No abstract

The teachers who play the all-important role of enabling students to learn on clinical clerkships must balance the two essential skills of being a good role model and maintaining objectivity in order to identify students with a variety of problems. This study describes the findings of a survey that identifies both the type of the problems that most bother teachers and the relative frequency of those problems. Non-cognitive problems (poor interpersonal skills and non-assertive, shy students) were identified by teachers as being seen at the same relative frequency but posing greater difficulty than cognitive problems (poor integration skills, disorganization, poor fund of knowledge, etc.). A variety of the types of interventions to these problems are discussed.

Although gradual global progression is one of the cardinal features of primary degenerative dementia of the Alzheimer type, clinical observation of patients suggested that there is some variability in the degree and rapidity of decline of different symptoms of this illness. In particular, it appeared that language fluency and self-awareness of memory problems did not decline simultaneously. This study was designed to test the hypothesis that an inverse relationship exists between self-awareness and fluency in patients with Alzheimer's disease. Thirty-two patients suffering from Alzheimer's disease were divided into two groups on the grounds of presence or absence of self-awareness of memory handicaps. These patients were also assessed in regard to fluency using a three-point scale devised for this purpose. A significant inverse association was found between self-awareness and fluency. This appeared to be a specific relationship, unrelated to global indicators of function including Mini-Mental Status Evaluation, Aphasia Screening Test scores or demographic features. Possible implications of this with reference to intracerebral localization issues in mild-moderate Alzheimer's disease are discussed.K E Y WORDS-Alzheimer's disease, language, fluency, self-awareness, memory.

Conclusions: Measurements of urinary albumin, total protein, and albumin-to-creatinine ratio are minimally affected by storage at ؊70°C for approximately 2.5 yr. Prolonged storage results in small decreases of urinary albumin and protein that do not substantially affect phenotype classification of overt renal disease.

The PASARR referral process detected a group of seriously mentally ill, functionally disabled patients, most of whom required the level of care that nursing homes provide. Depressed and psychiatrically impaired dementia patients were underrepresented in the referral pool as measured against widely accepted prevalence figures for mental disorders in nursing home populations. The PASARR process as currently configured appears to be most efficient in identifying schizophrenic patients, who represent a small minority of nursing home residents, and the skewed sample it generates fails to provide an adequate basis for estimating overall mental health services needed in nursing homes. The PASARR process should be altered to improve referral rates for depressed and behaviorally disturbed dementia patients.