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Biomedical subjects

R Ram

Publications and source records attributed to R Ram.

15 recordsLinked to original sources
PubMed1994

Eliciting psychotic symptoms using a semi-structured diagnostic interview. The importance of collateral sources of information in a first-admission sample.

This study addressed the importance of medical record information in determining the presence of psychotic symptoms in first-admission patients. A sample of 232 first-admission inpatients screened for psychotic symptoms by facility personnel was administered the Structured Clinical Interview for DSM-III-R (SCID) followed by a medical record review and interview with a significant other. Medical records were unavailable for sixteen patients. These patients were more often female, married, and more suspicious than patients whose records were reviewed. Of those having interviews and record reviews, 49 showed no clear evidence of psychosis. The remainder were divided into three groups: 97 subjects who revealed all of their psychotic symptoms during the interview (SCID-ALL); 61 who revealed only some of their delusions or hallucinations during the interview (SCID-PART); and 25 who revealed none of this information during the interview but whose records clearly described psychosis (SCID-NONE). The three groups were reasonably similar demographically and with respect to clinical history. Clinically, at the time of interview, SCID-NONE subjects were less often still psychotic, were rated on the Brief Psychiatric Rating Scale as less depressed, more withdrawn, less cooperative and less severely ill, and had poorer insight ratings on the Hamilton Depression Scale.

Adult↗
PubMed1994

Six-month stability of psychiatric diagnoses in first-admission patients with psychosis.

OBJECTIVE: The short-term diagnostic stability of schizophrenic and other psychotic disorders was examined in first-admission patients, with attention to the principal reasons for diagnostic change. METHOD: Hospitalized first-admission patients (N = 278) participating in an epidemiologic study were interviewed at baseline and after 6 months with the Structured Clinical Interview for DSM-III-R. A best estimate diagnosis was made at both time points with the use of all available sources of information. Reasons for changes in diagnosis were determined by two psychiatrists. RESULTS: Affective psychosis and schizophrenic disorders were relatively stable broad diagnostic categories over the 6-month period, with 86.5%-88.9% of the patients remaining in the same category, although findings for specific diagnoses within these categories ranged from 61.5% to 85.7%. The groups with unknown and nonspecific diagnoses showed less stability; the diagnoses of more than one-third of these patients remained unknown or nonspecific at the 6-month evaluation. If the 6-month diagnoses are used as the research standard, somewhat lower percentages of patients received the same diagnoses at baseline. Forty-three percent of the changes in diagnosis were attributed to the clinical course of illness; the rest were attributed to the diagnostic process itself. CONCLUSIONS: A longitudinal diagnostic assessment based on multiple sources of information is crucial for categorizing first-admission psychotic patients, particularly those who do not initially fit into a DSM-III-R category. The short-term stability of a diagnosis is a function of multiple factors, including the changing clinical picture, additional sources of information, and new interpretations of original data.

Adolescent↗
PubMed1993

Transient gene expression of foreign genes in preheated protoplasts: stimulation of expression of transfected genes lacking heat shock elements.

Transfection of preheated petunia protoplasts with several biologically active DNA constructs resulted in a significantly higher gene expression than that observed in transfected unheated protoplasts. It was observed with supercoiled, linearized and single-stranded DNA structures that stimulation of transient gene expression in preheated protoplasts was neither dependent on the reporter gene nor on the regulatory elements used. Heat treatment at 42 degrees C also increased expression in protoplasts transfected with a plasmid bearing the tobacco mosaic virus (TMV) translational enhancer, omega. Northern blot analysis revealed that heat treatment of protoplasts before the transfection event greatly increased the amount of the newly synthesized transcripts. Preheating of protoplasts did not affect the transfection efficiency, namely the number of transfected cells in the population, nor the amount of DNA in transfected nuclei, as was inferred from histochemical staining and Southern blot analysis, respectively. The possible mechanism by which heat treatment stimulates transient gene expression of genes lacking obvious heat shock elements is offered. The relevance of the present findings to transient gene expression in plants in general and to viral gene expression in particular is discussed.

