Reconstitution of the T cell receptor alpha beta repertoire in recipients of allogeneic BMT.

This report describes the qualitative analysis of T cell receptor (TCR) repertoire regeneration in recipients of BMT. RNA samples from patient and control peripheral blood lymphocytes were prepared and tested for the presence of multiple V alpha and V beta transcripts by the polymerase chain reaction. TCR V gene expression was highly diverse within the first 6 months post-transplantation in recipients receiving either T cell-depleted or T cell-replete marrow, and in HLA mismatched as well as matched donor-recipient pairs. The sequencing of TCR message from BMT recipients also demonstrated J gene diversity and apparently normal junctional diversity at the V-J alpha join. Thus, T cell pools in BMT recipients are largely heterogeneous, not mono- or oligoclonal.

The promise of partial hospitalization: a reassessment.

In this review of trends in partial hospitalization since 1987, the authors provide a brief overview of the field, summarize recent research findings, examine the data on the growth of partial hospitals, and outline recent changes in public- and private-sector use of this treatment modality. Support for intermediate and long-term partial hospitalization is diminishing rapidly, while support for short-term partial hospitalization as an alternative to inpatient care is increasing in the private sector and diminishing in the public sector. The future for partial hospitals seems uncertain, as the treatment functions of these programs are being assumed by psychosocial and vocational rehabilitation programs and assertive community treatment teams. In light of these trends, the authors recommend new directions for partial hospital research involving comparisons between short-term day hospitalization and intensive outpatient interventions.

Overnight hospitalization of acutely ill day hospital patients.

As the trend toward community-based treatment of the seriously mentally ill has continued, partial hospital programs have admitted an increasing number of highly symptomatic individuals. As a result, patient crises occur more often in these programs, and staff have had to develop novel crisis intervention strategies that do not rely on standard hospital care. One such strategy involves the use of "overnight hospitalization" or a "backup bed" to provide temporary safety and clinical management with the goal of returning the patient to the partial hospital within 24 hr. Given the lack of data on this intervention the present study was designed to provide further information about the implementation and effectiveness of this clinical strategy. The authors outline the rationale and procedures for a backup bed system and provide data on outcome that is drawn from an examination of backup bed utilization in a public-sector mental-health setting over a 1-year period. Clinical implications of the findings for future use of overnight hospitalization with partial hospital patients are reviewed.