ABSTRACT
OBJECTIVE: The authors examined the (under) utilization of the psychiatric consultation service for patients aged sixty to seventy-five who were hospitalized for medical reasons, and explored whether one could retrospectively document and identify a greater need for psychological support than the one reflected in the number of actual consultations requested. Three questions were addressed: 1) the psychiatric consultation rate; 2) the frequency of unrecognized medical, psychiatric, and psychosocial complicating factors; and 3) whether the distribution of these factors differed by gender. METHOD: Records of 203 consecutively-admitted elderly patients hospitalized on medical wards were reviewed by two experienced general hospital psychiatrists for any indication of medical, psychiatric, and psychosocial risk factors. The frequency of actual psychiatric consultations was also recorded. RESULTS: Three or more risk factors were noted in the records of 36 percent of all patients. Consultation was sought for only 3 percent. Gender differences in type and distribution of risk factors were identified. CONCLUSIONS: Indicators and profiles that define probable need for psychiatric consultation were identified and briefly discussed. More well-designed, prospective studies testing these indicators and profiles are needed.
Subject(s)
Aged , Anxiety Disorders/psychology , Depressive Disorder/psychology , Health Services Needs and Demand , Referral and Consultation , Anxiety Disorders/classification , Anxiety Disorders/diagnosis , Depressive Disorder/classification , Depressive Disorder/diagnosis , Female , Geriatric Psychiatry , Geriatrics , Health Services for the Aged , Humans , Male , Psychiatric Status Rating Scales , Retrospective Studies , Risk FactorsABSTRACT
Recurrent pericarditis can be associated with many chronic illnesses. Dermatitis herpetiformis is a chronic papulovesicular eruption which is characterized by granular IgA deposits in the dermal papillary tips and associated with a gluten-sensitive enteropathy. We describe the first case of recurrent pericarditis in association with dermatitis herpetiformis. This supposition is supported by exclusion of other possible etiologies and pericardial biopsy which revealed the deposition of IgG, IgA and complement.
Subject(s)
Dermatitis Herpetiformis/immunology , Pericarditis/immunology , Pericardium/immunology , Complement System Proteins/analysis , Dermatitis Herpetiformis/complications , Female , HLA Antigens/analysis , Humans , Immunoglobulin A/analysis , Immunoglobulin G/analysis , Malabsorption Syndromes/complications , Middle Aged , Pericarditis/complications , Recurrence , Skin/immunologyABSTRACT
In July, 1975, the Departments of Internal Medicine at the Yale University School of Medicine and eight community hospitals in southern and western Connecticut formed the Yale Affiliated Hospital Program (YAHP) in Internal Medicine. The YAHP provides a planned and focused program of continuing education for medical staff and housestaff at the affiliated hospitals. Six formats for the over 1,000 rounds, lectures, and conferences given annually are used. The members of the YAHP also cooperate in housestaff and faculty recruiting, evaluation of quality of care and evaluation of the process of continuing medical education itself. This report summarizes the organization, goals and future plans of the YAHP.
Subject(s)
Education, Medical, Continuing , Internal Medicine/education , Connecticut , Hospitals, Community , Humans , Organization and Administration , Schools, MedicalABSTRACT
Three patients with Wilson's disease and initial manifestations of intravascular hemolysis also had transient elevations of hemoglobin A2. It is important to recognize such manifestations in establishing an early diagnosis.
