Biomedical subjects
R Farmer
Publications and source records attributed to R Farmer.
Suicide on the London Underground System.
Over the past 50 years there has been an increase in the numbers of people jumping/falling in front of trains on the London Underground system. Case-fatality rates have fallen from 70% in the 1950s to 55% today. The proportion certified as suicide has fallen while the proportions certified as accidents or open verdicts have risen. There is unusual clustering of events at some stations which are adjacent to psychiatric units. The hypothesis that ease of access to London Underground stations may sometimes be a determinant of suicide is investigated.
Predictions bullish for industry's future.
What's around the corner and down the road for the textile rental industry? Four CEOs--Richard Farmer, William Leonard, Richard Senior, and James Stefoff--give their views on future industry profitability, evolutionary trends and specialization, healthcare market stability, and survival tactics.
Preoccupation with suicide in patients treated with fluoxetine.
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Mianserin and agranulocytosis.
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Differences in disability between people with mental handicaps who were resettled in the community and those who remained in hospital.
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Dynamics and dilemmas in a DDU.
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Indicators of mental hospital bed use.
This study explored the use of survivorship curves as a type of indicator of lengths of hospital stay. Using data from the psychiatric services of a single Region, an attempt was made to determine the existence of a performance indicator with the advantages of fixed cohort analysis. By comparison with the proposed Department of Health indicators, this approach offers advantages in that it is less distorted by the presence in a District of large numbers of long-stay beds. However, although the findings show that patients are discharged more slowly from Districts with a large mental hospital and that a greater proportion of patients are still resident one year after admission, it is important to stress that measures of bed use of this type alone are not an indication of the quality of psychiatric services provided.
A method of displaying assessment information about people with multiple handicaps as a disability profile.
A method is described of displaying information about the range of multiple disabilities experienced by individuals who are also mentally handicapped, using the assessments available on a Mental Handicap Register. The presentation, in the graphical form suggested, enables groups to be compared whilst retaining details of an individual's problems.
Life events and hostility in self-poisoning.
Life events in 82 self-poisoning subjects were studied using the Bedford College LEDS to see whether there was a difference between those who had a clear depressive syndrome (according to the Present State Examination) and the remainder. Equally high levels of severely threatening events were found in the depressed and non-depressed groups, but the former were older, had experienced more chronic difficulties and had been treated more often in the past for depression. Greatest numbers of life events were found in those with high levels of extrapunitiveness (recorded on the HDHQ), whereas those who had not experienced a severe life event showed predominance of intropunitiveness. Suicidal intent was not related to experience of life events, but has previously been shown to be associated with high intropunitiveness. The findings are discussed in the light of current theories linking life events, depression and parasuicide, and emphasise the need for longitudinal studies to examine these factors in relation to repeated parasuicide.
The efficacy and toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex (ARC): an open uncontrolled treatment study.
The efficacy and toxicity of oral azidothymidine has been studied in 145 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC). The median survival time of AIDS patients on azidothymidine was 4.5 times higher when compared to a historical AIDS group who had not received the drug. This result must be interpreted with caution because of changes in treatment of HIV infection and growing awareness of AIDS which may have led to earlier diagnosis in the group treated with azidothymidine. The mortality was significantly higher in those patients who received transfusions and was particularly high in those who were transfused before azidothymidine. There was a significant difference in the occurrence of opportunistic infections in the patients who received transfusions compared with those who did not. AIDS patients treated immediately after an episode of Pneumocystis carinii pneumonia survived significantly longer than those in whom treatment was delayed for three months or more, and longer than those who were treated with azidothymidine because of another opportunistic infection or Kaposi's sarcoma. The T4 cell median counts increased in patients treated with azidothymidine reaching a peak at the end of the fourth month of treatment in the ARC group and at the end of the first month in the AIDS group with a subsequent fall in both groups. Sixty per cent of patients were p24 viral antigen positive at the start of treatment and 19 per cent of these patients had a fall of more than 50 per cent in antigen level while 32 per cent became antigen negative following treatment with azidothymidine. The mortality in the patients where the antigen disappeared or in whom there was a major fall of more than 50 per cent in antigen level was significantly less than in those where there was no change in antigen level. Twenty-nine patients were treated with azidothymidine because of skin Kaposi's sarcoma and in 17 tumour regressed or was stable. Thirty-two per cent of patients treated with azidothymidine became anaemic. Neutropenia occurred in 3 per cent of patients. Platelets increased initially after treatment but subsequently fell to thrombocytopenic levels in eight patients. Nine of 12 patients with thrombocytopenia before azidothymidine was commenced responded with an increased platelet count.
