Search PubMed⌕ Search

Biomedical subjects

J W Thompson

Publications and source records attributed to J W Thompson.

At least 55 records · Page 3Linked to original sources
PubMed1995

Psychiatric hospital care and changes in insurance coverage strategies: a national study.

The 1975, 1980, and 1986 sample surveys from the National Institute of Mental Health were used to predict the type of inpatient psychiatric facility where people were admitted. Predictors used were demographics (age, gender, race, marital status, and education), psychiatric diagnosis, and insurance status (primary payment source). A discriminant analysis revealed that insurance status was the most important discriminator in predicting hospital type. State hospitals were more likely to care for patients with little or no resources, whereas private hospitals cared for patients with some form of insurance. The authors discuss the implications of insurance status and access to psychiatric treatment.

Demography↗
PubMed1995

Trends in the inpatient care of persons with schizophrenia.

This report analyzes nationally representative data to examine inpatient services provided to persons with schizophrenia. The data are for patients admitted to general hospitals, private psychiatric hospitals, and State and county mental hospitals between 1970 and 1986 (weighted n = 860,637). The proportion of admissions diagnosed as having schizophrenia decreased from 21 percent in 1970 to 16 percent in 1986; this proportion decreased in public general hospitals and increased in private general hospitals. The rate of admissions for schizophrenia decreased in public general hospitals and State and county mental hospitals and increased in private general hospitals. The overall admissions rate decreased for whites with schizophrenia and increased for African-Americans, owing entirely to increased admissions of African-American males. Private general hospitals and State and county mental hospitals relied less over time on private insurance; the use of Medicare increased in both public and private general hospitals; and Medicaid use increased in private general hospitals. Further research on services for this population is necessary as a baseline for health care reform.

Adolescent↗
PubMed1995

Schizophrenia: treatment outcomes research--editors' introduction.

Considerable research over the past few decades on the nature and treatment of schizophrenia has yielded important advances to improve the outcomes of this disorder. Recent action plans, including the "Decade of the Brain," the National Institute of Mental Health (NIMH) A National Plan for Schizophrenia Research, and NIMH's report, Caring for People With Severe Mental Disorders: A National Plan of Research to Improve Services, promise major new advances over the next several years. As research advances, it is critical to ensure that patients in everyday practice receive the most effective treatments being developed. This issue of the Schizophrenia Bulletin reviews the research on outcomes of treatments for schizophrenia and lays out an agenda for available research knowledge to be translated into practice and for future research to improve outcomes.

Combined Modality Therapy↗
PubMed1995

Adjunctive treatments in schizophrenia: pharmacotherapies and electroconvulsive therapy.

Substantial proportions of patients with schizophrenia do not achieve acceptable levels of response with antipsychotic therapy alone, which commonly leads clinicians to use additional somatic interventions. This article reviews the literature on the use of adjunctive pharmacological treatments and electroconvulsive therapy (ECT) in schizophrenia. The authors find that, despite a large volume of literature, it is difficult to draw conclusions or treatment recommendations from available data because of small sample sizes and widely divergent study designs. At present, there is little firm evidence that adding adjunctive agents to standard neuroleptics will dramatically change the somatic treatment of schizophrenia. The most promising adjunctive agents are benzodiazepines, lithium, and carbamazepine, as well as antidepressants and ECT for affective symptoms. Future inpatient research on adjunctive treatments should be multicenter studies, followed by long-term outpatient trials that assess quality-of-life issues as well as symptom relief.

Antipsychotic Agents↗
PubMed1995

Digital clubbing associated with polymyositis and interstitial lung disease.

Clubbing of the fingers is commonly associated with interstitial lung diseases (ILDs). Although ILD occurs in as many as 40% of patients with polymyositis/dermatomyositis (PM/DM), clubbing of the digits has never been reported to occur in patients with PM/DM and ILD. We report the first case of clubbing associated with PM/DM and ILD.

Adult↗
PubMed1994

Use of ECT in the United States in 1975, 1980, and 1986.

