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Biomedical subjects

R E Drake

Publications and source records attributed to R E Drake.

At least 91 records · Page 5Linked to original sources
PubMed1996

Tissue protein washout in sheep lung lymph.

At high microvascular filtration rates, the lung lymph protein concentration (C1) may be higher than the filtrate protein concentration due to protein washed into the lymph from the lung tissue space. To test that hypothesis, we increased the microvascular filtration rate in 5 anesthetized sheep and determined the relationship between C1, and the plasma protein concentration (Cp). Then we extrapolated the data to estimate C1 at Cp = 0. Because the filtrate protein concentration should be zero at Cp = 0, we recorded the extrapolated C1, as the concentration of tissue protein in the lymph (C1). Our C1 estimate (0.92 +/- 0.38g/dl) was significantly greater than zero (P < 0.05). This result is important because tissue protein in lymph may cause errors when investigators use lung lymph to study microvascular permeability. However, our technique to estimate Ct may allow investigators to correct for the tissue protein problem.

Animals↗
PubMed1995

A scale for assessing the stage of substance abuse treatment in persons with severe mental illness.

Substance abuse is common among persons with severe mental illness, but few measures exist for clinicians to evaluate treatment progress. The Substance Abuse Treatment Scale (SATS) combines a motivational hierarchy with explicit substance use criteria to form an eight-stage model of the recovery process. Data are presented supporting the reliability and validity of the SATS, based on its use in a community-based sample of persons with dual disorders. The SATS can be used as either a process or an outcome measure, for individuals or for groups, and its value in making explicit the stages of substance abuse treatment is discussed.

Case Management↗
PubMed1995

Long-term course of substance use disorders among patients with severe mental illness.

OBJECTIVE: This study assessed the long-term course of substance abuse and dependence among severely mentally ill patients. METHODS: A prospective, naturalistic, seven-year follow-up of severely mentally ill outpatients (most with schizophrenia and schizoaffective disorder) successfully located and reassessed 79.1 percent (N = 148) of the patients from the original study group. The follow-up study group was assessed for alcohol and drug use at baseline and seven-year follow-up by their case manager or primary clinician using the Case Manager Rating Scale (CMRS) for the assessment of substance-related problems among severely mentally ill patients. RESULTS: The prevalence of active substance use disorder changed little from baseline to follow-up. Alcohol abuse or dependence was present in 24 percent of the patients at baseline and 21 percent at follow-up, and drug abuse or dependence was present in 20 percent at baseline and 17 percent at follow-up. However, those with initial alcohol abuse had a higher rate of remission (67 percent) than those with initial alcohol dependence (33 percent). Similarly, those with initial drug abuse had a higher rate of remission (54 percent) than those with initial drug dependence (31 percent). CONCLUSIONS: The higher rates of change for those with initial substance abuse compared with substance dependence suggest that distinguishing between abuse and dependence may have important implications for assessment and prognosis of individuals with a dual diagnosis of a substance use disorder and severe mental illness.

Alcoholism↗
PubMed1995

Evaluating use of continuous treatment teams for persons with mental illness and substance abuse.

OBJECTIVE: Continuous treatment teams serving persons with co-occurring severe mental disorders and substance abuse disorders at seven sites in New Hampshire were evaluated to determine their fidelity to a model based on the Program for Assertive Community Treatment. METHODS: Continuous treatment teams and standard case management programs at the seven sites were evaluated on 13 criteria for fidelity to the continuous treatment team model over a 27-month period. Data sources included clinicians' activity logs, agencies' management information systems, interviews, observation of staff activity and practices, and clinical records and other documents. RESULTS: The continuous treatment teams scored significantly higher than the case management programs on ten of the 13 criteria. The teams were more effective than the case management programs in implementing substance abuse treatment. CONCLUSIONS: Evaluation of the programs' fidelity to the model criteria allowed differentiation of successfully implemented continuous treatment teams from standard case management and from an unsuccessfully implemented team. The results confirm the need for careful measurement of model implementation and for investigation of organizational issues such as administrative support and clarity of program mission.

Adult↗
PubMed1995

The test-retest reliability of standardized instruments among homeless persons with substance use disorders.

