Biomedical subjects
Publications and source records attributed to J Holmes.
To determine how missed clinical diagnoses revealed at autopsy might affect third-party payment through DRGs, the authors performed a retrospective comparison of clinical and pathologic diagnoses in 100 consecutive cases that came to autopsy. In 13 of these cases, the autopsy findings resulted in a change in DRG assignment, which could have produced an additional $14,235 for the hospital.
To test the hypothesis that ventricular arrhythmias detected by ambulatory electrocardiography can stratify mortality risk in patients with ischemic and those with nonischemic dilated cardiomyopathy, clinical, hemodynamic and neurohumoral findings were evaluated in 31 patients. By Kaplan-Meier analysis, the total population had 51% survival at 12 months and 19% survival at 25 months. Subgroups based on peak complexity of ventricular arrhythmias included 9 patients with simple ventricular arrhythmias (peak Lown grades 1 to 3) and 22 patients with complex ventricular arrhythmias (peak Lown grades 4 or 5). Clinical variables and baseline catecholamine levels and renin-angiotensin system activity were similar in the simple and complex arrhythmia subgroups. Patients with simple and those with complex arrhythmias were comparable by all hemodynamic indexes except for a higher mean pulmonary capillary wedge pressure in the complex arrhythmia subgroup. Survival was strikingly related to arrhythmias: mortality was 11% (1 of 9) in the simple ventricular arrhythmia subgroup and 59% (13 of 22) in the complex ventricular arrhythmia subgroup (p less than 0.025 by log-rank test). Twelve patients died suddenly and 2 patients died in circulatory failure, and the risk of death was not affected by the etiology of cardiomyopathy. The higher mortality among the patients with complex arrhythmia could not be explained by the presence of elevated filling pressures alone. Thus, ambulatory electrocardiography can stratify mortality risk among patients with severe ischemic and nonischemic dilated cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)
This article examines the relationship between differences in dental attendance patterns and variations in dental status. A sample of 336 dentate men and 110 dentate women were selected at random from employees of two industrial plants in N.W. England in 1980. They were given a dental examination and asked about visits to the dentist. Regression analysis showed that while the more frequent the dental visits, the lower the rate of tooth loss and the fewer the number of teeth with active decay, the higher, however, the average number of fillings. There were significant differences, moreover, between manual and non-manual workers, the former being more likely to lose their teeth and the latter to have their teeth filled, at each given age and frequency of dental visit. Though the more frequent dental attenders had the advantage over the less frequent of having, on average, a higher number of functioning teeth, restored or otherwise sound, they also had the disadvantage of having higher levels of treated disease and thus of disease experience. The results suggest that while frequent dental visits help to postpone tooth loss and to maintain dental function, they do not apparently help to prevent the onset of further disease.
The antianginal effects of diltiazem 180 mg/day and propranolol 240 mg/day, alone and in combination, were investigated in 15 patients with effort related angina in a double blind placebo controlled crossover trial, with each period of treatment lasting four weeks. Patients performed a symptom limited treadmill exercise test at the end of each period of treatment. Mean (SEM) time to onset of angina was increased from 293(32) s when receiving placebo to 347(38) s when receiving diltiazem alone, to 350(30) s when receiving propranolol alone, and further to 421(34) s when receiving diltiazem and propranolol combined. Similar changes occurred in the duration of exercise testing and time to 1 mm ST segment depression. The sum of ST segment depression at peak exercise was reduced by both diltiazem and propranolol alone compared with placebo, and combination treatment produced a further significant improvement. Rate pressure product was significantly reduced at rest and at peak exercise after propranolol alone and combination treatment. The study clearly showed the superior value of diltiazem and propranolol combined in effort related angina when compared with either drug used alone.
Psychoanalytical and family therapies are contrasted: psychotherapeutic change involves a change of frame. The new frame in family therapy is the system; for analytical therapy it is the unconscious, but there are striking formal similarities between them. To achieve this change, there are two basic modes of therapy, reflective and directive, each containing elements of both. An essential ingredient in therapy is an uncoupling of action from effect, which occurs in play; psychotherapy can be seen as a special type of play. In family therapy, the therapist may useful playful paradox: 'therapeutic double binds'. Transference, the vehicle of psychoanalytical therapy, is a metaphorical relationship that is also essentially playful--serious but not real. Some guidelines for considering the relative indications and contraindications of family and individual psychotherapy are offered.
A robust, arterially based, innervated island flap of thin skin has been successfully used in nine patients to repair defects around the ankle and heel. Based on the lateral calcaneal artery, the flap gives excellent, well-bedded cover in a short operation with insignificant donor site problems.
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Obsessional phenomena are discussed in the light of anxieties arising around the ages 8-12. Three cases of the disappearance of obsessional symptoms are then described. In one remarkable sequence of dreams preceded recovery; in another it was the establishment of a secure therapeutic bond; in the third it was falling in love. The capacity securely to differentiate between fantasy and reality is seen as an essential development element in the recovery from obsessionality.
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Back care advice similar to that used in "low back pain schools' was made available to a group of primiparous women as early in their pregnancy as possible. Subsequently it was shown that they experienced significantly less "troublesome' and "severe' backache (P = less than 0.01) than a control group for whom such advice was not available.
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A family of 6 affective ill siblings is described. Two suffered from bipolar illnesses, 2 from recurrent unipolar illness, and the remainder showed alcoholism, depression and schizo-affective disorder. HLA typing revealed that all the tested members shared the antigens A3 and B7. Because only ill members were available for testing, there was insufficient information in the family to draw any definite conclusion as to whether these antigens were linked to the illness. However, the observation is of some interest in the light of other recent reports which have suggested that these 2 antigens are associated with affective disorder.
Psychoanalytic and other literature relevant to the sibling relationship is reviewed. Cases are presented illustrating the role of feelings towards the sibling in psychotherapeutic practice. Three main areas are discussed: (1) the birth of a sibling as a 'fixation point'; (2) the effect of the sibling on identity formation; (3) the role of the sibling relationship in treatment, especially the importance of acknowledging sibling rivalry.
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