COVID-19 Vaccine Uptake and Its Impacts in a Cohort of Gay and Bisexual Men in Australia.

Successful use of biomedical forms of HIV risk-reduction may have predisposed many gay and bisexual men (GBM) to vaccination against COVID-19, which may, in turn, affect their sexual behavior. A total of 622 Australian GBM provided weekly data on COVID-19 vaccination history and sexual behaviour between 17 January 2021 and 22 June 2021. We identify factors associated with COVID-19 vaccination, and compare sexual behavior before and since vaccination. Mean age was 47.3 years (SD 14.0). At least one-dose vaccination coverage had reached 57.2%, and 61.3% reported that the majority of their friends intended to be vaccinated. Vaccinated men reported a mean of 1.11 (SD 2.10) weekly non-relationship sex partners before vaccination and 1.62 (SD 3.42) partners following vaccination. GBM demonstrated high confidence in COVID-19 vaccines. Their sexual activity increased following vaccination suggesting that greater sexual freedom may be a specific motivation for vaccine uptake among some men.

Diagnosis of illness presentation in the elderly.

In the standard medical model of diagnosis, there is a 1:1 correspondence between clinical symptoms and signs and a pathological disease process. However, it is believed that this model does not accurately define many illness presentations in elderly patients. The frequency with which the medical model is diagnostically accurate, and the other models that might more effectively diagnose geriatric illness, are unknown. This study was designed to ascertain the frequency with which the medical model of diagnosis pertains in a clinical population of older adults and to develop and validate alternative models for diagnosis of illness presentation in this population. Using a retrospective chart review (n = 86) and a prospective validation in a second sample (n = 56) of geriatric assessment clinic patients, it was found that the medical model of illness fit less than half of the patients. To describe the illness presentations of the remaining patients, four new diagnostic models of illness presentation were identified which incorporate comorbidity, functional, and psychosocial factors. Use of these new models along with the medical model of illness diagnosis may assist in more accurate and complete diagnosis in elderly patients and enhance teaching of effective diagnosis in geriatric medicine.

Cognitive-behavioural problem solving in the treatment of patients attending a medical emergency department: a controlled trial.

Previous research has pinpointed high levels of undetected psychiatric and psychosocial problems in medical attenders at an Accident and Emergency department (A&E). In a controlled trial, patients were selected if they fulfilled criteria which had been shown in the previous studies to be associated with high levels of psychopathology and repeat attendance at the A&E department. Patients were randomly allocated to either cognitive-behavioural problem solving treatment, or to a 'treatment as usual' control condition. The use of a brief, home-based treatment and assessments ensured 100% compliance. Results indicated only limited clinical benefits associated with such treatment. The reasons for the limited treatment response are considered; future treatments should be focused and evaluated in specifically defined problem and diagnostic groups. It is concluded that problem solving treatment should be confined to populations in which problem solving deficits have been identified, such as deliberate self-harm.

Out-of-hospital administration of mannitol to head-injured patients does not change systolic blood pressure.

OBJECTIVE: To determine the effect of out-of-hospital mannitol administration on systolic blood pressure (BP) in the head-injured multiple-trauma patient. METHODS: This was a prospective, randomized, double-blind, placebo-controlled clinical trial involving a university-based helicopter air medical service and level-1 trauma center hospital. Endotracheally intubated head-trauma victims with Glasgow Coma Scale (GCS) scores < 12 were enrolled from November 22, 1991, to November 20, 1992, if evaluated by the participating aeromedical transport team within 6 hours of injury. Patients were excluded if they were < 18 years old, had already received mannitol or another diuretic, were potentially pregnant, or were receiving CPR. All patients were intubated prior to study drug (mannitol [1 g/kg] or normal saline) use. Pulse and BP were measured every 15 minutes for 2 hours following study drug administration. RESULTS: A total of 44 patients were enrolled. After exclusion of 3 patients who did not meet all inclusion criteria, there were 20 patients in the mannitol group and 21 patients in the placebo group. The groups were similar at baseline in age, pulse, systolic BP (baseline mannitol: 124 +/- 47 mm Hg; placebo: 128 +/- 32 mm Hg), GCS score, and Injury Severity Scale score. Systolic BP did not change significantly throughout the observation period in either group. This study had 83% power to detect a mean systolic BP drop to < 90 mm Hg. CONCLUSION: Out-of-hospital administration of mannitol did not significantly change systolic BP in this group of head-injured multiple-trauma patients.

Psychiatric consultation to a continuing care retirement community.

Life care communities provide a continuum of residential services to the elderly. This report describes the provision of on-site psychiatric consultations to 82 individuals residing in one such community. Dementia and major depression were the most common diagnoses made.

Registrars' and senior registrars' perceptions of their audit activities.

OBJECTIVES: To ascertain the level and quality of audit activity among junior doctors, their attitudes to audit, and their views on its educational value. DESIGN: Postal questionnaire survey in April 1991. SETTING: Yorkshire region. SUBJECTS: All 610 registrars and senior registrars recorded as employed in the region. MAIN MEASURES: Grade, current specialty, details of last audit participated in and its educational usefulness, and attitude to audit. RESULTS: 255 (41.8%) completed questionnaires were returned, 148 from registrars and 101 from senior registrars; grade was not indicated in six. 27 respondents were in general medicine, 26 in general surgery, 30 in anaesthetics, and 36 in psychiatry; other specialties had fewer than 20 respondents. About a fifth (54) of respondents, most in psychiatry (19/36, 53%), had not participated in audit. Among the 201 who had participated, the audit topics covered most components of care (access to services (47, 23%), communication (51, 25%), and appropriateness (158, 79%) and effectiveness (157, 78%) of treatment); only 84 (41%) audits set standards, and in only half of them had the doctors been involved in doing so. Doctors responsible for gathering data and those responsible for collating and reporting data found their experience significantly less useful than those who were not. 172 (86%) respondents considered that audit had helped patient care. Suggested improvements to the educational value of audit were mostly for better methods but included requests for less "witch hunting," better feedback, more training, more time, and more participation by consultants. CONCLUSIONS: The educational value of audit to junior doctors could be improved by better audit methods, guidance, and feedback.

