It's officially known by the acronym CrisTAL (Criteria for Screening and Triaging to Appropriate Alternative Care), but it's more widely known as the Death Test. It's a 29-point checklist to help doctors determine if elderly patients are at risk of dying within the next three months. So, it seems like a more rigorous version of the "Surprise Question" which (as we've posted about before) is another test docs use to predict imminent death.
For patients with an age of 65 or over who have been admitted to hospital this time in an emergency:
1. Altered level of consciousness (Glasgow Coma Score change >2 or AVPU=P or U)
2. Blood pressure (a systolic blood pressure of less than 90 mm Hg)
3. Respiratory rate of more then five and less than 30
4. Pulse rate of less than 40 or more than 140
5. Need for oxygen therapy, or known oxygen saturation of less than 90 per cent
6. Hypolglaecemia blood glucose level (less sugar in the blood than normal)
7. Repeat or prolonged seizures
8. Low output of urine (less than 15 mL/h or less than 0.5 mL/kg/h) or a MEW or SEWS score of more than 4
9. Previous history of disease, including:
10. Advanced cancer
11. Kidney disease
12. Heart failure
13. Various types of lung diseases
14. Strokes and vascular dementia
15. Heart attack
16. Moderate to severe liver disease
17. Mental impairment such as dementia or disability from a stroke
18. Length of stay before this RRT call (>5 days predicts 1-year mortality)
19. Repeat hospitalisations in the past year
20. Repeat admission to the intensive care department of the hospital
22. Unexplained weight loss
23. Self-reported exhaustion
24. Weakness (being unable to grip objects, being unable to handle objects or lift heavy objects of less than or equal to 4.5kg,
25. Slow walking speed (walks 4.5m in more than 7 seconds) or is
26. Inability to do physical exercise or stand
27. Is a nursing home resident or lives in supported accommodation
28. Having urine in their blood (more than 30mg albumin/g creatinine
29. Abnormal ECG (irregular heartbeat, fast heartbeat and any other abnormal rhythm or more than or equal to 5 ectopics/min and changes to Q or ST waves)
The Yips are defined as "a disorder in which golfers complain of an involuntary movement — a twitch, a jerk, a flinch — at the time they putt or even when they chip. This interferes with their ability to perform that activity.” It was the subject of a multidisciplinary study by researchers at the Mayo Clinic, who concluded:
For <10 handicap male golfers and <12 handicap female golfers, the prevalence of the yips is between 32.5% and 47.7%, a high proportion of serious golfers. This high prevalence suggests that medical practitioners need to understand the aetiology of the yips phenomenon so that interventions can be identified and tested for effectiveness in alleviating symptoms. Although previous investigators concluded that the yips is a neuromuscular impediment aggravated but not caused by anxiety, we believe the yips represents a continuum on which 'choking' (anxiety-related) and dystonia symptoms anchor the extremes.
The Yips should not be confused with the Yip Yips, which are something completely different:
As reported by Israeli scientists Dr. Menahem Ram and Aladar Schwartz at a 1971 joint meeting of the Society for Cryobiology and the International Conference of Refrigeration:
Sudden temporary chilling of the big toes almost immediately brings about a lowering of the normal body temperature within the nose because, they said, the big toes and the nose are nervous system "reflectors" of one another in their response to external stress. And this nasal temperature-lowering—along with humidity-lowering—"dries up the nostrils," thereby "curing" the cold, they said.
Because she had been sneezing every few minutes since Oct. 9, Mary Margaret Cleer, 13, daughter of a Fort Myer, Va. gasoline station attendant, last week held the attention of a great many curious laymen and puzzled doctors. No one knew what caused the prolonged sneezing fit which had racked the child to skin & bones and put a constant, haggard sneer on her face.
To see if allergy to some substance caused the sneezing, Washington doctors scratched her skin some 80 times, rubbed into the scratches hay pollen, flower pollen, pulverized cat fur, dog hair, house dust, food extracts, dozens of substances.
Skin tests failed to reveal any specific allergy. A Washington doctor cut out the adolescent's tonsils, with no effect on the sneezing. Other specialists could find nothing unusual in her lungs or nervous system.
Lay cures for sneezing which Mary Cleer was urged to try included wearing a "magnetic" letter pinned to her night dress, looking down the bridge of her nose at pieces of bright silk held close to the tip, clipping an electrified wire to her nose and toes, getting tattooed, taking snuff.
Last week when Mary Cleer went to Johns Hopkins Hospital, the great medical faculty there had never before treated or even seen a girl who sneezed so persistently. Johns Hopkins specialists began a new series of tests. A psychiatrist examined the girl and summoned her parents to analyze their mental and emotional makeups. Mary underwent fluoroscopy, blood testing, other examinations. A gynecologist also took her in charge, for the nasal and genital tissues are histologically related. The mucous membranes of the nose swell during sexual excitement. This well-known phenomenon gives rise to a theory that the noses of many little girls become sensitive as they turn into young womanhood, and that this makes such girls sniff, lisp or pamper their noses in an apparently affected manner, and that this overture to womanhood causes an occasional girl to sneeze uncontrollably. That, a gynecologist might guess, was the trouble with Mary Cleer, 13.
Apparently the sneezing eventually stopped of its own accord. No one ever figured out what the cause was.
Decatur Daily Review - Dec 3, 1936
(left) Alexandria Town Talk - Oct 27, 1936
(right) Daily Clintonian - Dec 8, 1936
As described in the Canadian Medical Association Journal (Dec. 6, 2005), a man on vacation in rural Ontario experienced sudden, profound hearing loss. A family doctor on vacation in the same location was consulted and diagnosed the man as suffering from a buildup of cement-like ear cerumen. Lacking access to professional equipment for its removal, ingenuity was required. A child's Super Soaker Max-D 5000 proved to be the solution:
The Super Soaker Max-D 5000 was filled with body-temperature water and then mildly pressurized using the blue hand-pump. The trigger was depressed, releasing a gentle, narrow jet of water, which was then aimed along the posterior wall of the ear canal. After approximately 15 seconds, the jet was aimed along the anterior wall. This cycle was repeated (with occasional repressurizing) until the Super Soaker was empty.
Midway through the second load's stream, wax particles began to run out of the ear. Just after starting the third load, a large plug of wax burst forth from the patient's ear. The 3 generations of family members present took turns admiring (or recoiling from) the specimen. The patient exclaimed in joy, "I can hear again!"...
The clinician operator of the device was impressed by the Super Soaker's ease of use for this procedure. Specifically, the ability to control a narrow, mildly pressurized jet of water was considered excellent. As well, the device only had to be refilled once or twice before the cerumen was removed from each ear. This is in contrast to his experience of requiring up to 10 or more refills of standard ear-syringing equipment. Using the Super Soaker in standard practice could then lead to decreased overall time spent on this procedure, resulting in shorter waiting times for patients through increased physician efficiency.
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Alex is the creator and curator of the Museum of Hoaxes. He's also the author of various weird, non-fiction books such as Elephants on Acid.
Paul Di Filippo
Paul has been paid to put weird ideas into fictional form for over thirty years, in his career as a noted science fiction writer. He has recently begun blogging on many curious topics with three fellow writers at The Inferior 4+1.
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