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OBJECTIVE: to develop and validate an instrument which measures applied knowledge and practice regarding identification and management of potentially abusive situations in staff who work with older vulnerable inpatients. One of the anticipated uses will be to measure any change produced by attending an educational intervention designed to improve management of abuse. A vignette-based instrument was chosen to measure applied knowledge and practice over other methods of assessments which were felt not to be practical or provide too much cueing for the volunteering staff. METHOD: a parallel form vignette-based instrument was developed so that not only baseline knowledge but also change in knowledge could be measured. Abusive scenarios were adapted from researchers' clinical practice and from the literature. Advice from senior nurses about the suitability of the vignettes for ward and community based staff was obtained and the instrument was piloted. Staff working with older people and employed by health or social services working in inner London completed the questionnaire. RESULTS: 79 (92%) of the eligible staff took part in this study. All completed the instrument. Version A of the Knowledge and Management instrument was answered by 39 staff, whilst 40 answered version B. The proportion of qualified and unqualified staff as well as the proportion employed by health or social services was similar for each parallel version of the instrument. The measure of internal consistency Cronbach's alpha was 0.89 for version A and 0.79 for version B. Parallel form reliability coefficient was calculated as 0.82, indicating that the two versions of the Knowledge and Management instrument perform similarly. Measures for concurrent validity according to years of experience and professional education also proved significant. Inter-rater reliability was calculated at 0.98 (P=0.01). Test-retest reliability at 0.69 (P=0.01) indicated that the instrument is stable yet sensitive to change. CONCLUSION: this instrument is a valid assessment tool that can be used to identify gaps in applied knowledge and management in potentially abusive situations in older people and allow knowledge in this field to be built on. [ABSTRACT FROM AUTHOR]

This study assessed the feasibility and efficacy of an intervention focusing on primary care professionals' attitudes to, problem-solving in and practice relating to depression in old age before and after a nurse-implemented educational intervention. One hundred and twenty-one practices were approached, in which 297 doctors worked. Most practices did not want to be involved in this study. Evidence from previous studies and this one suggests that GPs are more amenable to interventions which are implemented by doctors rather than other health personnel. In addition, the lack of interest in this intervention may be a reflection of the therapeutic nihilism of primary care physicians regarding depression in older people. Sixteen surgeries expressed an interest in the study, of whom 14 participated in the study comprising 40 GPs. Thirty-one GPs and 24 nurses completed the baseline questionnaires. Only six GPs and no nurses returned completed questionnaires post-intervention. The only statistically significant before versus after change in the attitude questionnaire was found in 'I need more training to be able to deal effectively with depression in the elderly'. Mean scores were 0.73 and 0.47 respectively (p<0.05; 95%CI 3.2-47.1). Significant improvements post-intervention were, however, found in the answers to three questions (all p<0.05) addressing whether patients with depression complicated by or presenting with physical illness were referred appropriately and/or followed up. The results of our study do not indicate that the evaluation of nurse-led educational interventions in primary care is feasible in the field of depression in old age. The belief that all that is needed is the provision of accessible education of professionals by experts in the field to change attitudes and practice has not been reinforced. The high refusal rate suggests that such interventions are unlikely in any case to be generally acceptable. [ABSTRACT FROM AUTHOR]

Abstract. Eighty individuals (55 adults and 25 children) who were residents of four cities (Kiev, Mozyr, Gomel and Bobrujsk) located 100-200 km from Chernobyl at the time of the accident in 1986 were tested after immigrating to the US from 1989-1991. A whole-body counter was employed to quantitate radiocesium content. In addition, two biological measures of radiation effects, namely, chromosomal integrity using the micronucleus assay and somatic mutation analysis of erythrocytes at the glycophorin A (GPA) locus, were applied to this group. Radiocesium activity in the body ranged from 0 to 56.8 Bq/kg with a mean and standard deviation of 5.0 8.2 and a median value of 2.0 Bq/kg. Mean radiocesium content by groups was highest in adult males (9.0 11.7; range 0.21-56.8 Bq/kg) followed by adult females (3.3 4.5; range 0-21.3 Bq/kg), male children (3.0 5.7; range 0-20.2 Bq/kg) and lowest in female children (1.6 3.5; range 0-12.7 Bq/kg). Individuals with the highest radiocesium content in each group belonged to one family that lived in Mozyr (100 km from Chernobyl) until emigrating in 1989. The frequency of lymphocyte micronuclei and erythrocyte GPA alleleloss (O/N) somatic mutations were both significantly correlated with radiocesium content ( r 0.57, p 0.002; r 0.75, p 0.002, respectively). The micronucleus frequency also correlated with the estimated internal absorbed dose from radiocesium in a subset of 20 immigrants for whom this calculation was possible ( r 0.71, p 0.0005). Altogether, the biomonitoring data indicate that some subjects had radiation doses sufficient to produce gene and chromosomal mutations in blood cells, although these effects cannot be attributed solely to radiocesium exposure. [ABSTRACT FROM AUTHOR]

Subjects over 65 with DSM-III-R dementia and Living in the community (with carers) who were General Health Questionnaire (GHQ) cases were recruited. Subjects were assessed using the Mini Mental State Examination and the Geriatric Mental State (GMS). Carers were interviewed using the GMS or the CIS (Clinical Interview Scale). Information was collected on behavioural disturbance in their relatives using the Present Behavioural Examination: the most distressing behaviours were noted. A multidisciplinary team generated an individualized plan aiming to reduce the most distressing behaviours. Couples were then randomized into groups 1 and 2. For group 1, plans were implemented over 16 weeks and they were then reassessed using the same rating scales as before (phase 1). They were followed up a further 16 weeks later to see if the benefits of intervention were sustained (phase 2). Group 2 were assessed after a period as waiting list controls (phase 1). Their plans were then implemented and they were reassessed (phase 2). There was an improvement in carer mental health and in the behavioural difficulties of the person with dementia for group 1: the two measures of outcome were associated. For group 2, there was no improvement in either outcome measure. The findings are discussed in relation to their relevance for clinical practice. [ABSTRACT FROM AUTHOR]

