Hospital In Manhattan Research Articles

Maladaptive denial of physical illness: a useful new "diagnosis".

Denial of physical illness and/or refusal of treatment are critical issues in the practice of medicine. A previous article proposed DSM-IV consider a new diagnosis for a subgroup of patients who refuse treatment, i.e., maladaptive denial of physical illness [1]. It is necessary to be able to use this form of denial as a diagnosis rather than invoke the term denial as merely a mental mechanism. This is a report of a prospective descriptive study of psychiatric consultations for medical inpatients who deny that they are ill or who refuse treatment. In order to investigate the utility of this proposed diagnosis we conducted a one year study of all psychiatric consultations at a community hospital in Manhattan, New York. The diagnosis of maladaptive denial of physical illness was made in 2.5 percent of 317 psychiatric consultations. The patients did not fit into other DSM-III-R or DSM-IV categories. We suggest a clarification of the concept of denial for use with medically ill patients. The findings in this study demonstrate that the current categories in DSM-IV do not provide physicians with a diagnosis that describes this particular type of pathological denial of illness.

The Evolution of the Modern Ambulance

The 19th-century concepts of rapid transport and treatment of the injured developed primarily in the military contexts of the Napoleonic and American Civil wars. Before the 1790s, wounded soldiers were either left on the battlefield until the day after the battle or carried to the rear lines by comrades. Under the direction of Napoleon's surgeon, Dominique Jean Larrey, the Grande Armee developed mobile field hospitals, or ambulances volantes (flying ambulances), as well as a corps of soldiers specially trained and equipped to remove the wounded from the battlefield and initiate treatment. Follow¬ ing French practice, for most of the 19th century the word meant both a horse-drawn transport wagon and crew as well as a mobile field hospital.1 A system of railroad ambulance cars and base hospitals appeared on the Union side during the American CivilWar—developments that have prompted many historians to cite the Civil War as the be¬ ginning of the modern military ambulance system. It is important to note, however, that systematic practices for care of the wounded existed in substantial form only in the Union Army and then only because prominent civilians, in¬ cluding several physicians, expressed outraged at the lack of treatment for the wounded in the war's first years. For ex¬ ample, at the second battle of Bull Run in August 1862, 3000 wounded Union soldiers lay on the battlefield for 3 dayswith no medical care, and 600 languished for 1 week.2 Union am¬ bulance wagons existed before that time, but they were not under medical direction, and an inspection team led byWilliam Bowditch, MD, reported sufficient atrocities of poor care to enable the Surgeon-General to gain control of ambulance services from the quartermaster corps, which previously had not considered care of the wounded a major priority.3 Civil War medical experiences shaped a whole generation of postwar medical reformers, particularly in the northern states. Under the stewardship of Edward B. Dalton, MD, New York City, which then comprised only Manhattan, as¬ sumed world leadership in ambulance services in the late 1860s. Forging an alliance between public agencies and hos¬ pitals and private hospitals in Manhattan, Dalton and his successors crafted a system that divided the city into ambu¬ lance zones, with each hospital accepting responsibility for its zone. Most service requests came through the police, whose stations maintained dedicated electronic links (via telegraph and, later, telephone wires) to hospitals. Also, citizens made use of fire alarm signal boxes dispersed around the city. Horse-drawn ambulances, which carried 2 pa¬ tients, a driver, and an ambulance surgeon, also carried medi¬ cine chests that included emetics for overdoses and poisonings, anesthetics, morphine, amyl nitrite for cardiac patients, as well as other drugs and equipment. Despite their impressive array ofmedicines and equipment,most 19th-century ambulance sur¬ geons limited their field interventions to first aid, performing definitive care on arrival at the hospital. Although 19th-century technology may seem crude to us, meticulous logs kept during the 1880s documented a typical 8-minute response time from receipt of signal to arrival on the

Does a cheaper mask save money? The cost of implementing a respiratory personal protective equipment program.