Pericardial effusion. Unusual complication in thyroid cancer.

A case in which a prolonged hypothyroid state resulted in development of a pericardial effusion is presented. The compensatory mechanism for protein homeostasis is lost in severe hypothyroidism. Iodine is transported to the pericardial space, which is filled with a high-protein content fluid and remains trapped. The mechanism for the accumulation of the fluid in the pericardial space is discussed. To prevent this unusual but dangerous complication, the authors recommend close monitoring of the patient's clinical status and serum thyroid stimulating hormone. The use of a short acting thyroxine substitute for at least 2 weeks can decrease occurrence of this complication and will shorten the time the patient needs to be hypothyroid.

Evaluation of hospital-based aeromedical transport programs using therapeutic intervention scoring.

The number of patients transported by hospital-based aeromedical transport programs is increasing rapidly across the country. How many of these patients really need this kind of transport and how to compare the performance of different services in this regard remain controversial issues. We examined these questions in a prospective analysis of 1,081 flights in 5 aeromedical transport programs using the Therapeutic Intervention Scoring System (TISS) as the basis for an index of appropriateness. An average of 41.5% of flights in all programs were clearly appropriate according to the index, i.e., had scores associated with a 99% probability of validation by direct review. Another 34.9% of flights had a greater than 50% probability of being appropriate. From 18 to 28% of flights had scores associated with only a 20% probability of justification. Although TISS scoring, which is carried out after transfer, cannot provide a means of selecting individual patients for aeromedical transfer, a TISS-based index appears to be a simple and useful method for examining overall appropriateness of program activity, and could be used to set objective standards of appropriateness for evaluation and comparison of aeromedical programs.

An educational model for medical appointments.

A model of planned appointments to the training and consultant grades in the National Health Service is proposed. Contracts in each grade would begin and end at fixed dates. The aim of the model is to provide a coherent educational and career plan for each doctor with minimal disruption of the clinical service. It is proposed that a phased introduction of the scheme would allow the process of change to be acceptable and the model to be evaluated before a commitment to its full introduction is made.

Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide. A controlled trial.

In a controlled trial, 20 patients at high risk of repeated suicide attempts were randomly allocated to either cognitive-behavioural problem solving or a 'treatment-as-usual' control condition. The group practising problem solving improved significantly more than controls on ratings of depression, hopelessness, suicidal ideation and target problems at the end of treatment and at follow-up of up to one year, and there was evidence of an effect on the rates of repetition over the six months after treatment.

Community psychiatric nursing intervention in an accident and emergency department: a clinical pilot study.

In a pilot study, 99 patients referred from a general hospital accident and emergency department were seen by a community psychiatric nurse (CPN) using a time series design. They were categorized into those patients having a previous psychiatric history and those with none. The level of service use for the 6 months immediately prior to CPN intervention, 6 months following referral, and 6 months of follow-up indicated a very high level of psychiatric and general medical service use by this group. Referral to the CPN was associated with substantial reduction in the demands on other services made by the group with previous psychiatric history. The group with no previous history showed a decrease in total service usage at follow-up.

Aeromedical transport of patients with post-traumatic cardiac arrest.

Patients experiencing cardiac arrest secondary to trauma make up 8% to 15% of air ambulance scene flights in reported series. Our study examined the role of aggressive physician intervention at the accident scene in conjunction with rapid air transport to a trauma center in reducing the mortality after post-traumatic cardiac arrest. We retrospectively studied 67 patients who experienced cardiac arrest before the arrival of the flight team. Fifty-eight patients were victims of blunt trauma, and nine sustained penetrating trauma. Forty-seven patients were transported to the base hospital; 20 were pronounced dead at the scene after resuscitation attempts were made. Six patients developed a pulse and blood pressure and were hospitalized; none survived to hospital discharge. Review of autopsy data revealed that the majority of patients had head or thoracoabdominal injuries or both that were incompatible with life. We conclude that physician intervention at the scene and rapid aeromedical transport are not likely to improve mortality after traumatic cardiac arrest.

Psychiatric morbidity in an accident and emergency department. Characteristics of patients at presentation and one month follow-up.

In order to evaluate how many patients presenting at accident and emergency (A&E) departments show signs of psychiatric disturbance, 140 consecutive medical presentations to an A&E department were evaluated using a range of simple self-report and rater measures, then followed up a month later. High levels of reported psychological problems were detected at screening, and these persisted at follow-up. Correlates of psychological disturbance and repeated attendance at A&E were investigated, indicating the relevance and feasibility of psychiatric intervention related to simple predictors.

Deliberate self-harm and substance dependence: the management of patients seen in the general hospital.

The aim of this study was to examine management decisions made at the time of assessment of an episode of deliberate self-harm seen in the general hospital and examine the extent of referral to a specialized addiction unit. Factors involved in making a clinical decision regarding the appropriate management of self-harm cases when alcohol factors were identified are reviewed. Simply referring to a specialized addiction unit was found to be an unsatisfactory method of providing a comprehensive response to the problem of substance misuse and deliberate self-harm. It is suggested that services should be developed using active posthospital discharge community follow-up. Motivational interviewing used in such a setting may increase the number of patients who will go on to accept specialist care.