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Biomedical subjects

D Goldberg

Publications and source records attributed to D Goldberg.

At least 235 records · Page 13Linked to original sources
PubMed1987

How psychiatric disorders are missed during medical consultations.

There is a strong correlation between patients' scores on a psychiatric screening questionnaire and the number of cues indicative of psychological disturbance that patients give during the medical interview. Verbal cues have the strongest correlation with psychological distress as measured by the questionnaire, but movement cues and postural cues are also important. The reason why some doctors are better able than others to detect psychiatric illness is that they are more likely to allow patients to express verbal and vocal cues.

Cues↗
PubMed1987

Fetal hemoglobin gene activation in a phase II study of 5,6-dihydro-5-azacytidine for bronchogenic carcinoma.

5-Azacytidine and several of its analogues are known to inhibit DNA methylation, alter gene expression, and inhibit cell growth. We report a Phase II study in which we investigated the antineoplastic activity of 5,6-dihydro-5-azacytidine and its induction of fetal hemoglobin synthesis when given by a 5-day continuous i.v. infusion of 1650 mg/m2/day that was repeated every 21 days. Fetal hemoglobin was measured in all patients; increased synthesis was found in 13 of the 17, in the absence of clinically significant anemia. Of the four patients who did not develop increased fetal hemoglobin, three had only one cycle of therapy. Fourteen patients with bronchogenic carcinoma were treated, and ten were evaluable for disease response. Five patients had disease stability of 2 or more mo, and five progressed on treatment. Three additional patients with mesothelioma were treated, and the two who were evaluable for disease response had stabilization of their disease. Fifteen of the 17 patients who received 5,6-dihydro-5-azacytidine developed a pleuritic-type chest pain, 12 had abnormal electrocardiograms, and four developed positive anti-nuclear antibodies. No significant hemopoietic, hepatic, or renal toxicities were observed. This study demonstrates that 5,6-dihydro-5-azacytidine in the dose and schedule used has no significant therapeutic activity in the treatment of lung cancer but does possess an unusual spectrum of clinical toxicities as well as the property of inducing fetal hemoglobin synthesis.

Adult↗
PubMed1987

Improving the psychiatric skills of established general practitioners: evaluation of group teaching.

Ten established general practitioners, eight of whom were also trainers, took part in a course designed to improve their psychiatric interviewing skills. Participants were instructed in the problem-based model with audiotape and videotape feedback of real consultations in a group setting. Although those attending were experienced practitioners with a particular interest in the management of psychological problems, evaluation demonstrated a significant improvement in their skills after training. It is suggested that trainers could be trained to provide a similar teaching experience for their own trainees.

Attitude of Health Personnel↗
PubMed1987

Students' attitudes towards psychiatry.

Using a reliable measure, a self-administered questionnaire (ATP), and adequate numbers of students, this study demonstrates the negative effects of general medical/surgical training and the positive effect of the psychiatry clerkship on students' reported attitudes towards psychiatry. A negative view of psychiatry at the beginning of the clerkship may make students reluctant to improve their interview skills but is otherwise unimportant in determining their reactions and performance in the clerkship. Medical students' interest in psychiatry as a career increases during the psychiatry clerkship but this merely offsets the decline in interest that occurs at other stages during the clinical training. Much of the attitudinal change that occurs during the psychiatry clerkship is maintained into the pre-registration year but the housemen recorded a significant negative change on the items concerning efficacy of psychiatric treatment and attitudes towards psychiatric patients. Additional training by psychiatrists during the pre-registration year might increase the motivation of young doctors to detect and treat psychiatric illness which they will encounter in all branches of medicine.

Attitude of Health Personnel↗
PubMed1987

Doctors' interest in psychiatry as a career.

Fifty pre-registration housemen were interviewed to elicit their attitudes towards a career in psychiatry. The doctors were all those in one academic year who were recommended for honours on the basis of their performance during the psychiatry clerkship. Those who gained honours in other subjects as well as psychiatry were unlikely to choose a career in psychiatry. The study indicates that further improvements in the psychiatry clerkship will not improve recruitment. Factors outside psychiatry--the pull to general practice and other specialties and the negative attitudes towards psychiatry expressed by other doctors--are among the major deterrents for young doctors considering a career in psychiatry. Collaborative teaching between psychiatrist, physicians and surgeons during the pre-registration year should encourage recruitment and gradually improve the widely held negative attitudes towards psychiatry.

Attitude of Health Personnel↗
PubMed1987

Hysterical personality disorder. The process of diagnosis in clinical and experimental settings.

A study of the case notes of 52 patients with a diagnosis of hysterical personality disorder showed that 27 had no recorded features of that condition, but were frequently described as aggressive, uncooperative, or attention-seeking. Although 60% were recorded as depressed, only 17% received antidepressant treatment. In an experimental study, the core traits of the disorder were found to have a low inter-rater reliability. Two patients, who had received hospital diagnoses of hysterical personality disorder, were shown to display behaviour that caused psychiatrists to make a diagnosis on wholly inadequate information.

