RESUMO
BACKGROUND: Alcohol use disorders (AUD) are of high prevalence in the community. The aim of the present study is to examine the diagnostic and therapeutic strategies of psychiatrists and psychotherapists in patients with AUDs. METHODS: A standardized questionnaire was sent to all psychiatrists and psychologists in the South Badenia region (n = 745). It consisted of general questions and those regarding diagnostic and therapeutic procedures in the last patient seen with an AUD. A total of 224 questionnaires sent back by 160 psychotherapists [PT] and 64 psychiatrists [P] could be included in the analysis. RESULTS: The mean stated prevalence of AUDs was 5 %. The mean age of the reported patient was 44 +/- 10 years, 60 % were men. The initial reason for consultation in psychotherapy was in 61.9 % depression in comparison to 40.7 % psychiatry (p < or = 0,01). The majority of patients seen by psychiatrists (44.1 %) were referred by their general practitioners. Standardised screening instruments were rarely used. The concordance of the diagnostic judgement and formal ICD 10-criteria was 74.5 % [P] vs. 45.5 % [PT] (p = 0,001). 60 % [P] and 24.1 % [PT] were referred to addiction counselling services (p < or = 0,001). Patient related factors were largely seen as major impediments for adequate diagnosis and treatment. DISCUSSION: The study demonstrates significant differences in the patient population and the diagnostic and therapeutic strategies in the two groups of therapists. Many aspects of the data point towards the need to improve networking and to integrate services to be able to provide better care for patients with AUDs.
Assuntos
Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/terapia , Adulto , Idoso , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Interpretação Estatística de Dados , Feminino , Alemanha/epidemiologia , Pesquisas sobre Atenção à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Psiquiatria , Psicoterapia , Inquéritos e QuestionáriosRESUMO
A prison inmate was referred to us for diagnostic procedures and therapy due to a combination of pneumomediastinum with emphysema of neck and face. External injuries were absent and pathogenesis remained uncertain until thorough examination of the patient revealed two intraoral wounds, presumably from a needle, reaching into the maxillary sinus. This large subcutaneous emphysema of the face, neck and mediastinum was the result of an exaggerated Valsalva maneuver. With this self-inflicted injury, unknown to us, the prisoner achieved the desired immediate admission to hospital.
Assuntos
Enfisema/etiologia , Enfisema Mediastínico/etiologia , Automutilação , Enfisema Subcutâneo/etiologia , Ferimentos Penetrantes/complicações , Adulto , Face , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Boca/lesões , Pescoço , Prisioneiros/psicologia , Enfisema Subcutâneo/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ferimentos Penetrantes/psicologiaRESUMO
This paper describes the use of a scale to assess the therapist's perception of the client and the client's perception of the therapist within behaviour therapy. A factor analysis revealed specific therapist and client factors which describe aspects of each participant's activity within sessions. The results suggest that the therapist's interpersonal manner is important in treatment and that attention should be given to this in training behaviour therapists.
Assuntos
Atitude do Pessoal de Saúde , Terapia Comportamental , Comparação Transcultural , Transtornos Neuróticos/terapia , Relações Profissional-Paciente , Transtornos Psicofisiológicos/terapia , Adulto , Feminino , Humanos , Masculino , Transtornos Neuróticos/psicologia , Testes Psicológicos , Psicometria , Transtornos Psicofisiológicos/psicologiaRESUMO
The problem of the difficulty experienced by non-radiologists in reading a convention knee arthrogram is discussed. A new method is proposed, consisting of air as contrast medium in combination with direct radiological magnification. Operative control of the first 100 patients showed correct arthrographic diagnosis in 91%. The advantage of the new method is a better presentation of meniscus pathology to the operating surgeon and the possibility of video documentation.
Assuntos
Artrografia/métodos , Articulação do Joelho/diagnóstico por imagem , Ar , Meios de Contraste , Feminino , Humanos , Masculino , Ampliação Radiográfica/métodosRESUMO
In a retrospective study of 47 cases of chondromalacia proved by operation, a correct diagnosis had been made by arthrography in three cases. In 44 patients a false negative finding had been obtained. A prospective study was carried out comparing single and double contrast arthrography as well as double contrast arthrotomography and scintigraphy in ten patients with typical chondropathia. It was confirmed by arthroscopy in nine cases. Only two patients with severe chondromalacia showed abnormal findings by arthrography or scintigraphy. Our investigation has led to the conclusion that arthrography is not a suitable method for demonstrating idiopathic chondropathia of the patella.
