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Biomedical subjects

J W Thompson

Publications and source records attributed to J W Thompson.

At least 73 records · Page 4Linked to original sources

How mental health providers see managed care.

This paper reports findings from two focus groups on managed care conducted in a large U.S. city in 1989. Questions addressed included how managed care had affected mental health practice, specific experiences with managed care, the mechanisms of managed care, and how managed care could be improved. The practitioners complained of multiple problems, but clearly distinguished between "good" and "bad" firms. Firms seen as more positive struck a balance between quality care and cost containment, built ongoing relationships with providers, and negotiated with providers, rather than prescribing a treatment plan. The authors conclude that some of the poor reception by providers of managed care may have been created unnecessarily by firms which have not attended to these factors, and that attention to such factors might lead to a more ready acceptance of managed care.

Attitude of Health Personnel↗

Analgesic effects of different pulse patterns of transcutaneous electrical nerve stimulation on cold-induced pain in normal subjects.

The analgesic efficacy of various pulse patterns of transcutaneous electrical nerve stimulation (TENS) were assessed in 84 normal healthy subjects using the cold pressor pain technique. Burst, modulation, random and continuous TENS all significantly elevated ice pain threshold. Continuous (80 Hz) TENS produced the greatest mean elevation in threshold but the response to random TENS showed the least inter-subject variation. Ice pain tolerance was increased by all modes of TENS, continuous TENS producing the greatest magnitude of response, although these changes did not reach statistical significance. Increasing the size of electrodes reduced the effect of continuous TENS. The clinical implications of these findings are discussed.

Adolescent↗

An in-depth study of long-term users of transcutaneous electrical nerve stimulation (TENS). Implications for clinical use of TENS.

This in-depth study examines the relationships between patient, stimulator and outcome variables in a large number of chronic pain patients utilising TENS on a long-term basis. 179 patients completed a TENS questionnaire designed to record age, sex, cause and site of pain and TENS treatment regime. Of these 179 patients, 107 attended our research unit for assessment of the electrical characteristics of TENS during self-administered treatment. Although a remarkable lack of correlation between patient, stimulator and outcome variables was found to exist, the analysis revealed much information of importance: 47% of patients found TENS reduced their pain by more than half; TENS analgesia was rapid both in onset (less than 0.5 h in 75% patients) and in offset (less than 0.5 h in 51% patients); one-third of patients utilised TENS for over 61 h/week; pulse frequencies between 1 and 70 Hz were utilised by 75% of patients; 44% of patients benefitted from burst mode stimulation. The clinical implications of these findings are discussed.

Adult↗

The consistency of pulse frequencies and pulse patterns of transcutaneous electrical nerve stimulation (TENS) used by chronic pain patients.

This study records the consistency of transcutaneous electrical nerve stimulation (TENS) pulse frequency and pulse pattern used by 13 chronic patients over a 1 year period. The results show that patients prefer specific pulse frequencies and pulse patterns unique to the individual and that they turn to such frequencies and patterns on subsequent treatment sessions. Pulse frequencies and pulse patterns were not related to the cause and site of pain, a finding consistent with previous study in this laboratory. This observation, coupled with the large variability in pulse frequencies and pulse patterns used between individuals, implies that patients prefer such frequencies and patterns for reasons of comfort which may not be related to mechanisms specific to the pain system.

Adult↗

The effects of auricular transcutaneous electrical nerve stimulation (TENS) on experimental pain threshold and autonomic function in healthy subjects.

The present study examines the effects of auricular transcutaneous electrical nerve stimulation (TENS) on electrical pain threshold measured at the ipsilateral wrist and autonomic functions including skin temperature, blood pressure and pulse rate in 24 healthy subjects. TENS was administered as low frequency trains of pulses delivered at a 'strong but comfortable' intensity to 1 of 3 auricular points to be examined: (i) autonomic effects (autonomic point), (ii) pain threshold effects (wrist point), and (iii) placebo effects at an unrelated point (face point). A fourth untreated group was designated as a situation control. The main finding of the study was that auricular TENS produced no significant overall effects on experimental pain threshold or autonomic functions recorded under the present conditions. However, pain threshold was found to increase by over 50% of its pretreatment baseline in 4 subjects and by 30% in 6 subjects. This rise was not dependent upon the site of auricular TENS. The possible mechanisms of such changes are discussed.

Adolescent↗

Psychotropic medication prescription in U.S. ambulatory medical care.

Because of the pharmacologic power of psychotropic medications, the potential for adverse effects, and the changing popularity of particular psychotropic drugs, it is vital for pharmacoepidemiologists to monitor the prescribing patterns of these medications. Using data from the 1985 National Ambulatory Medical Care Survey (NAMCS), this article assesses psychotropic medication prescribing by U.S. ambulatory care physicians. Psychotropic medications are classified into three categories: minor tranquilizers (i.e., anxiolytics and sedative-hypnotics), antidepressants, and antipsychotics. The prescribing patterns of psychiatrists, primary care clinicians, and all other physicians are compared. Differences in psychotropic prescribing patterns by psychiatric diagnosis are examined as well. The excessive use of minor tranquilizers, the continuing use of first-generation psychotropic medications (particularly minor tranquilizers), and the lack of concordance between diagnoses and prescribed psychotropic medications are discussed.

