Biomedical subjects
Publications and source records attributed to R Rogers.
Hepatitis continues to pose a serious risk to the health of staff and patients. A number of procedures can be put in place to protect the health and safety of nurses exposed to the risk. Nurses should be aware of systems and policies in their own work area.
PURPOSE: We determine which clinical characteristics correlate with a successful outcome following external beam radiation for the management of biopsy proved, locally recurrent prostate cancer after radical prostatectomy. MATERIALS AND METHODS: The clinical records of 34 patients who were treated at our institution with external beam radiation for biopsy proved local disease recurrence after radical prostatectomy were reviewed. Mean followup was 77.9 months after radical prostatectomy and 38.3 months after radiotherapy. Preoperative, postoperative and pathological characteristics were examined for the ability to predict failure following radiotherapy. RESULTS: Of the 34 patients 9 (26%) exhibited persistently low and stable serum prostate specific antigen (PSA) (less than 0.5 ng./ml.), while 7 (21%) had an undetectable serum PSA (less than 0.1 ng./ml.) during followup. These 16 patients were considered to be successfully treated by radiation and in the remaining 18 (53%) radiation was considered to have failed. The likelihood of successful treatment at 3 years after radiotherapy for all patients was 48%. Preoperative PSA, PSA at first elevation, postoperative PSA velocity and pathological stage were not significant predictors of a successful outcome following radiation treatment. Patients with a serum PSA of 4 ng./ml. or less before receiving radiotherapy and those with a prostatectomy specimen Gleason score of 7 or less were significantly more likely to be successfully treated by radiotherapy. CONCLUSIONS: Radiation therapy is a viable treatment option for select patients with biopsy proved local disease recurrence following radical prostatectomy. The chance of achieving and maintaining a persistently low and stable or undetectable serum PSA is likely in those patients with a prostatectomy specimen Gleason score of 7 or less and a pre-radiation PSA of 4.0 ng./ml. or less. More effective treatment regimens are needed for those patients in whom radical prostatectomy fails.
The present study investigated differences in anxiety symptoms and associated features between 129 first-time and multiple-time male inmates from a large urban jail. Participants were assessed on three separate anxiety measures: the Structured Clinical Interview of DSM-III-R Disorders (SCID) anxiety disorders module, the State Trait Anxiety Inventory, and anxiety scales of the Personality Assessment Inventory (PAI). First-time inmates were found to have more symptom severity for Generalized Anxiety Disorder, especially symptoms related to scanning and vigilance. Both first-time and multiple-time inmates evidenced higher state than trait anxiety, although this pattern did not hold for African Americans. Contrary to previous research, few ethnic differences were found in this incarcerated sample.
The safe and effective management of mentally disordered offenders is a paramount concern in decisions for community placement. Treatment effectiveness is often vitiated by medication noncompliance. In the current study, clinical and sociodemographic correlates of treatment compliance were examined in outpatients with schizophrenia. Level of medication compliance, assessed independently by treatment staff at two outpatient settings, resulted in 40 compliant, 38 noncompliant, and 12 partially compliant patients. Key symptoms associated with medication noncompliance were anger, delusions, and hallucinations. As an initial investigation, a stepwise discriminant analysis was moderately successful at predicting medication noncompliance. The implications of these findings to mentally disordered offenders are explored.
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Provision of mental health services to correctional populations places considerable demands on clinical staff to provide efficient and effective means to screen patients for severe mental disorders and other emergent conditions that necessitate immediate interventions. Among the highly problematic behaviors found in correctional settings are forms of acting out (e.g., suicide and aggression towards others) and response style (e.g., motivations to malinger). The current study examined the usefulness of the Personality Assessment Inventory (PAI) in assessing problematic behaviors in a corrections-based psychiatric hospital. As evidence of criterion related validity, selected PAI scales were compared to (a) evidence of malingering on the Structured Interview of Reported Symptoms (SIRS), (b) suicidal threats and gestures, and (c) ratings of aggression on the Overt Aggression Scale (OAS). In general, results supported the use of the PAI for the assessment of these problematic behaviors.
OBJECTIVE: Our goal was to evaluate whether active management of labor lowers cesarean section rates, shortens the length of labor, and overcomes any negative effects of epidural analgesia on nulliparous labor. STUDY DESIGN: We randomly assigned 405 low-risk term nulliparous patients to either an active management of labor (n = 200) or our usual care control protocol (n = 205). Patients who were undergoing active management of labor were diagnosed as being in labor on the basis of having painful palpable contractions accompanied by 80% cervical effacement, underwent early amniotomy, and were treated with high-dose oxytocin for failure to progress adequately in labor. RESULTS: The cesarean section rate in the active management of labor group was lower than that of controls but not significantly so (active management, 7.5%; controls, 11.7%; p = 0.36). The length of labor in the active management group was shortened by 1.7 hours (from 11.4 to 9.7 hours, p = 0.001). Fifty-five percent of patients received epidural analgesics; a reduction in length of labor persisted despite the use of epidural analgesics (active management 11.2 hours vs control 13.3 hours, p = 0.001). A significantly greater proportion of active management patients were delivered by 12 hours compared with controls (75% vs 58%, p = 0.01); this difference also persisted despite the use of epidural analgesics (66% vs 51%, p = 0.03). CONCLUSIONS: Patients undergoing active management had shortened labors and were more likely to be delivered within 12 hours, differences that persisted despite the use of epidural analgesics. There was a trend toward a reduced rate of cesarean section.
