Biomedical subjects
Publications and source records attributed to J M Stack.
Stillbirth is a professional blind spot for physicians and nurses, who may experience denial in dealing with the bereaved mother and her family. Providing choices and information about the conduct of labor and perinatal decisions, as well as pictures of the infant, a hospital birth certificate and other memory items, may be helpful to the parents in their grief. Hospital perinatal loss teams can provide support both to families and to medical staff.
According to previous reports, the quality of the physician-patient relationship plays an important role in medical outcome. A patient's responsiveness to suggestions, perceptions of treatment, and physical distress may be affected both by the type of interpersonal relationship and by the patient's anxiety. To test these hypotheses, 57 women who received elective abortions were treated by the physician in either a "paternalistic" or "egalitarian" interpersonal style. Each patient was tested for responsiveness to suggestions regarding changes in somatic perception such as heat or pain; a measure of psychological dependency on the physician was also obtained in addition to ratings of discomfort and signs of physiological distress during the medical procedure. Patient anxiety was not related to any of these variables, but patients treated in a paternalistic manner had higher responsiveness to suggestibility (P less than .001), felt they could depend more on the physician and perceived him as warmer and more supportive (P less than .01), had less discomfort during the procedure (P less than .05), and had a lower incidence of physiological distress compared with patients treated in an egalitarian manner. It was concluded that, for patients in crisis, paternalistic treatment by a physician may promote positive psychological and medical outcome.
To make a differential diagnosis between depression, normal grieving, and pathological grief reactions is a common problem for family physicians. Patients often present to the family physician with physical symptoms, such as pain, headache, dizziness, fatigue, and disturbances of digestion and sleep, rather than psychological symptoms. Treatment modalities and effectiveness differ depending on specific diagnosis. The family physician is in a unique position to influence prevention, early detection, and morbidity of these disorders.
Delayed, unresolved and pathologic grief reactions are common and often unrecognized occurrences following spontaneous abortion. The loss is frequently not appreciated, so the woman may not have the opportunity to work out her grief reaction. Family physicians can facilitate normal grieving and can detect delayed or pathologic reactions. It is helpful to encourage the woman and her partner to ask questions and to discuss such issues as cause, blame and guilt.
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Rural areas face severe problems related to the inadequate distribution of psychiatrists. This paper describes a model of inpatient psychiatric care in a rural general hospital which has successfully overcome many of the constraints of the rural setting using a four member psychiatric consultation team. Using the medical community and its resources as the basis for care, a strong emphasis is also placed on continuing education for care providers. Important factors in the system include allowing all physicians to admit and care for psychiatric patients and the use of the emergency room physicians as interim admitting doctors when patients have no family physician. Other factors in the program are discussed. Problem areas have included continuity of care and treatment of certain types of patients. The results of the project have been an increase in the number of psychiatric patients admitted (140 to 268 per year) and a decrease in the number of patients sent to the state institution. Consultations requested on non-psychiatric patients, including children have increased from thirty-five to sixty-seven per year. Most patients now remain in the care of their own physicians throughout a mental illness episode. Cooperation between community practitioners and the center staff has improved. With increased skill, center and community physicians have shown greater self sufficiency in working with hospitalized patients and their families.
Compliance management was taught to the mother of a 6-year-old girl with attention deficit-hyperactivity disorder who had not responded to methylphenidate. Compliance improved from 13% during baseline to better than 80% during training. When methylphenidate was terminated during compliance training the child's behavior simultaneously improved in one setting and temporarily decreased in another setting. Child behavior remained positive during two years of follow-up. Possible reasons for these findings and implications for practice are discussed.
Clinically, the first line of treatment for patients experiencing potentially lethal arrhythmias includes antiarrhythmic medications and/or treatment of underlying causes such as ischemia or congestive heart failure. However, if the treatment is not successful in controlling the arrhythmia, the automatic implantable defibrillator is a viable alternative for the prevention of sudden death in these patients. The case report presents one example of how the automatic implantable defibrillator can supplement conventional medical therapy when success in suppressing recurrent arrhythmias cannot be obtained. This concept has been demonstrated in this 59-year-old woman who underwent several medication trials in an attempt to control her life-threatening arrhythmias.