Biomedical subjects
P Appelbaum
Publications and source records attributed to P Appelbaum.
Insight and the clinical outcome of schizophrenic patients.
At the time of discharge from their index hospitalizations, 52 schizophrenic patients initially admitted for acute psychotic episodes were assessed on an Insight and Treatment Attitudes Questionnaire. When these patients were followed up 2 1/2 to 3 1/2 years later, adequate information on their clinical courses and outcomes was available in 46 cases. A global assessment of aftercare environment was made in each case, reflecting the degree to which individuals other than the patient were helpfully invested in maintaining the patient in treatment, whether these individuals were in the patient's living or treatment situations. Five factual outcome variables were also assessed: a) compliance with treatment 30 days after discharge; b) long-term compliance; c) whether or not patients were readmitted; d) readmissions per year; and e) percent of time spent in the hospital. As expected, aftercare environment was significantly related to outcome (p = .039). The overall relationship between insight and the outcome variables closely approached statistical significance (p = .053). Patients with more insight were significantly less likely to be readmitted over the course of follow-up. There was a trend for patients with more insight to be compliant with treatment 30 days after discharge. No significant interaction between aftercare environment and insight was found, suggesting that insight may influence outcome independently of aftercare environment.
Use of peripheral intravenous cannulas in premature infants: a controlled study.
A randomized, controlled study was done to determine whether a 25-gauge steel needle or a 24-gauge Teflon catheter was preferable for the administration of peripheral intravenous fluids and medications to premature infants. A total of 58 cannulas--28 steel needles and 30 catheters--were used in 34 infants. The needles remained in place for 15.4 +/- 13.2 hours (mean +/- SD) and the Teflon catheters for 49.5 +/- 30.9 hours (mean +/- SD). All of the steel needles had to be removed because of infiltration whereas only 17/30 (57%) of the catheters infiltrated. A local inflammatory reaction, which was not related to infection, occurred with 11/30 (37%) of the Teflon catheters. Following removal, Staphylococcus epidermidis was grown from the culture of 1/19 steel needles and 1/25 catheters. In both instances this organism was thought to be a contaminant. Teflon catheters remain functional three times longer than steel needles with no apparent increase in complications. The use of these catheters, therefore, appears to be the preferred method for administering intravenous fluids to premature infants.