Cell Division↗
PubMed1993

Development of a portable information system: connecting palmtop computers with medical records systems and clinical reference resources.

The portability of palmtop computers makes them an ideal platform to maintain communication between busy physicians and medical information systems. In our academic FHC (Family Health Center) we have developed software that runs on a palmtop computer allowing access to information in the HIS (Hospital Information System) and our FHC's AAMRS (Automated Ambulatory Medical Record System). The resident physicians who staff the hospital and the FHC are frequently at home or otherwise off-site where terminal access is not available. Using a Hewlett-Packard 95LX palmtop computer as the base platform, custom software has been developed to access summary data on in-patients and out-patients. Data is downloaded into a database on a palmtop computer memory card. ASCII data from Medical Information Systems (MIS), is transformed into a database format readable on the palmtop. Our hospital MIS department transmits information daily on our in-patient service (20-30 patients). We also download, weekly, a patient summary on all of our active out-patients in our MUMPS-based AAMRS (2500-3000 patients). Each morning the resident in the Family Practice program updates his palmtop memory card at a central workstation. Palmtop computers with downloaded databases, can be valuable in care of patients when the physical or on-line chart is not easily accessible. They are particularly useful in multi-physician groups when the on-call physician provides care for the patients of other physicians. We have made the palmtop computer even more valuable to physicians by providing an integrated software package.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗
PubMed1992

Schizophrenia and rheumatoid arthritis: a review.

Fourteen epidemiologic studies of the relationship of rheumatoid arthritis to schizophrenia have been conducted between 1934 and 1985. Twelve of the studies report a lower-than-expected rate of rheumatoid arthritis in populations of schizophrenics. Methodologic weaknesses in the studies are assessed. Nutritional, hormonal, psychosocial, genetic, and immunologic data and theories are briefly reviewed which might explain the epidemiologic results. There is sufficient evidence for the negative association between the two disorders to justify further research.

Arthritis, Rheumatoid↗
PubMed1992

The natural course of schizophrenia: a review of first-admission studies.

In this article, research on the natural course of illness among first-admission schizophrenic patients is reviewed from an epidemiological perspective. Three types of studies are considered: statistical reports dating primarily from the preneuroleptic era; long-term followback studies; and more recent prospectively designed cohort studies. Although relatively more first-admission patients have a positive course than do multiple admissions patients, the findings confirm the substantial heterogeneity in course and outcome. Methodological improvements in first-admission research are suggested, including separating the analyses of first-episode patients from those with past psychotic experiences; employing longitudinal methods for deriving diagnosis; including patients with drug and alcohol problems where appropriate; enlarging the samples either by multisite or multicenter collaborations or by pooling data across studies; and obtaining better data on treatment experiences in naturalistic research.

Female↗
PubMed1992

The epidemiology of psychosis: the Suffolk County Mental Health Project.

This article describes the rationale, aims, and methodology of an epidemiological study of psychosis being conducted in Suffolk County, New York. A sample of first-admission patients is drawn from 10 inpatient and 25 outpatient facilities. Diagnostic psychosocial interviews are conducted shortly after admission to treatment, and at 6- and 24-month followup. Consensus diagnoses are made after each interview. Demographic and clinical background characteristics of the first 250 subjects enrolled over a 2-year period are presented here. The response rate was 76 percent. Based on the initial interview, 75 percent of subjects received a diagnosis involving psychosis. The three most common diagnoses were schizophrenia, bipolar disorder with psychotic features, and major depression with psychotic features. Among subjects with psychosis, 58 percent of males and 29 percent of females had a history of substance abuse/dependence. Gender differences were found on several background and clinical characteristics. Males were somewhat younger, less likely to have ever married, and had less education. Although the median length of hospitalization was the same for females and males (27 days), females were more likely to be hospitalized within 1 month of the occurrence of their first psychotic symptom (60% of females compared to 37% of males). Subjects with schizophrenia-related disorders were significantly more impaired on an assessment of negative symptoms than were affectively ill subjects, but clinical ratings of depression were not significantly different across diagnostic groups.

