[Use of lyophilized cellulose in peripheral nerve lesions with loss of substance]. / Uso da celulose liofilizada em lesões de nervos periféricos com perda de substância.

Lyophilized cellulose was analysed to verify the degree of inflammatory reaction and axon realignment in the sciatic nerve after loss of neural substance. Ten mongrel dogs were divided into: Group 1 - 1 cm section of sciatic nerve which was replaced at lesion site; Group 2 nerve section without fragment replacement. The section site was involved with lyophilized cellulose. Group 3 -1 cm fragment section sutured epineurally. Motor response started at eighth week. Moderate fibrotic reaction to cellulose was seen in Group 1 and 2 animals. Groups 1 and 3 showed coaptation between the nerve and nerve graft with ongoing axons. In Group 2, 1 dog showed regrowth of axons through the empty space. It was concluded that lyophilized cellulose caused moderate fibrous reaction when implanted in peripheral nerve lesions with loss of substance; it can act as envelop protection in those lesions mainly if a neural graft is inserted.

Teaching behavior change skills to first-year medical students: a small group experiential approach.

PURPOSE: Develop and evaluate a course to help first-year medical students learn about health-related behavior change by focusing on their personal health goals. COURSE METHODS: Students each identified two health-related behavior change goals for themselves. Lectures presented relevant content concerning behavior change. In small group, experiential sessions, students formed five-person teams and rotated positions as "patient," "doctor," "manager" and observers. "Doctors" and "patients" had one or two follow-up visits. Students evaluated their goal attainment and the value of their experience as "patient" and as "doctor." SAMPLE: 100 first-year medical students. RESULTS: Students chose exercise, nutrition, academic, interpersonal and psychological goals. Rating of the educational values and goal attainments were variable. Mean rating for educational value was 40%, and for goal attainment 55%. CONCLUSIONS: Experiential learning is valuable in introducing medical students to behavior change. Students learn from both the role of change agent and the role of "patient." Although the design of the course was cost-effective, with appropriate modifications considerably more impact could be gained from such a course. To improve this type of experiential learning we recommend careful attention to goal-setting, and more attention to developing the learners' feedback-giving and facilitation skills.

Psychopathology and emotional distress among older high-utilizing health maintenance organization patients.

BACKGROUND: Rates of psychopathology are often underestimated in primary care populations, especially older patient groups. High medical utilization is often a reflection of psychopathology and/or emotional distress. Increased awareness of primary care patients' emotional distress can help to improve well-being and reduce unnecessary high utilization of medical services. This study aimed to assess the degree of psychopathology present in a sample of older health maintenance organization (HMO) patients who utilized higher-than-average amounts of medical services. METHODS: Patients in a large HMO aged 55 years old and older who exceeded the mean number of inpatient and outpatient visits in the past year were recruited. Sixty-nine patients, mostly female (69%) and white (93%), volunteered. Patients were assessed with the Medical Outcomes Study SF-36 health survey and the Symptom Checklist-90-Revised (SCL-90-R). RESULTS: Respondents made a mean of 41 visits in the previous year to medical providers, versus 24 visits per year for the average patient of this age in the HMO. Significant elevations on SCL-90-R global psychopathology, obsessive-compulsive, somatization, and depression scales were found. All patients met SCL-90-R criteria for psychiatric caseness. SF-36 health ratings were comparable with those of patients with chronic medical conditions assessed in other SF-36 samples. CONCLUSIONS: Older high-utilizing HMO patients show significantly more psychopathology and view their health status as poorer than that of other medical subpopulations; results suggest that care for these problems is rarely received.

[Probable Rasmussen's syndrome. Case report]. / Provável síndrome de Rasmussen. Relato de caso.

The syndrome of chronic encephalitis with epilepsy (Rasmussen's syndrome) typically occurs in children and is characterized by the development of intractable focal seizures, progressive hemiparesis and intellectual deterioration. The etiology is unknown, and the pathological abnormalities vary. We report the case of a 17-year-old boy, presenting with clinical features typical of probable Rasmussen's syndrome. We discuss the etiology and treatment for this pathology.

[Hemostatic and structural effects of the lyophilized cellulose sponge]. / Efeitos hemostático e estrutural da esponja de celulose liofilizada.

