Marked tachypnea in siblings with chronic beryllium disease due to copper-beryllium alloy

Two biological sisters working at the same factory for > 9 years developed chronic beryllium disease (CBD) from a copper-beryllium alloy. Both had marked tachypnea (36 breaths/min and 45 breaths/min at rest, respectively), persisting over 8 years. Ventilation during exercise (assessed in one sibling) was grossly excessive (57 L/min, expected 23 L/min) with a respiratory rate of 64 breaths/min even with normal baseline routine pulmonary function tests. Blood beryllium lymphocyte transformation test and lung biopsies confirmed the diagnosis. No other cases of CBD have been reported from this plant among about 120 workers. These cases support the genetic basis for berylliosis and illustrate the marked tachypnea that may accompany this disease.

Pretreatment swallowing function in patients with head and neck cancer

BACKGROUND

Few objective data characterizing the pretreatment swallow function of patients with head and neck cancer are available.

METHODS

Pretreatment swallowing function in 352 patients with various lesions was evaluated with videofluoroscopy and compared with control subjects.

RESULTS

Patients had significantly longer oral and pharyngeal transit times, greater amounts of oral and pharyngeal residue, shorter cricopharyngeal opening durations, and lower swallow efficiencies. Swallow function worsened significantly with increased tumor stage, and patients with oral or pharyngeal lesions had worse swallow function than patients with laryngeal lesions. Frequency of complaint of swallow difficulty before treatment was 59%. Patients with lower stage tumors had fewer complaints of swallowing, as did patients with oral cavity lesions.

CONCLUSIONS

Despite demonstrating significant differences from control subjects, patients had highly functional swallows before treatment. The tendency for patients not to perceive a swallowing problem is consistent with the highly functional nature of their pretreatment swallow.

Efficacy of continuing advocacy in involuntary treatment

OBJECTIVE

The effectiveness of an experimental model of personal advocacy for involuntarily hospitalized psychiatric patients was examined. In the model, a personal advocate represented the needs and best interests of patients throughout the period of involuntary hospital treatment.

METHODS

The sample consisted of 105 involuntarily hospitalized psychiatric inpatients in Canberra, Australia. Fifty-three consecutive patients received personal advocacy, which started soon after they entered the hospital and lasted through the commitment process to the time of discharge from involuntary care. The outcome of this group was compared with that of 52 consecutive patients in a control group who received routine rights advocacy from hospital entry through the commitment hearing only.

RESULTS

The experimental and control groups were similar in demographic characteristics, diagnosis, and severity of illness. At the start of hospital care, satisfaction with care was similar in both groups; however, it improved significantly in the experimental group while it declined in the control group. Aftercare attendance was significantly better in the experimental group. The experimental subjects' risk of involuntary rehospitalization was less than half the risk of control subjects, and community tenure was significantly increased. Clinical staff reported that the experimental advocacy facilitated management of patients.

CONCLUSIONS

Compared with routine rights advocacy, the experimental advocacy based on patients' needs and best interests, which was maintained throughout the patients' involuntary hospitalization, significantly improved patients' and staff members' experience of involuntary treatment. Better compliance with aftercare among patients receiving personal advocacy led to a statistically and economically significant reduction in rehospitalization.

The truth about writing/writing about the truth

SUMMARY The essay examines how one writer turns her life experience into fiction, and explores the question so often asked of fiction writers, "Is that story really true?" Author Lesléa Newman uses her own work to show how the experience of losing her good friend, the poet Gerard Rizza, to AIDS, translated into a short story, a children's book and a novel told in fifty poems. Each form tells a different sort of truth about the experience the author went through in her process of assimilating her grief into her life and her work.