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Biomedical subjects

J Holmes

Publications and source records attributed to J Holmes.

At least 73 records · Page 4Linked to original sources
PubMed1996

Values in psychotherapy.

There is a tension between those who hold that psychotherapy is a scientific discipline and therefore "value-free," and those who believe that values are inherent in the nature of psychotherapy. Psychoanalysis has moved from a science-based ideology, through the ethical concerns of Melanie Klein, to a recognition of the "aesthetic" dimension--the creation of suitable forms that can contain psychological distress. From this latter perspective, the antagonism between religion and psychotherapy, initiated by Freud, becomes less acute. Action-based ethical systems, which ignore the inner world, are critically scrutinized. The evidence suggesting there is a relationship between good outcome in psychotherapy and shared values between therapist and client is reviewed. It is posited that through examination of the "ethical countertransference," therapists should become aware of their own value systems and how they influence practice.

Freudian Theory↗
PubMed1996

Dependence of retinopathy (and other complications) on glycaemic control and on weight over 5/10 years from diagnosis of type II diabetes.

Glycosylated haemoglobins and weights were recorded for 200 consecutive diabetic clinic attenders seen yearly for 5 years, 76 of whom were also seen up to 10 years from diagnosis of type 2 diabetes, representing 1380 patient years. Weight fluctuation (> 3 kg) was associated with increased final prevalence of hypertension, macroalbuminaemia and a raised creatinine (P < 0.002) but this relationship was abolished by correction for higher initial weight. Average glycaemia over 5/10 years [itself related to initial weight in women on tablets (N = 53) but not others, and to waist but not waist/hip ratio], correlated with prevalence and severity of retinopathy (N = 200; r = 0.38, P < 0.0006) seen also in the subgroup of patients on tablets (N = 145, P < 0.006). At HbA1 levels > 10.5% an increased prevalence of retinopathy was seen in those on insulin (N = 37, P < 0.001) and an increased prevalence of peripheral vascular disease was seen in men but not women (x2 = 2.87, P < 0.01) as well as in the prevalence of neuropathy. These findings suggest that good glycaemic control is of value in type 2 diabetes and less easily achieved in obesity.

Aged↗
PubMed1996

Psychotherapy integration: its implications for psychiatry.

BACKGROUND: The proliferation of psychotherapies has been balanced by an equal and opposite tendency towards integration. Integrative approaches are particularly relevant to psychotherapy in psychiatric settings. METHOD: MEDLINE and manual literature searches yielded over 250 articles on psychotherapy integration, which are reviewed in the light of the authors' experience in a district psychotherapy service. RESULTS: Psychotherapy integration is an umbrella term covering a wide range of meanings: rapprochement between different theoretical positions; convergence of ideas and techniques; eclectic selection from many different methods; and integration proper in specifically integrative therapies. Many effective psychotherapeutic treatments for psychiatric disorders are integrative, including those for depression, schizophrenia, bulimia nervosa and borderline personality disorder. CONCLUSIONS: Integration at the level of practice is common and desirable. At the level of theory, clarification and creative conflict are essential. Different therapeutic approaches should work closely together but retain their separate identities.

Cognitive Behavioral Therapy↗
PubMed1995

Short communication: selecting input distributions for use in Monte Carlo simulations.

Monte Carlo analysis is increasingly employed as a means of quantifying uncertainties in risk assessment. However, the output of any Monte Carlo analysis is extremely sensitive to the input distributions used. In this paper we present a simple set of guidelines for the selection of input distributions. The guidelines involve allocating variables with unknown distributions to appropriate distributional "classes," based on the range of possible values that could be obtained for the data and known characteristics about the behavior of the variable. If the class of distribution is not identifiable, then variables can be related to a specific distribution using goodness-of-fit techniques. If these identification schemes fail, bootstrapping techniques may be used to generate a sampled distribution from the available data. Finally, "default" distributions may be employed using analogous data if site-specific data are unavailable.

Mathematics↗
PubMed1995

Focal 2-DG uptake persists following olfactory bulb lesions.

Exposure of rats to different odors produces spatially distinct patterns of 14C-2-deoxyglucose uptake (2-DG) in the glomerular layer of the main olfactory bulb. However, lesions of specific regions of the bulb that reliably contain 2-DG foci reportedly do not impair the ability of rats to perform olfactory-guided behaviors, suggesting that the lesioned olfactory bulb retains odor-responsiveness. Because the absence of focal 2-DG incorporation in lesioned olfactory bulbs has not been verified by 2-DG autoradiography, it cannot be concluded that focal responses in the olfactory bulb do not contribute to the encoding of olfactory information. To examine the effects of bulb lesions on 2-DG uptake in the olfactory bulb, we placed lesions in specific regions of the bulb that reliably contain 2-DG foci. We then exposed rats to odors 3 or 6 weeks later to determine if the lesions effectively eliminated focal 2-DG uptake in these bulbs. The results indicate that lesioned olfactory bulbs contain focal regions of 2-DG uptake in response to odor stimulation.

Animals↗
PubMed1995

Prehospital classification combined with an in-hospital trauma radio system response reduces cost and duration of evaluation of the injured patient.

BACKGROUND: This study was undertaken to determine whether a prehospital trauma classification system (PHTCS) in combination with an in-hospital trauma radio system response (IHTRSR) impacts emergency care of the injured patient. METHODS: In 1991 our trauma center used no prehospital trauma classification system. A PHTCS was implemented in 1992, and in 1993 the PHTCS was integrated with an IHTRSR: RESULTS: Implementation of the PHTCS and IHTRSR resulted in a significant reduction in the time required for initial evaluation of the trauma patient with an associated reduction in cost. Reduction in time of the initial trauma evaluation was noted in both adult and pediatric populations, in patients with a blunt mechanism of injury, and in the injured patients posing the greatest strain to health care resources. CONCLUSIONS: Integration of a PHTCS with an IHTRSR has a significant impact on the cost and time of emergency treatment of the trauma victim with no adverse effect on patient outcome. Use of an integrated trauma response provides cost-effective and expeditious care of the injured patient and should be considered in trauma system development.

