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Biomedical subjects

J Richman

Publications and source records attributed to J Richman.

At least 19 recordsLinked to original sources
PubMed2001

Professional convergence in forensic practice.

This paper outlines the development and convergence of forensic science and secure psychiatric services in the UK, locating the professionalization of forensic nursing within a complex web of political, economic, and ideological structures. It is suggested that a stagnation of the therapeutic enterprise in high and medium security provision has witnessed an intrusion of medical power into the societal body. Expanding technologies of control and surveillance are discussed in relation to the move from modernity to postmodernity and the ongoing dynamic of medicalized offending. Four aspects of globalization are identified as impacting upon the organization and application of forensic practice: (i) organized capitalism and the exhaustion of the welfare state; (ii) security versus danger and trust versus risk; (iii) science as a meta-language; and (iv) foreclosure as a mechanism of censorship. Finally, as a challenge for the profession, some predictions are offered about the future directions or demise of forensic nursing.

Forecasting↗
PubMed2001

Humor and creative life styles.

This paper is based upon the writings of William James in the late 19th century, and Alfred Adler and Sigmund Freud in the 20th, enriched by the contributions of later personality and role theorists. The self is defined as the unique organization of each person; a style is the self in action. Different life styles and their components are expressed in different situations. I posit that humor and positive thinking, combined with meaning and purpose, are vital components of all constructive life styles. The knowledge of life styles cuts through diagnostic labels to reveal our universal humanity. It can be fruitfully applied to patients and nonpatients alike and, I found, for the self-understanding of therapist. The clinical application of life styles is illustrated through numerous vignettes.

Creativity↗
PubMed2001

Ward managers' attitudes towards external consultants in Ashworth, a special hospital, 1992-1994.

This case study elaborates the aftermath of the Blom-Cooper Inquiry (1992), which forced the special hospital, Ashworth, into a radical 'culture change'. To this end, two groups of external consultants--a management consultancy and a professional task force--were introduced into the hospital. Newly established ward managers were to spearhead the organizational change by bringing social and clinical order to the wards over which the higher management had lost control. Few studies have mapped out the interaction between segments of an organization and expert outsiders. In this study, the interaction of the ward manager to the newly appointed external management consultancy and task force was analysed. It was clear that ward managers rated poorly the efforts of the management consultancy and task force--it was considered that they were not giving value for money. The task force rated slightly more favourably than the management consultancy. The fact that the management consultancy did not have ward credibility in this closed forensic setting was attributed to low prestige. The management consultancy also failed to fulfill the organizational ambitions of ward managers, who wished to be central to the hospital's major decision-making process.

Attitude of Health Personnel↗
PubMed2000

Coming out of intensive care crazy: dreams of affliction.

The impetus for this article was the author's experience of illness, necessitating 5 months of hospitalization, 7 weeks of which were spent in a coma in an intensive care unit (ICU). The origins and general characteristics of ICUs are noted. A pastiche of illness narrative is constructed to allow for the author's own comment on his experience. The intensive care syndrome (ICS), a permeable category, continuing the aftermath of surgery and the social, psychological, mechanical, and pharmaceutical effects of the unit itself, is discussed. Dreams of affliction, a component of the ICS, are explored; the prior sociological history of the neglect of dreams, an essential universal, is also pointed out. The author's dream forms and their shamanistic parallels are explored. In Foucauldian language, they are considered a product of the fragmentation of the cosmological spirit, whereas the author was a medical object and mechanical appendage. Nursing is in a strategic position to make patients' dream narratives their own as an aid for understanding illness.

Anthropology, Cultural↗
PubMed2000

Health implications of modern childhood.

Childhood has undergone many reconstructions since its 'recognition' in the 18th century. The medicalized child is rooted in eugenics, political economy and professional interests and has implication for practice. The modern child is now viewed as a stakeholder in a political sense. Childhood requires recognition in a 'health' sense if it is to survive as a category. Different medical expectations and models of childhood are likely to evolve.

Attitude to Health↗
PubMed1999

Good & evil in the crusade of care. Social constructions of mental disorders.

Forensic nursing is a product of medicalized criminality, where social and moral issues are managed within a psychiatric ideology. The narrative accounts of nursing staff reflect a tension between scientific and lay interpretations of offending behavior. A nonprofessional discourse about "evil" presents a challenge to the structural and clinical credibility of forensic practice.

Culture↗
PubMed1997

Validity and reliability of the MTI photoscreener.

OBJECTIVES: The prevalence and necessity for early detection of vision problems illustrate the need for improved methods of vision screening in preschool children. This study assessed the validity and reliability of a new device, the MTI photoscreener in a cross-sectional field study. METHODS: An appropriate sample size (> 140) was calculated and recruited for the study. All children (N = 161) in a migrant workers summer education program were screened with the MTI Photoscreener. Simultaneously and in a masked design, disease status was determined by the Modified Clinic Technique, a well established method for diagnosing the conditions which the MTI screener was designed to detect. RESULTS: Validity measures revealed a sensitivity of 54%, specificity of 87%, phi coefficient of 0.40, and positive predictive value of 52%. Repeatability was assessed by the kappa coefficient, by a test for effect modification by examiner, and by comparison of sensitivity and specificity across 12 masked examiners. The kappa coefficient was 0.38. A test for effect modification suggested that differences existed among the examiners. Variability of sensitivity was high, but variability of specificity was low. CONCLUSIONS: Methods for vision screening in preschool children are limited. The MTI Photoscreener is an easy and efficient method, but the validity and reliability is a concern. Comparison of our results with other studies suggests future potential for this instrument provided protocols are refined and further field studies reveal efficacy.

