Single Weekday Research Articles

Understanding the route choice preferences of private and dock-based public bike users using GPS data in Seoul, South Korea

Analyzing route preferences is crucial for comprehending how individuals choose their travel paths, assessing road facilities, and anticipating upcoming traffic conditions. This study aimed to explore the factors influencing route selections made by private and public bike users and compare their decisions during peak and off-peak hours. Global positioning system (GPS) traces of 12,106 private bike users and 74,397 public bike users from a single weekday in Seoul, South Korea, were used. A map-matching process aligned the GPS data with a comprehensive cycling network encompassing bikeways, sidewalks, neighborhood roads, and their street attributes such as urban, park, and river streets. Choice sets composed of the shortest and 10th alternative routes were created to compare various road features with actual routes. By employing a path-size logit model to address overlapping issues among the routes, the results showed that buffered bike lanes separated from car flows positively influenced the route selection of bicyclists. Bike boulevards and shared sidewalk bikeways negatively impacted route decisions made by public bike users, with a more pronounced effect during peak hours. Furthermore, private bike users showed a decreased preference for routes in residential areas during peak hours, while an increased preference during off-peak hours. Moreover, public bike users preferred selecting routes in the presence of shopping-stores or amenities as well as public transit stations, with these effects being more pronounced during peak hours. These findings are expected to contribute to capturing valuable insights into the route preferences of bicyclists for the improvement of bicycle infrastructures.

Cross-analysis of the variability of travel behaviors using one-day trip diaries and longitudinal data

Many travel surveys used in transportation planning still collect information over a single weekday while mobility and activity patterns fluctuate from day to day. However, the emergence of new continuous data sources has led to the generation of large amounts of longitudinal data. Therefore, this paper aims to value these two data types to cross-analyze the temporal variability of aggregated travel behaviors. A weighting method based on large-scale single-day survey samples was first developed to extend the representativeness of the daily trip diaries available in the three most recent Origin-Destination household travel surveys of Montreal, Canada, to the entire data collection period (four months in the fall). This method was then validated using passive data streams (smart card and count data) for three modes: car, subway, and bicycle. The variations in the daily use of these modes measured independently by the surveys and passive data were compared over several months of the fall period and throughout an average week. Indicators were also proposed to evaluate whether the two data sources capture the same trend and seasonality, especially the weekly rhythms. The results show that it is possible to accurately infer day-to-day variability in travel behavior from a large-scale cross-sectional single-day survey. Furthermore, this paper demonstrates the potential for complementarity between traditional surveys and emerging data (at least over the survey period), as well as the possibility to combine them since there are large similarities in the aggregated travel patterns they allow monitoring.

Diurnal pattern of salivary cortisol and progression of aortic stiffness: Longitudinal study

BackgroundThe positive direct relation between stress and the development of cardiovascular disease has increasingly been recognized. However, the link between hypothalamic-pituitary-adrenal (HPA) dysregulation and subclinical cardiovascular disease has not been studied longitudinally. We investigated the relation of diurnal salivary cortisol, as a biological marker of stress levels, with progression of aortic stiffness over five years. MethodsA total of 3281 people (mean age 65.5) in the Whitehall II prospective study provided six saliva samples on a single weekday. We assessed the diurnal salivary cortisol using the daytime slope and bedtime level. Aortic stiffness was measured by carotid-femoral pulse wave velocity (PWV) at baseline (2007–2009) and five years later (2012–2013). Linear mixed models were used to estimate the association of diurnal salivary cortisol with baseline PWV and five-year longitudinal changes. ResultsDiurnal salivary cortisol were not associated with PWV at baseline. Among women but not men, a 1-SD shallower salivary cortisol slope at baseline was associated with a five-year increase in PWV (β = 0.199; 95% CI = 0.040, 0.358 m/s) and higher bedtime cortisol level (β = 0.208, 95% CI = 0.062, 0.354 m/s). ConclusionsDysregulation of the HPA axis measured using salivary cortisol (shallower slope, higher bedtime level) predicted the rate of progression of aortic stiffness among women.

