RESUMEN

Environmental health specialists, other onsite wastewater professionals, scientists, and homeowners have questioned the effectiveness of septic tank additives. This paper describes an independent, third-party, field scale, research study of the effects of three liquid bacterial septic tank additives and a control (no additive) on septic tank microbial populations. Microbial populations were measured quarterly in a field study for 12 months in 48 full-size, functioning septic tanks. Bacterial populations in the 48 septic tanks were statistically analyzed with a mixed linear model. Additive effects were assessed for three septic tank maintenance levels (low, intermediate, and high). Dunnett's t-test for tank bacteria (alpha = .05) indicated that none of the treatments were significantly different, overall, from the control at the statistical level tested. In addition, the additives had no significant effects on septic tank bacterial populations at any of the septic tank maintenance levels. Additional controlled, field-based research iswarranted, however, to address additional additives and experimental conditions.

Asunto(s)

RESUMEN

Protein S-100 beta has been suggested as a prognostic marker in traumatic brain injury. However, little is known of its behaviour in the immediate post-injury period. With Ethics Committee approval, we recruited 30 patients with a history of head injury presenting to our Accident and Emergency Department. Blood was taken on arrival and at four hours post-injury. Serum S-100 beta was estimated using an immunoluminometric assay. Levels of S-100 beta were seen to fall rapidly with time. Half-time was distributed non-parametrically with a median of 198 minutes. Using the Mann-Whitney U test we found a statistically significant difference between non-desirable (Glasgow Outcome Score 1-3) and desirable (Glasgow Outcome Score 4-5) outcome on admission (p = 0.0155) but not at four hours (p = 0.1336). Levels of S-100 beta fell rapidly after its release following traumatic brain injury. Time after injury is therefore critical in assessing the significance of levels of S-100 beta, and sampling should be as early as possible to gain maximum information. If S-100 beta is to be assessed as a monitor of ongoing brain injury in the intensive therapy unit sampling must be frequent (e.g. every 4 hours) to be able to detect rises in serum levels before they have decayed to baseline.

Asunto(s)

RESUMEN

We have evaluated the analytical and clinical performance of an automated immunoassay for serum cardiac troponin I (Bayer Immuno 1TM, Bayer Diagnostics, Tarrytown, NY). The between batch imprecision was found to be between 1.2 and 3.2% over the concentration range 2.5 - 34.0 microg/L. The analytical range obtained from duplicate analysis of patient samples and defined as a coefficient of variation of 10% or less was 0.3 - 200 microg/L. The detection limit was found to be less than 0.1 microg/L. A method comparison with the Dade Stratus method (Dade Behring, Wilmington, DE) yielded regression statistics with a slope of 0.705 and an intercept of -0.260. An analysis of samples from 40 patients with renal failure demonstrated six with detectable levels of troponin I (0.2 - 1.9 microg/L). Samples from patients with paraproteinaemia did not demonstrate detectable troponin I (from n = 30); however, two patients with elevated rheumatoid factor titers (from n = 20) demonstrated a detectable amount of troponin I (0.1 and 0.2 microg/L). In a study of 100 patients admitted with acute chest pain and a diagnosis of unstable angina, 6 were subsequently diagnosed as having suffered a myocardial infarction. On admission the sensitivity and specificity of the troponin I results were 26.7% and 94.7%, respectively, moving to 100% and 83% 12 hours after admission.

Asunto(s)

RESUMEN

The analytical, within-subject and between-subject components of variation were estimated for serum albumin, transthyretin, alpha 1-acid glycoprotein, alpha 1-antichymotrypsin, haptoglobin, beta 2-microglobulin and C-reactive protein in a cohort of 19 apparently healthy subjects over 20 weeks. Desirable analytical goals based on biological variation should be able to be met except for serum albumin and beta 2-microglobulin for which methodological improvement is warranted. All proteins showed marked individuality which casts doubt on the utility of conventional population-based reference values as interpretative criteria. The critical differences required for significance of changes in serial results differ markedly from protein to protein and the data presented allow generation of objective criteria for monitoring individuals.