Physical exercise and mental health.
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AIDS: an ethical puzzle.
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The University College Drug Dependence Unit.
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Functional abdominal pain, psychiatric illness, and life events.
Patients undergoing appendicectomy, attending a gastroenterology clinic or admitted to hospital after self-poisoning have been examined using the same reliable measures to establish whether life events and psychiatric illness preceded abdominal pain. Life events involving threat were experienced more commonly by those with organic and functional abdominal illness, compared with community comparison subjects. The greatest difference was with severe events, especially those involving the break-up of close relationships, which preceded the development of functional abdominal pain as often as they occurred before self-poisoning, and significantly more frequently than before the onset of organic gastrointestinal illness. Abdominal pain of recent onset, for which no organic cause is found, is often preceded by environmental stress, whether it presents to the surgeon or the physician. Those presenting in the clinic were older than those undergoing appendicectomy and had experienced more long lasting interpersonal difficulties. Many had psychiatric illness, but for the remainder the stress might either have caused colonic pain directly or led to consultation for abdominal pains that had not previously presented to a gastroenterologist.
Impact of diagnosis-related groups' prospective payment on utilization of medical intensive care.
We examined the financial impact of diagnosis-related groups (DRGs) payment for Medicare patients receiving medical intensive care and looked for any change in the type of patients admitted to the medical intensive care unit (MICU) after one year's experience with DRGs. During 1984, payment for 267 Medicare patients receiving medical intensive care at a large, multispecialty referral hospital was calculated to be $2.6 million below cost, representing an average loss per discharge of $9,794. For those who died (42 percent), the average payment per case was $11,418 below the average per discharge cost. In 1985, 241 Medicare patients treated in the MICU showed an average loss per discharge of $14,113, which rose to $20,271 for those who expired (39.4 percent). There was no significant difference in mortality between the two groups and in type of patients per DRG assignment (p = 0.56 and p = 0.88, respectively) by Chi-squared test. Despite the 1984 DRG experience, there was no change in admission practices or utilization of MICU beds during 1985. Appropriate management responses are needed from both the Federal government and the medical profession for better utilization of MICU resources.
Hostility and deliberate self-poisoning: the role of depression.
The evidence for an association between hostility and deliberate self-poisoning is reviewed. Although the concept of hostility is poorly defined and different measuring instruments may not measure the same entity, self-poisoning subjects as a group appear to have very high levels of hostility. However, depression is also associated with hostility and when studies have taken into account the psychiatric diagnosis of overdose patients it is outwardly-directed hostility which distinguishes these individuals from other psychiatric patients or normals. A model is proposed to show the inter-relationships of hostility, depression and self-poisoning.
NE-19550: a novel, orally active anti-inflammatory analgesic.
NE-19550, N-(3-methoxy-4-hydroxybenzyl)oleamide, is a capsaicin analogue that has been shown to possess oral activity in the 55 degrees C rat hot-plate and mouse phenylquinone abdominal constriction analgesia tests. The compound also displayed anti-inflammatory activity orally in the carrageenan-inflamed rat-paw test and topically in the croton oil-inflamed mouse-ear test. NE-19550 activity in the thermal analgesia assay was not blocked by the opioid antagonist naloxone, and no inhibition of prostanoid synthesis in rat platelets or tissues was seen following a high analgesic and anti-inflammatory oral dose (300 mg/kg). A wide variety of known neuronal antagonists (adrenergic, serotonergic, dopaminergic, cholinergic, GABA-ergic, histaminergic) were found not to inhibit NE-19550 analgesia, further indicating a lack of involvement of known drug receptors mediating analgesic responses. Analgesic doses of NE-19550 were also found to lack the acute toxicity and thermoregulatory desensitization characteristics of the parent natural product capsaicin. It appears to represent a new class of potent-acting, non-narcotic, anti-inflammatory analgesic agents.