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Biomedical subjects

D Faust

Publications and source records attributed to D Faust.

36 records · Page 2Linked to original sources
PubMed1995

Modulation of mRNA expression and secretion of C1q in mouse macrophages by anti-inflammatory drugs and cAMP: evidence for the partial involvement of a pathway that includes cyclooxygenase, prostaglandin E2 and adenylate cyclase.

Isolated BALB/c mouse thioglycollate-elicited (inflammatory) peritoneal macrophages release at least 10 times more C1q than do isolated resident peritoneal macrophages. Addition of non-steroidal anti-inflammatory drugs (NSAID) to thioglycollate-elicited macrophages in culture inhibited the release of C1q and reduced levels of C1q-specific mRNA. Contrastingly, the NSAID were found to enhance C1q-specific mRNA levels in resident macrophages, although no increase in C1q levels secreted was observed. This suggests that the response of macrophages to NSAID, with respect to C1q synthesis, reflects the developmental stage of the macrophage. The gold salt auranofin (AFN) was found to enhance markedly C1q synthesis at both transcriptional and secretory levels in thioglycollate-elicited macrophages whilst, conversely, AFN reduced mRNA levels in resident macrophages. This indicates that AFN and the NSAID may work via the same or similar biochemical pathway, but with opposing effects. The glucocorticoid hydrocortisone (HC) greatly enhanced C1q-specific mRNA levels in both thioglycollate-elicited and resident macrophages, although no parallel increases in C1q secreted were observed. The data on inhibition of C1q biosynthesis by NSAID in thioglycollate-elicited macrophages are supported by the enhancement of C1q biosynthesis following addition of prostaglandin E2 (PGE2) or dibutyryl cyclic AMP (dBcAMP) to the cultures. From these experiments, it is concluded that C1q biosynthesis is controlled, at least in part, by a pathway involving cAMP.

Adenylyl Cyclases↗
PubMed1992

Integrating the cognitive mental status examination into the medical interview.

The frequency of cognitive deficits in medical patients makes the cognitive mental status evaluation an important component of the medical interview. This paper helps delineate the clinical situations in which formal cognitive mental status questioning is indicated. We address the critical issues involving the doctor-patient interaction in order to facilitate the evaluation of mental status without alienating the patient or introducing artificial and unnecessary questions. We review more specifically the areas of attention, memory, language, constructional ability, and higher cognitive functions. Finally, we address issues of referral for further evaluation.

Attention↗
PubMed1991

Forensic neuropsychology: the art of practicing a science that does not yet exist.

Despite its future promise, neuropsychological evidence generally lacks scientifically demonstrated value for resolving legal issues, and thus, if admitted into court, should be accorded little or no weight. In support of this contention, examples of problems and limits in forensic neuropsychology are described. These include contrasts between the clinical and forensic context; the base-rate problem; lack of standardized practices; problems assessing credibility or malingering; difficulties determining prior functioning, limits in the capacity to integrate complex data; and the lack of relation between judgmental accuracy and education, experience, or credentials. Some possible counterarguments are also addressed.

Activities of Daily Living↗
PubMed1990

To say it's not so doesn't prove that it isn't: research on the detection of malingering. Reply to Bigler.

Research that directly examines clinicians' capacity to detect malingering creates doubt about their success in this endeavor and about confident self-appraisals of detective abilities. We argue that Bigler's counterassertions lack supportive evidence or conflict with research on such topics as clinicians' level of training and experience and their judgmental accuracy. We further note that lack of both base rate information and definitive outcome information compound doubts about clinicians' capacity to detect malingering.

Child↗
PubMed1989

Clinical versus actuarial judgment.

Professionals are frequently consulted to diagnose and predict human behavior; optimal treatment and planning often hinge on the consultant's judgmental accuracy. The consultant may rely on one of two contrasting approaches to decision-making--the clinical and actuarial methods. Research comparing these two approaches shows the actuarial method to be superior. Factors underlying the greater accuracy of actuarial methods, sources of resistance to the scientific findings, and the benefits of increased reliance on actuarial approaches are discussed.

Actuarial Analysis↗
PubMed1989

Improving the accuracy of clinical judgment.

Diagnostic reasoning in psychiatry is as intricate as it is risky (Elstein et al. 1978; Fitzhenry-Coor 1986; Fitzhenry-Coor and Nurcombe 1983; Gauron and Dickinson 1965; Sandifer et al. 1970; Kendell 1973; Nurcombe and Fitzhenry-Coor 1982). During the clinical encounter, the clinician elicits, notes, and verifies pertinent clinical cues. Early in the encounter, from an assembled but incomplete pattern of data, an array of diagnostic hypotheses is generated. Subsequently, in the light of evidence systematically gathered, each diagnostic possibility is progressively refined or deleted until the diagnostic conclusion is reached. The validity of the clinical endeavor, thus, depends upon the pertinence of the hypotheses generated, for it is upon them that deductive reasoning will hinge. It also depends upon the reliability of the history, signs, and investigations that constitute the evidence gathered for or against each of the hypotheses. The purpose of this paper is to propose systematic strategies based on principles of probability and empirical research, with the aim of sharpening clinical reasoning.

Diagnosis, Differential↗
PubMed1989

The development and initial validation of a sensitive bedside cognitive screening test.