Ambulatory Care↗

Competency to stand trial: description and initial evaluation of a new computer-assisted assessment tool (CADCOMP).

The authors describe a Computer-Assisted Determination of Competency to Proceed (CADCOMP), a new instrument that collects data directly from the defendant through an interactive computer program and renders a report covering relevant historical, psychopathological, and legal information. The comprehensive report could be utilized by the clinician to focus the clinician's interview with the defendant on areas requiring further probing, thus reducing the time required to assess competency. Preliminary reliability and validity assessment studies are reported. The results support the predictive validity of CADCOMP used as a screening instrument and found the CADCOMP to be sufficiently reliable to be used for screening purposes.

Adult↗

Vocal cord paralysis and superior laryngeal nerve dysfunction in Reye's syndrome.

Bilateral vocal cord paralysis and absent laryngeal sensation are previously unrecognized sequelae for Reye's syndrome, a severe acute encephalopathy in children. Four patients were seen at varying periods ranging from 2 weeks to 5 years after their diagnosis of an episode of severe Reye's syndrome over a 20-year period at the Children's Hospital of Los Angeles (Calif). All of the patients had bilateral true vocal cord paralysis with absent laryngeal sensitivity that was documented at endoscopy. As many as 50% of survivors of severe Reye's syndrome have breathy voices or aphonia. It is suggested that some of these children may have vocal cord dysfunction that is not the result of intubation, and are at risk for aspiration and its dangerous sequelae. A vagal nuclear injury is theorized to explain the sensory motor dysfunction of the larynx in these children.

Child↗

Fc-gamma receptor-ligand interactions enhance macrophage GSIB4-binding activity.

Activated macrophages have an increased ability to bind the lectin Griffonia simplicifolia-IB4 (GSIB4). Since macrophages readily use the Fc-receptor (FcR) during several immunologic and inflammatory processes, it is important to determine whether interactions with this moiety affect GSIB4-binding ability. Peritoneal macrophages cultured in vitro with Fc fragments of immunoglobulin G (IgG), whole IgG, or heat-aggregated IgG demonstrate an increase in this function. Conversely, treatment of macrophages with (Fab')2 fractions alone has no direct effect on this activity. Although the GSIB4-binding response is minimally expressed by normal macrophages, it is more markedly apparent on macrophages from LPS-treated animals. In both cases, however, pretrypsinization of the cells renders them refractory to IgG-mediated induction of the GSIB4-binding response. Moreover, macrophages cultured independently with IgG subclasses 1, 2a, or 3 demonstrate that the magnitude of their response to this signal is directly associated with the type of subclass used. Although each subclass enhanced the response, in this study interactions with IgG2a produced the best results. Overall, however, the greatest GSIB4-binding activity is generated when FcRs are crosslinked by aggregated IgG rather than simply bound by independent monomeric interactions at the FcRs. This suggests that the event of appropriately interacting with the FcRs amplifies the GSIB4-binding function. Such a mechanism could play a key role in coordinating the humoral, cell-mediated, and innate responses of the immune system.

Animals↗

Phobia: prevalence and risk factors.

This article is the presentation of the main phobia data from the Epidemiologic Catchment Area (ECA) program, with a sample size of n = 18.571. Work on this article was initiated in 1981 at the beginning of the ECA study, but publication has been delayed a decade. Phobias are determined from information from the Diagnostic Interview Schedule (DIS), classified according to DSM III. Phobias are found to be the most common psychiatric disorder in the community, more common than major depression or alcohol abuse or dependence in the month prior to interview. The one month prevalence is between 4.0 and 11.1%, with the estimated prevalence in the United States being 6.2%. There were nine community surveys of the prevalence of phobia that pre-dated the ECA studies, which found a wide range of prevalence rates from 1.2% to 26.1%. By far the strongest risk factor associated with phobias is the presence of another psychiatric disorder. Prevalence rates of simple phobia and agoraphobia are found in the ECA studies to be significantly higher in women; social phobia, which is less prevalent, has no significant sex difference. The prevalence rates are higher in younger age groups, and in those with low socioeconomic status (SES). The onset of phobias occurs primarily in the childhood or teenage years, and they tend to be chronic conditions. Less than a quarter of phobics receive treatment.

Adolescent↗

A case of a sheep-goat hybrid in New Zealand.

The natural mating of a doe with a ram produced a female hybrid which had 57 chromosomes, including three metacentric autosomes. We believe this to be the first authenticated report of a sheep-goat hybrid in New Zealand.

Journal Article↗

Ventral cleft of the larynx: a rare congenital laryngeal defect.