HPA-axis activity and the moderating effect of self-esteem in the context of intimate partner violence in Cameroon

ABSTRACT Background: The experience of intimate partner violence (IPV) is stressful. One objective way to monitor it is to assess victims’ stress response by measuring the concentration of their salivary cortisol, the major stress hormone released by the hypothalamic–pituitary–adrenal axis. Objective: We investigated how the IPV experienced by women in Cameroon affects their stress levels and those of their children. Method: We recruited 50 mother–child dyads exposed to IPV and a control group of 25 mother–child dyads. All mothers completed questionnaires, including the Revised Conflict Tactics Scale to assess IPV, the Sense of Coherence Scale, and the Self-Esteem Scale, to assess their psychological resources. Mothers were asked to collect 3 saliva samples from themselves and 3 from their children on a single weekday: immediately after waking up, 30 minutes after waking up, and 45 minutes after waking up. The total cortisol secretion over the first hour after awakening was determined by calculating the area under the curve with respect to the ground (AUCg). Results: Mothers exposed to IPV exhibited higher total post-awakening cortisol concentrations compared with those in the control group. However, no significant difference was found between exposed and non-exposed children. In addition, higher IPV, specifically injuries, was significantly and positively associated with greater AUCg among mothers exhibiting lower self-esteem. When self-esteem was high, however, no significant effect of IPV on AUCg was observed. Conclusions: Of particular clinical significance is that self-esteem can modulate the stress levels of women exposed to IPV, a valuable insight into the development of effective psychosocial interventions to support IPV victims in sub-Saharan Africa.

Significantly Minimizing Drug Wastage and the Cost of Cabazitaxel Used to Treat Metastatic Castration-Resistant Prostate Cancer

Cabazitaxel is used to treat patients with metastatic castration-resistant prostate cancer progressing after docetaxel. It is prepackaged in 60 mg single-dose vials, a quantity much higher than the average prescribed dose, which leads to, substantial drug wastage (DW) and associated costs. To minimize DW we implemented a cost-saving, cohorting strategy where multiple patients scheduled to receive cabazitaxel (at a dose of 20mg/m2 every 3 wks) were cohorted and treated on a single weekday whenever possible. Excess drug from each vial was then saved and used for subsequent patients treated on the same day. The drug cost with cohorting was calculated from the actual number of vials used, and the drug cost without cohorting was estimated by assumingthat one vial was used per treatment. The cost of DW was determined based on the amount of drug that was discarded. All cost calculations also accounted for the discount incentives offered by Sanofi-Aventis. Over a 3-yr period, 74 patients received 402 treatments of cabazitaxel. Multiple patients were treated on 67.4% of the treatment days, and grouping of three patients on one day saved one vial. The estimated total drug cost saved was $394 536 CAD (21.1%). Pending further studies on safety and efficacy, this strategy could potentially be adopted to mitigate DW for cabazitaxel and similarly for other oncology drugs. This would significantly decrease the overall financial burden on patients, institutions, and stakeholders. Patient summaryCabazitaxel chemotherapy is associated with substantial drug wastage and associated costs. By cohorting patients scheduled to receive cabazitaxel on a single weekday, the total drug cost was decreased by $394 536 CAD (21.1%) over a 3-yr period. Similar strategies could be considered to overcome the prohibitory costs associated with drug wastage for cabazitaxel and other cancer drugs.

Haptic Nudges Increase Affected Upper Limb Movement During Inpatient Stroke Rehabilitation: Multiple-Period Randomized Crossover Study.

BackgroundAs many as 80% of stroke survivors experience upper limb (UL) disability. The strong relationships between disability, lost productivity, and ongoing health care costs mean reducing disability after stroke is critical at both individual and society levels. Unfortunately, the amount of UL-focused rehabilitation received by people with stroke is extremely low. Activity monitoring and promotion using wearable devices offer a potential technology-based solution to address this gap. Commonly, wearable devices are used to deliver a haptic nudge to the wearer with the aim of promoting a particular behavior. However, little is known about the effectiveness of haptic nudging in promoting behaviors in patient populations.ObjectiveThis study aimed to estimate the effect of haptic nudging delivered via a wrist-worn wearable device on UL movement in people with UL disability following stroke undertaking inpatient rehabilitation.MethodsA multiple-period randomized crossover design was used to measure the association of UL movement with the occurrence of haptic nudge reminders to move the affected UL in 20 people with stroke undertaking inpatient rehabilitation. UL movement was observed and classified using movement taxonomy across 72 one-minute observation periods from 7:00 AM to 7:00 PM on a single weekday. On 36 occasions, a haptic nudge to move the affected UL was provided just before the observation period. On the other 36 occasions, no haptic nudge was given. The timing of the haptic nudge was randomized across the observation period for each participant. Statistical analysis was performed using mixed logistic regression. The effect of a haptic nudge was evaluated from the intention-to-treat dataset as the ratio of the odds of affected UL movement during the observation period following a “Planned Nudge” to the odds of affected limb movement during the observation period following “No Nudge.”ResultsThe primary intention-to-treat analysis showed the odds ratio (OR) of affected UL movement following a haptic nudge was 1.44 (95% CI 1.28-1.63, P<.001). The secondary analysis revealed an increased odds of affected UL movement following a Planned Nudge was predominantly due to increased odds of spontaneous affected UL movement (OR 2.03, 95% CI 1.65-2.51, P<.001) rather than affected UL movement in conjunction with unaffected UL movement (OR 1.13, 95% CI 0.99-1.29, P=.07).ConclusionsHaptic nudging delivered via a wrist-worn wearable device increases affected UL movement in people with UL disability following stroke undertaking inpatient rehabilitation. The promoted movement appears to be specific to the instructions given.Trial RegistrationAustralia New Zealand Clinical Trials Registry 12616000654459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370687&isReview=true

