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Biomedical subjects

A Richman

Publications and source records attributed to A Richman.

At least 55 records · Page 3Linked to original sources
PubMed1985

More and more is less and less the myth of massive psychiatric need.

The idea of massive unmet need for mental health services is a myth, generated and perpetuated by processes within the system which provides psychiatric care and within society. Diffusion of the traditional boundaries of mental health care, lack of norms and standards, medicalisation and 'healthism', specialoid practice and patient selection, diversion of resources from the long-term mentally ill and their absorption by better-functioning patients, substitution and development of new mental health service providers, and changes in the threshold for help-seeking all affect our assumptions of need. Needs are less massive, if the boundaries of psychiatry are defined so as to include only those disorders which the profession is best able to treat.

Delivery of Health Care↗
PubMed1984

Breaking the 'detox-loop' for alcoholics with social detoxification.

A significant number of alcoholics do not respond to detoxification as a step on the way to rehabilitation. Instead, they periodically 'dry out' and subsequently return to alcohol abuse. They do not accept the responsibilities inherent in the sick role (cooperation in order to improve status of health by entering and continuing treatment), although they do accept the privileges (care, shelter and asylum). Repeated detoxifications (within medical and non-medical settings) of persons who do not commit themselves to entering rehabilitation, are of minimum benefit to the patient and absorb resources which could be better used by those more amendable to treatment. An appropriate level of care--social detoxification--should be provided for ' detox - loopers '. Such a model can focus on the alcoholic's social welfare needs. Social detoxification provides both respite and basic care. The door to ongoing rehabilitation through professional services, as well as self-help groups, can remain open, without being the main objective of the centre.

Alcoholism↗
PubMed1984

The relevance of socio-demographic and resource factors in the use of acute psychiatric in-patient care in the Atlantic Provinces of Canada.

This study assessed the inter-relations of socio-demographic, resource and policy factors with standardized measures of short-term psychiatric bed-use in 42 counties of Atlantic Canada. The policy factor made up two-thirds of the total variability (61%) accounted for among males, and nearly one-half of the 47% accounted for among females. An accurate assessment of in-patient resource needs is seen as resulting from intertwining morbidity surveys with utilization studies.

Bed Occupancy↗
PubMed1984

Electroconvulsive therapy: a Canadian perspective.

Recent ECT practices in Canada are reviewed from a historical perspective with respect to specific criticisms. Utilization is decreasing; utilization rates vary widely between Provinces and between regions; disproportionate numbers of females have been receiving ECT; a substantial group of patients diagnosed as neurotic and schizophrenic continue to receive ECT; criteria and guidelines for its use are not consistently applied. Expected rates of ECT used are estimated, based on theory and practice as well as on published data on the epidemiology of affective disorders. Data on actual Canadian usage are reviewed and compared with an estimated minimum ratio of 30-45+ cases per year of non bi-polar depression per 100,000 population requiring ECT. Results show that there may be a substantial number of patients in some Provinces for whom ECT is the best available treatment and who are not receiving it. There is some ethical concern associated with possible under-use of ECT as the best therapy available for certain patient groups. Clinical cases and patterns of care should be reviewed at the hospital level to determine how best to effect improvements in the use of this treatment.

Adult↗
PubMed1984

Project outreach: volunteer transitional employment.

The importance of individual and group volunteer transitional placement as work activity is addressed as a primary component of the hospital-based psychiatric rehabilitation process. The current model synthesizes traditional volunteerism and transitional employment as a viable rehabilitation step to facilitate vocational awareness, vocational choice, or re-entry into the work world. The model has further application for vocational counseling and exploration, goal development, and rehabilitation planning. Aspects of program development, implementation, and maintenance are presented. Discussion of community resource development and public relations strategies which have helped this project expand and improve are included. Client contribution and involvement is emphasized.

Community-Institutional Relations↗
PubMed1983

Cost/effectiveness analysis of alcoholism and drug abuse treatment programs: the relevance of recidivism and resource absorption.

Cost/effectiveness measures are increasingly being applied to alcoholism and drug abuse treatment programs. Program evaluators usually regard readmissions as inadequate for assessing outcome, and resource absorption is rarely examined; this paper presents the argument that increased attention to recidivism and resource absorption is integral to the program evaluation process. Readmissions formed 53% of admissions to U.S. drug abuse programs, and in alcoholism treatment centers, 4% of the patients accounted for 24% of the detoxications. Problems with assessing cost/effectiveness are associated with duration of treatment, average cost, time span of analyses, quasi-experimental designs, multiple episodes of treatment, "silting up", and extrapolation. Five approaches to dealing with these problems are suggested: analyzing existing program data bases for recidivism and resource absorption, considering recidivism when evaluating programs, tempering clinical enthusiasm with skepticism, matching patients with levels of care appropriate to previous treatment history, and assessing additional benefit derived from increasing amounts of care per patient as part of cost/effectiveness analysis.

