Acyclovir or prednisone for treating herpes zoster.
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Acyclovir↗
Biomedical subjects
L A Becker
Publications and source records attributed to L A Becker.
Eye movement desensitization and reprocessing (EMDR) treatment for psychologically traumatized individuals.
The effects of 3 90-min eye movement desensitization and reprocessing (EMDR) treatment sessions on traumatic memories of 80 participants were studied. Participants were randomly assigned to treatment or delayed-treatment conditions and to 1 of 5 licensed therapists trained in EMDR. Participants receiving EMDR showed decreases in presenting complaints and in anxiety and increases in positive cognition. Participants in the delayed-treatment condition showed no improvement on any of these measures across the 30 days before treatment, but after treatment participants in the delayed-treatment condition showed similar effects on all measures. The effects were maintained at 90-day follow-up.
Adult↗
Patient consent to observation. Responses to requests for written consent in an academic family practice unit.
OBJECTIVE: To examine patient rates of consent to observation and response to being asked for written consent. DESIGN: Patients were asked to provide written consent for a supervising physician to observe a resident performing a physical examination, or for both direct observation and videotaping of the visit. After the visit, all patients were interviewed, and patients who had given written consent completed a questionnaire. SETTING: The family practice unit at a teaching hospital affiliated with the University of Toronto. PARTICIPANTS: A representative sample of new and returning patients. MAIN OUTCOME MEASURES: Patient consent to observation or videotaping. RESULTS: Most patients (92.2%) agreed to be observed. Of those asked only for consent to observe, 97.3% agreed. Of those asked for consent to observe and videotape, 85.2% agreed. When specifically asked, 22% of patients who agreed to observation expressed concerns. CONCLUSION: We must devise clear policies and procedures for obtaining patient consent that are both sensitive to patients' concerns and administratively effective.
Adult↗
On the relationship of the five-factor personality model to personality disorders: four reservations.
McCrae and Costa since 1986 have proferred a five-factor personality model as a lingua franca among different psychometric test users, and they suggest that their operationalization of the five-factor model, the NEO Personality Inventory, may also be useful in the clinical assessment of the abnormal personality. The present study examined the inventory and its relationship to the 11 personality disorders of Axis II of DSM-III-R in a sample of 180 adults. Correlational multivariate analyses appear to indicate a limited usefulness of the five-factor model in the understanding of personality disorders, and four major objections are offered. Further research with clinical samples, other models of personality, and other measures of personality disorders are encouraged.
Adolescent↗
Further characterization of the behavioral effects of peripherally administered corticotropin-releasing factor in guinea pigs.
Guinea pig pups were either not injected (NI) or given SC injection of either saline vehicle (SAL) or 14 micrograms of corticotropin-releasing factor (CRF). In an isolation test, mean number of vocalizations and several measures of locomotor activity were markedly lower for CRF pups than for NI or SAL controls. CRF pups defecated less than did SAL pups. No differences were found among conditions for self-grooming. Behavioral freezing was shown by only two pups in the entire study. Significantly more CRF pups displayed piloerection, eye-closing, and a characteristic crouched stance than did controls. In a defensive withdrawal test, no differences among conditions were found for the proportion of pups entering a darkened chamber or for the latency to enter the chamber; however, CRF pups entered the chamber significantly fewer times during the 60-min test than did controls. There were no differences among conditions in the distance swum or number of turns made in a forced-swim test. These results replicate our earlier findings that peripheral injection of CRF suppresses vocalizing and a measure of locomotor activity in isolated guinea pig pups and identifies a number of additional behavioral effects. Of central interest here, the results indicate that the suppression of vocalizing and locomotion during isolation is not due to an increase in competing stress-related behavior or to diminished motor capacity.
Aggression↗
Use of CT scans for the investigation of headache: a report from ASPN, Part 1.