Minimizing drug wastage (DW) and cost of cabazitaxel used to treat metastatic castrate-resistant prostate cancer (mCRPC).

6550 Background: Cabazitaxel is indicated for mCRPC, but is associated with substantial DW and financial strain on hospital budgets. It is only available in single-dose 60mg vials and has short reconstituted drug stability of &lt; 24 hours. We aimed to determine feasibility and cost savings of an aggressive batching strategy to facilitate vial sharing of Cabazitaxel. Methods: Our mitigation strategy was to administer Cabazitaxel 20mg/m2 q3-weekly (without prophylactic G-CSF) on a single weekday whenever possible. Drug was prepared after patient (pt) arrival. Remaining amount from each vial was saved for subsequent pts on the same day. Amount administered, discarded and number of (#) vials used were obtained from pharmacy records. We estimated drug cost without batching by assigning 1 vial/treatment, and drug cost with batching from the actual # vials used. Cost of DW was determined from the amount discarded. All cost calculations were based on market price ($96.7CAD/mg) accounting for Sanofi’s discount incentive (5 vials for the price of 4), allowing a real-world cost assessment. Results: Between 09/2015 and 09/2018, 74 pts received 404 Cabazitaxel treatments on 164 days using 319 vials. Multiple pts were batched on 68% treatment days. Every 3 pts batched saved 1 vial. Average dose/treatment was 37mg (20-45mg). Among 10 treatment cancellations, prepared drug was administered for subsequent pts in 9 cases. Drug and DW costs over the 3-year period with and without batching are shown in Table. Conclusions: Batching ≥3 pts on a single weekday was feasible and significantly lowered drug cost of Cabazitaxel by reducing wastage. This strategy could help mitigate costs associated with wastage for other oncology drugs. [Table: see text]

Impact of the Weekday of Surgery on Outcome in Gastric Cancer Patients who Underwent D2-Gastrectomy.

The impact of the weekday of surgery in major elective cases of the upper-GI has been discussed controversially. The objective of this study was to assess whether weekday of surgery influences outcome in patients undergoing D2-gastrectomy. Patients who underwent D2-gastrectomy for gastric adenocarcinoma between 1996 and 2016 were included. Weekday of surgery was recognized, and subgroups were analyzed regarding clinical and histopathological differences. Survival analysis was performed based on weekday of surgery, and early weekdays (Monday-Tuesday) were compared with late weekdays (Wednesday-Friday). In total, 460 patients, 71% male and 29% female, were included into analysis. The median age was 65years. Distribution to each weekday was equal and ranged from 86 cases (Wednesday) to 96 cases (Tuesday). The pT, pN and M category and the rate of patients who underwent neoadjuvant treatment did not show significant differences (p=0.641; p=0.337; p=0.752; p=0.342, respectively). The subgroups did not differ regarding the number of dissected lymph nodes and rate of R-1/2 resections (p=0.590; p=0.241, respectively). Survival analysis showed a median survival of 43months (95% CI 31-55months), and there was no single weekday or a combination of weekdays (Mon/Tue vs Wed/Thu/Fri) with a significant favorable or worse outcome (p=0.863; p=0.30, respectively). The outcome did not differ regarding mortality within the first 90days after surgery (p=0.948). The present study does not show any evidence for a significant impact of weekday of surgery on short- and long-term outcome of patients undergoing gastrectomy for gastric adenocarcinoma.