Child↗
PubMed1997

Being suicidal and elderly in changing times: a case history.

Mr. Andrew A, at age 67, is a physically well and mentally active man who is involved in business failures and marital conflicts, which brought him dangerously close to precipitating his own demise. He is different from my other elderly suicidal patients, most of whom were ill, disabled, and in decline. They were grieving for many reasons, such as the loss of a spouse or-frequently-themselves as they had been. Andrew's story has hopeful implications for the changing nature of aging and suicide that extend beyond himself as an individual or my interventions as a therapist.

Aged↗
PubMed1996

Jokes as a projective technique: the humor of psychiatric patients.

Jokes were obtained from psychiatric patients during the course of diagnostic testing and interviewing. The material was subjected to a content analysis which included the nature of the main characters and their relationships, the situations presented, and the major overt and concealed themes. This paper discusses and gives examples of the projective and psychodynamic value of humor in professional practice. The jokes helped in the understanding of diagnosis, symptoms, and basic conflicts. They provided guidelines for treatment and the treatment plan. They depicted the struggles of the participants to cope with relationships, problems, crises, and change. None of these struggles were unique to patients. Jokes cut through professional distinctions and diagnostic classifications, and present the person behind the label. They reflect the nature of the self especially in its more troubling and problematic aspects; yet they also reveal the healthy and intact part of the person. Jokes were valuable as a projective method because they constituted a non-threatening vehicle for revealing otherwise threatening and concealed truths about the person; they communicate those aspects of the human condition that are most anxiety provoking; and last, but not least, they end the interview on an enjoyable and positive note.

Adult↗
PubMed1996

Results of a program to improve the process of inpatient care of adult asthmatics.

OBJECTIVE: To assess the effectiveness of a program to improve care of adult patients hospitalized for asthma. DESIGN: Retrospective analysis of patient and house staff education, patterns of medication use, spacer use, peak flowmeter use, and length of stay before and after team intervention. SETTING: A 960-bed teaching hospital in New York City. PATIENTS: All patients admitted to the hospital with a primary diagnosis of acute asthma exacerbation for 2 separate similar calendar periods, 1 year apart, before and after program intervention. We excluded patients who were hospitalized for less than 24 h or greater than 10 days. The preintervention group comprised 61 patients and the postintervention group 65 patients, well matched in their demographic characteristics and severity of disease. INTERVENTIONS: Using a team approach, we analyzed the process of inpatient treatment of asthma exacerbation, identified root causes for quality deficiency, and implemented specific improvements in the process. These included dedicated nurses who focused on the education of care providers and patients, a personalized attending-intern educational approach, and improvement in the supply and delivery of spacers, peak flowmeters, and medications to the patients. RESULTS: There was a significant increase in use of spacers, peak flowmeters, and inhaled corticosteroids. Systemic corticosteroid and methylxanthine use declined. Length of stay was reduced without increasing early hospital readmission rates. CONCLUSIONS: This program improved the treatment process of adults hospitalized for asthma.

Acute Disease↗
PubMed1996

Varus migration of PCA stems.

Forty-seven patients with cementless, porous-coated anatomic hip replacements were evaluated after a minimum 2-year follow up with specific attention to varus migration of the stem. A cadaver study was done to define a relationship between projected size of the lesser trochanter seen radiographically, rotation of the femur, and stem position. Seven (15%) of the stems migrated into varus with the distal tip moving laterally. Thigh pain occurred in patients with varus migration and those with no change in stem position. A lower percent canal fill was seen on the lateral radiograph (P < .001) and larger average width of radiodense lines in zone 1 superolateral, and zone 6, midstem medial (P < .005) in the patients with varus migration. Poor distal stability associated with a lower percent canal fill at the stem tip seen on the lateral radiograph may result in varus migration.

Biomechanical Phenomena↗
PubMed1995

The lifesaving function of humor with the depressed and suicidal elderly.

This article describes situations where laughter or humor occurred during therapy with depressed and suicidal patients. Therapeutic humor is associated with five principles: (1) a positive doctor-patient relationship includes the freedom to be humorous; (2) the humor is life affirming; (3) the humor increases social cohesion; (4) the humor is interactive; (5) the humor reduces stress. The application of these principles is based upon a knowledge of the required interventions and an awareness of when humor is or is not appropriate. The main effects are symptom relief and increased cohesion. Recommendations are made to health practitioners for the optimal use of humor.

Aged↗
PubMed1994

The cloning and expression of a human creatine transporter.

A human creatine transporter (hCRT-BS2M) cDNA clone was isolated from a human brainstem/spinal cord using a PCR and phage plaque hybridization based technique. This clone included an open reading frame of 1,905 base pairs(bp) within a 2,283bp cDNA. Northern blot hybridization detected the expression of corresponding mRNAs most prominently in the skeletal muscle, heart and kidney. Peptide sequence analysis of the hCRT-BS2M protein product revealed 12 putative transmembrane domains. The predicted protein sequence further demonstrates that the hCRT-BS2M has highly conserved amino acid identity with the other members of the sodium dependent plasma membrane transporter family. Transient expression of the hCRT-BS2M in COS-7 cells demonstrates sodium dependent [14C]creatine uptake with a KM value of 14.9 +/- 3.0 microM (n = 5) that is attenuated by creatine and selective structural analogues of creatine.

Amino Acid Sequence↗