Search PubMed⌕ Search

Biomedical subjects

R C Hall

Publications and source records attributed to R C Hall.

At least 19 recordsLinked to original sources
PubMed1992

Developing a level III/IV medical/psychiatry unit. Establishing a basis, design of the unit, and physician responsibility.

This article is part of a series defining the administrative, logistical, and funding issues necessary for the establishment of a medical/psychiatry unit. It emphasizes the experience of individuals who have developed such units and is offered in an attempt to prevent duplication of costly mistakes. Administrative issues, factors affecting the physical design of the unit, requirements for medical coverage and medical and psychiatric programmatic support, and the ethical issues encountered in managing such a unit are discussed.

Delivery of Health Care↗
PubMed1992

Categorization of types of medical/psychiatry units based on level of acuity.

Medical/psychiatry units can be categorized by the level of acuity of medical and psychiatric illness. Type I units are categorized as those that primarily provide psychiatric care with a low level of medical acuity. Type II units include general medicine or medical subspecialty units that are associated with a psychiatric liaison service and provide low levels of psychiatric care to those admitted to the general medical setting. Type III and Type IV units are characterized by a true departure from the current ward settings and care for patients who have concurrent and more severe medical and psychiatric problems in a unified setting. Both of these units require special physical changes in the ward structure, additional nurse training, and coordinated physician coverage to function effectively.

Acute Disease↗
PubMed1992

Quality assurance in a setting designed to care for patients with combined medical and psychiatric disease.

In an attempt to address the needs of patients with combined medical and psychiatric illness, a variety of clinical centers are now creating medical/psychiatry units. These units differ widely in their clinical capabilities, yet no adequate delineation of safeguards regarding quality of care currently exists. This article discusses minimum quality guidelines for four types of medical/psychiatry units that are based on the level of acuity of patients' medical and psychiatric disease.

Acute Disease↗
PubMed1992

Bulimia nervosa. Four uncommon subtypes.

The histories and psychological profiles of more than 500 patients meeting DSM-III-R criteria for bulimia nervosa were reviewed. A total of 310 patients demonstrated the most characteristic pattern of bulimia, with finger-induced purging and occasional diet pill, diuretic, or laxative abuse. Seventeen patients reported binge eating with no self-induced vomiting but with severe laxative abuse (i.e., greater than or equal to 50 laxatives daily). A total of 126 patients reported bulimia with finger-induced purging and regular mild (i.e., 2-3 daily) laxative abuse. Eight patients reported bulimia without finger-induced purging, diuretic, or laxative abuse but with the regular abuse of ipecac as a means of inducing vomiting. Four clinical subtypes of bulimia were seen. These were overt bulimia, which occurred in 8.9% of the sample; obsessive-ritualistic bulimia, which occurred in 2% of the sample; sexually evocative bulimia (Fatal Attraction Syndrome), which occurred in 2.9% of the sample; and masochistic bulimia, which occurred in 4.9% of the sample. Each of these subtypes of bulimia are described and defined. The characteristic psychologic profile, clinical features, and implications for treatment and research are discussed.

Acting Out↗
PubMed1992

Dual-purpose tube for enteroclysis and nasogastric-nasoenteric decompression.

A catheter designed for the dual purpose of nasogastric-nasoenteric decompression and enteroclysis is described. The catheter facilitates direct decompression of the obstructed small bowel and, if necessary, subsequent performance of enteroclysis. The use of this tube obviates dual intubation and its accompanying discomfort.

Catheterization↗
PubMed1992

Rectal indomethacin.

Explore the source record for details and available documents.

Administration, Oral↗
PubMed1991

Evaluation of a simple weight-loss method for determining the permeation of organic liquids through rubber films.

The standard ASTM method for determining permeation of liquid penetrants through polymeric films (F739-85) was compared with a simple weight-loss method. The weight-loss permeation cell was constructed of off-the-shelf components, a conventional analytical balance was used to measure the weight loss, and a chamber with continuous ventilation was used to hold the cell at constant temperature and evacuate the permeating penetrant. The advantages and limitations of the weight-loss method were illustrated by using data obtained from the permeation of acetonitrile, n-hexane, and methanol through films of four acrylonitrile-butadiene copolymers. The steady-state flux obtained by using the weight-loss method gave results statistically equivalent to the more analytically complex ASTM standard method. The weight-loss method required the experimenter to monitor the weight of the cell and its contents over time to obtain the steady-state flux whereas the ASTM method required the experimenter to chemically analyze for the penetrant concentration in the effluent gas stream as a function of time. The ASTM method required more analytical skill and training and more costly analytical equipment than did the simple weight-loss method. The weight-loss method needs further improvement and validation but shows promise even in its present form. By using the weight-loss method, the potential exists for far more chemical protective clothing users to conduct their own low-cost permeation testing as an initial screening to determine the relative permeation performance of candidate protective clothing materials. The weight-loss method is not meant to replace the standard ASTM method but to supplement it as a screening test.

