A widower, set. 69, was admitted recently to the Glasgow Royal Mental Hospital in an anxious, apprehensive, excited, restless state. The history of the case showed that he had come of a good stock, and that he had been a strong, healthy man. For a period of forty-six years he had been employed by the same firm of lawyers, and latterly had been their cashier. He had married twice; there were four children from the first marriage and two from the second. He had divorced his second wife on account of her unfaithfulness. In January, 1919, he resigned his position, sold his home, and made plans to live with his daughter. Three days after his home and furniture had been sold he made a determined attempt on his life by cutting his throat. One month later he was admitted to the Glasgow Royal Mental Hospital. Following his admission he continued in a state of abject misery, he moaned and groaned, wrung his hands, resented any interference, and was very restless. He realised that he was in a hospital, but his mind was so occupied by his depressive thoughts and he was so miserable that he would not assist in a satisfactory mental examination. Physically he was in poor general health, his pulse was irregular and intermittent, and he had peripheral arterio-sclerosis. During the next few months he gradually improved in strength and general condition but mentally panics of anxious apprehension supervened from time to time, in which he became self-accusatory, and expressed hopeless feeling as regard his prospect of recovery. At the same time he was perfectly oriented, and his memory, general knowledge, and personality were all well retained. No particular attempt was ever made at psycho-analysis (his age seemed to preclude such a procedure), but nevertheless casual conversations* were sufficient to allow him to give expression to his fears, and incidentally to show where his conflicts and difficulties lay. He complained of the other patients, said that they looked as if they could tear his bones out, that they wished to do him an injury, that they slandered him, that they accused him of incest with his daughter. At this point he began to defend himself with great warmth and emphasis, and said, quite unnecessarily, that the only thing that supported him was the consciousness of his own rectitude, that nothing had been further from his thoughts, etc. These matters were never argued out with him, but he was encouraged always to say what he had to say, and eventually six months after admission he was discharged as recovered.
Abstract Background To facilitate early detection and prompt isolation of infected patients during the 2022-23 and 2023-24 fall/winter seasons, the NIH Clinical Center, a clinical research hospital serving a significantly immunocompromised patient population, augmented symptom screening with Influenza and RSV testing of all patients on admission. Methods Nasopharyngeal (NP) swabs were collected on admission from November 2022-April 2023 and September 2023-April 2024. All samples were tested for Influenza and RSV by PCR on the Panther Fusion® SARS-CoV-2/FluA/B/RSV Assay (Hologic, Inc.) or the Xpert® Xpress CoV-2/Flu/RSV test. Patients who disclosed symptoms on admission were tested using the BioFire® Respiratory Panel. Medical chart reviews and discussions with patient care providers elucidated whether cases identified on admission were asymptomatic. Results Of 3197 NP swabs collected from patients admitted to our hospital, 31 swabs were from patients who were symptomatic on admission. Of the remaining 3166 NP swabs (from 2352 unique patients, as some patients had multiple admissions), 17 patients were found to be infected: 7 (0.22%) Influenza A, 1 (0.03%) Influenza B, and 9 (0.28%) RSV. Of these patients that were asymptomatic on admission, 8 (47%) subsequently disclosed symptoms (1 with recent confirmed diagnosis of Rhinovirus/Enterovirus infection), 2 (12%) disclosed a recent history of an unknown respiratory infection, and 7 (41%) were asymptomatic. Seven Influenza A and 8 RSV infections were detected between the months of November and January, yielding positivity rates of 0.57% and 0.66%, respectively, during these months when community transmission was highest. Conclusion Admission surveillance for Influenza and RSV during months of increased community transmission allowed us to isolate seventeen patients on admission who would likely not have been appropriately isolated based on symptom screening alone. Admission surveillance testing, in conjunction with symptomatic surveillance, is important to identify infected patients promptly during increased respiratory virus activity in the community, and especially for institutions serving immunocompromised patients. Disclosures All Authors: No reported disclosures
We evaluated saliva (SAL) specimens for SARS-CoV-2 reverse transcriptase PCR (RT-PCR) testing by comparison of 459 prospectively paired nasopharyngeal (NP) or midturbinate (MT) swabs from 449 individuals with the aim of using saliva for asymptomatic screening. Samples were collected in a drive-through car line for symptomatic individuals ( n = 380) and in the emergency department (ED) ( n = 69).
