harrisburg area were asked to evaluate the competency and traits of clinical psychologists, licensed professional counselors, and psychiatrists. Results indicated that the general public believed counselors to be more caring than psychologists and psychiatrists. All three professional groups were perceived to be comparable in their ability to treat the least severe disorders. Licensed counselors were perceived to be most competent to treat disorders rated by the subjects as moderately severe, comparable in competence to clinical psychologists for adjustment disorders, and comparable to psychiatrists for marital problems. Psychiatrists and psychologists were considered the most competent to treat the most severe disorder, major depression. The results indicate that while clinical psychologists often were viewed as competent, they were not viewed as the single practitioner of choice for any diagnostic classification, nor were they noted to have positive character traits.