Adult↗
PubMed1987

The evaluation of a hostel ward. A controlled study using modified cost-benefit analysis.

A controlled modified cost-benefit evaluation of a hostel ward caring for new long-stay patients is described and results are presented for the first two years. In some respects the residents of the hostel ward had fewer psychotic impairments than those remaining on the wards of the district general hospital, mainly because the latter seem to continue to acquire such defects, while the former have remained relatively unchanged. The hostel ward residents also develop superior domestic skills, use more facilities in the community, and are more likely to be engaged in constructive activities than controls. These advantages were not purchased at a price, since the cost of providing this form of care for these patients has cost less than care provided by the district general hospital.

Adolescent↗
PubMed1987

Preliminary analysis of a randomized comparison of 5-fluorouracil versus 5-fluorouracil and high-dose continuous-infusion folinic acid in disseminated colorectal cancer.

In this study, 50 patients were randomly assigned to treatment with 5-fluorouracil (FUra) or FUra plus high-dose continuous-infusion folinic acid. Five of 27 evaluable patients in the FUra group versus 10 of 21 patients in the FUra plus folinic acid arm of the study had objective partial remissions, P = 0.02. Time to progression was 3.9 months for FUra and 8.0 months for FUra and folinic acid, P = 0.006; however, median survivals (11.9 versus 14.5 months) were not different in this crossover study. Toxicity in both treatment arms was mild, although patients receiving FUra plus folinic acid experienced significantly more stomatitis than patients treated with FUra alone. This study suggests that high-dose, continuous-infusion folinic acid, which produces a steady-state level of biologically active folates of 10 microM, significantly increases the therapeutic activity of FUra.

Adenocarcinoma↗
PubMed1987

Systemic salmonellosis in patients with disseminated histoplasmosis. Case for 'macrophage blockade' caused by Histoplasma capsulatum.

Five patients are described with disseminated histoplasmosis and systemic salmonellosis. Four of these patients were also immunocompromised because of the acquired immunodeficiency syndrome in two patients and renal transplantation in another two patients. Histologic studies in two patients showed histiocytes that were heavily laden with Histoplasma capsulatum yeast-phase organisms. We postulate that diffuse parasitization of the reticuloendothelial system (RES) by Histoplasma organisms may cause "RES blockade," which then predisposes to systemic salmonellosis, as reported in certain other infections and in sickle cell anemia.

Adult↗
PubMed1987

Screening for psychiatric illness in general practice: the general practitioner versus the screening questionnaire.

This study compares the characteristics of general practitioners and a pen and paper test in the detection of psychiatric disorder in primary care settings. A psychiatrist interviewed a stratified sample of 283 patients drawn from 590 consecutive new illnesses seen in 15 general practices. Research diagnoses could be made in between one-quarter and one-third of the consecutive new illnesses. Two different research diagnostic systems agreed quite well with one another about who should be regarded as a psychiatric 'case' - although agreement between them for individual diagnoses was less impressive. Research diagnoses of psychiatric illnesses could be made in approximately 30% of new episodes of illnesses seen. If the DSM-3 system was used as a criterion of 'caseness', the specificity of the general health questionnaire was 75.4%, and the sensitivity was 87.1%. The general practitioners had fewer false positives than the questionnaire, but they were much more likely to miss psychiatric cases. Use of the general health questionnaire could increase their sensitivity from about 50% to 95%.

Family Practice↗
PubMed1986

Analysis of DR beta and DQ beta chain cDNA clones from a DR7 haplotype.

A cDNA library was constructed from a DR7, DRw53, DQw2 homozygous cell line, cDNA clones corresponding to DR beta and DQ beta chains were isolated, and the nucleotide sequences of the polymorphic first domains of these chains were determined. A novel screening strategy allowed rapid and simple identification of cDNA clones corresponding to both DR beta chains (DR7 beta1 and DR7 beta2): DR7 beta2 clones have a recognition site for the enzyme BssHII, whereas DR7 beta1 clones do not. The DR7 beta 1 sequence differs significantly from all previously described DR beta chains. As predicted by the presence of the BssHII site in DR7 beta 2 clones, the DR7 beta 2 sequence differs from the DR7 beta 1 sequence. The sequence of the DRw53-associated DR7 beta 2 chain is identical to the reported sequence of the DRw53-associated DR4 beta 2 chain. In addition, the sequence of the DQ beta chain from the DR7, DQw2 cell line is identical to the reported sequence of a DQ beta chain from a DR3, DQw2 cell. These findings raise interesting questions about the evolution of the DR3, DR4, and DR7 haplotypes.

Amino Acid Sequence↗