Awareness of illness in schizophrenia

This article reviews the literature on "poor insight" or unawareness of illness in schizophrenia. A large body of knowledge representing several different perspectives on insight has developed. This work can be divided into three broad categories, suggesting an important role for insight in the phenomenology, pathophysiology, and treatment of schizophrenia. The argument is made here that many of the self-awareness deficits observed in schizophrenia are of diagnostic significance, are neurally based, and are indispensable in guiding treatment decisions. In addition, this article proposes guidelines for assessing unawareness of illness in schizophrenia and discusses the relevance of such deficits to the diagnosis of schizophrenia.     

Community absorption of the mentally ill: The new challenge

In 1975, twelve years after enactment of the Community Mental Health Centers Act, we find one of the greatest obstacles to fulfillment of our hopes to be pervasive hostility to acceptance of the mentally ill in many communities. The River Region Program has hurdled this obstacle by breaking the artificially large mental health catchment areas into manageable segments of 16 smaller service areas close to the people it serves in seven counties of Kentucky. In each of these service areas it has involved a broad spectrum of citizens in the planning of every service. All of this is of particular relevance today in light of the Supreme Court's D,onaldson decision, that mentally ill persons cannot be confined involuntarily if they are not dangerous and can live safely in the outside world. The outside world must be prepared to receive these people, and we in the mental health field must do our job in this vital preparation.Mr. Gorman originally presented this paper as a speech at the Annual Dinner, of the River Region Mental Health — Mental Retardation Board in Louisville, Kentucky, on June 20, 1975.     

Intravenous tissue plasminogen activator for acute ischemic stroke in patients aged 80 years and older : the tPA stroke survey experience

BACKGROUND AND PURPOSE: Intravenous tissue plasminogen activator (tPA) administered within 3 hours of symptom onset is the first available effective therapy for acute ischemic stroke (AIS). Few data exist, however, on its use in very elderly patients. We examined the characteristics, complications, and short-term outcome of AIS patients aged >/=80 years treated with tPA. METHODS: Patients aged >/=80 years (n=30) were compared with counterparts aged <80 years (n=159) included in the tPA Stroke Survey, a US retrospective survey of 189 consecutive AIS patients treated with intravenous tPA at 13 hospitals. RESULTS: Risk of intracerebral hemorrhage (fatal, symptomatic, and total) was 3%, 3%, and 7% in the elderly age group and 2%, 6%, and 9%, respectively, in their younger counterparts (P=NS for all comparisons). Likelihood of favorable outcome, defined as modified Rankin score 0 to 1, National Institutes of Health Stroke Scale score /=80 years was identified.     

The future of medical education is no longer blood and guts, it is bits and bytes

In the United States, medical care consumes approximately $1.2 trillion annually (14% of the gross domestic product) and involves 250,000 physicians, almost 1 million nurses, and countless other providers. While the Information Age has changed virtually every other facet of our life, the education of these healthcare professionals, both present and future, is largely mired in the 100-year-old apprenticeship model best exemplified by the phase "see one, do one, teach one." Continuing medical education is even less advanced. While the half-life of medical information is less than 5 years, the average physician practices 30 years and the average nurse 40 years. Moreover, as medical care has become increasingly complex, medical error has become a substantial problem. The current convulsive climate in academic health centers provides an opportunity to rethink the way medical education is delivered across a continuum of professional lifetimes. If this is well executed, it will truly make medical education better, safer, and cheaper, and provide real benefits to patient care, with instantaneous access to learning modules. At the Center for Advanced Technology in Surgery at Stanford we envision this future: within the next 10 years we will select, train, credential, remediate, and recredential physicians and surgeons using simulation, virtual reality, and Web-based electronic learning. Future physicians will be able to rehearse an operation on a projectable palpable hologram derived from patient-specific data, and deliver the data set of that operation with robotic assistance the next day.     

A Review of Studies Comparing Checklist and Interview Methods of Data Collection in Life Event Research

Abstract

This article is concerned with the relative merits of checklists and interviews as techniques for collecting data in the study of life events. It presents a detailed review of studies that have directly compared checklists and interviews. The author's conclusion is that the two techniques should not be seen as equivalent in the assessment of life events. Virtually all of the studies reviewed showed a marked tendency to overreport on checklists. The method appears inadequate in distinguishing truly stressful events from trivial occurrences. In contrast, the in-depth interview is sensitive to the subtleties of life events and should be the preferred method when data of any precision and accuracy are required in an empirical study.     

Simulated Transfer of Liquids and Powders from Hands and Clothing to the Mouth

A series of laboratory experiments was carried out to assess transfer of liquids (vinegar) and powders (calcium acetate and magnesium carbonate) from hands, arms, gloves, respirators, clothing, and pens to the oral cavity or the perioral area (the area surrounding the mouth). Experiments were carried out with four volunteers. The donor area (the hands, arms, gloves, and so on) was loaded with a known mass of the test substance and was then brought into contact the receiver area (the oral cavity or the perioral area). The percentage of the substance on the donor that transferred to the receiver (the transfer efficiency or TE) was assessed using saliva samples and gauze wipes of the perioral area. Magnesium carbonate was measured on gauze and in saliva using inductively coupled plasma/atomic emission spectrometry. Calcium acetate and vinegar were measured using ion chromatography/electrochemical detection. Average transfer efficiencies were calculated for each substance and transfer scenario; these were compared using ANOVA and Kruskal-Wallis tests. Overall, direct transfer from the hands to the oral cavity was significantly higher (mean TE = 51.6) than indirect transfer from the hands to the oral cavity via the perioral area by licking the lips (mean TE = 11.5). The results suggested higher TEs for liquids than for solids and that hand-to-mouth TEs may increase with water solubility. Transfer from bare arms to the perioral area was higher than from arms covered by cotton sleeves for both liquids and powders. Although TE data are often required by models estimating exposure by inadvertent ingestion, relatively few published data are available. This study has provided evidence of some factors that may influence transfer of chemicals from hands or objects to the mouth (physical form, use of clothing, and so on) and has provided data that are essential for the development of predictive exposure models of inadvertent ingestion exposure.