Assuntos
Doenças das Cartilagens/diagnóstico , Patela , Adolescente , Adulto , Artroscopia , Doenças das Cartilagens/diagnóstico por imagem , Feminino , Humanos , Masculino , Cintilografia , Tomografia por Raios XAssuntos
Doenças Ósseas Metabólicas/diagnóstico , Adolescente , Adulto , Idoso , Envelhecimento , Neoplasias Ósseas/secundário , Criança , Diagnóstico Diferencial , Fraturas Espontâneas/etiologia , Humanos , Pessoa de Meia-Idade , Osteíte Deformante/diagnóstico , Osteomalacia/diagnóstico , Osteoporose/diagnóstico , Tomografia Computadorizada por Raios X , Deficiência de Vitamina D/complicaçõesAssuntos
Livros , Meios de Contraste , Vértebras Lombares/anatomia & histologia , Ilustração Médica , Mielografia , Livros de Texto como Assunto , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Região Lombossacral , Doenças da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/diagnóstico por imagemRESUMO
In 102 cases with arthrographic proven lesion of the medial meniscus clinical, radiological and operative results were correlated. In 10% the lesion could not be found by arthrotomy. These were all cases with lesions in the posterior part of the meniscus, mostly at the basis. It must be assumed, that the posterior portion of the medial meniscus cannot be judged completely by arthrotomy, especially if a ventral approach is used.
Assuntos
Traumatismos do Joelho/diagnóstico por imagem , Lesões do Menisco Tibial , Adolescente , Adulto , Humanos , Traumatismos do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Radiografia , Instrumentos CirúrgicosRESUMO
A simplified method of 1,5 to 2,0 x radiographic magnification is presented with a focal spot of 0,15 mm. The examination of 358 patients shows a gain in clinical information in 74%, which was decisive in 24%. The place of magnification radiography in orthopedic diagnostic procedures is defined.
Assuntos
Doenças Ósseas/diagnóstico por imagem , Ampliação Radiográfica , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Humanos , Pessoa de Meia-IdadeRESUMO
In patients with stump problems, radiological examination of the stump is desirable. To get a maximum of information, the X-ray technique has to be adapted to the qualities of the stump which are different from the corresponding part of a normal limb. Special techniques permit further diagnosis.
Assuntos
Cotos de Amputação , Coxa da Perna/diagnóstico por imagem , Humanos , Perna (Membro)/cirurgia , RadiografiaRESUMO
The additional information obtained by direct radiographic magnification is examined in comparison to standard exposures of 50 bone tumors. A diagnostically significant increase in information is obtained in 84% of these cases. This is distributed at an irregular rate over the various decisive phases of the tumor diagnosis. In 24% of the cases the magnification exposure was helpful excluding other diseases, in 40% it permitted a differentiation between benign and malignant lesions and in 20% it permitted a classification of the type. The clinical importance of the magnification technique is relevant.
Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Ampliação Radiográfica , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
31 myelograms of patients with the syndrome of lumbar spinal canal constriction were analysed. Two forms can be distinguished - a primary form with hypoplasia of the lumbar section of the spinal canal, and a secondary form with circumscribed constriction through olisthy or spondylosis deformans. The characteristics symptoms of the primary form (n = 21) are: difficult lumbar puncture, the ascent of the contrast medium in the thoracic section of the vertebral canal, multiple protrusions of the intervertebral discs, reduced sagittal diameter of the dural area which is marked by additional signs of spondylosis. In this connection, the alterations were so characteristic that it was possible to diagnose the condition even before the operation. The myelogram with water-soluble contrast-medium is considered to be markedly superior to other methods of radiological examination.
Assuntos
Mielografia , Canal Medular/anormalidades , Adulto , Idoso , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Masculino , Pessoa de Meia-Idade , Canal Medular/diagnóstico por imagem , Canal Medular/cirurgia , Osteofitose Vertebral/complicações , Espondilolistese/complicações , SíndromeRESUMO
The syndrom of the narrow spinal canal is today to be separated from other lumbar diseases by its nosological entity. It starts slowly and becomes manifest in middle and advanced age. Claudicatio intermittens is the characteristic symptom of this disease the aetiology of which is multifactory. Most patients show in the myelogram konstitutionell alterations combined with localized or generalized degenerative narrowing of the spinal canal. The clinical findings correspond to the lumbar segments affected. With localized narrowing the differential diagnosis of disc herniation is generally possible by myelography. This is of therapeutic consequence because in this cases a removal of the disc is unnecessary.