Anaesthetic agents.
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Biomedical subjects
Publications and source records attributed to M Stevens.
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One-month old testosterone-injected ducklings were observed in groups of three males and their social behaviour compared to that of oil-injected control birds. Most elements of adult sexual behaviour and one pattern of aggressive behaviour (chest fight) occurred more frequently in the experimental animals. It was shown that the same hormonal treatment induces different behavioural responses in different animals. Unlike previous studies, no social displays were observed in the testosterone-injected ducklings. Possible explanations of this fact are discussed.
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70 patients with endogenous depression, defined by strict criteria, who fulfilled the Newcastle indications for electroconvulsive therapy (ECT) were randomly allocated either to a course of eight simulated ECTs or to a course of eight real ECTs. The improvement in terms of psychiatrists' ratings in the group of patients given real ECT was significantly greater (p < 0.01) than that in those given simulated ECT, but the difference between the two groups was small in relation to the considerable improvement of both groups over the 4-week treatment period. No differences were found between the two groups at one-month and six-month follow-up. The therapeutic benefits of electrically induced convulsions in depression were of lesser magnitude and were more transient than has sometimes been claimed. In the real-ECT group memory was impaired during treatment but memory tests revealed no difference between the groups at six-month follow-up.
The authors analyze the use of mental health care resources before and after the initiation of risperidone therapy in patients of Valley Mental Health, an agency providing aggressive community-based treatment in Salt Lake County, Utah. Sixty-three patients were treated with risperidone during the period from February 1994 through June 1995. Data for at least 6 months before (pre-period) and after (post-period) risperidone therapy were available for 61 patients; the mean period for which data were obtained was 31.8 months (pre- plus post-period). Risperidone use was associated with a reduction, albeit nonsignificant, in the numbers of patients requiring acute inpatient hospital care (-29%), days hospitalized (-1 day per year), residential treatment days (-0.7 days per year), and day-treatment visits (-1.7 visits per year), together with small increases, also nonsignificant, in the need for emergency/crisis intervention (0.1 visit per year), outpatient treatment (0.1 visit per year), and case management (2.3 visits per year). The costs of institutional plus ambulatory care declined from $7949 to $6910 per patient per year (-13%); the greatest reduction was in the cost of acute inpatient care (-18%). With the addition of risperidone, the cost of psychotropic medications doubled, resulting in a statistically nonsignificant mean increase in total costs of $305 per patient per year. Among the 36 patients who received risperidone during > or = 70% of the post-period and the 17 patients who had been hospitalized during the pre-period, total costs declined -3% and -13%, respectively. The results confirm those of previous studies and demonstrate that risperidone can reduce the use of mental health services.
SUPPORT (The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment) failed to produce changes in 5 quantitative outcome measures of care received by nearly 10,000 seriously ill patients in major teaching hospitals. This article reports a content analysis of documents produced during the SUPPORT study by the 17 nurses who delivered the intervention. "Effective communication" emerged as the central category, with "educational support" and "emotional support" as subcategories. "Readiness" of patients and families to accept prognoses, engage in decision making, and the like also arose from this analysis as an important concept. The investigation suggests that the SUPPORT intervention did have an important impact, albeit not one captured by the main effects analysis.
It is well recognized that serious illness in children can have important consequences for siblings who may manifest their concerns as behavioural difficulty. The aim of the present study was to explore sibling psychological response to childhood cancer and to observe the effects that sibling knowledge had on their response. Siblings and parents of patients at the Children's Hospital, Birmingham, were interviewed using the Achenbach Child Behavior Checklist and semi-structured 'Illness Knowledge' questionnaires designed by the first author. Siblings were not experiencing significant behaviour problems. The level of sibling knowledge about cancer was related to the level of sibling social competence but not to the prevalence of behaviour problems. One-third of the siblings were talking to no one at all about their feelings, and sibling feedback yielded some important sibling needs. It was concluded that sibling response to childhood cancer may not necessarily be pathological and may also be mediated by the level of sibling social competence as well as sibling knowledge.
The excretion of retinol-binding protein in early morning urine samples, expressed as a ratio to urinary creatinine (RBPCR), was used as a measure of proximal renal tubular toxicity in children during or after treatment with ifosfamide-containing chemotherapy. The results showed a progressive increase in renal tubular leak after exposure to ifosfamide that persisted after treatment. The toxic effect appeared to be greatest in younger children and at least partly dose-dependent, although partially reversible after each course of chemotherapy. However, few patients had related symptoms and none experienced major metabolic difficulty. RBPCR appears to offer a sensitive and noninvasive way of monitoring sequential change in renal tubular function after exposure to ifosfamide. Further studies are required to define more clearly the effect of cumulative dose, age, and drug scheduling and to identify whether a level of renal tubular dysfunction, measured by RBPCR or a similar noninvasive technique, can identify a threshold beyond which further exposure to ifosfamide is likely to be significantly and permanently damaging.