Search PubMed⌕ Search

Biomedical subjects

A Richman

Publications and source records attributed to A Richman.

At least 37 records · Page 2Linked to original sources
PubMed1992

Level of care for deinstitutionalized psychiatric patients.

The New York state Level-of-Care Survey (LOCS) was used in 1987-88 to assess the community care and social support needs of 936 mentally disabled community residents in Halifax, Nova Scotia. The cases were assigned an appropriate level-of-care by the computerized algorithm based on an 101-item questionnaire covering all aspects of the cases' physical and mental condition, needs and activities. Compared with their current setting, the algorithm assigned 60% of cases to the same level-of-care, 17% to a lower level, and 23% to a higher level-of-care. The net effect on social service costs of the reassignments would be a 7% increase. The increased costs for some cases ($1.5 million) would be partly offset by lowered costs for others ($900,000). The gradual shifting of 14 cases from the relatively expensive rehabilitation unit to more independent living at lower levels of care would compensate for most of the increases.

Aged↗
PubMed1991

National health insurance and private psychiatry.

From 1972-73 to 1988-89, the number of Canadian psychiatrists doubled. Most psychiatrists are in fee-for-service practice. The median earnings of psychiatrists are close to those of internists. There is lack of psychiatric services available, but not a lack of psychiatrists. The lack of services is due largely to the allocation of psychiatric resources. The maldistribution of psychiatrists is increasing as more settle in urban centres. The U.S. General Medical National Advisory Council recommends that psychiatry spend two thirds of clinical time treating severe illnesses such as psychoses. Before any changes are made to the structure of Canadian psychiatry, more data are needed on patterns of fee-for-service practice, the characteristics of patients, the course and outcome of private psychiatric care, and alternative patterns of practice in which psychiatrists are consultants to family physicians and non-medical therapists.

Canada↗
PubMed1990

Does psychiatric care by family practitioners reduce the cost of general medical care?

This is the first "impact" type of economic study of psychiatric/counseling services from general practitioners. The paper analyzes a province-wide database that collates statistical data from all inpatient and outpatient psychiatric services as well as from private physicians. This paper asks whether psychiatric services from family physicians also reduce the overall costs of medical care. This research supports the general research findings that medical costs are lower after psychiatrists' care. ECT patients show a marked reduction in their medical costs. Patients with psychotherapy/counseling from family physicians did not show statistically significant reductions in overall medical costs. We need new classifications for the kinds of mental disorders seen in primary care settings.

Electroconvulsive Therapy↗
PubMed1990

Factors affecting length of stay in a psychiatric intensive care unit.

As a response to the challenge posed by an increasing number of agitated and violent patients, there is in Canada a growing number of psychiatric intensive care units (PICUs), in both general and psychiatric hospital settings. In this article, the functioning of such a unit in a general hospital context is reviewed. Statistically significant changes in average length of stay (LOS) were observed, with an increase from 5.8 to 7.3 days over the period studied. The factors influencing the functioning and LOS of this PICU are analyzed. A possible "deskilling" of the staff in other wards is discussed, and alternative explanations are hypothesized in an attempt to shed light on the interaction between this unit and its environment.

Adolescent↗
PubMed1990

The treatment of mental disorders in hospitals.

This article examines mental disorders treated in Canadian general and psychiatric hospitals from 1971 to 1985-86. Significant changes occurred over the period of study. The analysis is based on hospital discharge data from eight provinces. For several decades, mental disorders have been among the leading causes of hospital use. In 1985-86, mental disorders accounted for about 10.8% of total days of care given in general hospitals. The total discharge rate for mental disorders treated in general and psychiatric hospitals declined moderately from 1971 to 1985-86. However the rate for functional psychoses has increased, while for other diagnoses the rates have decreased. The two diagnostic categories most often found in active treatment programs shifted position over the period. In 1971, the rate for general clinical disorders was almost twice that of functional psychoses; since 1981-82, the functional psychoses rate has exceeded the general clinical disorders rate. Discharge rates for functional psychosis for the elderly increased considerably, but remained stable in other age groups. This suggests that mental illness is being diagnosed more often in the elderly, and that treatment of their mental illnesses is more often undertaken.

Age Factors↗
PubMed1989

Normal expression of a rearranged and mutated c-myc oncogene after transfection into fibroblasts.

