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Biomedical subjects

C S Roberts

Publications and source records attributed to C S Roberts.

At least 55 records · Page 3Linked to original sources
PubMed1995

Effect of predischarge interventions on aftercare attendance: process and outcome.

A widely recognized problem in the mental health services delivery system is that of patients' early discontinuance of therapy. But less attention has been given to the high rate of nonattendance at initial appointments in outpatient mental health settings. The purpose of the study discussed in this article was to determine if particular predischarge interventions had an effect on whether psychiatric patients attended their initial aftercare appointments at a Veterans Administration mental health clinic. Two groups of patients were given predischarge interventions and one was not (a control group). Results showed a trend of greater attendance at initial aftercare appointments by those who received a predischarge intervention; however, the differences were not statistically significant. Suggestions for clinicians and researchers are provided.

Aftercare↗
PubMed1994

Influence of physician communication on newly diagnosed breast patients' psychologic adjustment and decision-making.

BACKGROUND: Physician-patient communication is of critical importance when a breast cancer diagnosis is made, because the emotionally overwhelmed patient must be educated about her disease and available treatments so she can participate in decisions about her care. A research study addressed the hypothesis that patients whose surgeons used psychotherapeutic techniques during the cancer diagnostic interview would have better psychologic adjustment to their cancer. METHODS: One hundred women surveyed 6 months after surgery completed the Cancer Diagnostic Interview Scale (CDIS) and the SCL-90-R, a measure of psychologic well being. RESULTS: Factor analysis of the CDIS revealed that the physician's caring attitude was perceived by the women as most important, with information-giving as a much weaker component. Multiple regression analysis supported the hypothesis that psychologic adjustment was predicted by physician behavior during the cancer diagnostic interview. Other significant predictors of adjustment were a history of psychiatric problems and premorbid life stressors. CONCLUSIONS: Provision of information needed for decision-making appears to be valued largely within the context of a caring physician-patient relationship. Specific surgeons' behaviors believed to facilitate patient adjustment include expressing empathy, allowing sufficient time for patients to absorb the cancer diagnosis, providing information, and engaging the patient in treatment decision-making.

Adaptation, Psychological↗
PubMed1994

Tracheoesophageal compression from aortic arch anomalies: analysis of 30 operatively treated children.

During a 16-year period (1976 to 1992), 30 children underwent surgery for tracheoesophageal compression caused by aortic arch anomalies. The age range was 3 days to 12 years (median, 3 months); 19 (63%) were male, and 20 (67%) were white. Of the 30 patients, 10 had a double aortic arch (the left was atretic in 6), 5 had a left-sided arch with an aberrant right subclavian artery (4) or innominate artery (1), and 15 had a right-sided arch with an aberrant left subclavian artery (14) or with mirror-image branching (1). There was no mortality during hospitalization or within 30 days of surgery. The left ductus arteriosus was divided in 26 of the 30 patients. Among the 10 patients with a double aortic arch, division of the atretic left arch (6), the lesser left arch (3), or the lesser right arch (1) was carried out. All 4 patients with a left arch and aberrant right subclavian artery had division of the artery. Of 14 patients with a right arch and aberrant left subclavian artery, only 3 underwent division of the artery. Of the 30 patients, anterior arteriopexy was performed in 9 (30%), and reoperation for persistent symptoms was necessary in 4 (13%). The second operation usually consisted of aortopexy or tracheopexy. Of the 4 patients with associated cardiac anomalies, 2 underwent simultaneous cardiac repair. The duration of hospital stay for the 30 patients ranged from 4 to 148 days (median, 6 days). Excluded from this series are patients with vascular rings who were asymptomatic and patients with the pulmonary vascular sling syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta, Thoracic↗
PubMed1994

Aortic dissection originating in the suprarenal abdominal aorta.