OBJECTIVE: Standardized instruments are widely used to assess homeless persons, but basic data on their reliability and validity in these populations have not been available. The purpose of this study was to examine the reliability of standardized instruments used in a cooperative agreement on homeless persons with substance use disorder. METHOD: This study examined the 1-week test-retest reliability of the Alcohol Dependence Scale, the Addiction Severity Index and the Personal History Form, using 189 randomly selected subjects participating in a multisite study of services for homeless persons with alcohol and other drug abuse problems. In addition to scales and items, factors hypothesized to influence reliability related so subject, interviewer and setting were examined. RESULTS: Results showed substantial reliability for scale scores (> .60) but mixed reliability for individual items. Reliability was greater when items were factual and based on a recent time interval, and when subjects were interviewed in a protected setting. Higher reliability was also related to younger age, female gender, a first episode of homelessness and lower severity of psychiatric problems. CONCLUSIONS: Reliability should be examined in individual studies of homeless persons, and efforts should be made to minimize controllable sources of unreliability.

Adult↗
PubMed1995

Incentives for community treatment. Mental illness management services.

Serving people with mental and other chronic illnesses in community settings may improve compliance and satisfaction with treatment, but existing payment mechanisms often favor office-based treatment. This study examines the effect of a change in Medicaid payment on the location and amount of service provided by case managers. Amounts of service given by treatment providers to 185 of their clients in community settings and in mental health centers were compared before and after reimbursement changed from an all-inclusive prospective rate to a mixed prospective/retrospective payment. Clients were enrolled in two different treatment programs: continuous treatment teams with extensive training in in vivo treatment, and a case management program that emphasized office-based treatment. In-community service increased, and the amount of office-based treatment decreased. Continuous treatment teams increased in-community services more than case managers did; case managers decreased office-based treatment more. There was no change in total amount of services provided. It was concluded that mixed prospective and retrospective reimbursement can remove financial barriers to in-community treatment, but it works best in combination with a training program. Additional research is needed to determine the precise financial impact of such changes.

Adult↗
PubMed1994

Expenditures of time and money by families of people with severe mental illness and substance use disorders.

Families are typically a major source of support for people with mental illness, but substance abuse places an additional burden on family relations and could reduce the amount of direct support they give. Data from families of 169 people with co-occurring mental illness and substance abuse indicate that they give a substantial amount of time and money to their relatives with dual disorders. More severe current substance abuse appeared to reduce family spending but not direct caregiving. Clients with more severe alcohol problems were more likely to live with parents than with other family members.

Adult↗
PubMed1994

Individual Placement and Support: a community mental health center approach to vocational rehabilitation.

Individual Placement and Support (IPS) is a vocational rehabilitation intervention for people with severe mental disabilities. IPS draws from components and philosophies of several other models. Employment specialists, who are part of the community mental health center team, provide services in the community. IPS emphasizes client preferences, rapid job finding, continuous assessment, competitive employment, integrated work settings, and follow-along supports. Initial research on IPS shows favorable results.

Community Mental Health Centers↗
PubMed1994

Rehabilitative day treatment vs. supported employment: I. Vocational outcomes.

Day treatment remains a core component in many community mental health programs for persons with severe mental disorders throughout the United States. Many other mental health centers are moving away from day treatment toward psychosocial and vocational rehabilitation programs. Empirical research directly comparing these two systems of organizing outpatient services is needed. In this study the authors compared a rehabilitative day treatment program in one small city with a similar program in a nearby city that changed from day treatment to a supported employment model. Clients who were enrolled in community support services during a baseline year prior to the change and during a follow-up year after the change (71 in the program that changed and 112 in the other) were evaluated during both intervals. In the program that changed, competitive employment improved from 25.4% to 39.4% for all clients, and from 33.3% to 55.6% for those clients who had been regular attenders of day treatment during the baseline. Hours worked and wages earned similarly improved after the program change. For all work variables, clients who had not worked during the baseline year accounted for the improvements in outcome. Meanwhile, employment remained stable in the day treatment program. No negative outcomes were detected. These results indicate that eliminating day treatment and replacing it with a supported employment program can improve integration into competitive jobs in the community.

Adolescent↗
PubMed1994

Measuring resource use in economic evaluations: determining the social costs of mental illness.

