Long term results and functional outcomes following cardiac surgery in octogenarians

Objective. Cardiac surgery for patients >80 years has seen a dramatic increase in the last decade. The aim was to assess the long term survival and quality of life in this patient population.

Method. Patients who underwent cardiac surgery between 1995 and 2007 were identified and case notes reviewed. Follow-up was undertaken by personal interview with the patient or the nearest kin to complete a pre-planned questionnaire.

Results. Sixty six (M:F; 45:21) octogenarians had Coronary artery bypass grafting (CABG) only (55%), Aortic valve replacement (AVR) only (12%), Mitral valve replacement (MVR) only (3%), Valve and CABG (25%) and complex procedures (5%). Fifty-eight percent were elective procedures. Operative mortality was 8% (n = 5). Multivariate analysis identified complex procedures, prolonged bypass time and re-do/emergency surgery as predictors of death (p < 0.05). Median Intensive care unit (ICU) stay was 206 h (range 43–1176 h), with >70% leaving ICU in 72 h. Late mortality involved five patients (8%) who died at 10 yr; 7 yr; 3 yr; 1 yr; and 8 months; and 2 yr and 7 months, respectively. Survival by Kaplan–Meir was 8.8 yr (Standard Error (SE) = 0.66, Confidence interval (CI) 7.6–10.1), median survival was 10 yr and mean Barthel's index 17.7 (min 0, max 20).

Conclusions. Cardiac surgery can be accomplished in octogenarians with good long-term survival and quality of life. However, complex procedures, prolonged bypass and re-do/emergency surgery contribute significantly to mortality.     

Co-Occurring Disorders Among Jail Inmates: Bridging the Treatment Gap

ABSTRACT

This paper presents findings based on a retrospective review of health and mental health records of 359 mentally ill jail inmates. Regardless of demographic group, substance-related disorders are the most prevalent disorder. Sixty-seven percent of the sample had a substance-related disorder, 37% an adjustment disorder, 23% a mood disorder, and 12% had schizophrenia or another psychotic disorder. Comorbidity was extensive with close to 45% of the sample having both a substance-related disorder and an additional major mental illness. Study findings indicate that there is a great need to strengthen services and create jail-community linkages for inmates with comorbid mental health and substance abuse disorders. Innovative program and resource information are provided.     

Ethical Dilemmas of Practicing Social Workers Around Psychiatric Medication

Abstract

It is acknowledged that social workers in mental health and other settings routinely experience client-related ethical dilemmas. Further, there is wide recognition of the potential impact of ethical dilemmas on social work practice with clients who use psychotropic medication. Little is know empirically, however, about the experiences of practitioners with these dilemmas. This article describes the results of a national survey of practicing social workers regarding the nature of ethical dilemmas they face related to their work with clients on medication issues. The results make it clear that social workers regularly confront a variety of ethical dilemmas in this type of practice. Many of these dilemmas are related to ambiguities around the knowledge base of practice, appropriate roles of providers, and basic personal and professional values. The authors present implications of these findings for social work practice and further research.     

黄土高原植被建设中几个方向性问题的探讨

黄土高原植被建设多年来存在着造林成活率低、保存率低、林木生长率低的所谓“三低”现象。其原因很多 ,既有自然问题 ,也有技术问题 ,还存在着管理问题。生态学理论和多年的实践证明 ,仿拟自然植被群落结构是植被建设的基础 ;实施抗旱集流造林技术是植被建设的核心 ;开展人工植苗造林是植被建设的主要手段 ;加强对病、虫、鼠、兔、牛、羊危害的防治是植被建设的关键。这些方面的问题解决了 ,必将再造一个“山川秀美”的黄土高原地区。     

老年人股骨颈骨折术后的康复治疗

目的提高老年人股骨颈骨折术后的生活质量和康复效果。方法使用CPM及各关节主动被动活动,进行康复训练,整个过程注意患者的心理康复。结果本组病例均正常出院,经过两年随访,优良率为90.2%。结论老年股骨颈骨折术后患者经过科学的康复治疗后,可明显提高患者生活质量,达到康复目标。     

