A preliminary report on the discrepancy between clinical and test evaluations of competence.

This report demonstrates the discrepancy that can occur between clinical and test evaluations of competence. It presents retrospective examination of 35 assessments of competence performed on 24 subjects by a multidisciplinary competency panel. The findings of the panel are compared with the subjects' results on the Cognitive Competency Test and on the Mini-Mental State Examination. The results show that the multidisciplinary competency panel will more often find subjects competent than indicated by their psychometric test scores. A process approach to the use of tests is recommended. Reliance on tests to decide the outcome of difficult cases does not appear to be warranted.

Palliative care needs of residents, families, and staff in long-term care facilities.

While there is growing recognition that the physical needs of LTC residents have increased markedly in the 20 years, the palliative care needs of facility residents and their families are poorly understood. There also is a dearth of information on the educational and support needs of LTC facility staff vis-a-vis palliative care. Operating from the Juan de Fuca Hospital Society (a network of extended care facilities in Victoria), our Palliative Support Team (PST) was conceived in order to act as an educational resource to JdF staff as well as to provide expert consultation on palliative care issues. As part of the evaluation of this pilot program, a sample of 74 Juan de Fuca workers were interviewed to determine their perceptions of resident, family, and staff needs in relation to palliative care. In this paper, discussion is focused on the palliative care needs identified by professional caregivers. The ways in which a palliative care consultation team can address some of these needs are also discussed.

The impact and experience of adventitious deafness.

Relatively little well controlled, empirical research has examined the problems, experiences, functional limitations and coping strategies of late-deafened individuals. The present paper summarizes, integrates and evaluates the literature on adventitious deafness. Several issues are explored in detail, including: a) a comparison of congenital and acquired deafness; b) a critical review of the literature investigating the psychiatric problems experienced by late-deafened individuals; c) an examination of the effects of acquired deafness on identity and personal control; and d) a consideration of adventitious deafness among the elderly.

Brief assessment of cognitive impairment in patients with stroke.

The Stroke Unit Mental Status Examination (SUMSE) has been developed to provide a reliable poststroke test of cognitive functioning that may be administered at bedside. SUMSE was designed to assess major cognitive disorders caused by stroke (eg, language disorders, visuoperceptual deficits, and memory disorders) while avoiding, as much as possible, reliance on patients' English language skills and motor movements. SUMSE's reliability and validity were evaluated by administering it to patients on a stroke rehabilitation unit in conjunction with already validated tests. The results indicated that SUMSE has the potential to become a useful tool for the bedside assessment of mental impairment in stroke patients.

Fever in Haemophilus influenzae type B meningitis.

Ninety-nine cases of Haemophilus influenzae type B (HIB) meningitis were analyzed to assess the causes of secondary and persistent fever and outcome of treatment. Secondary fever developed in 47 patients, 11 had persistent fever and 4 patients died. Secondary fevers were associated with intercurrent illness in 30 per cent, drug fever in 15 per cent, and neurologic complications in 13 per cent. Serious neurologic or other complications were no more common in patients with than in those without secondary fever. However, patients with persistent fever demonstrated a higher rate of neurologic complications. Neither persistent nor secondary fever are markers of bacteriologic relapse or inadequate therapy.