Editorial

Many readers will be familiar with the challenges associated with the measurement of quality in acute medicine. The annual Society for Acute Medicine Benchmarking Audit (SAMBA) has attempted to map performance of acute medical units (AMUs) against quality standards established by SAM in 2011. The data presented in this autumn’s edition need to be interpreted with some caution – a single weekday in June is not necessarily representative of practice at other times of the year, and the figures are more than one year old, with the 2015 audit data currently being analysed. However the paper contains some interesting points which are worthy of comment. Overall, around 20% of patients waited more than 4 hours from arrival on the AMU before being seen by a ‘competent decision maker’, while more than a third of patients waited longer than the defined standard (8 hours during daytime and 14 hours after 5pm) to see a consultant. It should be noted, however that almost 70% of these patients passed through the Emergency Department (ED) prior to their arrival on the AMU, and many will therefore have already seen a senior ED clinician with a management plan being initiated. It is clearly important that Units who admit significant numbers of patients directly from General Practitioners are recording time delays for this group of patients, who should be subject to the same degree of rigorous prioritisation afforded to patients in the ED. It is also of interest that those patients least likely to fulfil all three of the defined standards were those who arrived on the AMU in the early evening period (5pm-10pm), while patients who arrive after 10pm were most likely to be seen within the appropriate time period. This is not surprising when one considers the way in which arrangements for consultant review are often designed, with morning ‘post take’ ward rounds enabling review of those patients who were admitted overnight. This needs to be addressed – 25% of patients arrived on the AMU during the evening period, and local experience suggests that many of these are patients referred directly by general practitioners. Many units now have a consultant presence on AMU until 8pm and some have extended this further to enable real-time consultant review of this cohort of patients later into the evening. Of the units which participated in SAMBA14, 97% were visited daily by a pharmacist. Pharmacists have clearly become an integral part of the AMU team over the past decade, and their value in performing medicines reconciliation is highlighted in Maria Richards’ article. While it is disappointing to read that the error rate in the medical drug history was so high for patients admitted to the AMU, accuracy was greater for patients sent in by general practitioners, suggesting that the availability of information at the time of clerking was a key factor. Widening access to, and use of the Summary Care Record, as recommended by the authors, would be a major step forward in reducing the risk associated with drug errors. Our ‘viewpoint’ section features two articles promoting different approaches to the interface between primary and secondary care. Stephen Gulliford has presented a year’s worth of data from his Ambulatory Emergency Care service in Wigan. The importance of a protected space in close proximity to the ED is demonstrated by the dramatic reduction in numbers of patients utilising the service when it was relocated due to local bed pressures. Overnight conversion of ambulatory care areas into bedded facilities may provide a temporary solution to operational pressures, but the knock-on impact can be significant. Ben Jamieson’s ambulatory service in Plymouth is staffed by General Practitioners, who also take calls from their colleagues working in the community. Utilising this model has enabled 50% of GP referrals to be managed without overnight admission, with a combination of clinical advice, ambulatory care and alternative pathways. Dr Jamieson highlights the complimentary skills which GPs can bring to an acute medicine team, although widespread adoption of this model might be limited by current recruitment challenges – which are apparently as great in general practice as they are in acute medicine.

Epigenetic modulation of glucocorticoid receptors in posttraumatic stress disorder

Some individuals suffering from posttraumatic stress disorder (PTSD) exhibit lower basal salivary cortisol and higher glucocorticoid receptor (GR) sensitivity. Recent studies suggest that epigenetic mechanisms regulate the activity of cortisol and GR. As a means to combine and cross-validate those findings, we compared cortisol, GR expression and promoter methylation levels in peripheral T lymphocytes of healthy controls versus individuals endorsing a diagnosis of lifetime PTSD. Thirty subjects with lifetime (current or remitted) PTSD and 16 subjects never exposed to trauma were recruited. Salivary cortisol was collected at six time points over the course of a single weekday and analyzed utilizing a time-resolved fluorescence immunoassay. GR expression (GRtotal, 1B, 1C, 1F and 1H) was measured by quantitative RT-PCR. DNA methylation levels in human glucocorticoid receptor (hGR) 1B and 1C variant's promoter were quantified by epityper in T lymphocytes isolated by magnetic-assisted cell sorting. Individuals with lifetime PTSD have lower morning cortisol release, higher mRNA expression of hGRtotal, 1B, and 1C and lower overall methylation levels in hGR 1B and 1C promoters. Cortisol levels were inversely correlated with hGR 1B mRNA expression. Moreover, overall and CpG site-specific methylation levels were inversely correlated with hGRtotal and 1B mRNA expression. There was no difference between current and remitted PTSD across cortisol, GR expression mRNA and DNA methylation data. Traumatic events induce DNA methylation alterations in distinct promoters of hGR with transcriptional modifications that associate with hypoactive hypothalamus-pituitary-adrenal axis in individuals with PTSD. Our results also point toward an important role of hGR 1B variant in PTSD.

