A wireless potentiostat for mobile chemical sensing and biosensing

Wireless chemical sensors are used as analytical devices in homeland defence, home-based healthcare, food logistics and more generally for the Sensor Internet of Things (SIoT). Presented here is a battery-powered and highly portable credit-card size potentiostat that is suitable for performing mobile and wearable amperometric electrochemical measurements with seamless wireless data transfer to mobile computing devices. The mobile electrochemical analytical system has been evaluated in the laboratory with a model redox system - the reduction of hexacyanoferrate(III) - and also with commercially available enzymatic blood-glucose test-strips. The potentiostat communicates wirelessly with mobile devices such as tablets or Smartphones by near-field communication (NFC) or with personal computers by radio-frequency identification (RFID), and thus provides a solution to the 'missing link' in connectivity that often exists between low-cost mobile and wearable chemical sensors and ubiquitous mobile computing products. The mobile potentiostat has been evaluated in the laboratory with a set of proof-of-concept experiments, and its analytical performance compared with a commercial laboratory potentiostat (R(2)=0.9999). These first experimental results demonstrate the functionality of the wireless potentiostat and suggest that the device could be suitable for wearable and point-of-sample analytical measurements. We conclude that the wireless potentiostat could contribute significantly to the advancement of mobile chemical sensor research and adoption, in particular for wearable sensors in healthcare and sport physiology, for wound monitoring and in mobile point-of-sample diagnostics as well as more generally as a part of the Sensor Internet of Things.

Psychiatric evaluation of death-hastening requests. Lessons from dialysis discontinuation

The authors aim to facilitate the psychiatric evaluation of death-hastening decisions, such as cessation of life-support treatment or physician-assisted suicide, by deriving principles for evaluating patients from a literature review and a recently completed prospective study on dialysis discontinuation conducted by consultation psychiatrists. Factors are delineated and suggestions are provided for the evaluation of requests to accelerate dying. Included are the authors' method for determining major depression in the context of terminal illness and their "vector analysis" in assessing patient requests to stop dialysis. As our society heatedly examines the care provided to the terminally ill, psychiatry also needs to reconsider whether actions that foreshorten life can be normative and permissible. Familiarity with competency, psychiatric diagnosis, and ease in communication and negotiation between patient, family, and staff are resources that psychiatrists can bring to these complicated assessments. Challenging areas include diagnosing depression, establishing the adequacy of palliative care, and appreciating issues related to personality features, family dynamics, and ethnic differences.

An annotated bibliography for ethics training in consultation-liaison psychiatry

The expanding field of bioethics has created a need in psychiatry for rapid access to the complex bioethics literature. This is especially true in consultation-liaison work. An annotated bibliography was created by a task force of the Academy of Psychosomatic Medicine charged with exploring how psychiatrists function on bioethics committees. The bibliography is organized into headings that reflect how bioethical problems came to the attention of psychiatrists. Introductory references allow the reader an overview of the history of bioethics and a selection of useful textbooks. References are provided explaining how ethical principles are used. References are also organized by areas of medical work frequently visited by consultation-liaison psychiatrists.

Psychiatry and bioethics. An exploration of the relationship

Psychiatrists have been extensively involved in ethics in the general hospital over the past two decades and have functioned in that area in a variety of roles. The basis for psychiatry's strong interest in bioethics can be understood as related to three factors: familiarity with many of the clinical problems that lead to bioethics consultation, the frequent importance of psychiatric aspects of ethics, and the observation that psychiatrists already possess many of the clinical skills necessary for doing ethics work. The particular value of training psychiatrists to serve as ethics consultants, in addition to the importance of their continuing role on hospital ethics committees, is discussed.

Four-year follow-up of the influence of psychological comorbidity on medical rehospitalization

OBJECTIVE

This study tested the hypothesis that psychiatric comorbidity measured in medical and surgical general hospital inpatients predicts increased readmissions and days spent rehospitalized at the same hospital up to 4 years after discharge.