Hemostatic effects of oxidized cellulose (Surgicel) are well known. Based on a possible similar effect of a sponge obtained after lyophilization of biosynthetic cellulose, two different experimental studies were planned. Phase I-Pieces of cellulose sponge were inserted into small provoked cortical wounds of twelve dogs. The time elapsed to obtain bloodstill after cortical damage and application of cellulose was observed in every dog, searching to detect any possible hemostatic effect of the material. The animals were sacrificed after 7, 30 and 90 days. An average time of 1 minute was elapsed until bleeding control was achieved. No clinical adverse effect was noticed. Microscopy showed histiocytic and mild foreign body reaction at 7 days, which diminished at 30 days. Almost no reaction surrounded the implant at 90 days. Lyophilized cellulose has a peculiar eosinophilic appearance, composed by thin irregular filaments which diminished their thickness with the time. At 90 days only sparse irregular cellulose filaments could be detected. Phase II-Small equal sponge fragments were inserted in the liver of twelve rats and observed 7, 30 and 90 days. At autopsy, small peritoneal adhesions were noticed at 30 and 90 days. Microscopy showed intense histioplasmocytic and foreign body reaction in all animals mainly at 7 days. In two animals, refringent intracellular cellulose particles were evident inside giant foreign body cells after 90 days. This fact evidences that cellulose can be reabsorbed by phagocytic phenomena when implanted in mammalians. A comparative group with other hemostatic material and the same method must be done to clarify the issue of hemostatic effects of this membrane.

Orienting a new graduate nurse to home healthcare.

As the amount of hospital positions dwindles for the graduating nurse, more are looking for initial employment in home health care. A rural home healthcare agency in Virginia developed a preceptor program that effectively helps new graduates to make the transition to the home care nursing role by use of a 13-week orientation program using preceptors and clinical time in the hospital.

Effect of methylphenidate on brain injury-related anger.

Anger and temper outbursts can be serious clinical problems after brain injury. This study used a randomized, pretest, posttest, placebo control group, single-blind design to evaluate the therapeutic usefulness of methylphenidate to control brain-injury-related anger. The 38 subjects in the study were young adult males who had sustained serious brain injuries and who were beyond the period of rapid, spontaneous recovery. The subjects were divided into two groups, one that received 30 mg of methylphenidate per day and the placebo control group. A comparison of the drug group with the placebo group before and at the end of the six-week treatment period on all the anger outcome measures analyzed simultaneously with multivariate analysis indicated a significant drug-by-time interaction effect, F(4.33) = 5.29, p = .002, demonstrating the therapeutic effect of methylphenidate on anger. The study found that drug responders could be predicted by pretreatment level of anger with a .09 probability of misclassification. Methylphenidate also significantly reduced impairment on all of the general psychopathology outcome measures (F[3.31] = 5.42, p < .01). The drug improved memory for those subjects in the treatment response group but did not result in changes on measures of attention, nor did it have an effect on a checklist of subjective side effects, suggesting that it has minimal or absent cognitive toxicity and is likely to be tolerated well by individuals with brain injuries.

Creative financing.

By taxing or seeking donations from health care providers, states have increased federal matching to pay medicaid costs. The Bush Administration views the practice as a scam.

Psychological safety of a multiple channel cochlear implant device. Psychological aspects of a clinical trial.

Fifty-three deaf patients were screened psychologically and medically for suitability to receive an intracochlear implant. After initial screening for psychological normalcy, candidates were assessed again 1 year postimplant. Isolated deleterious psychological effects were found, and certain aspects of psychological functioning were enhanced. Overall evidence suggests that the implant is not psychologically damaging.

Prognosticating speech performance in multichannel cochlear implant patients.

Twenty patients received multichannel cochlear implants between April 1984 and May 1986 at the University of Utah Medical Center. All patients have been followed for at least 1 year postimplant. Preimplant screening included audiometric testing, electronystagmogram (ENG), promontory stimulation, computed tomography (CT) scanning, and psychological evaluation. Based on postimplant audio-only CID sentence discrimination scores, these patients were divided into three groups: good (CID greater than 79%), intermediate (CID, 21% to 79%), and poor (CID less than 21%). Preimplant factors that correlated with CID scores were hearing loss duration, previous use of hearing aids, lip-reading ability, tinnitus, positive ENG calorics, preimplant pure-tone average, promontory stimulation threshold, and understanding of the project. Only previous hearing aid usage approached statistical significance (p = 0.05). A larger patient sample is needed to verify these results.

Fiscal catastrophe.

The revolt against the catastrophic care law may be less important for what it says about a troubled program than for what it may mean for financing of unmet needs.