Spontaneous dissection of the abdominal aorta originating from the suprarenal aorta is very rare. Previous reports attest to the lethal nature of this disorder. This case represents the first report of successful repair of a spontaneous suprarenal abdominal aortic dissection by graft insertion with obliteration of both the entrance tear and the false lumen with reimplantation of the visceral vessels.

Aged↗
PubMed1994

A closer look at social support as a moderator of stress in breast cancer.

This study explored the effects of perceived social support from friends, family, and spouses on the psychological adjustment of 135 newly diagnosed breast cancer patients. Initial data analyses revealed moderate correlations between greater psychological distress and lower levels of social support. However, when the personality variable of social desirability was controlled for, the relationship between social support and well-being were substantially weakened or eliminated. It is concluded that characteristics of the person, rather than of the situation, underlie the apparent relationship between social support and adjustment to illness. Social workers are advised to make in-depth assessments of ego strengths and past psychological functioning as better predictors of patient adaptation to disease.

Adaptation, Psychological↗
PubMed1994

Use of allografts after failed treatment of rupture of the anterior cruciate ligament.

A prospective study was done of the use of allogeneic tissue to reconstruct the anterior cruciate ligament in knees in which an intra-articular or an extra-articular operation had failed. Sixty-six consecutive patients (sixty-six knees) had such an operation with use of bone-patellar ligament-bone allografts; all but one returned for follow-up evaluation twenty-three to seventy-eight months (mean, forty-two months) after the operation. A total of 235 previous operations had been performed in these sixty-six knees, including eighty-one procedures for rupture of the anterior cruciate ligament. The results of the allograft procedure were evaluated with a subjective and objective system that rated twenty factors. The anterior-posterior displacement was substantially improved in most of the patients. According to data derived from arthrometric studies and pivot-shift tests of the fifty-seven patients who were so evaluated and in whom the condition was unilateral, 53 per cent (thirty) of the reconstructed ligaments were determined to be functional; 21 per cent (twelve ligaments), partially functional; and 26 per cent (fifteen ligaments), a failure. When we calculated the rate of failure by including ten failures that had occurred within two years after the operation with the fifteen that occurred in patients who had been followed for at least two years, the over-all rate of failure was 33 per cent (twenty-five of seventy-five operations). There was significant improvement in the subjective ratings of functional limitations and symptoms (p < 0.01) and in the over-all rating score (p < 0.0001). However, there was a significant difference between the scores of the patients in whom the surfaces of the articular cartilage had appeared normal at the index operation and those of the patients in whom there had been noteworthy fissuring and fragmentation or exposure of subchondral bone. After the program of rehabilitation, which included immediate motion of the knee, a range of motion of 0 to 135 degrees was restored in all but five knees, four of which lacked only 5 degrees of this extent of flexion or extension. The results demonstrate that bone-patellar ligament-bone allografts may be used when proper autogenous tissues are not available and that symptoms and abnormal displacement were reduced in most of our patients.

Activities of Daily Living↗
PubMed1994

New patterns of transplant nephrectomy in the cyclosporine era.

Several significant advances in transplantation during the last decade, among them the introduction of cyclosporine, have greatly altered the management of allograft recipients. To determine the frequency and pattern of transplant nephrectomy (TN) since cyclosporine was introduced in 1984, we reviewed our results from 1968 through 1990. During the 23 year period, 766 renal transplants were performed; 280 before 1984, when cyclosporine was first introduced into routine care and 486 after that time. Of the 280 recipients undergoing transplantation before 1984, 70 underwent TN, whereas only 61 of the 486 recipients in the cyclosporine period have undergone TN (p < 0.01). Comparing the demographics of those who had TN before 1984 with those who had TN in the cyclosporine era shows similarities: the mean age at TN (32 versus 32 years), percent male (66 versus 61), percent black (51 versus 61), percent of TN operations within six months of graft insertion (80 versus 70) and percent perioperative complications (nine versus 11). During the precyclosporine era, TN was performed more frequently in patients who received allografts from cadavers versus living related donors (30 versus 8 percent, p < 0.05), but this difference was eliminated after 1983 (11 versus 13 percent, p = NS). TN was performed more frequently after secondary versus primary transplants in the early (36 versus 23 percent) and later (23 versus 11 percent) time periods (p < 0.05 only for the later time period). It is also noteworthy that the rate of TN decreased significantly for primary and secondary transplants in the later time period. For low risk white patients and higher risk black patients the rate of TN decreased in an identical manner. We conclude that since the introduction of cyclosporine, TN is performed less frequently, the frequency of TN in lower risk (primary white) and higher risk (secondary, black, cadaveric) groups has decreased and TN has been and remains a safe procedure.