OBJECTIVE: The objective was to analyze nationally representative data from the National Institute of Mental Health (NIMH) to update trends in the use of ECT in the United States. METHOD: The data are estimates from the NIMH Sample Survey Program for 1975, 1980, and 1986, which include representative samples of inpatients in psychiatric facilities in the United States. The authors' analyses use trend data from public general hospitals, private general hospitals, private psychiatric hospitals, and state and county mental hospitals. They report on 126,739 patients who received ECT in 1975, 1980, and 1986, focusing on data from 1980 and 1986. RESULTS: In 1986, 36,558 patients received ECT. This represents a decrease from the 1975 figure (58,667 patients) but no change from 1980 (31,514 patients). ECT was used primarily in private general hospitals (64%) and private psychiatric hospitals and much less often in public general hospitals and state and county mental hospitals. In 1986 over 90% of ECT recipients were white, and 84% had an affective disorder diagnosis. Although 71% of the patients who received ECT were women, hospital type and age were more important than gender in predicting ECT use. Individuals 65 years of age and older received ECT out of proportion to their numbers in inpatient care. CONCLUSIONS: The declining use of ECT in the United States ended in the 1980s. Few African Americans receive ECT, and its use is becoming more targeted toward patients with affective disorders. The amount of services research done on this modality is very small. Basic questions have yet to be answered, including who refers patients for ECT and why, and how ECT fits into the overall course of treatment.

Adolescent↗
PubMed1994

Trends in the development of psychiatric services, 1844-1994.

Over the past 150 years, support for providing appropriate services for mentally ill persons has waxed and waned. In colonial America, mentally ill persons were institutionalized in jails or almshouses. In the 18th and 19th centuries, asylums constituted the primary psychiatric service. Only in the late 19th and early 20th centuries did alternatives to long-term hospitalization appear. The mental hygiene movement of the early 20th century and the community mental health centers movement of the 1960s and 1970s both increased the number of services and introduced new types of services. Today, however, despite hopeful signs of reduced public prejudice against mentally ill persons, a new "dark age" for support of psychiatric services may be dawning, as negative attitudes about mental illness continue to drive public policy.

Community Mental Health Centers↗
PubMed1993

Implications of mental and substance use disorders. A comparison of single and dual diagnosis patients.

To understand better the implications of co-occurring mental and substance use disorders, we examined DSM-III-R diagnoses and life problems among a representative sample of 314 patients admitted to either a psychiatric hospital or a residential substance abuse treatment program from the same inner-city catchment area. Based upon the Structured Clinical Interview for DSM-III-R, the patients were divided into four groups. The first two groups had dual diagnoses, either: a) a primary axis I mental disorder (MD) and a comorbid psychoactive substance use disorder (PSUD); or b) a PSUD-related mental disorder and a PSUD, but no primary axis I MD. The third and fourth groups had a single diagnosis, either: c) a primary axis I MD, but no lifetime PSUD; or d) a PSUD, but no lifetime primary axis I MD. As expected, the two dual disorder groups had more cumulative problems than did either of the single disorder groups. Dually disordered patients with PSUD-related MD most resembled single-diagnosis PSUD patients in terms of substance use profile and life problems. Dually disordered patients with primary MD more resembled single-diagnosis MD patients, but had more severe life problems. Presence of a PSUD was associated with male gender, antisocial personality disorder, and more severe legal problems. Presence of a primary mental disorder was associated with more extensive prior hospitalizations and greater psychiatric severity.

Adolescent↗
PubMed1993

Changing characteristics of schizophrenic patients admitted to state hospitals.

OBJECTIVE: Characteristics of schizophrenic patients admitted to state hospitals between 1970 and 1986 were studied to examine changes in the demographic profile of the patient population and in principal sources of payment for hospitalization over the study period. METHODS: Information on patients' demographic characteristics and principal payment sources was obtained from a nationally representative data base compiled about every five years by the National Institute of Mental Health. RESULTS: Among schizophrenic patients admitted between 1970 and 1986, the proportion of African-American males increased. By 1986 patients were less likely to pay for care through private insurance or their own resources. They were more likely to receive Medicare and to lack medical insurance. Medicare use increased largely among white patients, and medical indigency largely among African-American patients. CONCLUSIONS: Changes in the characteristics of schizophrenic patients admitted to state hospitals between 1970 and 1986 may be related to changes in nosology, in the prevalence of schizophrenia, and in the types of patients likely to be admitted to state hospitals. The increase in the number of medically indigent patients accentuates the need for more adequate finding of state hospitals.

Adult↗
PubMed1993

Adverse effects of newer cephalosporins. An update.

While classifications into generations according to antimicrobial activity has helped clinicians incorporate the increasing number of cephalosporins into their pharmacological repertoire, adverse effects among the different agents fail to follow similar categories. In general, cephalosporins are fairly well tolerated antibiotics, and toxicity has been limited to specific agents. Subtle differences in chemical structure and pharmacokinetics can influence the potential for adverse effects. The route of administration may result in minor adverse reactions, including thrombophlebitis and pain. The most common adverse effects of cephalosporins are allergic reactions, occurring in 0.9 to 3.2% of patients. Cephalosporins have very rarely been associated with haematological toxicity (less than 1% of patients), but specific agents have been associated with neutropenia, hypoprothrombinaemia, haemolytic anaemia, and problems with platelet production and function. Other reactions include localised gastrointestinal disturbances, hepatotoxicity (e.g. biliary sludging), nephrotoxicity and mild central nervous system effects. The cephalosporins are generally well tolerated in the paediatric population. Very few interactions have been observed between cephalosporins and other drugs, largely because cephalosporins do not affect the microsomal P450 hepatic enzyme system. While cephalosporins are considered to be relatively 'safe' drugs, the introduction of newer members warrants continued careful observation for reporting of adverse drug reactions.

