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Biomedical subjects

C Brewer

Publications and source records attributed to C Brewer.

At least 73 records · Page 4Linked to original sources
PubMed1989

Coping with patients' problem drinking.

Confronting patients appropriately is a difficult skill to master. The practitioner must first overcome his own inherent biases and feelings of discomfort before tackling the patient on threatening issues. This problem is compounded by delay when a patient has seen his GP for a number of years before a review of the notes reveals the hitherto unsuspected diagnosis.

Adult↗
PubMed1989

Helping students respond to stressful interactions with cancer patients and their families: a pilot program.

This pilot program was designed to help medical students improve their ability to respond to the psychological needs of cancer patients and their families. Third-year students on the hematology/oncology rotation were offered a series of seminars dealing with the psychological and social impact of cancer on patients and their families. The goal of these seminars was to help the students develop working knowledge, understanding, and skills for dealing with cancer patients and families. The seminars used didactic input, videotaped interactions, and guided discussion. Experienced counselors, with the help of an oncologist, led the seminars. Findings from this pilot program suggest that medical students can benefit from specific training in the psychosocial aspects of cancer.

Communication↗
PubMed1988

Opioid withdrawal and naltrexone induction in 48-72 hours with minimal drop-out, using a modification of the naltrexone-clonidine technique.

Using clonidine, naltrexone, and diazepam, 60 withdrawals from heroin and other opioids involving 56 addicts were carried out with only one patient dropping out. In the last 23 cases, we used a modification of the standard technique, giving significantly higher doses of naltrexone and clonidine on the first day. This significantly reduced the average withdrawal time from 3.30 days to 2.32 days, despite lower clonidine dosage and significantly lower diazepam dosage on the second day. The speed, effectiveness, economy, and high acceptability of this withdrawal technique have implications for both private and state-funded treatment programmes.

Adolescent↗
PubMed1988

Team treatment. Does a specialized unit improve team performance?

The treatment of inpatients in a contiguous hospital area designated the Arthritis Rehabilitation Unit (ARU) as opposed to the treatment of patients on units discretely spaced throughout the hospital was studied by means of independent retrospective audit of randomly chosen charts with the primary diagnosis of rheumatoid arthritis. Three time periods were considered: T-1 (2 months to 0 months prior to the beginning of the ARU), T-2 (0 months to 5 months of operation of the ARU), T-3 (after 18 to 24 months of operation of the ARU). At T-1 only seven charts were reviewed; ten charts were reviewed at T-2 and T-3. The frequency of fulfillment to audit criteria was calculated as the arithmetic mean. No weighting or preference was given to any of the items. P values were calculated utilizing the Mann-Whitney U test for nonparametric measures. The criteria by which the charts were reviewed were developed through the Delphi method of opinion convergence. Criteria were generated using the principle of optimal medical care. The categories included initial evaluation, treatment plan, outcomes and discharge plan. T-1 compared to T-3 yielded results in overall percentage of effectiveness of: physician, 81 v 90 (NS): nurse, 42 v 60 (P 0.043); occupational therapy, 62 v 58 (NS); physical therapy, 69 v 78 (NS); and social worker, 17 v 88 (P less than 0.001) Geographic isolation of arthritis rehabilitation patients improved measured aspects of their care but not uniformly throughout the rehabilitation team.

Arthritis, Rheumatoid↗
PubMed1986

Supervised disulfiram in alcoholism.

Despite its well-documented specific effectiveness in controlled trials, the alcohol-sensitizing drug disulfiram (Antabuse) is not widely prescribed in Britain for the management of alcohol abuse and it often arouses hostile and irrational feelings. However, interest in it is reviving. This paper reviews the evidence for its effectiveness, emphasizes the importance of correct dosage and supervised administration and of viewing disulfiram as generally only one component of treatment. Its low toxicity--especially compared with alcohol--is emphasized and the main arguments of its opponents are examined.

Alcoholism↗
PubMed1986

Patterns of compliance and evasion in treatment programmes which include supervised disulfiram.

Examination of the compliance patterns of 84 patients offered supervised disulfiram in aqueous suspension, and for whom adequate supervision by family members, friends or colleagues was possible, showed that 38 took disulfiram regularly and remained abstinent throughout the minimum six-month period for which it was prescribed. Twenty risked drinking alcohol while taking disulfiram, half of whom did not experience a significant reaction on doses of 200-300 mg daily. In nine patients there was a temporary lapse of supervision. Two patients induced vomiting of disulfiram. Four substituted inert medication. Nine dropped out of treatment--usually after separating from their partner--and two refused to start disulfiram. Apart from these 11 patients, attempts to sabotage or evade treatment were not necessarily associated with a poor response. In most cases it was possible to out-manoeuvre the patients by increasing the dosage or modifying the supervision techniques. Awareness of these possible patient responses is essential if the considerable potential of supervised disulfiram is to be maximised.

Alcoholism↗