Improving the network management of integrated primary mental healthcare for older people in a rural Australian region: protocol for a mixed methods case study.

Introduction: An integrated approach to the mental healthcare of older people is advocated across health, aged care and social care sectors. It is not clear, however, how the management of integrated servicing should occur, although interorganisational relations theory suggests a reflective network approach using evaluation feedback. This research will test a network management approach to help regional primary healthcare organisations improve mental health service integration.

Use of microdialysis-based continuous glucose monitoring to drive real-time semi-closed-loop insulin infusion.

Continuous glucose monitoring (CGM) and automated insulin delivery may make diabetes management substantially easier, if the quality of the resulting therapy remains adequate. In this study, a semi-closed-loop control algorithm was used to drive insulin therapy and its quality was compared to that of subject-directed therapy. Twelve subjects stayed at the study site for approximately 70 hours and were provided with the investigational Automated Pancreas System Test Stand (APS-TS), which was used to calculate insulin dosage recommendations automatically.

Feasibility of overnight closed-loop control based on hourly blood glucose measurements.

Introduction: Safe and effective closed-loop control (artificial pancreas) is the ultimate goal of insulin delivery. In this study, we examined the performance of a closed-loop control algorithm used for the overnight time period to safely achieve a narrow target range of blood glucose (BG) concentrations prior to breakfast. The primary goal was to compare the quality of algorithm control during repeated overnight experiments.

Implications of bed reduction in an acute psychiatric service.

Objective: To evaluate the impact of psychiatric inpatient bed closures, accompanied by a training program aimed at enhancing team effectiveness and incorporating data-driven practices, in a mental health service.

Design And Setting: Retrospective comparison of the changes in services within three consecutive financial years: baseline period - before bed reduction (2006-07); observation period - after bed reduction (2007-08); and intervention period - second year after bed reduction (2008-09). The study was conducted at Cramond Clinic, Queen Elizabeth Hospital, Adelaide.

Long-term potentiation in the dentate gyrus of the anaesthetized rat is accompanied by an increase in extracellular glutamate: real-time measurements using a novel dialysis electrode.

We have used a glutamate-specific dialysis electrode to obtain real-time measurements of changes in the concentration of glutamate in the extracellular space of the hippocampus during low-frequency stimulation and following the induction of long-term potentiation (LTP). In the dentate gyrus, stimulation of the perforant path at 2 Hz for 2 min produced a transient increase in glutamate current relative to the basal value at control rates of stimulation (0.033 Hz).

Suprarenal intraarterial infusion of alloxan and streptozotocin during balloon occlusion of the juxtarenal abdominal aorta: a simple technique for inducing diabetes mellitus in canines with reduced mortality.

Rationale And Objectives: The authors performed this study to evaluate the mortality and morbidity associated with a simple technique for inducing diabetes in dogs--suprarenal intraarterial infusion of alloxan and streptozotocin during balloon occlusion of the juxtarenal abdominal aorta.

Materials And Methods: The authors attempted to induce diabetes in six purpose-bred dogs. After the dogs were fasted for 12 hours, the abdominal aorta at the level of the origin of the renal arteries was occluded with an angioplasty balloon introduced by means of a femoral approach.

A prospective study of laboratory and clinical measures of postural stability to predict community-dwelling fallers.

Background: The identification of specific risk factors for falls in community-dwelling elderly persons is required to detect early changes and permit a preventative approach to management. This study determines the ability of various laboratory measures and clinical tests of postural stability to prospectively predict fallers in community-dwelling elderly women.

Methods: One hundred elderly women (65-86 years, mean age 73 +/- 5 years) performed a reaction-time step task, a limits of stability, and a quiet stance balance task.

Lateral reach: a clinical measure of medio-lateral postural stability.

Background And Purpose: Medio-lateral postural instability has recently been identified as a risk factor for falls in the elderly community-dwelling population. However, few clinical tests involve challenges to stability limits in the medio-lateral direction. A lateral reach test was thus developed.

Ascorbate and glutamate release in the rat hippocampus after perforant path stimulation: a "dialysis electrode" study.

Excitatory amino acids have been proposed to play a critical role in the development and maintenance of epileptic seizures and in the development of neuronal damage. Previous animal studies of glutamate during seizures, however, have often failed to measure any rise in glutamate. We have overcome many of the problems of these studies by using an animal model in which epileptic afterdischarges are induced by stimulation of the perforant path, and glutamate and ascorbate are measured using a newly developed microdialysis electrode that combines the advantages of microdialysis and in vivo electrochemistry.