Expression of the c-myc oncogene is deregulated in a variety of malignancies. Rearrangement and mutation of the c-myc locus is a characteristic feature of human Burkitt's lymphoma. Whether deregulation is solely a result of mutation of c-myc or whether it is influenced by the transformed B cell context has not been determined. A translocated and mutated allele of c-myc was stably transfected into fibroblasts. The rearranged allele was expressed indistinguishably from a normal c-myc gene: it had serum-regulated expression, was transcribed with normal promoter preference, and was strongly attenuated. Thus mutations by themselves are insufficient to deregulate c-myc transcription.

Animals↗
PubMed1989

Physician practice style variations.

This article studies the variation in physician practice style among geographic regions and across time. A physician practice profile is defined and a simple model for profile variation is developed. Ratios are calculated for the components of the profile--ambulatory visit rate, hospitalization rate and length of hospitalization--and studied in terms of adaptation to resource constraint and nonspecific style. The methods are applied to hospital use in the Census Metropolitan Areas of Canada.

Ambulatory Care↗
PubMed1989

Serum-inducible expression of transfected human c-myc genes.

Activation of the c-myc proto-oncogene is implicated in the initiation or progression of many vertebrate cancers. In nontransformed cells, the expression of c-myc is induced by growth factors. Studies have indicated that such induction is effected by multiple mechanisms. To study regulation of c-myc expression, a transfection system has been developed in which introduced c-myc genes exhibit serum-responsive activity. The responsiveness assayed is not mediated by increased transcription initiation. Rather, it is effected at a point(s) between transcription and stabilization of the RNA.

Animals↗
PubMed1987

Prevention of alcohol-related problems. Introduction to a symposium.

Despite major biomedical advances, the most important health gains of this century have been due to preventive measures. Primary prevention includes: (a) health protection--the use of public direct regulatory activities (e.g. regulations regarding the sale and availability of alcohol, requirements for warning labels); (b) disease prevention--services directed to reducing the occurrence of specific identifiable disorders (e.g. Fetal Alcohol Syndrome) using strategies derived from risk factor research; and (c) health promotion--activities which foster positive behaviors and general good health practices. Although there is a measure of agreement that 'something must be done' to prevent alcohol problems, it is not quite so easy to find agreement on what is the best preventive approach, or even what the focus of prevention should be--problem drinkers, drinking habits or alcohol itself. To change attitudes and practices requires more than token nods towards alcohol education. More attention is now being given to psychologically and socially based prevention programs. The next three papers discuss behavioural approaches to prevention of alcohol-related problems.

Alcoholism↗
PubMed1987

Heterologous enzyme function in Escherichia coli and the selection of genes encoding the catalytic RNA subunit of RNase P.

The gene for the catalytic RNA subunit of RNase P has been isolated from several Enterobacteriaceae by complementation of an Escherichia coli strain that is temperature-sensitive for RNase P activity. The selection procedure relies on the ability of the heterologous gene products to function enzymatically in E. coli. This procedure obviates the need for positive results in DNA blot hybridization experiments or for the purification of holoenzyme to identify the RNA component of RNase P and its corresponding gene from organisms other than E. coli. Comparisons of the variations in sequences provide the basis for a refined two-dimensional model of the secondary structure of M1 RNA.

Base Sequence↗
PubMed1987

Adaptive decisions in the use of hospital beds.

This article investigates the manner by which a physician adapts his decision on referral to hospital and length of hospital stay to variations in the pressure (access) to hospital beds. An index of adaptation is developed which measures the adaptation to pressure from standard bed-use statistics. An example of the index is given for psychiatric bed use in Canada.

Bed Occupancy↗
PubMed1986

A recessive circadian clock mutation at the frq locus of Neurospora crassa.

