Faculty Bibliography

Like many developing countries, Zimbabwe has a shortage of trained mental health professionals. The country is coping by developing an expanded role for nurses and other nonphysician mental health workers and by emphasizing use of medication in treating mental illnesses. The authors review traditional Zimbabwean beliefs about mental illness and healing and describe culturally specific patterns of illness presentation. To reverse the historic pattern in which psychiatric care was centralized in cities, Zimbabwe is establishing a countrywide system of primary health clinics, part of whose role is to screen and treat common mental disorders, educate communities about mental illness, and promote prevention of illness

Research in hemodialysis adaptation has been facilitated by the use of reliable outcome measures such as BUN, K, and interdialysis weight gain. Their use, however, has at times been impressionistic, without reference to the actual range and distribution of those markers in a large population of dialysis patients over a long period of time. This study is a retrospective review to determine that range and distribution at one center. We found the interdialysis weight gains for most patients to be much higher than the levels used in the literature as cut-off points in determining 'non-compliance'. High levels on non-compliance in previous reports may be inflated. Significant correlations among the three biological markers and between each marker and staff assessment of compliance validate the use of inter-dialysis weight gain. Suggestions are made for interpreting such data in the future

The use of staff ratings as an outcome measure in adaptation to hemodialysis studies is discussed, and the absence of reliability or validity of such ratings is emphasized. Staff ratings for global impressions of patient compliance are collected in an outpatient hemodialysis unit, inter-rater reliability is calculated, and the rating averages are correlated with three biological markers. A high degree of exact inter-rater agreement is found and correlation of ratings with inter-dialysis weight gain, mean BUN, and mean K are determined

A brief review of the literature is presented followed by a discussion of three main groups of liaison problems on a dialysis service: patient non-compliance, inter-staff disputes, and patient-staff emotional involvements. Clinical vignettes are used to illustrate the discussion and suggested guidelines for intervention are offered . Basic principles underlying a 'liaison stance' are outlined