Asunto(s)

RESUMEN

Many have expressed concern regarding both the deterioration in the quality of patient care provided by CMHCs and the exodus of competent psychiatrists from them. Earlier efforts by the Joint Commission to serve as an accrediting body for CMHCs were ineffective. Two factors may well have contributed to this. First, the Joint Commission's community mental health "Principles" were not medically based and, therefore, may not have been sufficiently able to assure quality of care, especially for the seriously mentally ill. Secondly, the "Principles" did not enjoy widespread use among CMHCs. Heretofore, CMHCs have not been required to meet national accrediting standards to qualify for governmental and other third-party reimbursement. Tying reimbursement to a meaningful accreditation process, as is done for hospitals, would solve the latter problem. Redressing the former problem might be accomplished by incorporating guidelines for psychiatric practice, such as those proposed in this article, into JCAHO's and CARF's accreditation standards for CMHCs. Such standards would then, by linking authority to responsibility, provide the CMHC psychiatrist with a foundation upon which to reasonably practice and thereby assure quality patient care. Although 55% of CMHCs were headed by psychiatrists in 1971, only 8% had psychiatrist CEOs as of 1985. Although psychiatrists need not be administratively in charge of CMHCs, the importance of their clinical leadership role is undeniable. Yet, in many centers, this role has been sorely compromised. It is anticipated that a clearer delineation of the psychiatrist's and, more specifically, the medical director's role will benefit all involved: patients, families, psychiatrists, other clinical staff, executive directors, and CMHC boards of directors. Centers that have strong psychiatric leadership will clearly benefit in three ways: (1) liability risk will be kept to a minimum; (2) recruitment and retention of competent psychiatrists will be enhanced; and (3) with CMHCs remaining clearly in the medical mainstream, they will be assured of continued governmental and other third-party healthcare funding. O'Leary, President of JCAHO, writes the following: The Joint Commission has never placed a direct role in the development of clinical standards, and we do not intend to begin now. But we do urge appropriate specialty groups to establish this task as a high priority. While consensus standards are inherently imperfect, they do reflect unique collections of wisdom and experience.(ABSTRACT TRUNCATED AT 400 WORDS)

Asunto(s)

Asunto(s)

RESUMEN

Comments gathered in a national survey of community mental health center (CMHC) psychiatrists indicate that many suffer from burnout. Of the 96 respondents who provided comments, 46 expressed dissatisfaction with their work in CMHCs, 14 expressed satisfaction, and seven had mixed feelings. Factors contributing to the respondents' dissatisfaction included a lack of administrative support and validation, low pay, responsibility without authority, and pressure to sign documents related to patients unknown to them. Factors contributing to their satisfaction were having a variety of tasks, being valued for having uniquely comprehensive experience, being supported in the clinical oversight role, being in charge of CMHC operations, and working in a CMHC affiliated with an academic center or the medical community. The authors believe that CMHCs must redress the issues contributing to burnout among CMHC psychiatrists if they are to retain psychiatrists and provide quality patient care.

Asunto(s)

Asunto(s)

RESUMEN

A national survey of community mental health center psychiatrists was designed to assess the extent to which they experience professional burnout. 214 psychiatrists responded to the survey. The largest single group of respondents (23.4%) was attracted to community mental health primarily by normative values (e.g., "serving the indigent"). The critical variable which has or would cause most of the respondents to leave their community mental health center is conflict over the psychiatrist's role and/or value. Despite problems encountered by many, 78.5% of respondents expressed a greater than 50% overall satisfaction in their work at Community Mental Health Centers. 34.1% of respondents have practiced in a community mental health center for more than 10 years. 31.7% of respondents spend half-time or less of their working time in a community mental health center, raising questions about possible limitations in psychiatrist roles. Thirty-one of respondents spend more than three quarters of their community mental health center time evaluating and treating patients, raising questions as to whether community mental health center psychiatrists are utilized in oversight roles appropriate to their levels of expertise.

Asunto(s)

Asunto(s)

Asunto(s)