Staffing levels and patient dependence in English stroke units

Little research has been performed to determine how a stroke unit should be staffed and what the links are between patient dependency and staffing. For this study, 140 stroke units were randomly selected--35 from each of the four quartiles of performance in the National Sentinel Audit of Stroke. A questionnaire was sent to each of the units to collect data on patient numbers and dependency, staffing numbers and therapy, and nursing contact times on a single weekday. The response rate was 66% (92 sites) and information on 1,398 patients was provided. The median number of beds was 18 (interquartile range 12-24). Staffing levels per 10 beds were a median of 10.9 nurses, 1.7 physiotherapists, 1.3 occupational therapists and 0.4 speech and language therapists. Of the patients, 74% received physiotherapy, 46% occupational therapy and 25% speech and language therapy during the day with median contact times being 170 minutes for nursing, 40 minutes for physiotherapy, 45 minutes for occupational therapy and 30 minutes for speech therapy. There was a weak correlation between patient dependency and contact time with nurses and therapists. Stroke patients in England receive relatively little rehabilitation from therapists and there is a wide variation in the amount of nursing time each patient receives.

Hospital in‐patients with diabetes: increasing prevalence and management problems

To re-assess the prevalence, management problems, clinical outcomes and discharge summaries of hospital in-patients with diabetes. Case records of all patients occupying in-patient beds were audited on a single weekday in 2003 in a large urban hospital and repeated after 3 months. Data was compared with an identical audit 12 years previously. Over 12 years the number of beds available for admission (1191) had reduced by 25% with a bed occupancy of 97%. Diabetes prevalence had increased from 7.0% to 11.1% (P < 0.01) (97% Type 2). Diabetes management was considered inappropriate in 29%, more than in 1991 (20%). After 3 months, discharge summaries had been completed on 75% of patients but diabetes was mentioned in only 53%. The prevalence of in-patient diabetes (11.1%) was over 50% greater and diabetes management was suboptimal in more patients than in 1991. In many length of stay was prolonged and almost half of the discharge summaries did not mention diabetes. These findings have major implications for service delivery and resource planning.

Weighing in the Issue of Heavy Schoolbags Carried by Pupils in Primary School

LANGUAGE NOTE | Document text in English; abstract also in Chinese.The issue of heavy schoolbags is a common concern among educationists, parents and school children. The pervasiveness of the carriage of heavy schoolbags among 482 primary school pupils from two schools was studied. Participants were grouped according to sex and primary levels (i.e. P1 &amp; P2, aged 7-8 years and P3 &amp; P4, aged 9-10 years). Body mass with and without schoolbags was measured on a single weekday using a calibrated weighing machine. Pupils also completed a 10-item questionnaire that solicited responses about the type of schoolbag carried, the number of bags carried, how the bags were carried, whether they felt that their bags were too heavy, if they had suffered pain, soreness or numbness from carrying the schoolbags and information about their travel to and from school. Results revealed that pupils carried bags that weighed about 15% to 17% of body weight. The figures also indicated that 60.4% of the lower primary group (P1 and P2) exceeded the guideline of 3.5 kg outlined by the Ministry of Education (Singapore) for schoolbags, and 55.8% exceeded the guideline of 4.5 kg for the middle primary group (P3 and P4). Participants also reported that they carried bags that were too heavy, and experienced pain, soreness or numbness in the neck, shoulders or back. Results of this study indicate that more can be done to reduce the physical load of schoolbags for primary pupils. Implications of the findings are discussed, including two current initiatives to create an electronic learning environment within the school compound where pupils can access textbook and workbook information.在發展中國家與發達國家中，學齡兒童的書包重量不當是引起青年期或成年后腰背部疼痛的常見原因之一，往往是由於書包過重所致。本文對新加坡兩所小學進行了調查，結果提示學生書包的重量普遍超過健康指南所規定的最大重量。因此，在提高健康水平及健康敎育方面還需做大量的工作，以減輕小學生，特別是低年級學生體力上的負荷。