The social role of alcohol in Russian culture

The year 1995 marks the tenth anniversary of the beginning of perestroika in Russia. The country has paid with its health for all the social, economic and political reforms. The chronic state of social stress, which is already in its tenth year, has led to a sharp growth in alcoholism and drug addiction, an increasing prevalence of neurosis and psychosomatic diseases and an increase in the death rate and decrease in the birth rate. This is the degeneration of the Russian nation. Alcohol stimulates and alcoholism indicates the process of self-destruction of the population. Unfortunately, there are no accurate statistics on alcohol consumption and problems in Russia today, as there is no state monopoly on alcohol production and sale and no common drug treatment service for the whole country. According to generalized estimates from epidemiological investigations, the average prevalence of alcoholism is 200–250 per 1000 adults, but this differs significantly in different professional groups: 10% of the workers in the nuclear energy industry suffer from alcoholism, 35% of the sailors, 22% of the workers in the machine-tool industry and 42% of the people working in the woodworking industry. There is one woman alcoholic for each 5 men. On average, only 1 of every 7 alcoholics seeks medical and social aid. The main cause of alcoholism is alcoholism itself -its uncontrolled and expanding reproduction. The investigation of alcoholism is being intensively removed from the clinical to the social sphere. It can be explained by understanding the role of social and psychological factors in the origin and development of alcoholism and the harsh socio-economic consequences and moral damage. The appearance of a new class of specialists - social workers - in Russia in 1991 was predetermined by these factors. The main objective of social workers is to fight social diseases and alcoholism in particular as the most terrible social disease of the Russian Federation. The history and place of alcohol in modern Russian culture, the stages and forms of the development of alcoholism and its ethnocultural peculiarities in different social strata of the population are described in this article. The reasons for and consequences of alcoholism are systematized, and the principles and directions of the activity of the social services in dealing with the treatment of alcoholism and rehabilitation of the diseased are defined.     

The Role of a Psychiatric Pharmacist in College Health

Abstract

Published evidence indicates there is a growing prevalence of psychiatric illnesses on college campuses, and that approximately one quarter of students may be taking psychotropic medications. But attracting and retaining experienced mental health care professionals to college health settings is a challenging task. The psychiatric pharmacist is one professional resource that can serve as both a clinical and educational consultant for college mental health services. A pilot psychiatric pharmacist service project is described.     

The Wider Benefits of Adult Learning: An Illustration of the Advantages of Multi‐method Research

This study presents a technique for enhancing causal validity in in‐depth interview research. The technique is based on the logic of control, as applied in various research contexts such as experiments and statistical analyses. According to this logic, to detect the real effect of an independent variable on a dependent variable, all other variables must be held constant. By using interview control questions (ICQs), this study applies this principle in in‐depth interviewing. An ICQ is a probe question that controls an independent variable in the participant’s thinking. Two modes are presented: simple control (neutralizing an independent variable to examine whether it is a necessary condition for an outcome) and parallel control (isolating an independent variable to examine whether it is a sufficient condition for an outcome). In both modes, the method allows for additional independent variables to surface. Applications in in‐depth interviews exploring attitudes toward victimless deviance are presented.     

Successful Vocational Rehabilitation for Individuals with Significant Mental Disabilities

ABSTRACT

Individuals with significant mental disabilities (SMD) frequently have scattered work histories (Finch, 1997; Tan, 1996). Often the SMD consumer is unable to find competitive employment or, if a job is secured, termination repeatedly ensues because of impaired interpersonal skills, faulty behaviors such as the inability to interact with coworkers, inadequate follow-through such as not reporting to work, and poor hygiene (Tan, 1996). The services provided to SMD consumers in this study were designed to address a cadre of support needs that would foster job retention and increase the number of successful employment closures. This cross-sectional exploratory study sampled 211 SMD consumers who received vocational rehabilitation support services through a vocational rehabilitation center in Columbus, Ohio. The SMD consumers sampled experienced both successful and unsuccessful employment closures.     

Prevalence of Traumatic Events and PTSD Symptomatology Among a Selected Sample of Undergraduate Students

Abstract

University faculty and mental health counselors often work with students in distress which may be related to their experiences with traumatic accidents, interpersonal violence, or natural disaster. Traumatic events can have long-lasting effects, which include somatic complaints, substance abuse, “flashbacks,” and a reduction in memory and recall. The purpose of this study is to identify the number, types and severity of traumatic events that occur among a student sample from three academic departments (Sociology and Criminal Justice, Social Work, and Human Development) at a rural southern university. The sample of 234 undergraduate students confirmed previous research regarding the high number of self-reported traumas among college students. The study found that college-aged women are much more likely than men to report trauma and to seek counseling and treatment for its effects. Significant differences were noted in distributional patterns for men and women when reporting exposure to stressful events. The study's findings serve as an important indicator of the need for prevention, early recognition, and treatment for trauma victims. Suggestions are also provided to assist administrators in implementing the appropriate workplace and academic accommodations for PTSD victims under the Americans with Disabilities Act (ADA) and the Rehabilitation Act of 1973 (Section 504).