BACKGROUND: Clinicians in the Ambulatory Sentinel Practice Network (ASPN) order computed tomography (CT) scans for approximately 3% of patients with headache. This study was undertaken to provide information about the reasons for ordering CT scans and the results obtained. METHODS: Weekly return cards were used to collect data on every patient for whom a CT scan was ordered to investigate a headache during a 19-month period. Copies of CT reports were reviewed, and a chart audit was performed to collect further clinical information whenever an intracranial tumor, subarachnoid hemorrhage (SAH), or subdural hematoma (SDH) was reported. RESULTS: Clinicians in 58 practices ordered 349 CT scans. Only 52 patients (15%) had abnormalities noted on neurological examination. Most CT scans were ordered because the clinician believed that a tumor (49%) or an SAH (9%) might be present. Fifty-nine (17%) were ordered because of patient expectation or medicolegal concerns. Of the 293 reports reviewed, 14 indicated that a tumor, an SAH, or an SDH was present. Two of the 14 (14%) were false positives. Forty-four (15%) of the reports noted incidental findings of questionable significance. CONCLUSIONS: Because there are no clear guidelines for the use of CT for the investigation of headache, physicians must exercise good clinical judgment in their attempts to identify treatable disease in a cost-effective manner. ASPN clinicians made selective use of CT scans based on a combination of factors that included physician and patient concerns. CT was an imperfect tool in this setting. Most of the positive results represented false positives or incidental findings that could have led to adverse effects and additional costs.
Adolescent↗
Detection of intracranial tumors, subarachnoid hemorrhages, and subdural hematomas in primary care patients: a report from ASPN, Part 2.
BACKGROUND: The initial diagnosis of intracranial tumor, subarachnoid hemorrhage (SAH), and subdural hematoma (SDH) can be difficult. This study was undertaken to determine the incidence and presenting signs and symptoms of these disorders in primary care settings, and to determine whether a more aggressive investigative strategy for patients with headache is justifiable. METHODS: Weekly return cards and a chart audit were used to collect data over a 19-month period on every patient who had a new diagnosis of intracranial tumor, SAH, or SDH. Age and sex reports were collected annually. RESULTS: Twenty-five new tumors, 17 SAHs, and 8 SDHs were reported in 58 practices (a rate of 12/100,000 patients per year). Only one half of these patients had headaches, and no abnormalities were found on neurological examination of many. Diagnosis was delayed in only four patients with headache caused by a brain tumor and in three patients with SAHs. Diagnosis was delayed in two of the latter because of false-negative CT scans. CONCLUSIONS: Although clinical findings and CT scans are not reliable indicators, clinicians are able to detect the majority of these rare conditions without undue delay by selecting a small subset of patients for further investigation. More extensive use of CT scans appears to be a weak strategy to improve detection of these serious disorders, as increased use would lead to increased health care costs and unintended adverse effects, and provide little benefit.
Adolescent↗
Effects of centrally administered corticotropin-releasing factor (CRF) and alpha-helical CRF on the vocalizations of isolated guinea pig pups.
Intraventricular corticotropin-releasing factor (CRF) was administered to guinea pig pups both with a freehand injection technique and via indwelling cannula. Behavioral effects depended upon the technique used. The highest dose of CRF (5 micrograms) inhibited the vocalizing of pups in a subsequent isolation test only when CRF was given by freehand injection. The possibility that disturbance attendant to the freehand procedure can account for this difference is discussed. To determine the effect of endogenous CRF in the absence of additional disturbance, the CRF antagonist alpha-helical CRF (ahCRF) was administered with the indwelling cannula procedure. ahCRF enhanced vocalizing during the first 10 min, and enhanced locomotor activity during the last 10 min, of a 30-min isolation test. Overall, the results indicate that endogenous CRF reduces vocalizing and locomotion during social isolation and that under certain injection conditions exogenous CRF can exacerbate the behavioral effect. The results also demonstrate the potential impact of the technique used to administer exogenous CRF. Further, the prevailing view, that CRF mediates stress-related behavioral responses, is supported only if behavioral inhibition, rather than vocalizing or locomotor activity, is viewed as the stress-related response in this situation.