An anterior cleft of the larynx is apparently extremely rare. Only two patients with this defect have been reported in the American literature. The purpose of this paper is to present a child who was aphonic at birth and who was later found to have a congenital anterior cleft of the larynx. The diagnosis is established by the clinical symptoms, direct laryngoscopic examination, and radiographic studies. While severe voice change is the most prominent symptom of this defect, chronic aspiration is also a disquieting symptom, albeit controllable. The literature is reviewed, and the patient's symptoms and radiographic findings are documented. The clinical course over a period of almost 4 years is discussed.

Child, Preschool↗

Otitic candidiasis in children: an evaluation of the problem and effectiveness of ketoconazole in 10 patients.

The purpose of this paper is to report a group of children with recurring ear infections in whom persistent otorrhea was found to be due to monilial (Candida) infection of the middle ear. Some of the patients had associated mastoid disease. A review of the literature reveals few reports of otitis media and/or mastoiditis due to Candida infection. Ten patients who had persistent otorrhea were found to have monilial infection as a cause of the ear disease. None of the patients were immunosuppressed or immunocompromised. Nine of the 10 patients (one was lost to follow-up) were treated with antifungal medication, and the effectiveness of ketoconazole therapy is evaluated. None of the children in this series had systemic candidiasis. The probable causes of the problem of yeast infection of the ear are explored and appear to be related to the use of multiple broad-spectrum antibodies and local antibiotic-steroid ear drops.

Candidiasis↗

Psychotropic medication and priapism: a comprehensive review.

Numerous reports have emphasized the association between priapism and the ingestion of psychotropic medication. Clinicians are becoming increasingly aware of this association and its subsequent severe morbidity. Review of the literature reveals that medications possessing alpha-adrenergic blocking properties are most frequently associated with priapism. These medications include trazodone, several antipsychotics, and the antihypertensive agent, prazosin. Awareness of these associations and an appreciation of potentially serious consequences of this disorder may assist clinicians in choosing psychotropic agents that minimize the risk of developing priapism. It is essential that patients who are to receive psychotropic medications be forewarned about priapism. In addition, patients should be questioned concerning prior occurrence of prolonged erections, since a past history of delayed detumescence is present in approximately 50% of subsequent cases of priapism.

Adolescent↗

Management of bilateral carotid body tumors and a glomus jugulare tumor in a child.

This paper reports on a 14-year-old female child with bilateral carotid tumors and a glomus jugulare tumor, a rare combination of tumors in any patient and previously unreported in a child. The literature is reviewed and the details of the history, physical findings, results of laboratory tests, and the surgical management of the patient are discussed. The need for an exhaustive preoperative evaluation is stressed so that the proper surgery can be planned. The difficulties of surgical management, the complications, morbidity and potential hazards of surgery in these vascular tumors are presented. The unusual complications that a patient in the pediatric age group encountered as compared to those seen in adults are discussed.

Adolescent↗

Analgesic effects of different frequencies of transcutaneous electrical nerve stimulation on cold-induced pain in normal subjects.

The efficacy of transcutaneous electrical nerve stimulation (TENS) in producing analgesia in cold-induced pain was assessed using a range of 5 stimulating frequencies (10 Hz, 20 Hz, 40 Hz, 80 Hz and 160 Hz) in 83 normal healthy subjects. TENS significantly elevated ice pain threshold when compared with sham and control groups. TENS frequencies between 20 and 80 Hz produced greatest analgesia, while frequencies below and above this level (10 Hz and 160 Hz), although significantly elevating ice pain threshold, produced effects of a lesser magnitude. The frequency of pulse delivery was the governing factor as no significant differences in stimulus intensity were observed across the treatment groups. Measurement of ice pain tolerance was found to be unreliable under the present conditions. No significant relationships were observed between personality variables as measured by Eysenck Personality Questionnaires and the degree of TENS response.

Adolescent↗

Prescribing of psychotropics in elderly nursing home patients.

This study examined the prescribing of psychotropic drugs for patients 65 years of age and older in nursing homes using data from the 1984 National Nursing Home Survey pretest. The most frequently used antipsychotic, anxiolytic, antidepressant, and sedative/hypnotic medications were respectively: haloperidol, hydroxyzine, doxepin, and temazepam. Results indicate that more than one-fifth of the patients having orders for psychotropic medications did not have a documented mental disorder. More than one-fourth of the study patients had orders for more than one psychotropic medication. Nursing home patients who received psychotropics had concurrent orders for an average of 3.3 nonpsychotropic medications, many of which could increase the possibility of drug interactions and potential side effects.

Aged↗

A crosswalk from DSM-III-R to ICD-9-CM.

The authors describe a crosswalk, or translation, from DSM-III-R to ICD-9-CM. They present differences in the purposes and formatting of these two documents and discuss different levels of compatibility between the two. They demonstrate several problems at the code, rubric, and case levels of compatibility. Ninety-seven percent of DSM-III-R codes are compatible with ICD-9-CM at the case level. The problems in most cases are minor, and in the authors' opinion are not problems in actual clinical or medical records use. The development of DSM-IV and ICD-10 should include attention to translation issues early in the process from the perspectives of clinical work, research, and medical records.

Adolescent↗