No abstract

Although 10% to 15% of patients admitted to acute care hospitals are in a state of delirium, few patients are given this diagnosis by their clinician. We field-tested the Diagnostic and Statistical Manual III (DSM-III) criteria for diagnosing delirium on 133 consecutively admitted patients to an acute medical ward. Twenty patients were delirious using DSM-III criteria, 19 more patients than were reported by the primary clinician. Seven delirious patients were less than 65 years of age (range, 32 to 64 years). Sixty-five percent of patients with delirium died, whereas significantly fewer (3.3%) of patients without delirium died (P less than .0001). We found that delirium could be readily and reliably detected (kappa coefficient of agreement = 0.62 for interrater reliability) using the DSM-III criteria. Clinicians should routinely screen hospitalized patients of all ages using DSM-III criteria to identify delirious patients for an immediate evaluation and treatment.

Objective. To examine response to highly active antiretroviral therapy (HAART) among a sample of treatment-experienced patients in the late stage of human immunodeficiency virus (HIV) infection in residential health care facilities (RHCFs) in New York City facilities designated for HIV/AIDS (acquired immunodeficiency syndrome) when access and adherence are maximized. Methods. Medical record review of 111 patients.Results. Demographics were mean age 42 years; 58% male; 60% African-American; 31% Hispanic; 57% injection drug users (IDUs); 23% with history of dementia; 52% hepatitis C virus (HCV) antibody seropositive; 80% on HAART, of whom 18% had lipodystrophy. Of 88 patients on HAART, 52% had a decreased viral load (> 89 log) versus 13% of 23 not on HAART (P < .05); a > 89 log viral load increase was seen in 8% and 35%, respectively (P < .05). Those with viral load increase were more likely than those with stable/decreased viral load to be IDUs (71% vs. 64%) and to have HCV seropositivity (86% vs. 53%), even with similar initial CD4* cell count, viral load, and follow-up time.Conclusion. In a predominantly minority IDU population who are treatment experienced, 50% of the patients successfully responded to treatment with supervised therapy. The RHCFs in New York City provide a unique opportunity to examine further factors associ- ated with response to HAART in an environment in which medication administration and adherence are maximized and monitored carefully.

Men of African descent are at high risk for prostate cancer. The paper's goal is to evaluate the effectiveness of computer assisted instruction (CAI) in increasing prostate cancer knowledge/awareness. Primary aims are to evaluate and compare the effectiveness of the CAI to an earlier version. Secondary aim is to evaluate the role of racial identity. Forty-three males recruited at two churches completed in-depth survey, pre/posttest questionnaire, cross racial identity scale, and J Afr Am St (

Hepatitis C Virus (HCV) has become increasingly prevalent within traditionally undeserved communities. The paper describes the formative evaluation of a HCV Computer Assisted Instruction (CAI) tool. Specific aims are to describe the feasibility of a CAI tool with a high-risk population, and the use of Nigrescence Theory to develop targeted messages. Three participants, recruited at an all-male substance abuse halfway house, reviewed the CAI in a mini-focus group. A Health History/HCV Knowledge Questionnaire, The Cross Racial Identity Scale and a focus group question route were used to collect qualitative and quantitative data. The analysis plan utilized descriptive statistics, content analysis and profile analysis. Results suggested that the CAI was acceptable to this segment of the population, and Nigrescence Theory provided a context for targeting messages to differing segments of the target group. Recommendations are offered to health promotion programs targeting people of African descent.