Measurement in vitro of human plasma glycerol with a hydrogen peroxide detecting microdialysis enzyme electrode.

Human plasma glycerol was determined with a microdialysis electrode, containing the enzymes glycerol kinase and glycerol phosphate oxidase held stationary within the electrode. A microdialysis electrode is essentially a conventional microdialysis probe, with a platinum working electrode inserted into the tip of the dialysis fiber and reference and counter electrodes contained in the upper compartment. The linear range of response to glycerol was directly dependent on the concentration of ATP.

Changes in medical referrals to an outpatient physiotherapy department.

The information provided in 10 per cent of all written medical referrals received by a teaching hospital physiotherapy outpatient department in each of the years 1982 and 1989 was systematically analysed to identify any demonstrable changes in emphasis. Significant between year differences indicated fewer referrals containing a diagnosis in 1989 than in 1982, less emphasis on requests for physiotherapy modalities and a significant increase in more generalised requests and inclusion of aims of treatment. These results suggest that greater clinical autonomy is expected of physiotherapists by medical practitioners in this particular hospital setting, The method used in this study could be applied in future to monitor referral to physiotherapy to examine whether these results represent a real trend.

A double-blind, placebo-controlled trial of a new veno-active flavonoid fraction (S 5682) in the treatment of symptomatic capillary fragility.

The efficacy and safety of a new veno-active flavonoid fraction (S 5682) consisting of micronized diosmin (90%) and hesperidin (10%) have been studied in 100 patients with symptomatic capillary fragility in a double-blind, randomized, placebo-controlled trial. Treatment lasted 6 weeks and consisted of 2 daily tablets of either S 5682 or placebo. Patients were examined at weeks 0, 2, 4 and 6.

[Depression in elderly patients. Value of tianeptine in 140 patients treated for 1 year].

An open multicenter study of the efficacy and acceptability of tianeptine, a new antidepressant structurally related to tricyclic antidepressants, was conducted by 36 gerontologists. There were 228 patients in the study; 140 were treated for one year. The patients' overall MADRS score started to decrease on day 14 and continued to decline to month 3.

Pharmacokinetics of the antidepressant tianeptine at steady state in the elderly.

The pharmacokinetics of tianeptine, an antidepressant with an original serotoninergic neurochemical action, was investigated in elderly patients. Kinetic profiles were developed in 12 elderly patients (age range: 72-81 yr) after single (12.5 mg) dose and multiple oral dosages (12.

[Short-stay hospitalization of elderly persons: first step toward institutionalization?].

One month outcome after hospitalization was studied in 1695 persons aged 75 and over, living in the community and admitted to acute care medical units: only 9.6% of them were then institutionalized. Returning home requires a high level of independence for feeding, mental status and continence.

Morphological study of the aging human peripheral nerve.

The superficial peroneal nerve from 46 elderly patients was studied by light and electron microscopy. Like most elderly people, these patients displayed evidence of varying degrees of peripheral nervous system dysfunction, but they were not suffering from any disease known to alter the peripheral nerve. A quantitative study showed that myelinated fiber loss predominated in the large diameter group.

Antihypertensive efficacy and acceptability of rilmenidine in elderly hypertensive patients.

Elderly hypertensive patients (older than 70 years, with a diastolic blood pressure [BP] between 95 and 114 mm Hg) were entered into a study after a 2-week wash-out period and randomized to 2 parallel groups: rilmenidine (n = 28) and methyldopa (n = 30). The initial dose (rilmenidine, 1 mg once daily A.M.

Hypertension in the elderly.

The incidence of definite hypertension increases with advancement of age, and one third of the elderly population is affected. Isolated systolic hypertension is frequent in this population (10 to 12 percent in subjects between 65 and 74 years of age). The role of hypertension as a cardiovascular risk factor has been confirmed in the elderly population by the increase in cerebrovascular accidents, and by the incidence of myocardial infarction with the rise in blood pressure.

[Factors related to length of hospitalization of elderly patients during short stay].

Length of stay of elderly patients in hospitals can be subdivised into a medical stay followed by a social stay. The average length of stay of 2134 patients aged 75 and over, admitted to 23 medical or geriatric acute wards in Aquitaine, was 13.6 days; 18% of the patients experienced a social stay of at least one day.