Adolescent↗
PubMed1993

Case report 808: Avulsion fracture of the greater trochanter.

The differential diagnosis of unexplained hip pain after trauma in patients with normal radiographs includes both soft tissue and bony abnormalities. We have presented a case of an isolated fracture of the greater trochanter in an adult with normal radiographs where the diagnosis was made by MRI.

Adult↗
PubMed1993

Relation between choice of prostheses and late outcome in double-valve replacement.

The purpose of this study was to determine if the combination of a mechanical and bioprosthetic valve in the aortic and mitral positions influences late morbidity and mortality when compared with patients who had dual mechanical or dual bioprosthetic valves inserted. We reviewed the course of 89 hospital survivors of combined aortic and mitral valve replacement. The mean postoperative follow-up interval was 6.6 years, with a total follow-up of 583 years (98% complete). At 12 months after operation, mean functional class decreased from 3.1 to 1.7 (p < 0.05) and mean cardiac index increased from 2.1 to 2.5 L.min-1.m-2 (p < 0.05). Actuarial survival for the 89 patients (exclusive of < 30-day or in-hospital mortality, 14%) was 70%, 51%, and 33% at 5, 10, and 15 years. Freedom from reoperation was 93%, 78%, and 68%, and freedom from combined thromboembolism and anticoagulant-related hemorrhage was 82%, 60%, and 50%. These results show that there was no difference in overall survival in patients with dual mechanical valves, dual bioprosthetic valves, or a combination of both types at 15 years. There was, however, a lower reoperation rate in the group with dual mechanical valves as compared with the group with dual bioprosthetic valves (p < 0.05 at 10 years) or with a combination of valves (p < 0.05 at 15 years). The higher the number of mechanical valves the higher the combined risk of thromboembolism and anticoagulant-related hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

Late results after triple-valve replacement with various substitute valves.

The purpose of this study was to determine what influence various combinations of mechanical and bioprosthetic valves in the aortic, mitral, and tricuspid positions had on late morbidity and mortality of 40 hospital survivors of triple-valve replacement. At operation the patients ranged in age from 27 to 69 years; 73% were women. The mean postoperative follow-up interval was 8.3 years, with a total follow-up of 331 years (100% complete). At 12 months after operation, functional class decreased from 3.3 to 1.6 (p < 0.05), cardiac index increased from 2.0 to 2.6 L.min-1 x m-2 (p < 0.05), and pulmonary artery pressures decreased from 59/27 to 40/17 mm Hg (p < 0.05). There were no differences in preoperative variables between groups. Actuarial survival for the 40 patients (exclusive of 30-day or in-hospital mortality, which was 31%) was 78% and 74% at 5 and 10 years. At the same milestones, freedom from reoperation was 96% and 54%, freedom from combined thromboembolism and anticoagulant-related hemorrhage was 68% and 56%, and freedom from all late valve-related morbidity and mortality was 64% and 25%. Comparison of the patients with two or more mechanical prostheses with the patients having two or more bioprostheses indicated no significant differences in actuarial freedom from late death, thromboembolic events, or anticoagulant-related hemorrhage. However the actuarial freedom from reoperation in the groups with two or more mechanical valves was lower than that of the groups with two or more bioprosthetic valves (0/10 versus 13/30; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

Meniscal allografts.

