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Biomedical subjects

R C Hall

Publications and source records attributed to R C Hall.

213 records · Page 12Linked to original sources
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Global assessment of functioning. A modified scale.

The modified Global Assessment of Functioning (GAF) scale has more detailed criteria and a more structured scoring system than the original GAF. The two scales were compared for reliability and validity. Raters who had different training levels assigned hospital admission and discharge GAF scores from patient charts. Intraclass correlation coefficients for admission GAF scores were higher for raters who used the modified GAF (0.81), compared with raters who used the original GAF (0.62). Validity studies showed a high correlation (0.80) between the two sets of scores. The modified GAF also correlated well with Zung Depression scores (-0.73). The modified GAF may be particularly useful when interrater reliability needs to be maximum and/or when persons with varying skills and employment backgrounds--and without much GAF training--must rate patients. Because of the increased structure, the modified GAF may also be more resistant to rater bias.

Activities of Daily Living↗
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The clinical and financial burden of mood disorders. Cost and outcome.

Depressive disorders are a chronic, recurrent, and severe burden to both patients and their families. Depressive disorders represent a major national public health problem, ranking within the top 10 most costly diseases in the United States. In 1990, depressive disorders afflicted at least 11 million Americans and cost the U.S. economy an estimated $44 billion. In addition, affective disorders are associated with increased accident rates, increased rates of substance abuse (especially alcoholism), increased medical hospitalization, and an increase in somatic illnesses and outpatient medical utilization. Despite their ranking as a major health problem, depressive disorders are often underdiagnosed and undertreated. Brief treatment strategies that focus only on acute episodes are often ineffective and result in chronic impairment, impairing performance at work and socially. Inadequate treatment increases costs, suffering, and lost productivity. Recent data suggest that effective treatment of depression requires long-term, skillful follow-up and active pharmacotherapy.

Cost of Illness↗
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Past mental health or substance use treatment history and psychiatric differential diagnosis in consultation-liaison patients.

The purpose of this study was to determine whether frequencies of any current primary or secondary (organic) psychiatric diagnoses in consultation-liaison (C-L) patients are associated with patient report of past history of mental health or substance use disorder treatment. Clinical information recorded in 134 C-L patients was retrospectively analyzed with the chi-square test, two-tailed, or Fisher's Exact Test when the sample sizes were < or = 5. The results revealed that the overall likelihood of the existence of a secondary psychiatric disorder diagnosis is elevated when there is no treatment history (P = 0.009). A primary psychiatric disorder is more likely to be diagnosed when there is treatment history (P = 0.009). Specific psychiatric diagnoses more likely to be present when there is no treatment history are organic mood disorder, depressed (P = 0.020) and adjustment disorder (P = 0.010). Specific diagnoses more likely to be present when there is treatment history are psychoactive substance-withdrawal syndrome (P = 0.014) and alcohol abuse or dependence (P = 0.028). The authors conclude that psychiatric treatment history can help C-L psychiatrists with differential diagnostic considerations.

Adolescent↗
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Psychiatric characteristics of consecutively evaluated outpatient renal transplant candidates and comparisons with consultation-liaison inpatients.

The purpose of this study was to empirically define psychiatric characteristics of renal transplantation candidates and determine whether demographic, psychiatric predisposition, psychiatric impairment, and psychiatric diagnosis characteristics differ from those of consultation-liaison (C-L) service inpatients. Standard clinical information recorded by a C-L service for 66 consecutively evaluated renal transplant candidates and 134 C-L inpatients was compared. The results revealed that the transplantation evaluation patients differ demographically from the C-L inpatients. The C-L inpatients are more likely to report past history of mental health treatment, but the two groups are equally likely to report past substance use disorder treatment. Mean scores on the Global Assessment of Functioning Scale and Hamilton Anxiety and Hamilton Depression scales are less impaired in the transplant candidates. Mini-Mental State Exam mean scores are not significantly different. Five psychiatric diagnoses are significantly more likely in the C-L inpatients; only one is more likely in the transplant candidates. The authors conclude that the psychiatric characteristics of renal transplant candidates are distinct in many respects, confirming the unique skills needed by C-L psychiatrists who do pretransplant psychiatric evaluations.

Ambulatory Care↗
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Long-term psychological and neurological complications of lindane poisoning.

