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Biomedical subjects

J Craven

Publications and source records attributed to J Craven.

31 records · Page 2Linked to original sources
PubMed1988

Research in consultation-liaison psychiatry: the Toronto General Hospital experience.

Research that has developed in association with the consultation-liaison service at the Toronto General Hospital is reviewed in this paper. The value of systematic investigation in the consultation-liaison setting is addressed. Such approaches may be necessary to establish consultation-liaison psychiatry as a theoretical discipline which can advance knowledge in addition to enhancing patient care.

Humans↗
PubMed1986

Loss of enhanced nocturnal growth hormone secretion in aging rhesus males.

Enhanced nocturnal release of GH is decreased with aging in man, a change that may implicate GH in a general decline in anabolic metabolism associated with aging. The aim of this study was to determine whether nonhuman primates experience an age-related reduction in plasma GH levels by comparing the 24-h patterns of GH secretion in unrestrained young and aged male rhesus monkeys. Six young (8 yr old) and six aged (22+ yr old) intact rhesus males were fitted with indwelling jugular catheters, cranial platforms, and stainless steel cable tethers. Catheters passed from a swivel device at the top of each cage through a wall to an adjoining room. On four occasions, 1.0-ml blood samples were obtained from each male every 20 min for 24 h for plasma GH RIA. Plasma GH data were analyzed by the PULSAR program to detect hormone peaks. Mean 24-h plasma GH was less (P less than 0.0005) in aged males [0.84 +/- 0.04 ng/ml (+/-SEM)] than in young males (1.37 +/- 0.09 ng/ml). Likewise, the amplitudes of GH pulses were less (P less than 0.001) in aged males than in young males. Although no circadian pattern of GH concentrations was apparent in either age group, young males displayed more (P less than 0.05) nocturnal GH pulses (5.73 +/- 0.41 pulses/12 h) than those occurring during lights-on (3.09 +/- 0.32 pulses/12 h). The numbers of GH pulses in aged males (4.00 +/- 0.63 pulses/12 h) were similar to those in young males during lights-on, but aged males showed fewer (P less than 0.05) nocturnal GH pulses (4.27 +/- 0.47 pulses/12 h) than did young males. The duration of GH pulses in aged males (53.6 +/- 5.0 min) was similar to that in young males (50.6 +/- 5.0 min) during lights-off. Young males showed an extended (P less than 0.001) GH pulse duration (88.8 +/- 8.8 min) during lights-on that was not evident in aged males (66.2 +/- 5.4 min). These data demonstrate that unrestrained young rhesus males experience an enhanced nocturnal release of GH in terms of pulse frequency, and as in humans, this enhanced nocturnal release of GH is diminished with age. In addition, rhesus males experience, as do humans, a reduction in circulating GH levels as a function of age.

Aging↗
PubMedDate not supplied

Lymphadenectomy for gastric cancer in clinical trials: update.

The controversy over the value of extended lymph node dissection for treatment of gastric cancer is fiercely debated. Whereas Japanese surgeons claim that the superior survival rates in their series are due to extensive resection (D2 resection), many Western authorities believe that their results only reflect differences in the prevalence of prognostic factors, inconsistencies between Japanese and Western staging systems, and the phenomenon of "stage migration," which occurs with extensive resection. Two small randomized prospective trials from Hong Kong and Cape Town showed a tendency toward high morbidity with extensive lymph node dissection but no survival benefit. In contrast, the recently completed prospective German Gastric Carcinoma Study demonstrated a clear survival advantage with D2 resection for tumor stages II and IIIa with no increase in perioperative morbidity or mortality. The long-term results of the still ongoing randomized MRC and Dutch trials are therefore eagerly awaited.

Clinical Trials as Topic↗
PubMedDate not supplied

Bibliotherapy for psychosocial distress in lung transplant patients and their families.

Thirty-six lung transplant candidates (n = 16), recipients (n = 11), and support people (n = 9) were examined for psychological distress, coping style, and orientation to independent learning before and after receiving a self-help book in a program designed to alleviate psychosocial distress and bolster adaptive coping. The subjects rated the book as highly acceptable, and none reported increased psychological distress. A further six subjects completed initial psychological measures but elected not to us the book. These subjects were compared with study completers and found to have significantly higher disengagement scores on the Coping Strategies Inventory. Although uncontrolled, significant changes were observed in coping strategies used by the completer group. The relevance of these findings to the use of bibliotherapy in medically ill populations is discussed.

Adaptation, Psychological↗
PubMedDate not supplied

Accuracy of clinical impressions and Mini-Mental State Exam scores for assessing capacity to consent to major medical treatment. Comparison with criterion-standard psychiatric assessments.

The authors evaluated the accuracy of clinical impressions and Mini-Mental State Exam scores for assessing patient capacity to consent to major medical treatment, relative to expert psychiatric assessment. Consecutive medical inpatients (N = 63) facing a decision about major medical treatment received a clinical impression of capacity from their treating physician and the Standardized Mini-Mental State Exam (SMMSE); 48 received independent psychiatric assessment of capacity. Analyses revealed that both clinical impressions and SMMSE scores were generally inaccurate in determining capacity, although all 23 participants with a clinical impression of "definitely capable" were found capable by the psychiatrist. Given the importance of assessing capacity to consent to major medical treatment, better approaches to the clinical assessment of capacity are required. Several strategies are discussed.

Adult↗
PubMedDate not supplied

Leadership at Mbarara.

Explore the source record for details and available documents.

Hospital Administrators↗