Animals↗
Distraction, choice and self-esteem effects on cognitive response facilitation.
From an integration of distraction-conflict theory and cognitive dissonance theory, it was hypothesized that distraction would increase, rather than disrupt, the proarguing of persons who had been given high choice to engage in discrepant behaviour, and would increase, rather than disrupt, the counterarguing of persons who had been given low choice to engage in such behaviour. Furthermore, it was expected that this cognitive response facilitation effect would more likely occur for persons high in self-esteem. The results supported the hypotheses and were interpreted as also confirming the notion that dissonance-related processes occur at the cognitive response level.
Adult↗
Peripherally administered CRH suppresses the vocalizations of isolated guinea pig pups.
In Experiment 1, an SC injection of 14 micrograms CRH greatly suppressed the vocalizing of isolated guinea pig pups 1 h later and produced highly elevated plasma cortisol levels. In Experiment 2, SC injection of 18 international units of ACTH produced similar cortisol elevations, but had a negligible effect on vocalizations. In Experiment 3, the minimum effective dose of CRH for suppressing vocalizations was found to be about 7 micrograms. This dose also suppressed locomotor activity and produced cortisol elevations that were as great as those produced by the 14 micrograms dose. In Experiment 4, suppression of vocalizations by CRH was not reversed by 1 or 5 mg/kg body weight of naloxone. Rectal temperature was unaffected by CRH or naloxone. Thus, peripheral administration of CRH has a suppressive effect on the vocalizations of isolated guinea pig pups. The effect is accompanied by a reduction in locomotor activity and does not appear to be mediated by ACTH, cortisol, beta-endorphin, or an altered body temperature response to the isolation procedure. These results are consistent with the hypothesis that increased secretion of CRH contributes to the waning of the vocalizations of guinea pig pups during prolonged isolation.
Adrenocorticotropic Hormone↗
Goal-oriented medical care.
The problem-oriented model upon which much of modern medical care is based has resulted in tremendous advancements in the diagnosis and treatment of many illnesses. Unfortunately, it is less well suited to the management of a number of modern health care problems, including chronic incurable illnesses, health promotion and disease prevention, and normal life events such as pregnancy, well-child care, and death and dying. It is not particularly conducive to an interdisciplinary team approach and tends to shift control of health away from the patient and toward the physician. Since when using this approach the enemies are disease and death, defeat is inevitable. Proposed here is a goal-oriented approach that is well suited to a greater variety of health care issues, is more compatible with a team approach, and places a greater emphasis on physician-patient collaboration. Each individual is encouraged to achieve the highest possible level of health as defined by that individual. Characterized by a greater emphasis on individual strengths and resources, this approach represents a more positive approach to health care. The enemy, not disease or death but inhumanity, can almost always be averted.
Adult↗
Family functioning and stress as predictors of influenza B infection.
A prospective cohort study was designed to study the effects of family functioning and stress on the incidence of influenza infection. Families from the clinic roster, containing two adults and at least one child between the ages of 1 and 18 years, were asked to participate. Baseline (pre-influenza) data included a serum determination for influenza A and B antibodies, family functioning as measured by the Family Adaptability and Cohesion Evaluation Scales (FACES) II and the Family APGAR, and parental stress as measured by the social readjustment rating scale (SRRS). During the study all family members of patients with upper respiratory tract infection symptoms or fever were seen, and throat swabs were obtained for viral culture. Approximately 2 weeks after the influenza epidemic ended (March 1984), sera for antibodies were again collected on all family members. Chi-square analysis showed that infection (defined as a fourfold titer rise or a positive viral throat culture) was significantly associated with both cohesion and adaptability as measured by FACES II. Neither the Family APGAR nor the SRRS was associated with influenza B infection. It was concluded that family functioning affects the frequency of influenza B infection within families. This finding raises the possibility that family dysfunction may lead to altered immune responses, which increases susceptibility to infection.