A thin, healthy, partial-vegetarian, white female, who was exposed to three doses of lindane (through the application of Kwell), developed a severe case of long-term lindane poisoning. Review of the literature suggests that her toxicity was so severe because of the repetitive nature of her exposure and the fact that she was partly protein restricted when first exposed. She developed profound central nervous system toxicity, as well as skin and gastrointestinal changes, that persisted for 20 months. She was treated with high doses of Valium. It was noted that every time her Valium was diminished below a critical level, her symptoms tended to recur until she had adequately cleared the lindane from her system. We believe this is the longest term of poisoning reported following exposure to an organochloride insecticide. Her symptoms are well explained by the physiology of these compounds as described in the literature. The case is important, for it represents the longest persistence of symptoms clearly associated with poisoning by the potent gamma isomer of BHC-lindane.

Administration, Topical↗
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Suicide risk assessment: a review of risk factors for suicide in 100 patients who made severe suicide attempts. Evaluation of suicide risk in a time of managed care.

A study of 100 patients who made a severe suicide attempt suggested that the managed care criteria often applied for approving admission to hospitals for potentially suicidal patients were not, in fact, predictive of features seen in patients who actually made such attempts. Severe anxiety, panic attacks, a depressed mood, a diagnosis of major affective disorder, recent loss of an interpersonal relationship, recent abuse of alcohol or illicit substances coupled with feelings of hopelessness, helplessness, worthlessness, global or partial insomnia, anhedonia, inability to maintain a job, and the recent onset of impulsive behavior were excellent predictors of suicidal behavior. The presence of a specific suicide plan or suicide note were not. Patients with managed care were overrepresented by 245% in the study.

Adolescent↗
PubMedDate not supplied

A quantitative study of aromatic amine permeation through protective gloves using amine adsorptive pads.

A quantitative study of aromatic amine permeation through a glove material using Permea-Tec aromatic amine pads, used for the detection of chemical breakthrough of protective clothing, was performed for aniline following the microwave extraction process and gas chromatographic analysis. Aniline exhibited >99% adsorption on the pads at a spiking level of 1.94 mg (1.9 microL). Aniline showed recoveries from 65 to 89% (RSD < or =5.6%) over the range 1.1-1.9 microL (1.12-1.94 mg) of aniline applied to pads. The modified ASTM F739 and direct permeability testing procedures were used to determine breakthrough times for five protective glove materials using aniline as a challenge chemical. Breakthrough times for six protective gloves were determined, ranging from 182 sec to 82 min. The quantitative concentration of aniline on the pads following permeation through the gloves also was determined, ranging from 0.53 to 0.55 mg/cm2 (1.79-1.88 mg/pad).

Adsorption↗
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Psychological aspects of long-term home hyperalimentation.

Ten patients (24--66 yr), maintained on ambulatory home intravenous hyperalimentation (HIVH) for 1/2--3 1/4 years, have undergone psychological evaluation. Acceptance of oral deprivation and the inconveniences, restraints, and risks of long-term or life-long HIVH, and the mechanisms for coping with these stresses, varied among this group. At times, the fear related to the HIVH apparatus and its function assumed almost delusional proportions; at other times, the patients acted indifferently or even irresponsibly toward the management of their life-sustaining system. These patients had to cope with public inquisitiveness as well as their own self-consciousness in public. Stress seemed to be related to the patient's prognosis, not only regarding recovery from the primary pathologic process, but also his/her prospects for return of normal gastrointestinal function. Stress reactions also varied among the spouses and families of the patients, and the quality of their psychological support appeared to affect the patient's mental, physical, and social wellbeing significantly. An entirely new spectrum of psychologic and social problems have emerged to challenge the IVH team who successfully manage patients unable to sustain themselves nutritionally. It is imperative that we recognize, prevent, ameliorate, and treat these problems with the same degree of enthusiasm and competence with which we nourish the patients.

Activities of Daily Living↗
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Detachable drive unit for assistant controlled manual wheelchairs.

A self-contained power unit designed to assist porters and nurses with the task of moving patients in unpowered wheelchairs is described. It can be quickly and easily clamped onto a wheelchair and used to provide assistance for negotiating ramps or long corridors. This paper describes the design and performance of the prototype.

Electric Power Supplies↗