Adolescent↗
PubMed1992

Status of lymphatic filariasis in some select slum clusters of Delhi.

Filaria surveys conducted in some select slum clusters namely Hari Nagar, Yamuna pusht near Vijaya Ghat along the Ring Road and Timarpur in Delhi during 1989, 1991 and 1992 respectively, covering a population of approximately 5000 slum dwellers revealed the presence of bancroftian microfilaria (mf) carriers and disease cases. The mf and disease rates (per cent) in these three slum areas were in the order of 6.3, 2.2, 3.7 and 1.4, 0.5 and 0.1 respectively. The mf density varied from 3.1 to 12.3 per 20 cumm. blood. High ten man hour densities of Culex quinquefasciatus (581) in Yamuna pusht followed by (355) in Timarpur were recorded during entomological investigations. Hari Nagar accounted for least ten man hour density of Cx. quinquefasciatus (160), because collection was made during winter months (November-December). The dissection of Cx. quinquefasciatus did not reveal any human filarial infection except in Yamuna pusht where out of 139 only one Cx. quinquefasciatus was found infective.

Animals↗
PubMed1992

Signing out patients for off-hours coverage: comparison of manual and computer-aided methods.

UNLABELLED: This paper evaluates the communication of information to physicians who provide off-hours coverage to inpatients in two Family Practice residency programs. METHOD: To describe the importance and accessibility of clinical information used by on-call residents in covering hospital patients, we administered a questionnaire. Then following the use of a new computerized sign-out system in one of the programs, residents filled out the same questionnaire again. RESULTS: Residents felt that a "to do" list and information about the patient's "code status" were the most important data desired from sign-out sheets. However, 69% of residents in both programs felt that provision of this information was normally poor. Nearly all of the residents in Buffalo, using an entirely handwritten sign-out sheet, felt it was in need of improvement. Residents in Pittsburgh, using a summary aided by the hospital's computer print-out, felt this need much less acutely. After implementation of a new computerized sign-out sheet in Buffalo, residents indicated a slightly higher level of satisfaction. The work of data entry and re-entry into the computer was unpopular and inefficient. CONCLUSION: The present method of transferring information at the end of a work day is not satisfactory for residents. Provision of data summaries from existing hospital information systems is a good first step in improving data transfer. A further study of more comprehensive automated sign-out systems is important, because of the increasing discontinuity of house officer care.

Attitude to Computers↗
PubMed1991

No genetic linkage detected for schizophrenia to Xq27-q28.

The hypothesis that at least a subgroup of familial cases of schizophrenia could be due to a genetic defect on the X chromosome is supported by the observation of an excess of X-chromosome aneuploidies (XXX and XXY) among populations of patients with psychosis. The distal long arm, Xq27-q28, is a candidate region where linkage has been claimed to manic-depressive disorder and a fragile site has been associated with schizophrenia spectrum disorders. The present study excluded linkage to a large part of this region using four polymorphic probes and multipoint lod-score analysis in 10 families with multiple members with schizophrenia.

Chromosome Banding↗
PubMed1982

Randomized comparative trial of a ward discussion group.

A randomized controlled study of 38 catchment unit psychiatric in-patients in a discussion group showed no significant additional benefit compared with 36 in-patients in an activity group. Symptom change scored by three rating groups agreed closely, average r = +0.64. Patients treated with ECT showed 2.6 times as much reduction in morbidity as those not so treated, but there was still no appreciable difference between discussion and activity groups when this was allowed for. Other treatment factors and the Hawthorne effect appeared to obscure any effect due to group therapy.

Adult↗