To determine the annual cost of implementing and maintaining a respiratory personal protective equipment (PPE) program at an urban hospital. St Clare's Hospital and Health Center, a 250-bed hospital in Manhattan that treats 60 to 100 cases of tuberculosis annually. Review of Purchasing Department records for all masks acquired by the hospital from 1992 to 1995, and an estimate of administrative time spent developing and implementing the guidelines recommended by various agencies during the study interval. Respiratory isolation was provided for 6,360 to 10,883 days annually during the 4-year interval. Yearly costs for the PPE program ranged from $86,560 to $175,690. Of note, the daily cost for a respiratory isolation day decreased dramatically between 1994 and 1995 ($25/day to $13/day), when the high-efficiency particulate air-filter (HEPA) respirator was used by all staff. The decrease occurred because of lower administrative costs and a sharp decrease in the numbers of HEPA units purchased. Objective measures of worker compliance with HEPA respirators demonstrated the decrease was not due to less HEPA use but rather that employees were using each HEPA unit for several weeks, as recommended. We found a significant decrease in cost in the second year of our HEPA program due to increasing employee familiarity with the program. Newly approved, cheaper, but less durable, N-95 masks are unlikely to withstand multiple wearings and may be discarded after a few uses. Thus, cheaper masks may result in a more expensive PPE program.

Establishing an employee injury prevention program.

In the years between 1987 and 1989, REHAB reduced injuries from 3.5 to 1 per 50 employees. This program continues, and REHAB continues to refine it to reduce the rate even more. A strong management commitment to prevent injuries, increased staff awareness, and a program for gradual return to work all were instrumental in a significant reduction of injuries at REHAB.

Manhattan Country Doctor

Manhattan Country Doctor is indeed about a country doctor who, after unsuccessfully searching for a rural practice in post-Depression Virginia, was told by his wife that People are the same everywhere... so is medicine. You can be a country doctor in Manhattan. Dr Slocum is a trained journalist writing about his medical career, from his internship at Flowers Hospital in Manhattan and postgraduate studies in Vienna through the end of his career in Hell's Kitchen 35 years later (he retired to practice 15 more years in California). This easily read memoir is essentially a professional autobiography tracing the medical career of a country doctor through the multiplicity of learning experiences that led to his becoming a well-rounded physician. The book itself is composed of many short chapters, each dealing with an interesting aspect of the practice of medicine, such as hiring and working with office assistants (his wife always interviewed

Data quality and DRGs: an assessment of the reliability of federal beneficiary discharge data in selected Manhattan hospitals.

New York County Health Services Review Organization (NYCHSRO), the physicians' professional standards review organization of Manhattan, examined whether diagnostic coding errors identified in Manhattan hospitals would affect reimbursement under a diagnostic-related group (DRG) method of financing inpatient services. A sampling of 1,027 Medicare and Medicaid cases representing discharges from 18 Manhattan hospitals during 1982 and 1983 revealed incorrect DRG assignment for 17.5% of patient record abstracts, but these appear to have been unsystematic rather than deliberate errors. The difference between estimated reimbursement based on original and reabstracted records was not statistically significant either in the aggregate or for specific hospitals. It is emphasized that while New York State's Prospective Hospital Reimbursement Methodology (in effect during the study period) is not solely dependent upon DRG's case-mix is one of several factors used to make adjustments to existing per diem rates. A key recommendation is that hospitals conduct internal monitorings with all involved departments to improve the quality of the data abstracting process.

Trauma Teams and Their Use in Aircraft Disasters

The concept of treating mass casualties in major disasters, particularly at or near airports, has gained considerable momentum in recent years (1). Major urban airports are almost without exception, plagued by access road traffic problems even under normal circumstances. Given a disaster within the confines of an airport, emergency equipment and medical support are found to be mired in a morass of sightseer and emergency service vehicles, compounding the congestion already present immeasurably (2).Evolving from experiences gained over the past 30 years in handling masses of casualties resulting from aircraft disasters, we at Kennedy Airport have developed a Mobile Emergency Hospital which now serves as the “workshop” for stabilizing large numbers of injuries prior to subsequent transfer to definitive hospitals. The keys to this plan are the Trauma Team support used in conjunction with the mobile hospitals.The ideal trauma team consists of 2 surgeons or trauma-trained physicians, one surgical nurse and one medical or 2 surgical technicians. These teams can be varied according to the immediate situation, time of day, available physicians, nurses and technicians. Anesthesiologists respond either individually or as members of some of the teams reporting directly to the operating units on arrival.For an efficient response plan to function, previous liaison must be established primarily with teaching hospitals with a surgical staff that includes surgery and trauma residents. The Kennedy plan has a working arrangement with the New York Medical College and 8 of its affiliated major teaching hospitals in Manhattan, as well as in the main campus at Valhalla, which maintains an associated Burn Center.

