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Biomedical subjects

A M Freeman

Publications and source records attributed to A M Freeman.

At least 37 records · Page 2Linked to original sources
PubMed1986

Coronary artery bypass surgery in older patients: psychiatric morbidity.

Coronary artery bypass grafting in older patients usually results in a favorable surgical outcome. To assess whether age confers greater risk for postoperative psychiatric symptoms in these patients, we retrospectively examined 58 cases (mean age 62.5 years) comparing pertinent clinical features of the index patients to matched controls (mean age 51.7 years). Analysis of the data, including scores on preoperative and postoperative scales measuring anxiety, depression, and cognitive function, showed a statistically significant difference in the cognitive performance of the elderly as shown by lower scores on the Mini Mental State examination (chi-square, P less than .025). Our findings support future efforts to address the clinical relevance of cognitive dysfunction in older coronary bypass patients.

Age Factors↗
PubMed1986

Quality of life six months after coronary artery bypass surgery: a preliminary report.

Ninety-six patients who had coronary artery bypass grafting showed improvement on the Psychosocial Adjustment to Illness Scale at six months postoperatively. Findings of improved sexual function and vocational status were unexpected in light of previous studies. Older patients showed less psychologic distress than younger ones after coronary artery bypass surgery.

Adaptation, Psychological↗
PubMed1986

Alprazolam treatment of postcoronary bypass anxiety and depression.

The effectiveness of alprazolam in treating symptoms of anxiety and depression in 60 patients undergoing coronary bypass surgery was assessed in a double-blind, placebo-controlled study. The results indicate that alprazolam treatment for anxiety following coronary bypass surgery, particularly symptoms occurring in the immediate postoperative period, can significantly affect patient outcome. Specifically, only modest but statistically significant improvement was observed in the alprazolam-treated groups at 1-month follow-up; however, alprazolam-treated patients were significantly more likely to experience a very rapid anxiolytic effect by postoperative day 8. The implications of this study are discussed with respect to patient management and models for future studies of anxiety in postoperative patient populations.

Adult↗
PubMed1985

Münchausen's syndrome and other factitious illness.

Current perspectives on Münchausen's syndrome and other factitious illnesses are presented in this article. Self-destructive behavior manifested by the artificial production of illness remains a puzzling but fascinating clinical entity. A distinction between the clinical features of those cases that are more treatable suggests an optimistic rationale for approaching these difficult patients.

Adolescent↗
PubMed1984

Factors and their influence on regional cerebral blood flow during nonpulsatile cardiopulmonary bypass.

In this study we examined the relationship of regional cerebral blood flow (CBF) to mean arterial pressure, systemic blood flow, partial pressure of arterial carbon dioxide (PaCO2), nasopharyngeal temperature, and hemoglobin during hypothermic nonpulsatile cardiopulmonary bypass (CPB). Regional CBF was determined by clearance of xenon 133 in 67 patients undergoing coronary bypass grafting procedures. There was a significant decrease in regional CBF (55% decrease) during CPB, with nasopharyngeal temperature and PaCO2 being the only two significant factors (p less than 0.05). In a subgroup of 10 patients, variation of pump flow between 1.0 and 2.0 L/min/m2 did not significantly affect regional CBF. We conclude that cerebral autoregulation is retained during hypothermic CPB. Under the usual conditions of CPB, variations in flow and pressure are not associated with important physiological or detrimental clinical affects.

Adult↗
PubMed1982

Psychiatric education for primary care: a pilot study of needs of residents.

The study reported here documents a variety of psychiatric educational needs of residents in internal medicine. By studying 150 medical outpatients, the authors found that 59 percent of the patients had probable emotional disorders, 48 percent suffered from significant symptoms of depression, negative life events and low social support were significantly associated with both probable emotional disorder and depressive symptoms, only 20 percent of the patient charts contained psychiatric diagnoses, 78 percent of the charts contained no mental status data, patients on the average could report only 56 percent of their diagnoses and 60 percent of their management plans, and 70 percent of the patients reported that they were not asked about personal problems. These results have formed the basis for a psychiatric educational program in internal medicine at the University of Alabama in Birmingham and will serve as pretraining comparison data for the evaluation of outcome.

Female↗
PubMed1981

Feasibility of outpatient management after intra-articular yttrium-90: comparison of two regimens.

In a study comparing two regimens of treatment after intra-articular irradiation of the knee with yttrium-90 one group of patients was allocated to bed rest for 48 hours in hospital and the other to mobilisation at home. Initially a Robert-Jones orthopaedic bandage was applied to the knee in all patients, serving as a semi-rigid splint, but as loss of isotope from the knee was appreciable in the mobilised patients, subsequent patients were sent home with the knee in a plaster-of-Paris cylinder. No difference in extra-articular spread or chromosomal damage was found between the patients sent home with their knee in a rigid splint and those treated by bed rest. Clinical outcome at three months was satisfactory in all three groups. These results show that rigid splinting is essential in reducing extra-articular spread of the isotope but that bed rest is not necessary. Increases in intra-articular pressure associated with quadriceps muscle activity combined with flexion of the knee may be the most important factor affecting extra-articular spread of isotope.

Ambulatory Care↗
PubMed1978

Planning community treatment for sex offenders.

In California and in Great Britain plans are being made to move the treatment setting for many sex offenders from large state hospitals to community sites. The most useful aspects of the state hospital programs can be adapted to the community setting. In the proposed treatment centers, graded levels of security may include inpatient, half-way house, and outpatient facilities. The therapist will coordinate social and educational programs as well as psychiatric care. Optimally, the community treatment center will have university support so as to facilitate training in forensic psychiatry and research into the etiology and management of sexually aggressive behavior.

Ambulatory Care↗