Background: There has been no published study that considers actual costs in a representative sample of people aged > or = 65 years. The present study describes the financial costs of formal community services for elderly people with dementia, depression, anxiety disorder or physical disability.Method: Psychiatric morbidity, physical disability and services received were assessed by standardised questionnaire in randomly selected Islington enumeration districts. Subjects were interviewed at home (n = 700).Results: Dementia was the most expensive disorder per sufferer in terms of formal services. Those with depression were also high users of health services. Despite presenting to health services, 90% were not treated with appropriate drugs. In contrast, social services were received by people who were activity-limited or with dementia. The highest service cost for the population as a whole was for the physically disabled. In multivariate analysis the significant predictors of high service costs were living alone, being physically ill, depression, dementia and increasing age.Conclusions: Failure to detect and treat depression and the anxiety disorders in older people, despite their presentation to medical services, may have major economic consequences as well as contributing to individual suffering. [ABSTRACT FROM AUTHOR]

The development and use of a new psychiatric symptom change scale based on the Present State Examination (PSE)--the PSE Change Rating Scale--is described. The advantages of the PSE are retained (the extensive glossary, the diagnostic facility and the standardised interview technique) while improving its sensitivity to change and decreasing its administration time. The scale has been designed to prevent feedback of results and 'halo' effects: it has proved highly reliable in use across raters with different backgrounds and experience. The scale has been used to monitor drug effects on clinical state across a variety of diagnoses and examples of its use are given. [ABSTRACT FROM AUTHOR]

Acute irradiation of Douglas-fir ( Pseudotsuga menziesii [Mirb.] Franco) pollen by X-rays enhances pollen tube elongation. To determine whether this effect was due to physical damage of the pollen membranes or to metabolic processes, irradiated and control pollen were grown under conditions of anoxia. Thus, it was determined that physical damage only could be of minor importance. As parameters for metabolic processes RNA- and protein synthesis were studied. The only difference between irradiated and control pollen with respect to RNA synthesis was the time at which it started. Protein synthesis in vitro revealed that polyribosomes from irradiated pollen were more active than those from control pollen at lower concentrations. These results were confirmed by in ovo experiments with both polysomal preparations. The results indicate that X-ray irradiation is interfering with the main regulatory mechanism of pollen tube growth, which is de- and re-masking of, mainly, presynthesized mRNA. [ABSTRACT FROM AUTHOR]

Twenty-six infants and children underwent anterior cricoid split (ACS) in an attempt to avoid tracheotomy. Twenty (77%) were extubated successfully without tracheotomy;six (23%) failed and required tracheotomy. Our experience corroborates that reported in the literature. To date, 106 (77%) of 138 patients who have undergone ACS have been extubated successfully without tracheotomy. These results substantiate the validity of the operation when done for the proper indications. Substantive glottic and tracheal pathology indicate a high likelihood of failure of ACS. [ABSTRACT FROM AUTHOR]

Presents several letters related to medicine. Problems of identifying and treating depression among the elderly; Investigation of the transient ischemic attack; Health effects of organophosphate sheep digs.

Focuses on a study which evaluated psychological stress of patients undergoing hemodialysis for chronic renal failure. Rehabilitation of patients with chronic illness; Discussion of the psychological stress related to dialysis treatment; Effect of long-term care on family relations.

Focuses on a study which investigated the psychological factors that relate to adjustment of patients in chronic hemodialysis. Characteristics related to patient adjustment; Evaluation of pretreatment prediction of adjustment; Characteristics related to potential adjustment.

Background: Hospitalisation is often harmful for people with dementia and results in high societal costs, so avoidance of unnecessary admissions is a global priority. However, no intervention has yet reduced admissions of community-dwelling people with dementia. We therefore aimed to examine hospitalisation rates of people with dementia and whether these differ from people without dementia, and to identify socio-demographic and clinical predictors of hospitalisation. Methods: We searched MEDLINE, Embase and PsycINFO from inception to May 9, 2019. We included observational studies which (1) examined community-dwelling people with dementia of any age or dementia subtype, (2) diagnosed dementia using validated diagnostic criteria, and (3) examined all-cause general (i.e. non-psychiatric) hospital admissions. Two authors screened abstracts for inclusion and independently extracted data and assessed included studies for risk of bias. Three authors graded evidence strength using Cochrane’s GRADE approach, including assessing for evidence of publication bias using Begg’s test. We used random effects meta-analysis to pool estimates for hospitalisation risk in people with and without dementia. Results: We included 34 studies of 277,432 people with dementia; 17 from US, 15 from Europe and 2 from Asia. Pooled relative risk of hospitalisation for people with dementia compared to those without was 1.42 (95% confidence interval 1.21, 1.66) in studies adjusted for age, sex, and physical comorbidity. Hospitalisation rates in people with dementia was between 0.37 and 1.26/person-year in high-quality studies. There was strong evidence that admission is associated with older age, and moderately strong evidence that multimorbidity, polypharmacy, and lower functional ability are associated with admission. There was strong evidence that dementia severity alone is not associated. Conclusions: People with dementia are more frequently admitted to hospital than those without dementia, independent of physical comorbidities. Future interventions to reduce unnecessary hospitalisations should target potentially-modifiable factors, such as polypharmacy and functional ability, in high-risk populations. [ABSTRACT FROM AUTHOR]