On Tort Liability for “Wrongful Life”

During the short period since the middle of the present century the courts of more than one country have been called upon to deal with unprecedented claims: actions against a parent in respect of his liability for the plaintiff's birth under handicap, whether physical (congenital disease) or social (illegitimacy). Proceedings have also been taken against the State of New York, to hold it liable for an institution for which it was responsible, a Manhattan hospital, which failed to prevent a rape from which the birth resulted.Together with our juridical interest in the solution of the problem—and perhaps even preceding it—we are curious to understand why it has not arisen before and now suddenly emerges simultaneously in a number of countries without apparently any mutual influence or awareness.

Fatal hemolytic transfusion reaction caused by sensitization to a new blood factor U: report of a case.

The purpose of this article is to describe a blood factor apparently not encountered previously. A case is reported in which sensitization to the new blood factor caused a fatal hemolytic reaction. REPORT OF CASE A Negroid woman, aged 35, was admitted to a hospital in Manhattan with the diagnosis of a bleeding peptic ulcer. According to the information received, the patient had been pregnant three times but had only one living child. On admission a blood count showed severe anemia, 4 gm. of hemoglobin per 100 cc, 1,280,000 red blood cells, and 29,000 white blood cells, with 73% neutrophils, 6% metamyelocytes, and 20% lymphocytes. A blood transfusion was attempted but discontinued after 100 cc. had been administered, because of a reaction consisting of chills and fever. A week later a blood count showed persistence of the anemia, and another From the Serological Laboratory of the Office of the Chief

Manhattan hospital eye, ear, nose and throat nursing.: As practiced at the manhattan eye, ear, nose and throat hospital, New York. 12 mo. of 338 pages, fully illustrated. W. B. Saunclcrs Company, Philadelphia and London. 1931. Price $2.25

Manhattan hospital eye, ear, nose and throat nursing.: As practiced at the manhattan eye, ear, nose and throat hospital, New York. 12 mo. of 338 pages, fully illustrated. W. B. Saunclcrs Company, Philadelphia and London. 1931. Price $2.25

Progress of Psychiatry in 1901

The record of American psychiatry for the past year is not an eventful one so far as matters of interest to trans-Atlantic readers are concerned. At the beginning of the year the subject of interest was the New York Pathological Institute and the difficulties that involved its management. For a number of months it has been in a state of suspended activity—not dead but sleeping—and now appears to be about to start again on a fresh career of usefulness. A new organisation has been planned, an advisory board appointed, consisting of recognised authorities in their departments, and including representatives of the related specialties of psychology and general biology, as well as those of pathology, neurology, and psychiatry. The gentlemen who have accepted positions on the board are well known, and their interest in the Institute and its aims undoubted. Their names will carry weight; Professor McKeen Cattell holds the chair of psychology in Columbia University, Professors Ewing and Herter represent the two great medical schools of Bellevue and Cornell, Dr. H. A. Hern, of Albany, a well-known neurologist, Dr. Bumpus, of the American Museum of Natural History, Drs. Pilgrim and Macdonald, representing the State Hospitals, and Dr. Frederick Peterson, ex officio, as commissioner of lunacy, complete the board. These gentlemen will exercise a general oversight over the work, and when a new working staff has been appointed, we may look for good work, carried on under more favourable conditions than was formerly the case. It is the intention in their reorganisation not only to carry on original research as in the past, but to utilize the Institute for special instruction of the members of the different asylum staffs in psychiatry and special research work. It will be located in one of the departments of the Manhattan Hospital until such time as a special reception hospital for the insane can be provided.