Evaluation Studies as Topic↗
PubMed1990

Ammonia and ethylene oxide permeation through selected protective clothing.

An automated permeation test system was developed to collect permeation data. Three test specimens were evaluated simultaneously versus a challenge gas. The study evaluated chemical protective clothing garment materials for use by emergency response personnel confronted by ammonia or ethylene oxide in the gas phase. A total of 13 encapsulating suit materials and 2 glove materials were tested. Surgical latex material is not recommended for use in handling ammonia or ethylene oxide; other materials offer much greater protection.

Ammonia↗
PubMed1989

Physical illness encountered in patients with eating disorders.

Careful evaluation for medical illness with a severity rating scale of 276 eating-disorder patients admitted to hospital revealed that patients with anorexia and bulimia were at risk for developing medical complications. Severe cardiovascular complications were most likely to occur in eating-disorder patients who were also diuretic and/or laxative abusers. Forty percent of patients with bulimia had significant medical complications. The findings suggest that a medical work-up should be carefully undertaken in both anorexic and bulimic patients admitted to hospital. A mixed history of severe anorexia nervosa alternating with periods of bulimia was most likely to lead to severe life-threatening illness. Seventy percent of the bulimic patients admitted required some medical treatment. Five percent were considered severely medically ill, while 34% suffered from a significant medical disorder. Ten percent of patients with restrictive anorexia or anorexia alternating with binge/purge required intensive care unit (ICU) placement. Most illnesses requiring medical treatment were unknown to the patient and the patient's physician at the time of admission.

Anorexia Nervosa↗
PubMed1989

Sexual abuse in patients with anorexia nervosa and bulimia.

Few studies have documented the extent and nature of sexual abuse among women who later come to treatment for anorexia nervosa or bulimia. This comparison study reports on a sample of 158 patients admitted to an eating-disorder unit, of whom 60 gave a history of sexual abuse, compared to 98 with no history of abuse. Fifty percent of the anorexic and bulimic patients had suffered sexual abuse, compared to only 28% of patients admitted with other eating-disorder diagnoses; this was a significant difference (p less than 0.001). Of the four types of abuse surveyed, only those patients suffering rape were likely to have sought help from caregivers prior to admission (p less than 0.001). The authors report on likely perpetrators of abuse, age of first abuse, and frequency of depressive symptoms in the abused population. The data from this study strongly suggest that the possibility of sexual assault or abuse must be assessed and the results included in a comprehensive therapy plan for eating-disorder patients.

Adolescent↗
PubMed1989

Mitral valve prolapse and anxiety disorders in patients with anorexia nervosa.

Much has been written about the occurrence of mitral valve prolapse among eating disordered patients. Despite this literature, a causal relationship between the two conditions has yet to be established. The present study evaluated 500 patients with eating disorders and demonstrated an association between a low median ideal body weight and the frequency of mitral valve prolapse (P less than 0.001). The physical signs and symptoms of mitral valve prolapse disappeared in eating disordered patients with the return of normal weight (P less than 0.001). Contrary to prior reports, there was no association between mitral valve prolapse and the occurrence of diagnosable panic or anxiety disorders. The results of this study suggest that the symptoms of anxiety and panic associated with mitral valve prolapse in eating disordered individuals may be due to physiologic change in cardiac status related to weight rather than central nervous system changes associated with classic anxiety disorders.

Adolescent↗
PubMed1989

Sexual abuse in patients with eating disorders.

The incidence of sexual abuse in eating disorder patients appears significant. Fifty percent of both our anorectic and bulimic patients reported a history of sexual abuse while only 28% of a non-anorexic, non-bulimic control population reported similar problems (p less than 0.01). Several patterns of behavior seemed related to previous sexual assault. In one, the eating disorder was used to change the body image of the patient and therefore to provide a defense to future abuse. Other behaviors which occurred more specifically in bulimic women dealt with a projection of repressed anger toward male authority figures. Forty six percent of the bulimic women seen in our study exhibited some promiscuous behavior, using sex either as a gauge of their own self worth or as a means of punishing men. It is essential that sexual issues be addressed early in the treatment of patients with eating disorders. Disclosure is often difficult particularly in outpatient situations where the patient lives at home with her family. It usually does not occur in such cases until the later stages of therapy, or until the patient is hospitalized. Rape is the exception since our data suggests that it is usually revealed early in the course of treatment (p less than 0.001). Once disclosure occurs, a dramatic change is usually seen in the patient and treatment becomes more effective. As the patient deals with the issues of sexual abuse, they no longer need to deny their sexuality or punish themselves or others. Issues of guilt, depression, repressed anger, low self-esteem, social isolation and inadequacy are important and need to be addressed during the course of therapy with sexually abused patients.

Adolescent↗