Alcoholism↗
PubMed1983

Involuntary hospitalization in Canadian psychiatric inpatient facilities, 1970-1978.

This study is concerned with providing quantitative information on involuntary hospitalization of the mentally ill in Canada. It presents national statistical data on involuntary hospitalization to provincial mental and psychiatric hospitals, and psychiatric units of general hospitals for the period 1970-1978. The data used are based on the statistical information on psychiatric inpatients collected by the Mental Health Program of Statistics Canada for the period 1970-1978. The data indicate a moderate decline in involuntary admission rates. Men had consistently higher involuntary admission rates and women had consistently higher voluntary admission rates for the same period. Of the total commitments 22% were to psychiatric units of general hospitals. A high commitment rate was found for the elderly. As this is the first national quantitative analysis, both in Canada and in the international literature, the information presented should provide a useful objective perspective for a historical review of involuntary admissions to mental and psychiatric hospitals and psychiatric units of general hospitals.

Adolescent↗
PubMed1982

Repair of sinus of Valsalva aneurysm associated with aortoventricular discontinuity.

The case of patient with unruptured sinus of Valsalva aneurysm with absence of the intervalvular lamina fibrosa is presented. The association of Valsalva aneurysm and aortic subvalvular defects has been explained as a deficiency of elastic tissue at the aortic root or maldevelopment of the fibrous trigone. Valvular aortic insufficiency with histological evidence of myxoid changes required prosthetic replacement. Myxomatous changes in the fibrous trigone and aortic annulus can explain this unusual, complex anomaly. Accurate preoperative diagnosis may require special views and simultaneous left and right injections at cineangiography. Techniques of repair that have been successful are reviewed, and the essential features of adequate correction are outlined.

Aortic Aneurysm↗
PubMed1981

Immune complex-mediated renal involvement in relapsing polychondritis.

A patient with relapsing polychondritis who presented with rapidly progressive glomerulonephritis is described. This is the fourth case in which this association is reported. Crescentic glomerulonephritis was found on renal biopsy. Evidence for immunologic participation in the pathogenesis of this condition is suggested by the demonstration of circulating immune complexes, immunoglobulin and complement deposition by immunofluorescence, and electron dense deposits by electron microscopy of the kidney. Favorable response followed therapy with prednisone and dapsone.

Aged↗
PubMed1981

Ribonuclease of Entamoeba invadens.

Two bands of RNAase activity were observed on gel electrophoresis of fractions obtained during partial purification of the RNAase of Entamoeba invadens. The faster migrating band which was responsible for most of the RNAase activity was isolated by gel electrophoresis. A pI of 5.5 was determined for this RNAase activity and estimates of its molecular weight and sedimentation coefficient gave values of about 25 000 and approximately 2.8 S. It exhibited maximum activity around pH 6, and digestion of RNA showed a pattern expected of an endoribonuclease.

Animals↗
PubMed1981

After how many detoxications is rehabilitation probable?

The outcome of alcohol detoxication programmes was assessed in Ontario and New York. Clinical records showed that less than 40% of patients completed the referral from thier fist detoxication to a rehabilitation programme and that the probability of entering a rehabilitation programme decreased markedly as the number of detoxications increased. Also, as the number of detoxications increased, patients were admitted to the centers more frequently and at shorter intervals. Only a small percentage showed marked benefit from multiple treatments. The success of detoxication facilities in achieving rehabilitation appeared limited.

Alcoholism↗
PubMed1981

A simple procedure for partial purification of an RNAase of Entamoeba invadens.

The behavior of an RNAase, present in centrifugally clarified homogenates of axenic trophozoites of Entamoeba invadens, on isoelectric focusing (IEF) and agarose-poly(G) chromatography is described. The results led to a simple two-step procedure for partial purification of the RNAase in which fractionation of the homogenate by IEF is followed by agarose-poly(G) chromatography. Recovery of enzyme activity has ranged from 50 to 80% of that present in homogenates, and increases of 80- to 160-fold in the specific activity have been obtained using the procedure. A single zone of activity was observed on analysis of the partially purified RNAase by sucrose gradient IEF and velocity zonal ultracentrifugation.

Animals↗