Adolescent↗
Biological psychology's relationships to psychology and neuroscience.
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Adult↗
A randomized trial of special packaging of antihypertensive medications.
This article reports a randomized controlled trial designed to test the effects of special packaging of antihypertensive medication on compliance and blood pressure control. One hundred eighty subjects who had exhibited elevated blood pressure greater than 90 mmHg in the two years prior to the study were recruited from patients receiving care at a community hospital-based family medicine practice. After completing preenrollment interviews and blood pressure measurements, subjects were randomly assigned to receive their antihypertensive medications either in the usual vials or in special unit dose-reminder packaging. Follow-up interviews, pill counts, and blood pressure measurements were performed at three-month intervals. There were no statistically significant differences between the control and experimental groups with regard to age, sex, race, employment, education, marital status, insurance coverage, or blood pressure regimens. Prior to the intervention, the experimental group had slightly lower diastolic blood pressure and reported better compliance than the control group. Analyses performed on 165 subjects completing the first follow-up visit revealed no significant improvements in blood pressure control or compliance for patients receiving special medication packaging. While some patients found it easy to remember to take pills packaged using this format, they also found the packages somewhat more difficult and inconvenient to use. In contrast to previously reported work, this study did not demonstrate any significant improvement in compliance with special packaging of antihypertensive medications.
Adult↗
Physicians' knowledge of prescribing for the elderly. A study of primary care physicians in Pennsylvania.
The 143 physicians who returned to Temple University Medical School a questionnaire on knowledge of prescribing for the elderly constituted 25% of a stratified random sample of general practitioners (GPs), family practitioners (FPs), and practitioners in internal medicine (IMs) reimbursed under Medicare in Pennsylvania in 1979. The mean score on the 23-item drug questionnaire was significantly lower (P less than .05) than the score deemed adequate by a panel of six experts in the field. Five variables, identified by survey questions, were positively associated with physicians' test scores: importance of professional meetings, perception of need for continuing medical education, board eligibility/certification, group practice, and a practice in which the elderly constitute 25 to 49% of all patients. Two variables were negatively associated: number of years since date of licensure and the importance of drug advertisements. Respondents and nonrespondents were compared on nine variables for which American Medical Association (AMA), American Osteopathic Association (AOA), or Blue Shield data were available. Pennsylvania graduates were significantly overrepresented in the respondent group. The only other significant difference found was in field of practice, where findings differed by source of information. There was no significant difference in mean scores of early and late respondents. The research findings support those of three previous studies, not limited to the elderly, which found prescribing knowledge inadequate. They suggest the need for examining/improving the opportunities for medical students and physicians to increase their knowledge of geriatric pharmacology.
Aged↗
Sex bias in the assessment of patient complaints.
This study investigates the contention that physicians have prejudicial attitudes toward female patients. One hundred twenty of 220 (58 percent) primary care physicians returned questionnaires that recorded their attitudes toward two hypothetical patients, one with a headache, one with abdominal pain. By changing only the gender of nouns and pronouns, two otherwise identical versions of each case had been constructed, one case describing a female patient, one a male patient. The physician subjects recorded their attitudes on a semantic differential scale designed to measure three dimensions of attitudes toward patients: authenticity, impression of severity of illness, and emotionality. The physicians judged the female patients to be more emotional (P less than .05) but no less authentic or ill than the male patients.
Attitude of Health Personnel↗
A conversion code from ICHPPC-1 to ICHPPC-2.
Faculty members from four departments of family medicine participated in the production of a definitive conversion from the first to the second versions of the International Classification of Health Problems in Primary Care (ICHPPC). A detailed conversion code with the appropriate ICHPPC-2 equivalent for each ICHPPC-1 diagnostic title is provided. Differences between the two classifications are discussed and suggestions are made for the use of the conversion code.
Disease↗
Bradycardia associated with cimetidine.
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Aged↗