Cephalosporins↗
PubMed1992

Esophagotracheal perforation during an emergency intubation.

The authors report the first known case of a simultaneous esophagotracheal perforation, which occurred during an emergency intubation of a patient with airway abnormalities. The perforation was suspected from the postintubation chest roentgenograph and confirmed by fiber optic bronchoscopy which showed that the endotracheal tube had entered through the posterior wall of the trachea after perforating the esophagus. The patient had a tracheostomy done and was placed on prophylactic antibiotic therapy; the esophageal tear was left to heal spontaneously. Risk factors for esophagotracheal perforation, means to avoid it, and diagnosis and treatment considerations are discussed.

Adult↗
PubMed1992

Initial level of care and clinical status in a managed mental health program.

Data from 9,055 adult intakes performed over two and a half years of a managed mental health care demonstration project in a large U.S. city were used as indirect measures of quality of care. The level of care to which patients were initially assigned was examined in relation to the patients' clinical status as judged by both managed care case managers and treatment providers. During the period, assignment to inpatient care of patients in almost every clinical category decreased. The decrease seemed to reflect a policy decision to limit use of all inpatient services rather than a selective elimination of unnecessary hospitalization. Case managers rated a smaller proportion of patients severely disturbed, partial hospitalization was rarely used as an alternative to inpatient care, and detoxification services were increasingly used as an inpatient alternative. Although these data reinforce common beliefs about managed care, the quality of managed care programs can be accurately assessed only with data collected specifically for evaluation purposes.

Alcoholism↗
PubMed1992

Long term use of transcutaneous electrical nerve stimulation at Newcastle Pain Relief Clinic.

This retrospective study of long-term use of transcutaneous electrical nerve stimulation (TENS) at Newcastle Pain Relief Clinic indicates that TENS has been a successful analgesic treatment for 58.6% of 1582 patients attending the clinic over a period of 10 years. A wide range of pain conditions were found to respond to TENS and many patients continued to use the treatment for several years. Most patients not responding to TENS (during a home trial) returned stimulators at the first follow-up appointment. Thus TENS should be considered as a simple, safe and reusable first line treatment for many pain conditions.

Ambulatory Care Facilities↗
PubMed1992

DSM-III-R brief reactive psychosis among Air Force recruits.

BACKGROUND: Clinical characteristics of patients diagnosed with brief reactive psychosis based on DSM-III-R criteria and the incidence of this disorder in a defined population have not been sufficiently studied. Some military recruits who are subjected to relatively uniform levels of stress in a monitored environment over a specified time period develop transient, severe psychotic symptoms consistent with a diagnosis of brief reactive psychosis. METHOD: We retrospectively reviewed all cases of brief reactive psychosis that occurred among 139,360 Air Force recruits during 6-week basic training experiences over a 3-year period. Brief case descriptions, including clinical courses, are provided. RESULTS: Six cases were found among 557 consecutive psychiatric admissions between January 1, 1988, and January 1, 1991 (annual incidence = 1.43 cases per 100,000 recruits). An apparent temporal relationship was found between the onset of the stressor (basic military training) and the development of psychosis. Paranoid symptomatology, including persecutory delusions, was present in all cases. Adjustment disorders were the most common diagnoses in patients admitted from the training environment (N = 464). CONCLUSION: Brief reactive psychosis is a rare discharge diagnosis in this large population of young Air Force recruits. Prospective studies are warranted to evaluate the usefulness of DSM-III-R criteria for this disorder and to determine the longitudinal course of patients who have received this diagnosis.

Adjustment Disorders↗
PubMed1991

Studies on the efficacy of deltamethrin applied to cattle for the control of tsetse flies (Glossina spp.) in southern Africa.

The tsetse fly (Glossina spp.) inhabits 11 million km2 of Africa (Greekmore, 1989) where it is responsible for the transmission of trypanosomosis to man and animals. Because of its slow rate of reproduction, with females producing only four to five pupae per annum, control of the tsetse fly is the best means of controlling trypanosomosis. A number of different methods have been and are used but, whilst successes have been achieved, a long term solution has not been found.

Administration, Topical↗