Modeling Annual Benzene, Toluene, NO 2, and Soot Concentrations on the Basis of Road Traffic Characteristics

The investigation of potential adverse health effects of urban traffic-related air pollution is hampered by difficulties encountered with exposure assessment. Usually public measuring sites are few and thereby do not adequately describe spatial variation of pollutant levels over an urban area. In turn, individual monitoring of pollution exposure among study subjects is laborious and expensive. We therefore investigated whether traffic characteristics can be used to adequately predict benzene, NO 2, and soot concentrations at individual addresses of study subjects in the city area of Munich, Germany. For all road segments with expected traffic volumes of at least 4000 vehicles a day ( n=1840), all vehicles were counted manually for a single weekday in 1995. The proportion of vehicles in “stop–go” mode, an estimate of traffic jam, was determined. Furthermore, annual concentrations of benzene, NO 2, and soot from 18 high-concentration sites (means: 8.7, 65.8, and 12.9 μg/m 3, respectively) and from 16 school sites with moderate concentrations (means: 2.6, 32.2, and 5.7 μg/m 3, respectively) were measured from 1996 to 1998. Statistical analysis of the data was performed using components of two different statistical models recently used to predict air pollution levels in comparable settings. Two traffic characteristics, traffic volume and traffic jam percentage, adequately described air pollutant concentrations ( R 2: 0.76–0.80, P=0.0001). This study shows that air pollutant concentrations can be accurately predicted by two traffic characteristics and that these models compare favorably with other more complex models in the literatue.

Malnutrition in hospitalized pediatric patients. Current prevalence.

To document the current prevalence of protein-energy malnutrition compared with that reported from the same institution in 1976. All inpatients of this tertiary-care facility were assessed by anthropometric, laboratory, and clinical nutrition assessment methods in a 1-day cross-sectional survey. The comparison study from 1976 was also a 1-day cross-sectional survey. A tertiary-care facility in Boston, Mass. The entire inpatient population was assessed on a single weekday in September 1992. Prevalence of acute and chronic malnutrition as judged by anthropometric and laboratory data. Data on demographics, admission classification, underlying disease, route of nutrition, and global nutritional status were also assessed. The prevalence of acute protein-energy malnutrition (weight for height) based on the Waterlow criteria was as follows: severe, 1.3%; moderate, 5.8%; mild, 17.4%; and none, 75.5%. The prevalence of chronic protein-energy malnutrition (height for age) was as follows: severe, 5.1%; moderate, 7.7%; mild, 14.5%; and none, 72.8%. Although the prevalence of acute and chronic protein-energy malnutrition was significantly less in 1992 than in 1976 (P = .03 and P < .001, respectively), the numbers are still alarmingly high. Children younger than 2 years and older than 18 years and those with chronic medical conditions had a higher prevalence of protein-energy malnutrition. Twenty-four percent of patients had a serum albumin level less than 30 g/L, 34.8% had a total lymphocyte count less than 1.5 x 10(9)/L, and 24.9% had a hemoglobin concentration less than 105 g/L. One fourth of all patients were obese (> 120% weight for height), with the greatest prevalence in children aged 2 to 18 years. Acute and chronic protein-energy malnutrition remains common in hospitalized pediatric patients in the United States. Important risk factors may be underlying chronic disease, periods of normally rapid growth, and recognized need for nutrition intervention.

Psychotropic drug prescriptions for elderly patients in a general hospital.

A survey was made of drug prescriptions written for all medical/surgical patients in a general hospital on a single weekday in 1978. Of these 348 patients, 195 were over the age of 60. In this elderly group, 62 (32 percent) were receiving psychoactive drugs. Flurazepam was the drug most commonly prescribed (in 63 percent of the patients). Diazepam was the most frequently prescribed nonhypnotic psychoactive drug (in 29 percent). Neuroleptic drugs and phenothiazine anti-emetics (in 52 percent) were not prescribed for psychosis but for augmenting analgesia and sedation and for reducing nausea. The average daily doses were about 20 percent of those used to treat psychotic young adults. All antidepressants (in 9.7 percent) had been prescribed before admission. No monoamine oxidase inhibitors were used, and doses of tricyclic antidepressants were half to one-third lower than those used to treat younger depressed adults. Antidepressants, which pose a risk to the elderly patient, were overprescribed and underdosed.