Concern over costs associated with mental disorders has led to an increase in the number of economic evaluations of treatment interventions; unfortunately, methods for measuring resource use have not kept pace with this concern. Although it is well-known that a significant proportion of the costs associated with mental illness are for resources other than treatment, program evaluators and researchers often count only treatment costs in cost-effectiveness comparisons. Further, existing methods for measuring resource use are plagued by faulty assumptions about resource use, poor validity and reliability, and difficulties quantifying resource use. The authors discuss these problems and suggest five ways of improving measurement of nontreatment resources: clarifying assumptions, using multiple data sources, flexible data collection strategies, methods for improving the accuracy of recall, and an episodic approach to measurement.

Cost of Illness↗
PubMed1994

Potential health hazards of pornography consumption as viewed by psychiatric nurses.

Adverse effects of pornography consumption (PC) have been identified from over 150 empirical studies conducted since 1970. Yet, the practice literature of psychiatric nurses does not address the health risks of PC. This study determines the perceptions of psychiatric nurses (n = 194) with regard to PC effects. A significant majority of psychiatric nurses agreed (72%) that there are potential adverse effects to PC, that there are risks for preadult consumers of pornography (78% agreement), and that PC risks need to be addressed by their profession (68% agreement). Agreement lends support for expanding nurses' knowledge concerning PC.

Adult↗
PubMed1994

Family history of alcoholism in schizophrenia.

Previous research has shown that family history of alcoholism (FHA) is associated with several aspects of the development and expression of alcohol use disorder in people who are not mentally ill. This study examined FHA in a group of 66 schizophrenic outpatients who were well characterized in terms of their alcohol use and were followed prospectively in treatment for 4 years. The FHA-positive probands (42.4% of the group) were more likely to have alcohol use disorder. Contrary to our prediction, the relationship between FHA and alcoholism in the probands was significant for women but not for men. Among schizophrenic probands with alcoholism, positive FHA was associated with more severe alcoholism and with the use of other drugs. Probands with positive FHA also responded less well to alcoholism treatment than did probands with negative FHA. These exploratory findings have significant implications for understanding risk, for conducting assessment, and for studying treatment, but should be confirmed in larger and more representative samples of people with schizophrenia.

Age of Onset↗
PubMed1994

Increased lymphatic pressure without increased neck vein pressure during intravenous infusions.

Postnodal intestinal lymphatic pressure increases during rapid intravenous infusions with Ringer solution in sheep. Part of the lymphatic pressure increase is due to increased venous pressure at the lymphatic outflow (the neck veins). We tested the hypothesis that other factors besides increased neck vein pressure may cause increased lymphatic pressure during intravenous infusions. We placed cannulas into postnodal lymphatic vessels in eight sheep. After the sheep recovered from the surgery, we infused Ringer solution [46 +/- 21 (SD) ml/kg body wt in 30 min] intravenously into the sheep and inflated a balloon in the inferior vena cava. We adjusted the balloon inflation to prevent any increase in neck vein pressure during the infusions. At baseline, the intestinal lymphatic pressure was 15.5 +/- 2.5 cmH2O. During the infusions, lymphatic pressure increased significantly, and for the last 10 min of the infusion period, intestinal lymphatic pressure was 24.0 +/- 6.1 cmH2O. These results are consistent with the hypothesis that factors in addition to increased neck vein pressure may cause increased intestinal lymphatic pressure during rapid intravenous infusions.

Analysis of Variance↗
PubMed1994

Increased abdominal lymph flow increases lung lymphatic outflow pressure in sheep.

We tested the hypothesis that increased lymph flow from the abdominal organs would increase the pressure within the thoracic duct at the thoracic duct-lung lymphatic junction. Cannulas were placed into the thoracic duct via the caudal mediastinal (lung) node efferent lymphatics in 4 sheep. After the sheep recovered from the surgery, we monitored the thoracic duct pressure with pressure transducers. To increase lymph flow from the lower body, we infused Ringers solution (59 +/- 19 [mean +/- SD] ml/kg body weight in 30 min.) intravenously into the sheep and we inflated a balloon in the inferior vena cava. This technique causes substantial increases in lymph flow from the lower body (mainly from the liver and intestines) through the thoracic duct. During the infusions, the thoracic duct pressure increased significantly from 4.1 +/- 2.9 cm H2O (baseline) to 6.8 +/- 1.7 cm H2O. The neck vein pressure (pressure at the outflow of the thoracic duct) did not increase from baseline (3.0 +/- 2.6 cm H2O). Thus our results support the hypotheses that increased flow through the thoracic duct causes increased thoracic duct pressure.

Abdomen↗