PC-based application programs in large health care systems.

Public health care agencies lack the infrastructure to meet the increasing operational demands on them, but there is little comparative data on alternative operational structures and systems from which to formulate remedies. Improved information management systems could help address both the workload and the gathering of critically needed data. PC-based database and application programs (PC-APs) that communicate with the mainframe are proposed as a methodology for filling the information-processing gap between mainframe computing and manual information systems. We also propose a model for systematic study of information management systems in clinical settings which can be used to evaluate other aspects of clinical program operations as well. A pilot study demonstrating these methodologies suggests that this is a fruitful approach to assessing ambulatory care operations and that PC-APs can improve administrative and clinical functions and enhance FTE productivity at lower overall cost.

Spirituality, medicine, and healing.

Contemporary medicine has given little attention to the spiritual dimension of human experience despite its relevance to our fundamental goal of healing. This exploratory work takes the position that this dimension can and should be reintegrated into health care models and practice. After delineating the scope of inquiry and providing some definitions, I draw upon paradigms from psychology and physics to provide a basis for such integration, and then extend the biopsychosocial model to include the spiritual dimension, discussing some ways in which this perspective might affect our thinking about disease and health care.

Further evidence of abnormal non-rapid-eye-movement sleep in schizophrenia.

Very low levels of visually scored stage 4 sleep are found in 40% to 50% of acute and chronic schizophrenics. Stage 4 is a visual estimate of high-amplitude delta (0.5 to 3 Hz) electroencephalographic waves; these waves can now be measured directly and reliably by computer. In this pilot study, we carried out such measurement in the successive non-rapid-eye-movement periods (NREMPs). We also sampled and measured visually sleep spindles by NREMP; spindles constitute a second distinctive feature of the NREM electroencephalogram. In five unmedicated, recently rehospitalized schizophrenic patients we found reduced delta amplitude and abundance (and increased spindle density) in NREMP1 (also called "REM latency") as compared with ambulatory normal controls. NREMP1 was also abnormally short with an average length similar to that reported for major depression. These striking abnormalities of NREM sleep may underlie the abnormal rapid eye movement distributions sometimes found in schizophrenic and depressed patients. Further studies are required to evaluate the relation of these NREM abnormalities to psychopathology (and hence their utility as biological "markers") and to rule out confounding effects of hospitalization or undetected napping.

Ultradian rhythms in walking gastric activity.

Ninety to 120 min ultradian rhythms have been described in physiologic and behavioral functions relating to biologic drives. Gastric contractility rhythms were examined in isolated fasting volunteers to supplement behavioral observations of "oral" drives. A clear ultradian rhythms was observed, indicating inherent physiologic oscillation in stomach contractions.