This pilot study prepares the way for a controlled evaluation of counselling of disabled stroke survivors and their carers. It assesses feasibility of methods and outcome measures potentially useful in the main study. The study elicited information about the psychological, physical, social and service needs, and the feelings of stroke survivors and their informal carers. Twenty patients and their carers were interviewed separately in their own homes. Results describe research tools which were refined, and demonstrate several unmet needs in the psychosocial domain. The main findings were a requirement for more information about stroke and for counselling in relation to 'care' problems arising out of the disability of stroke disease and the changes in dependency produced.
Current methods of contracting for patient treatment in the health service are not suitable for elderly patients with multiple pathology and functional impairment. This study examines Resource Utilization Groups (RUGs) for use in geriatric medicine in England and Wales, based on 1675 patients from 26 hospitals in eight health districts in England and Wales. Nurses completed a questionnaire on the clinical characteristics of patients required to allocate them to one of 44 RUG groups. Nurse/patient contact times were recorded over a 24-hour period. Therapist/patient contact times were recorded for a week. Data were analysed using analysis of variance with time as independent and RUG group as dependent variable. Variance explanation in excess of 45% was achieved in acute and rehabilitation wards. In long-stay wards, variance explanation (23%) was no better than ADL score alone. RUG-III could form the basis of a casemix system for geriatrics in England and Wales in acute and rehabilitation settings.
Nutritional status and in vivo immune responses were investigated in 30 patients with alcoholic liver disease who were drinking heavily up until emergency hospital admission. Investigations were performed on admission and after 2 wk abstention and adequate hospital diet. No relationship was found between the severity of liver disease revealed histologically and the recent quantity or total duration of alcohol intake, inadequacy of diet, or nutritional status. Skin anergy was more common in those patients with cirrhosis but did not relate to depletion in circulating T lymphocytes, poor nutritional status, or to the direct effect of alcohol toxicity. Acute alcohol toxicity did, however, produce extensive and rapidly reversible metabolic and cellular changes including reduction in serum potassium, magnesium and phosphate and depletion of all circulating lymphocyte subpopulations.
SUMMARY Fifty two patients with Crohn's disease (31 outpatients and 21 inpatients) were investigated for evidence of vitamin A deficiency. Eleven (21%) had low plasma retinol concentrations (<1.2 umol/l (34.3 ,ug%)). Five of these were outpatients and plasma retinol was only slightly reduced (>1.0 ,umoWl (28.6%)). All outpatients weighed 80% or-more of ideal, and were considered at low risk of developing vitamin A deficiency. In contrast, of the six inpatients with low plasma retinol concentration, five had a level of <1*0 ,umoUl (28.6 ,ug%) and weighed <80% ideal. Three of these had impaired dark adaptation and a plasma retinol concentration of <0.8 ,umol/1 (<22.9 ,ug%). As a group, the inpatients were more protein depleted than the outpatients, with respect to serum albumin (p<0-01), transferrin (p<0-001), and prealbumin (p<0.001) but retinol binding protein levels were not significantly lower. It is suggested that patients with extensive small bowel Crohn's disease, who weigh <80% of ideal weight, merit measurement of plasma retinol concentration. Those with plasma retinol <0.8 ,umol/l (<22.9
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