Paediatric assessment in a residential child and adolescent psychiatry unit.

OBJECTIVE: To document the health status, comorbidity and functional impairments experienced by a group of psychiatrically disturbed children and adolescents. METHODOLOGY: A detailed study of consecutive admissions to a residential unit over a two-year period was undertaken. All admissions had a comprehensive paediatric, speech pathology and psychiatric assessment. RESULTS: Compared to the general population, there was a significant history of developmental delay and low birthweight, but only a slightly greater prevalence of antenatal problems. Clumsiness (37%), severe speech and language disorder (32%), and hearing loss (15%) were prominent. Only 25% had no history of comorbid medical or neurological disorders. CONCLUSION: Children and adolescents presenting with moderate to severe mental health morbidity may have pre-existing comorbid medical problems, as well as unrecognised difficulties and impairments in other skills areas. Multidisciplinary assessment and intervention should be an integral part of the residential programme.

Live animal measurement of carcass traits by ultrasound: assessment and accuracy of sonographers.

The establishment and evaluation of an assessment system to accredit sonographers for measuring the carcass traits of subcutaneous fat depths and longissimus muscle area (LMA) on potential breeding animals by real-time ultrasound is described. Repeatability of operators, variation between the animal's left and right sides, and variations in technique were assessed from measurements and repeat measurements of 30 cattle by up to eight operators at three testing sessions. Accuracy of carcass data was determined by repeatability of measurements, variability between measurers, between left and right sides of the carcass, and variation due to handling and dressing procedures. Correlations with carcass data averaged .92 for rump fat, .90 for rib fat, and .87 for LMA. Residual SD averaged .81 mm, .88 mm, and 5.1 cm2. A very experienced sonographer can measure LMA only marginally less accurately than it can be measured on the carcass. In Session 3, the SE between repeat fat measurements for accredited sonographers averaged .43 mm, indicating that fat depths can be measured more accurately, but when comparing measurements from different operators, adjustments may be required for differences in technique, otherwise overall accuracy will be about the same, approximately 1 mm. Scanned rump fat measurements were consistently approximately 20% higher than on the chilled, hanging carcass 24 h after slaughter; after applying the standard correction factor of 1.17, LMA measurements were similar. Scan and carcass rib fat measurements were similar for animals with less than or equal to 10 mm of fat cover, above which carcass measurements tended to be higher.

An alternative model in geriatric care.

An analysis is presented of one long-term care facility's attempt to develop a comprehensive geriatric program including care of the patient in a hospital, a skilled nursing home, a day hospital, or a clinic for care of the ambulatory aged. The goal was to raise issues for debate and discussion, especially in terms of the evolving role of medical directors in long-term care. The need for group professionalism in cooperation with the Board of citizens in community geriatric practice is emphasized.