Adolescent↗
PubMed1995

Supportive psychotherapy. The search for positive meanings.

BACKGROUND: The attempt to define psychotherapeutic skills appropriate for psychiatrists has aroused an interest in supportive psychotherapy, a previously undervalued and underdeveloped member of the psychotherapeutic family. This has been coupled with an increasing recognition of the importance of support within formal psychotherapies, especially when working with highly disturbed patients. METHOD: A review of supportive psychotherapy (ST) was performed, based on a Medline literature search. RESULTS: It is argued that, from the perspective of attachment theory, support is an integral part of al psychotherapies. ST is also a specific mode of treatment suitable for some patients suffering from psychotic illnesses and borderline personality disorder. ST is an eclectic treatment drawing on many theoretical approaches. A common theme based on a narrative co-constructionist perspective, the search for positive meaning, is identified. CONCLUSIONS: Supportive psychotherapy is an essential component of good psychiatric practice. Further research is needed to define its benefits and limitations.

Borderline Personality Disorder↗
PubMed1995

Financial analysis of alternative treatments for clinical mastitis associated with environmental pathogens.

For two large California dairy herds with twice daily milking, 171 infected quarters of lactating cows with mild clinical mastitis were randomly assigned to one of three treatment groups. Group A (50 cows) was treated with 62.5 mg of intramammary amoxicillin every 12 h for three milkings. Group C (50 cows) was treated with 200 mg of intramammary cephapirin every 12 h for two milkings. Group O (71 cows) was treated with 100 U of intramuscular oxytocin every 12 h for three milkings. Clinical cure rates did not differ among treatment groups. The cost per episode of clinical mastitis was higher ($54.47) for group C than for groups A ($38.53) or O ($34.88). Group O had a higher incidence of relapse (41%), and a greater percentage of group O cows (65%) experienced an additional mastitic event in the enrolled lactation than did cows in groups A and C. Treatment had no effect on the mean number of nonsalable milkings (24.7) associated with mastitis in the lactation interval subsequent to enrollment on the trial. Twenty-two percent of the cows accrued more than 30 nonsalable milkings and produced 55% of the total nonsalable milkings associated with mastitis. There was no treatment effect on total milk production, fat production, or time to removal of the enrolled cows from the herd.

Amoxicillin↗
PubMed1994

A study of wound infections following inguinal hernia repair.

A prospective study was carried out to determine the incidence of wound infection following surgery for inguinal hernia repair in a day surgery unit. The study incorporated surveillance for 1 month postoperatively. All patients were contacted by telephone, and reports of possible wound infection investigated via their General Practitioners. Ninety-seven patients were included in the study and the infection rate was 4%.

England↗
PubMed1993

Cytotoxicity of orthodontic elastics.

The neon-colored orthodontic rubber bands have recently become remarkably popular to wear among the young patients. In this study we examined if the dyes used in the manufacture of these elastics might exhibit any toxic effects. Gingival fibroblasts were exposed to extracts of colored and plain elastics in vitro. Cytotoxicity was examined by cellular proliferation rate and viability. Results showed that both the plain and the colored elastics display identical toxic effects. This ex vivo cytotoxicity, however, could not be observed in orthodontic patients: gingival fibroblast viability is no different in patients with and without rubber band wear. We conclude that in in vitro conditions, all orthodontic rubber bands are cytotoxic. Clinically, however, this effect is not demonstrable.

Adolescent↗
PubMed1993

Spatio-temporal structure of the communities of helminths in the digestive tract of Sciaena umbra L. 1758 (Teleostei).

The helminth community in the digestive tract of the sedentary predatory fish, Sciaena umbra, near the Scandola Nature Reserve, Corsica, consists of 5 species of digeneans. Anoiktostoma coronatum (in the rectum) and Metadena pauli (in the intestine) were found in almost all the fish, and in high numbers; they are considered core species. Distomum aloysiae, Pleorchis polyorchis (both in the intestine), and Stephanostomum bicoronatum (in the rectum) were relatively uncommon, usually found in small numbers, and are considered satellite species. The two core species were very abundant in June, when the size of their populations was strongly correlated with the size of the host fish. At this time, M. pauli was found mainly in the duodenum, but in high populations was spread throughout the intestine (s. strict.). Both species were much less abundant in October, their populations were less dependent on host size, and M. pauli was more limited to the anterior intestine. Pleorchis polyorchis and Distomum aloysiae were more frequent in October, were found predominantly in fish with few M. pauli, and were found posterior to M. pauli, suggesting some interactions between these species. Stephanostomum bicoronatum showed no seasonal patterns, and no apparent interactions with A. coronatum.

Animals↗
PubMed1993

Attachment theory: a biological basis for psychotherapy?

John Bowlby bemoaned the separation between the biological and psychological approaches in psychiatry, and hoped that attachment theory, which brings together psychoanalysis and the science of ethology, would help bridge the rift between them. Recent findings in developmental psychology have delineated features of parent-infant interaction, especially responsiveness, attunement, and modulation of affect, which lead to either secure or insecure attachment. Similar principles can be applied to the relationship between psychotherapist and patient--the provision of a secure base, the emergence of a shared narrative ('autobiographical competence'), the processing of affect, coping with loss--these are common to most effective psychotherapies and provide the basis for a new interpersonal paradigm within psychotherapy. Attachment theory suggests they rest on a sound ethological and hence biological foundation.

Adaptation, Psychological↗