METHOD

A convenience sample of 273 medical/surgical inpatients aged 18 years and older were given psychological tests during their third to fifth hospital days on medical and surgical units from June 1, 1985, through June 30, 1986. The main outcome measure was the number of medical/surgical readmissions and number of days rehospitalized during a 4-year follow-up at the same institution.

RESULTS

Compared to the rest of the study group, the cognitively impaired patients (according to the Mini-Mental State examination) averaged twice as many rehospitalizations and three times as many days rehospitalized at 6-month follow-up and twice as many days rehospitalized at 2-year follow-up. Compared to the rest of the group, the patients who were depressed or who had high interpersonal sensitivity scores at the index admission spent twice as many days rehospitalized during the 4-year follow-up, while the patients with high hostility scores had almost twice as many readmissions. These results remained statistically significant after separate partialing out of the effects of severity of functional impairment, age, cognitive impairment, and number of admissions or days spent hospitalized before the index admission.

CONCLUSIONS

Psychiatric comorbidity, previously well documented as contributing to increased length of stay in the general hospital, is associated with increased hospital utilization for at least 4 years after discharge.

Consultation-liaison psychiatry fellowship in primary care

OBJECTIVE

This article describes the need for and development of an outpatient primary care psychiatry fellowship program.

METHOD

The Department of Psychiatry at Hillside Hospital established a primary care fellowship for psychiatrists in 1994, through its consultation-liaison (C-L) service. Staff alliances established by the C-L service with primary care physicians provided the basis for identifying appropriate outpatient practices in the community. Knowledge and skills objectives were adapted from a traditional C-L fellowship to outpatient primary care medicine.

RESULTS

The selection of a psychologically minded primary care practitioners was crucial. Practitioners used an inclusive model in which fellows would see all patients with them, not just those with mental disorders. Fellows have felt comfortable working in the primary care setting and have been well received by practitioners, staff, and patients. The practitioners were clearly more interested in psychosocial aspects of their patient than were primary care residents.

CONCLUSIONS

The gap in preparing U.S. psychiatrists to function in integrated primary care programs requires establishing a presence in the primary care setting. Skills and relationships from traditional C-L settings can be productively used to accomplish this goal.

Correlation of pain with temperature and blood-flow changes in the lower limb following chemical lumbar sympathectomy in reflex sympathetic dystrophy. A case report

Temperature and microcirculatory blood flow studies have been measured before and after chemical sympathectomy in a patient with reflex sympathetic dystrophy of the left leg present for at least three years following surgery for glomus tumour. Normalisation of temperature and blood flow was associated with the relief of pain, present initially when the limb was hypothermic and vasoconstricted and recurring when the limb was hyperthermic and vasodilated. It is possible that such objective measurement may be used to determine the optimal management of RSD.

Reflex Sympathetic Dystrophy and Repetitive Strain Injury: Temperature and Microcirculatory Changes following Mild Cold Stress

Temperature and blood flow studies were performed in the upper limbs of six patients with reflex sympathetic dystrophy (RSD), nine patients with repetitive strain injury (RSI) and 12 control subjects using thermography, laser Doppler flowmetry, infrared photoplethysmography and venous occlusion strain gauge plethysmography. The contralateral responses of the symptomatic and asymptomatic limbs were examined after being subjected, separately, to mild cold stress (20°C for 1 min). Altered thermoregulation and haemodynamics were evident in RSD. Though the pattern of response to contralateral cold challenge is similar to normal in RSI, vasodilatation and reduced vasomotion appears to be characteristic in this condition. Such changes may assist in distinguishing between RSD and RSI from other causes of chronic upper limb pain.

Design and evaluation of a device for measurement of interface pressure

An electropneumatic device has been designed to measure the interface pressure profile under compression bandages. The device uses commercially available pneumatic sensors (Talley Group Ltd, SJ235/3) and measures interface pressure at up to eight sites simultaneously along the lower limb, with an accuracy of +/- 3 mmHg. Measurements can be made in one of two modes: continuously at a rate of up to three samples per second with the results output to a suitable display device, or single measurements of interface pressure can be made and displayed on a digital display incorporated in the device. This enables the monitoring and recording of interface pressure under compression bandages during either ambulation or passive recumbency. The electropneumatic system is described together with its following characteristics: the hysteresis of the Talley pneumatic sensors, the accuracy of pressure measurement and the maximum achievable sample rate. Dynamic measurements in a single normal volunteer are shown.

