Update on lithium carbonate therapy in children and adolescents.

The use of lithium to treat child and adolescent psychiatric disorders is becoming more common. Since the publication of the report of The Committee on Biological Aspects of Child Psychiatry of the American Academy of Child Psychiatry in 1978, a considerable body of literature has accumulated on the efficacy of lithium in treating adolescent bipolar disorders, childhood aggression, and behavioral disorders associated with mental retardation and developmental disorders. Efforts to understand lithium's mechanism(s) and refinements in psychiatric diagnosis have contributed to its growing use.

The case for sunscreens. A review of their use in preventing actinic damage and neoplasia.

BACKGROUND: Recent controversy surrounding sunscreens has stimulated a reexamination of their use. The purposes of this article are to weigh the evidence regarding the value of sunscreens in preventing actinic damage and neoplasia and to evaluate the merit of objections that have been raised against their use for this purpose. Scientific aspects of damage from UV light, neoplasia, and sunscreens are reviewed. The value of sunscreen use in preventing actinic damage is discussed and a number of sunscreen controversies are revisited. OBSERVATIONS: The evidence favors the safety and efficacy of sunscreens for the prevention of actinic damage, melanoma, and nonmelanoma skin cancer. CONCLUSION: Sunscreens continue to be a practical and useful tool for the prevention of actinic damage and neoplasia.

Breaking through the hegemony of homogeneity: revitalizing curriculum and students.

Undergraduate programs provide fertile ground from which future practitioners, researchers, and teachers of psychiatric mental health nursing will emerge. Health care has changed dramatically, offering opportunities for new and innovative roles and prompting faculty to develop novel ways of thinking about the future role of psychiatric nurses. Nursing faculty are challenged to devise new and creative approaches to teaching psychiatric nursing at the undergraduate level in ways that will instill enthusiasm for the field. In this article, the efforts of the University of Pennsylvania to approach psychiatric mental health courses in new ways will be described. These innovations are designed to stimulate passion for what the authors see as a complex and exciting field that requires revitalization.

Discharge planning and home follow-up of the elderly patient with heart failure.

Older adults with heart failure have extensive and complex care needs. This article presents a framework for assessment and intervention with this fragile patient group. Comprehensive assessment of elders with heart failure includes gathering information about care, advocacy, and knowledge needs. Nursing interventions are focused on providing direct care, counseling, teaching, and advocacy. The unique role of the advanced practice nurse in discharge planning and home follow-up of elders with heart failure is emphasized.

Content analysis of pre- and post- discharge topics taught to hospitalized elderly by gerontological clinical nurse specialists.

THE PURPOSE OF this study was to analyze the content of topics taught to hospitalized elderly during hospitalization and after discharge by gerontological clinical nurse specialists (CNSs). Content analysis of the topics taught by two CNSs for 20 elderly subjects resulted in the identification of four major categories of patient information needs: management of the health problem that resulted in the current admission, need for and availability of post-discharge health and other support services, preparation for and care after diagnostic or surgical procedures, and health promotion and prevention of future health problems.

In situ photoimmunotherapy: a tumour-directed treatment for melanoma.

We report a new immunological treatment for advanced cutaneous melanoma which combines laser stimulation with topical application of a toll-like receptor agonist. This treatment, in situ photoimmunotherapy (ISPI), provides an alternative to traditional therapies for melanoma patients with cutaneous metastases. A 6-week cycle of ISPI is carried out on cutaneous metastases located in a designated 20 x 20 cm treatment area: 2 weeks of pretreatment with twice-daily topical applications of imiquimod (5% cream under plastic occlusion), with a laser treatment session at week 2 and again at week 4. Topical imiquimod is continued for the entire 6-week cycle. Two patients with late-stage melanoma were treated with ISPI. Patient 1 had the primary tumour and local metastases on the left arm, as well as metastatic tumours in the lungs [American Joint Committee on Cancer (AJCC) stage IV]. Patient 2 had a head and neck melanoma with multiple local metastases (AJCC stage IIIC), which had failed repeated attempts at surgical resection and high-dose radiation therapy. Patient 1 is now free of all clinically detectable tumours (including the lung metastases) >20 months after the first treatment cycle. Patient 2 has been free of any clinical evidence of the tumour for over 6 months. These two cases demonstrate that ISPI can clear local tumour and trigger beneficial systemic responses, with a side-effect profile that compares favourably with other treatments for advanced melanoma.

Comprehensive discharge planning for the elderly.

Discharge planning for the elderly can potentially reduce patient length of hospital stay, prevent rehospitalization, enhance patient outcomes and lessen the burden of care on the families. While increased numbers of elderly are being discharged earlier, there are few data on the process and effects of discharge planning protocols developed specifically for this population. The proposed study will attempt to answer the following questions regarding hospitalized elderly with selected DRG classifications: Are there significant differences between elderly patients who receive the hospital's general discharge planning procedure used for all categories of patients and elderly who receive the hospital's general discharge planning procedure plus a comprehensive discharge planning protocol specific to the elderly and implemented by a gerontological nurse specialist in: (1) Patient Outcomes (length of initial hospitalization; post-discharge morbidity; post-discharge health services; functional status; mental status; satisfaction with care; self-esteem; patient's perception of health status; and stress level); (2) Family Related Outcomes (primary care giver's functional status; mental status; care giving demands; stress level and family functioning); (3) Cost of Care Outcomes (charges for initial hospitalization, rehospitalizations, post-discharge health services; family related costs; and gerontological nurse specialist costs). The study design is a randomized clinical trial with a total of 280 elderly (2 groups of 140). The control group will receive routine discharge planning; the treatment group will receive routine discharge planning plus an elder-specific comprehensive discharge planning protocol. Data analysis will include frequency distributions and summary statistics. For each of the research questions, multivariate analysis of variance or chi-square statistics will be used.

Comprehensive discharge planning for the hospitalized elderly. A randomized clinical trial.

OBJECTIVE: To study the effects of a comprehensive discharge planning protocol, designed specifically for the elderly and implemented by nurse specialists, on patient and caregiver outcomes and cost of care. DESIGN: Randomized clinical trial. SETTING: Hospital of the University of Pennsylvania. PATIENTS: 276 patients and 125 caregivers. Patients were 70 years and older and were placed in selected medical and surgical cardiac diagnostic-related groups. MEASUREMENTS: Group differences in patient outcomes (length of initial hospital stay, length of time between initial hospital discharge and readmission, and rehospitalization rates) and charges for care (charges for initial hospitalization, rehospitalizations, health services after discharge, and nurse specialist services) were measured 2, 6, and 12 weeks after discharge. RESULTS: From the initial hospital discharge to 6 weeks after discharge, patients in the medical intervention group had fewer readmissions, fewer total days rehospitalized, lower readmission charges, and lower charges for health care services after discharge. No differences in these outcomes were found between the surgical intervention and control groups during this period. CONCLUSIONS: Study findings support the need for comprehensive discharge planning designed for the elderly and implemented by nurse specialists to improve their outcomes after hospital discharge and to achieve cost savings. The findings also suggest that this intervention had its greatest effect in delaying or preventing rehospitalization of patients in the medical intervention group during the first 6 weeks after discharge.