Biomedical subjects
G Charles
Publications and source records attributed to G Charles.
Ambulatory care classification systems.
This article describes several methods of classifying resources used in ambulatory care into isoresource consumption groups. These methods are based on resources used by patients during a year, rather than on resources used in a single visit. Variables used to partition patient-year charges into isoresource consumption groups are age, race, number of health problems or major diagnostic categories addressed, number of medications or categories of medications prescribed, and indexes developed to reflect resources used by diagnostic categories during a patient-year. Confirmation in other settings of the findings of this study would have important implications for the design of prospective payment plans for ambulatory care.
[A case of true hermaphroditism].
The authors report a case of true hermaphroditism, a rare intersexual condition characterized by the coexistence of ovarian and testicular tissue in the same subject. The authors have analysed this unusual condition in clinical and paraclinical terms and draw conclusions regarding the psychological and surgical principles to be applied in its treatment.
Growth hormone release after desipramine in depressive illness.
The effect of i.m. administration of 75 mg of desipramine on growth hormone (GH) secretion was investigated in a sample of 87 patients with major depressive disorders and in 31 normal controls. The GH response was lower in depressed females compared to depressed males, but no such difference was present in controls. In the premenopausal female group, GH response was significantly lower in depressed patients than in controls. No significant difference was found between normal males and male depressed patients. In the premenopausal group, no difference emerged between endogenous and nonendogenous depressed women.
The use of negative indexes of health to evaluate quality of care in a primary-care group practice.
A quality assessment method using negative indexes of health as a measure of the quality of medical care was applied in a hospital-based primary-care group practice. During a 5-year period, records of 1,147 patients were analyzed. The study led to several observations regarding the use of this method in this setting: 1) The negative indexes of health method encourages physicians to include both primary and secondary preventive measures in their practice of medicine and to see their role as a broad one, from providing good care to individual patients to influencing public policy. 2) Most medical records do not now contain all the data required for use of this method. 3) In cases where this method identifies only a few instances of possibly preventable disease or untimely death, it is impossible to know whether the care is good and the method of evaluation is sensitive, or whether the care is poor and the method is insensitive to deficiencies in care.
Classification of ambulatory care using patient-based, time-oriented indexes.
This paper presents a new approach to the classification of ambulatory care into isoresource consumption groups. In contrast to classification schemes based on visits, this case-mix approach creates an index based on resources used by diagnostic categories by a patient during a year. An application of this method to a primary care, group practice data base produced resource consumption groups with coefficients of variation in an acceptable range compared with the coefficients of variation of the diagnosis-related groups used to classify inpatient care.
The physician, rationing, and medical care in the Veterans Administration.
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Do patients want to participate in medical decision making?
Although shared decision making by patients and clinicians has been advocated, little is known about the degree of participation in decision making that patients actually prefer or about clinicians' appreciation of these preferences. We administered questionnaires about three aspects of decision making to 210 hypertensive outpatients and to their 50 clinicians, who represented three types of medical practices. We found that 41% of patients preferred more information about hypertension; clinicians underestimated patient preferences for discussion about therapy in 29% of cases and overestimated 11% (k = .22); and 53% of patients preferred to participate in making decisions, while clinicians believed that their patients desired to participate in 78% of cases. Many patients who preferred not to make initial therapeutic decisions did want to participate in ongoing evaluation of therapy. Thus, clinicians underestimate patients' desire for information and discussion but overestimate patients' desire to make decisions. Awareness of this discrepancy may facilitate communication and decision making.
Cost containment confronts physicians.
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Regional cerebral blood flow and lateralized hemispheric dysfunction in depression.
Cerebral blood flow is known as an indicator of cerebral metabolism. Using the 133Xenon inhalation method, we studied the regional cerebral blood flow (r-CBF) in patients with different subtypes of depression and in remission. A left frontal hypervascularization and a right posterior hypovascularization were found in major depressives, compared to normal subjects, minor depressives, and normothymic bipolar patients. These results tend to confirm the existence of cerebral dysfunction in both hemispheres in major depression, as reported by other authors using different techniques.
Comparison of two therapeutic regimens using the same topical corticoid for stable psoriasis.
In a masked, randomized, concurrently controlled clinical trial we compared the therapeutic response of two regimens in which the same topical corticoid was used to treat 52 men who had stable psoriasis. One regimen, called reduced dose, consisted of once-a-day application of a representative potent fluorinated topical steroid ointment, fluocinonide (Lidex), combined with three-times-a-day application of its vehicle. The other regimen, called traditional dose, consisted of four-times-a-day topical application of the same steroid. Patients were assigned to one of the two regimens and observed for six weeks. Confidence intervals for the difference in true mean response under these two regimens provide good evidence that for these patients the traditional dose was not clinically superior to the reduced dose.
The dexamethasone suppression test and cerebral blood flow in primary major depression.
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[The Risk-Rescue Scale and evaluation of suicidal persons].
The R-S scale evaluates the lethality of suicidal acting-out behavior. We applied it, in the first phase, to 97 patients. The differences between our results and those of Weisman and Worden bring us to frame two hypotheses: either the differences are due to the specific nature of each population, or the differences are due to the observers. In the second phase, we apply the R-S scale to 170 patients. Across the three groups studied (Weisman and Worden's, our first phase, our second phase), we note that in the first phase there are differences linked to the observers, but that the specific nature of the respective populations also contribute to the differences. This is all the more obvious when we consider the number of suicide attempt repeaters within each group.
[Detection of suicide attempts likely to be repeated within a year].
According to the World Health Organization, 20-30% of suicide attempters make a new attempt within 12 months. Buglass and Horton have proposed a 6-point clinical scale meant to predict the risk of repetition within a year. The authors used this instrument on 183 suicide attempters. Based on the new attempts actually observed, they discuss the validity and the specificity of this instrument.
[Dexamethasone suppression test and suicide].
Suicidal behavior may be related to perturbations of the hypothalamo-pituitary axis. We administered the DST to 51 patients admitted for suicide attempt on admission day. No correlation is found between DST result and type of suicide attempt. The DST's diagnostic predictive value was absent for our population. Neither alcoholism, nor repeat of suicide attempt, nor suicidal behavior rating scales were correlated with DST results. Drug interference effects and the "stress" factor may explain our DST results on a population of suicide attemptors.
Dexamethasone resistance and cortisol secretion in depressive illness.
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The dexamethasone suppression test in affective disorder: relationship to clinical and genetic subgroups.
Plasma cortisol suppression after dexamethasone administration in 113 consecutively hospitalized patients (54 patients with primary depression, 41 with secondary depression and 18 non-depressed controls) showed early morning hypersecretion of cortisol and cortisol non-suppression after dexamethasone mainly in patients with primary depression. The sensitivity of the dexamethasone suppression test was 79 per cent in unipolar and bipolar primary depressed patients, specificity 79 per cent and diagnostic confidence of a positive test 82 per cent. Non-suppression to dexamethasone was observed in 81 per cent of patients with psychotic depression but only 37 per cent of those with nonpsychotic depression. Age, sex and severity of depression, menopausal status, or benzodiazepines did not influence results. There was no association between cortisol non-suppression and any genetic subgroup of affective disorder.