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This study compared MMPI-2 profiles and evaluated the ability of the MMPI-2 and its two new post-traumatic stress scales (PK and PS) to discriminate women in outpatient substance abuse treatment reporting positive (n = 24) and negative (n = 69) child sexual abuse histories. T-tests revealed significantly higher mean scores for the sexual abuse group for the following scales: F, 1, 2, 3, 4, 6, 7, and 8. A discriminant analysis yielded a linear function of L, F, 3, 5, 8, and PK that correctly categorized 75% with positive histories and 77% with negative histories. The optimal cutoff PK score was 17, which correctly classified 75% and 46% of those reporting positive and negative abuse histories, respectively. These findings support early identification of abuse survivors among substance abusing women and suggests that the MMPI-2 may be useful in patient-treatment matching.

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OBJECTIVE: This study evaluated the institutional impact of a substance abuse consultation service in a hospital setting. METHOD: Treatment and matched comparison groups were compared on five outcome variables: length of stay, total cost, reimbursement, readmission, and appropriateness of care. The treatment group consisted of patients with discharge diagnoses falling into targeted Diagnostic Resource Groups (DRGs) and who received a substance abuse consultation. The comparison group consisted of patients with the same targeted DRGs, a coexisting substance abuse diagnosis, and who did not receive a substance abuse consultation. RESULTS: No statistically significant differences were found for the five outcome variables. Findings closely approached statistical significance for rate of readmission with treatment patients being less likely to be readmitted during the 12 months following the consultation. CONCLUSIONS: Although cost savings were not found during the hospitalization when the substance abuse consultation was provided, the data suggests that the consultation may reduce the need for readmission during the year following discharge.

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OBJECTIVE: Animal-assisted therapy involves interaction between patients and a trained animal, along with its human owner or handler, with the aim of facilitating patients' progress toward therapeutic goals. This study examined whether a session of animal-assisted therapy reduced the anxiety levels of hospitalized psychiatric patients and whether any differences in reductions in anxiety were associated with patients' diagnoses. METHODS: Study subjects were 230 patients referred for therapeutic recreation sessions. A pre- and posttreatment crossover study design was used to compare the effects of a single animal-assisted therapy session with those of a single regularly scheduled therapeutic recreation session. Before and after participating in the two types of sessions, subjects completed the state scale of the State-Trait Anxiety Inventory, a self-report measure of anxiety currently felt. A mixed-models repeated-measures analysis was used to test differences in scores from before and after the two types of sessions. RESULTS: Statistically significant reductions in anxiety scores were found after the animal-assisted therapy session for patients with psychotic disorders, mood disorders, and other disorders, and after the therapeutic recreation session for patients with mood disorders. No statistically significant differences in reduction of anxiety were found between the two types of sessions. CONCLUSIONS: Animal-assisted therapy was associated with reduced state anxiety levels for hospitalized patients with a variety of psychiatric diagnoses, while a routine therapeutic recreation session was associated with reduced levels only for patients with mood disorders.

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This case study describes the application of the action research model to managing change in an interdisciplinary inpatient unit. Special attention is given to potential resistances to the process and methods for addressing these. A needs assessment instrument assessing 40 program domains produced the initial data from which direction for change was derived. Active participation by all members in each phase of the process was found to contribute positively to the development and implementation of change efforts. Results indicate that the use of the model coupled with participation by the client group promoted positive staff morale, open communication, lower staff turnover, team problem solving, and improved goal attainment.

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Malfunction of the outlet mechanism, that is leakage of urine or difficulty in catheterization, has been the main problem in the evolution of continent urinary reservoirs. Urinary leakage in 3 patients with a right colonic reservoir (2 with an intussuscepted ileal nipple valve and 1 with a plicated ileal segment as a continence mechanism) was managed with tapered narrowing of the nipple valve and the ileocecal valve, respectively, using stapling techniques. Continence was thereby reestablished without impeding catheterization. Tapering is easy to perform and, when applicable, can obviate the need for a major surgical procedure.

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Since March 1989, 23 patients have undergone continent urinary diversion with an ileocecal bladder and a reimplanted appendix conduit. In 21 patients this procedure was combined with a radical cystectomy. Of the patients 7 required an endoscopic procedure before satisfactory self-catheterization could be established. This problem was more common early in the series. The continence mechanism is extremely simple and rapid to construct. Continence rates have been most satisfactory, with only 2 patients having secondary incontinence.

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Thirty patients with biopsy-proven chronic inflammatory bladder disease were treated with intravesical dimethyl sulphoxide (DMSO). Satisfactory symptomatic relief was achieved in 80% of patients completing treatment and no significant side effects were encountered. Despite the improvement in symptoms there was no significant alteration in the endoscopic or morphological appearance of the bladder after treatment. Intravesical DMSO is safe and relatively easy to administer and seems to have a place in the management of patients with this difficult problem.

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Although the extent of proptosis in exophthalmic Graves' disease has been measured directly and shown to correlate with serum content of a bioassayable exophthalmus-producing factor (EPS;1), a comparable relationship in an experimental model has not been reported. Progressive exophthalmos, measured from photographs and expressed as a ratio of intercorneal distance to intersupraorbital ridge distance, was produced in male guinea pigs when thyroid status was altered either by surgical thyroidectomy supplemented with 131-I treatment or by the administration of 6-propyl-2 thiouracil (0.1% in chow). In both groups, at time of sacrifice, serum content of EPF estimated by a modified goldfish bioassay using a known exophthalmogeric TSH preparation (Ambinon, Organon-Oss) as standard was positively correlated (r equals 0.804) with the terminal degree of exophthalmos. Daily replacement therapy with T4 (15mug/kg body wt) failed to alter significantly the exophthalmos which developed, even when replacement was initiated prior to the alterations of thyroid gland function; this observation tends to eliminate thyroid hormone deficiency per se as the causal event in exophthalmos. T4 treatment did, however, reverse or prevent the rises in serum TSH levels (McKenzie bioassay) thus dissociating TSH activity from EPF activity in the guinea pig. Treatment of guinea pigs with synthetic TRH (0.5, 1.0 OR 10 mug/kg body wt) for 21 days failed to produce demonstrable exophthalmos or assayable EPF levels although plasma TSH was significantly elevated.

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