Addressing the unequal impact of health disparities on historically marginalized communities is a top public health priority. Diversifying the work force has been lauded as key to addressing this challenge. Contributing to diversity in the workforce is the recruitment and retention of health professionals previously excluded and underrepresented in medicine. A major obstacle to retention, however, is the unequal way in which health professionals experience the learning environment. Through this perspective of 4 generations of physicians and medical students, the authors seek to highlight the similarities that have persisted over 40 years in the experiences of being underrepresented in medicine. Through a series of conversations and reflective writing, the authors reveal themes that spanned generations. Two common themes among the authors are the feeling of not belonging and feeling invisible. This is experienced in various aspects of medical education and academic careers. The lack of representation, unequal expectations, and over taxation contributes to the feeling of not belonging, leading to emotional, physical, and academic fatigue. Feeling invisible, yet paradoxically being hyper-visible, is also common. Despite the challenges, the authors conclude with a sense of hope for the future, if not for them, for the generations to come.
Letters and Corrections1 November 1981Varicella-Zoster Virus Infection Among Cancer PatientsDAVID K. HENDERSON, M.D., JOAN M. LANIAK, R.N., RAMONA F. MYERS, R.N., JOHN E. BENNETT, M.D., STEPHEN STRAUS, M.D.DAVID K. HENDERSON, M.D.Search for more papers by this author, JOAN M. LANIAK, R.N.Search for more papers by this author, RAMONA F. MYERS, R.N.Search for more papers by this author, JOHN E. BENNETT, M.D.Search for more papers by this author, STEPHEN STRAUS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-95-5-655_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: We read with interest the article on varicella-zoster virus infection among cancer patients (1). Although Morens and associates presented convincing evidence that the increased incidence of varicella-zoster virus infections from July to October 1976 may have represented an outbreak of varicella-virus infection, the evidence presented to delineate the route of spread of infection is not as well established. Most of this investigation was necessarily retrospective and was based on chart review, the written descriptions of lesions, and the recollections of hospital staff. The distinction of cases into the probable zoster (reactivation infection) and doubtful zoster (apparent exogenous...References1. MORENSBREGMANWEST DDC. An outbreak of varicella-zoster virus infection among cancer patients. Ann Intern Med. 1980;93:414-9. LinkGoogle Scholar2. STRAUSAULAKHRUYECHAN SHW. Studies on the structure of the varicella zoster virus DNA. J Virol. In press. Google Scholar1. HENDERSONLANIAKMYERSBENNETTSTRAUS DJRJS. Prevention of nosocomial varacella zoster disease. Ann Intern Med. 1981;95:515-6. Letter. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: DAVID K. HENDERSON, M.D.; JOAN M. LANIAK, R.N.; RAMONA F. MYERS, R.N.; JOHN E. BENNETT, M.D.; STEPHEN STRAUS, M.D.Affiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 November 1981Volume 95, Issue 5Page: 655-656KeywordsChartsLesions ePublished: 1 December 2008 Issue Published: 1 November 1981 PDF downloadLoading ...
This guideline provides the updated recommendations of the Society for Healthcare Epidemiology of America (SHEA) regarding the management of healthcare providers who are infected with hepatitis B virus (HBV), hepatitis C virus (HCV), and/or the human immunodeficiency virus (HIV). For the reasons cited in the guideline, SHEA continues to recommend that, although some aspects of the approach to and administrative management of each of these infectious syndromes in healthcare providers are similar, separate management strategies for healthcare workers who are infected with these unrelated viruses remain appropriate. As we did in both prior iterations of this document, SHEA emphasizes the use of appropriate infection control procedures to minimize exposure of patients or providers to blood, emphasizes that transfers of blood from patients to providers and from providers to patients should be avoided, and recommends that infected healthcare providers should not be totally prohibited from participating in patient-care activities solely on the basis of a bloodborne pathogen infection. The types of procedures assessed by the panel as associated with an increased risk for provider-to-patient transmission of these pathogens are discussed in detail. For each pathogen, recommendations are graduated according to the relative viral load level of the infected provider (Tables 1 and 2). However, SHEA emphasizes that, because of the complexity of these cases, each such case will be slightly different from the next, and each should be independently considered in context.