Brief bedside cognitive examinations such as the Mini-Mental State Examination are designed to detect delirium and dementia but not more subtle or delineated cognitive deficits. Formal neuropsychological evaluation provides greater sensitivity and detects a wider range of cognitive deficits but is too lengthy for efficient use at the bedside or in epidemiological studies. The authors developed the High Sensitivity Cognitive Screen (HSCS), a 20-minute interview-based test, to identify patients who show disorder on formal neuropsychological evaluation. An initial study demonstrated satisfactory test-retest and interrater reliability. The HSCS was then administered to 60 psychiatric and neurological patients with suspected cognitive deficits but without gross impairment, who also completed formal neuropsychological testing. Results of both tests were independently classified as either normal, borderline, or abnormal. The HSCS correctly classified 93% of patients across the normal-abnormal dichotomy and showed promise for characterizing the extent and severity of cognitive dysfunction.

Adolescent↗
PubMed1988

The expert witness in psychology and psychiatry.

The involvement of psychologists and psychiatrists within the legal arena continues to grow rapidly but remains highly controversial. Extensive research on clinical judgement provides a scientific basis for clarifying the growing disputes about the values of such professional activities. Studies show that professionals often fail to reach reliable or valid conclusions and that the accuracy of their judgements does not necessarily surpass that of laypersons, thus raising substantial doubt that psychologists or psychiatrists meet legal standards for expertise. Factors that underlie the research findings and implications for courtroom testimony are discussed.

Expert Testimony↗
PubMed1988

Prediction of the effects of mild head injury: a message about the Kennard Principle.

We surveyed assumptions with regard to the relation between age and outcome of head injury (a.k.a. the "Kennard Principle"). Two groups (N = 120) of practicing clinicians were sent background information about a mild to moderate head injury in which only the age of the patient varied and were asked to predict likely outcome (degree of impairment). Predicted outcome differed significantly, with an adolescent case judged much more likely to have serious impairment than a child case. Implications of the (mis)application of the Kennard Principle are discussed.

Adolescent↗
PubMed1988

Clinical utility of the MMPI in the evaluation of adolescent suicide attempters.

MMPI profiles of female adolescents hospitalized on a general pediatrics floor following a suicide attempt were compared to a control group of medically hospitalized, female adolescents referred for psychiatric evaluation. The suicide attempters had only a lower score on the K scale when compared to the control group. Results do not suggest that a single MMPI profile differentiates suicide attempters from a comparison group of adolescents with emotional difficulties. Implications of these findings are discussed.

Adolescent↗
PubMed1987

Moderately elevated blood lead levels: effects on neuropsychologic functioning in children.

Investigations of moderately elevated lead levels and children's cognitive functioning have yielded conflicting results, although studies showing no effects used measures of limited sensitivity and breadth. In this study, a comprehensive neuropsychologic battery was used to determine whether deficits would be revealed. An experimental group of 15 children with a past history of moderately elevated lead levels, but subsequently without increased lead levels for at least a year, were compared with a control group matched by residential area, socioeconomic status, parental IQ, age, and gender. The experimental groups' performance was lower on the battery overall and on measures of motor skill, memory, language, advanced spatial functions, and concentration. The results suggest that exposure to moderately elevated lead levels exerts significant and nontransient effects on cognitive functions.

Child↗
PubMed1986

Bedside cognitive screening instruments. A critical assessment.

Bedside cognitive screening instruments are used increasingly in clinical and research settings to detect cognitive impairment and to quantify its severity. The authors review the five most frequently cited bedside screening tests that use an interview format and require brief administration times: the Mini-Mental State Examination, the Cognitive Capacity Screening Examination, Mattis Dementia Rating Scale, Kahn's Mental Status Questionnaire, and the Short Portable Mental Status Questionnaire. The tests all have adequate inter-rater reliability, and adequate test-retest reliability has been established for three of the tests. All of the tests show close correspondence with clinical diagnoses of delirium and dementia and are useful for the diagnosis and quantification of these syndromes. However, there is currently no evidence that the tests increase the level of diagnostic accuracy achieved through clinical examination alone. All of the tests have substantial false-negative rates, with false-negative errors frequent among patients with focal lesions, particularly of the right hemisphere. False-positive errors may be more common among patients with less education and lower socioeconomic status. The tests reviewed do not detect many types of cognitive deficit that may bear critically on differential diagnosis and case management. Suggestions are given for further research on the current measures and for the development of new screening tests that would meet a broader range of clinical purposes.

Adult↗
PubMed1986

The empiricist and his new clothes: DSM-III in perspective.

The authors examine and critique the methodological underpinnings and programmatic goals of DSM-III's underlying doctrine--strict empiricism. The methodological program of DSM-III emphasizes description and the reduction of inference and theory. Regardless of appearances to the contrary, these goals have not been approached, cannot be attained, and should not be pursued, at least in their extreme form. They are throwbacks to earlier and now revised views of science. These goals give the highest priority to things that either should not receive it or that are secondary outgrowths of other accomplishments, and they have the potential to discourage the conceptual and theoretical developments that are the prime movers of scientific progress, according to the authors.

Data Collection↗
PubMedDate not supplied

Neuropsychological functioning in treated phenylketonuria.

Comprehensive neuropsychological assessment was performed on a series of patients with treated classical phenylketonuria. All patients showed a similar cluster of performance deficits in motor and visual-motor functions, spatial operations, academic skill areas, and select areas of higher level reasoning. The results are consistent with other neuropsychological studies of patients with early and late diet termination that have used differing assessment methods, thus allowing for greater confidence in the findings. Examination of underlying factors indicates that poor motor coordination, limits in the complexity of spatial problem solving, and limits in the amount of information that can be "processed" simultaneously may account for most or all of the performance deficits observed among these patients. Suggestions for future research and both clinical and theoretical implications of the findings are discussed.

Adolescent↗