A circadian clock mutant of Neurospora crassa, the most distinctive characteristic of which is the complete loss of temperature compensation of its period length, maps to the frq locus where seven other clock mutants have previously been mapped. This mutant, designated frq-9, is recessive to the wild-type allele and to each of the other frq mutants; thus, it differs from the other mutants, which show incomplete dominance to wild type and to each other. Complementation analysis suggests either that the frq locus is a single gene or that frq-9 is a deletion that overlaps adjacent genes. Preliminary efforts at fine structure mapping have indicated that recombination between certain pairs of frq mutations is less than 0.005%, a distance consistent with the locus being a single gene. The recessive nature of frq-9, coupled with complete loss of temperature compensation, suggests that this mutant may represent the null phenotype of the locus and that the frq gene is involved in the temperature compensation mechanism of the clock.--Genetic mapping studies have placed the frq locus on linkage group VIIR, midway between oli (oligomycin resistance) and for (formate auxotrophy), about 2 map units from each, and clearly indicate that frq and oli are separate genes.

Alleles↗
PubMed1985

General hospital psychiatry: are its roles and functions adjunctive or pivotal?

General hospital psychiatric divisions are an important part of the mental health care delivery system; however, in Canada and the United States, their role and function have not been well defined. In most places, the general hospital is peripheral to the mental hospital, and is thus an adjunctive element in the resulting two-tier mental health care delivery system. The adjunctive type of general hospital psychiatric division provides brief treatment to highly selective types of patients, and is relatively inaccessible to a wide variety of patients. In contrast, the general hospital can be central to the mental health care delivery system--in a pivotal position to patients, other mental health facilities, and community agencies. Important features of the pivotal type are: defined catchment areas, broad admitting criteria and effective discharge planning, linkages with extramural and community programs, staff reorientation, appropriate architectural features, and the ability to hear and respond to the needs of the community. The pivotal type of general hospital psychiatric division can provide appropriate levels of inpatient care, as well as the linkages and backup to extramural and community programs for the long-term mentally ill. The mental hospital would no longer be used as a backup for general clinical disorders, involuntary patients, or patients usually rejected by adjunctive hospitals. There would be collaboration with other agencies in developing programs for special clinical groups (low prevalence disorders), as well as for alcoholism, psychogeriatrics, and adolescent disorders. This article reviews the current polemic on the role and function of the general hospital psychiatric division, as part of the mental health care delivery system.

Canada↗
PubMed1985

Alcohol consumption and morbidity in the Canada Health Survey: inter-beverage differences.

This study examined inter-beverage differences in the relationship between alcohol consumption and health status as reported by 17 249 respondents to the Canada Health Survey. Self-reported morbidity rates (bed-days, activity loss, doctor visits) were computed for consumers of beer, wine, liquor and for those with no specific beverage preference. These rates were compared with the level of expected morbidity based on each group's demographic attributes. Subsequently, dose-response relationships were described relating frequency and quantity of consumption to a standardized morbidity rate for each beverage-preference group. In general, the results supported the importance of inter-beverage differences as an intervening variable in the relationship of consumption to morbidity. Overall morbidity rates and both frequency and quantity dimensions of the dose-response relationship varied markedly as a function of type of beverage consumed. Beer drinkers, in particular, varied from other consumers they had significantly lower rates of morbidity than expected. Increases in frequency of beer drinking were associated with reductions in morbidity, but mildly deleterious effects were associated with excessive consumption.

Accident Proneness↗
PubMed1985

Use of psychiatric services by the elderly in Canada.

There is increasing emphasis on identifying mental disorders in the elderly and developing appropriate mental health services. However, there are few quantitative studies on service use by the elderly. This paper gives a national perspective on the use of psychiatric services by the aged in Canada, and details two of the health care studies used to assess their mental health needs in southern New Brunswick. The elderly now make up a higher proportion of the long-term mental hospital population than they did 20 years ago. Despite the increase in number of short-stay general hospital psychiatric units, there are still marked differences in their use by the elderly. There is a marked decrease in short-term psychiatric in-patient care after the sixth decade. As well there are marked regional variations. The results of a Level of Care Survey in a New Brunswick mental hospital shows the discrepancies between the needs for care and the level of care actually received. In comparison with other patient sub-groups, elderly long-stay mental hospital patients had the highest proportion (79%) deemed suitable for care in alternative settings outside the hospital. The anonymized merged statistical file revealed that the elderly mentally ill were more likely to be identified and cared for within non-specialized wards of general hospitals, and least likely to have contact with mental health clinics. Instead of adding new services to the existing system, reallocation and redirection of existing resources are crucial strategies in improving the mental health services for the elderly. The general hospital is an important area for psychiatric consultation and back-up to primary care services.

Adolescent↗