Loss of the meniscus has been proved to be associated with increased joint pressures, mechanical changes, and ultimately hyaline cartilage degradation. Since the first arthritic changes following meniscectomy were appreciated, attempts have been made to alter and reverse the joint deterioration that occurs after removal of the knee fibrocartilage. Replacement of the fibrocartilage with either a prosthetic or biologic implant appears to be the only method of restoring normal joint anatomy. By inserting a meniscus substitute for the removed meniscus, the development of joint pathology should be avoided. This article focuses on the procedure of allogenic implants. Allogenic meniscal implants have been performed in humans for over 8 years. Recent clinical work has shown a rapid increase in the number of implants in the last 3 years with clinical review only now being presented. At present, the orthopedic surgeon has available cryopreserved, fresh-frozen, or frozen and irradiated tissue. Although much work has been performed in the animal with fresh-frozen tissue, the newly appreciated risk of disease transmission may require that all future implants be secondarily sterilized. Regardless of the type of implant, the early results of cell viability studies appear the same. Allogenic implants sustain new cellular ingrowth from the host and the DNA is replaced with host DNA. The ultimate success of this operation is not whether allogenic collagen can be transplanted into a host knee, but whether this tissue can be made to function and to preserve hyaline cartilage. Available data suggest that the technique being used to transplant the meniscus does not preserve normal meniscus function. These menisci may not function as they did in the donor. Additionally, few surgical techniques have been tested mechanically to compare meniscus function after transplantation. For these reasons, although transplant surgery for the meniscus remains an exciting and encouraging procedure to save the knee in a person who has had a total meniscectomy, the operation is currently being limited to those involved in study groups and investigational protocols. The long-term follow-up is at present limited or nonexistent. Objective parameters for evaluating posttransplant meniscus function are only now being collected and reviewed. Meniscal transplantation remains a cautiously optimistic treatment for the future.

Arthroscopy↗
PubMed1992

Elevated serum alpha-fetoprotein levels in primary gallbladder carcinoma without hepatic involvement.

BACKGROUND: Elevated serum alpha-fetoprotein (AFP) levels, although frequently associated with hepatocellular carcinoma, have also been reported in cases of primary gallbladder carcinoma. METHODS: The case of a 56-year-old man with a markedly elevated serum AFP level and primary gallbladder carcinoma without detectable hepatic involvement is reported. RESULTS: The patient had right upper quadrant abdominal pain and a palpable right upper quadrant mass. Computerized tomography scan of the abdomen showed a large, subhepatic mass consistent with the gallbladder, and normal liver parenchyma. Liver enzyme levels were normal. Management included cholecystectomy followed by postoperative radiation therapy to the gallbladder bed and portal areas and systemic chemotherapy. At the end of therapy, the AFP level had returned to normal. CONCLUSIONS: Gallbladder carcinoma is rarely diagnosed before surgery, which sometimes inhibits operative planning. AFP may be a useful preoperative tumor marker in differentiating the patient with primary gallbladder carcinoma from the patient with gallbladder hydrops.

Adenocarcinoma, Papillary↗
PubMed1992

Obstacles to effective case management with AIDS patients: the clinician's perspective.

A social work clinician filled the role of case manager with multiple functions of discharge planner, client advocate, counsellor and educator in her work with a young male AIDS patient and his family. Material from this case is used to illustrate seven problem areas identified as obstacles to effective case management: (1) The stigma of AIDS and homosexuality (2) Lack of adequate family support (3) Impact of AIDS dementia (4) Ethical dilemmas in discharge planning (5) Conflicts in the advocacy process (6) Lack of adequate resources and (7) Countertransference issues. Clinical observations are integrated with the existing social work literature which focuses on providing services to AIDS patients.

Acquired Immunodeficiency Syndrome↗