Psychological comorbidity and length of stay in the general hospital

OBJECTIVE

As general hospitals search for ways to cut costs without sacrificing efficiency, particular attention has been focused on factors that may prolong hospital stay. The results of prior studies that have reported an association between psychological and psychiatric comorbidity and longer hospital stays have been subject to different interpretations because of methodological design flaws. The current paper reports on a study of psychological comorbidity and length of stay that has been designed to avoid the methodological problems of earlier investigations.

METHOD

The study was performed at a 429-bed tertiary-care, university-affiliated, voluntary, teaching hospital. During hospital days 3 to 5, patients were tested as available with the Mini-Mental State examination, the Zung Depression Inventory, and the SCL-90 and were rated for physical impairment with the Karnofsky Performance Status Scale. Statistical analyses were performed for correlations between length of stay and test scores, rating scales, and demographic and discharge data from the chart.

RESULTS

Of 424 patients approached, 321 (76%) agreed to participate and 278 (65.6%) completed the test battery. Depression, anxiety, and organicity, measured by psychological tests, were significantly correlated with longer hospital stay. These correlations remained significant after the authors controlled for degree of physical impairment, emergency versus elective admission, and medical versus surgical service, which were themselves correlated with longer hospital stay.

DISCUSSION

This study confirms a significant correlation between psychological comorbidity and length of stay after correcting for the methodological pitfalls found in earlier studies. The clinical, research, economic, and policy implications of these findings are discussed.

"Doom anxiety" and delirium in lidocaine toxicity

Of 15 patients with psychiatric reactions to lidocaine, 12 (80%) had mood changes, 11 (73%) had "doom anxiety," eight (53%) had overt confusional states, and six (40%) had hallucinations and delusions. The authors contend that morbid fears of impending doom or the belief that death has occurred are specific manifestations of lidocaine toxicity and may be mistakenly attributed to "understandable" fears about death during the course of recovery from a myocardial infarction on the coronary care unit.

Psychological outcome of lumpectomy versus mastectomy in the treatment of breast cancer

Forty-six patients who underwent modified radical mastectomy were compared 14 months after surgery with 21 patients who underwent lumpectomy and radiation; all patients had stage I or II breast cancer. Lumpectomy patients reported less of a loss of feelings of attractiveness and femininity, were less self-conscious about their appearance, received more emotional support from friends, and were more open about their surgery and sexual feelings after surgery. Unlike the mastectomy patients, they saw their spouses' sexuality as enhanced after surgery. Lumpectomy patients were not less anxious or less depressed but showed better overall adaptation to their surgery and less functional change.

Psychiatric aspects of voluntary sterilization in young, childless women

An increasing number of young, childless women currently seek tubal ligation for fertility control. They state that they have no maternal aspirations and that available contraceptive methods are not safe enough. This aspect of voluntary sterilization has received little attention by psychiatrists in the past. This paper presents a psychological picture of seven women with a particular focus on some psychodynamic considerations underlying their wish to remain childless and the role of the psychiatrist in the decision-making process for this procedure.

Demographic and clinical characteristics of black psychiatric patients in a private general hospital

A study of 419 first admissions to a private general hospital psychiatric inpatient unit showed that only 8.8 per cent were blacks, while 23 per cent of the population in the community were blacks. When compared to white patients, blacks were much less likely to be rerred for hospitalization by private sources, were substantially younger, and had shorter hospitalizations. The most common diagnosis for blacks was paranoid schizophrenia. The authors conclude that despite the widespread availability of third-party insurance coverage, blacks use the private general hospital less ofter than whites and their patterns of use are substantially different.