The authors examined the construct of psychopathy as applied to 103 female offenders, using the multitrait-multimethod matrix proposed by D. T. Campbell and D. W. Fiske (1959). Instruments used in the study included the following: (a) Antisocial Scale of the Personality Assessment Inventory (L. C. Morey, 1991); (b) Psychopathy Checklist--Revised (R. D. Hare, 1990); and (c) Antisocial scale of the Personality Disorder Examination (A. W. Loranger, 1988). Criterion-related validity was also evaluated to determine the relationship between psychopathy and staff ratings of aggressive and disruptive behavior within the institution. Results revealed significant convergence and divergence across the instruments supporting the construct of psychopathy in a female offender sample. The measures of psychopathy demonstrated moderate convergence with staff ratings of violence, verbal aggression, manipulativeness, lack of remorse, and noncompliance. It is interesting to note that an exploratory factor analysis of the PCL-R identified a substantially different factor structure for women than has been previously found for male psychopathy.
Increasingly, investigations evaluating the effectiveness of the MMPI-2 in the assessment of malingering employ methodologies whereby research participants are asked to feigned specific disorders rather than just to "fake bad." Yet there is little research addressing the issue of whether different validity scales and indicators work differently in the detection of different feigned disorders. In this study the comparative effectiveness of a number of validity scales and indicators on the MMPI-2 to assess feigned depression and feigned schizophrenia were evaluated. Overall, the validity scales and indicators were better at detecting feigned schizophrenia than they were in detecting feigned depression, attributable, most likely, to closer familiarity with depressive experiences. The validity scales F, Fb, and F(p) best distinguish patients with schizophrenia from participants feigning schizophrenia, and F and Fb best distinguish patients with depression from participants feigning depression.
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Psychopathy is an important clinical construct in the evaluation and treatment of adolescent offenders. In this study, predictors of adolescent psychopathy are explored in 81 adolescents from a residential treatment program for dually diagnosed offenders. The number of aggressive conduct disorder symptoms and total rate (number x frequency of symptoms) of deceit/theft symptoms are predictive of adolescent psychopathy. Although age of onset for conduct disorder symptoms is associated with psychopathy, its interpretation appears to be confounded by gender and ethnicity correlates. Unexpectedly, adolescent psychopathy was only modestly associated with institutional infractions. Past research and current findings are summarized with reference to their forensic implications.
Solvent-tolerant and -sensitive Pseudomonas putida strains were studied to determine their cell envelope changes following exposure to o-xylene. Both strains produced trans-unsaturated fatty acids. The tolerant strain showed an increase in total fatty acids, an increase in saturated fatty acids, and modified lipopolysaccharide. It is suggested that these envelope modifications aid in survival at high concentrations of organic solvents.
Clinical decision rules for the assessment of feigning and related response styles have not been systematically investigated in adolescent populations. For instance, evaluations of feigning on the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) involve cutting scores extrapolated from adult studies with the MMPI/MMPI-2. Such extrapolations are unwarranted because (a) adolescents perform differently than adults on MMPI/MMPI-2 validity scales and (b) the MMPI-A validity and clinical scales are substantively different than the MMPI/MMPI-2. Given the dearth of adolescent data, this study examined the clinical usefulness of three measures in the assessment of feigning: MMPI-A, Structured Interview of Reported Symptoms (SIRS), and Screening Index of Malingered Symptoms (SIMS). Employing a within-subjects analogue study on 53 dually diagnosed adolescent offenders, we found that commonly used MMPI-A scales (F, F1, and F2) were ineffective, but that F-K > 20 appeared promising. For the SIRS, classification of feigning based on adult criteria yielded moderate positive predictive poser and superb negative predictive power. As a screen, the SIMS proved to be moderately effective in identifying feigned protocols. Finally, two-stage discriminant analysis offered initial support of the incremental validity of a combined SIRS and MMPI-A evaluation of adolescent feigning.
Psychological assessment with multiscale inventories is largely dependent on the honesty and forthrightness of those persons evaluated. We investigated the effectiveness of the Personality Assessment Inventory (PAI) in detecting participants feigning three specific disorders: schizophrenia, major depression, and generalized anxiety disorder. With a simulation design, we tested the PAI validity scales on 166 naive (undergraduates with minimal preparation) and 80 sophisticated (doctoral psychology students with 1 week preparation) participants. We compared their results to persons with the designated disorders: schizophrenia (n = 45), major depression (n = 136), and generalized anxiety disorder (n = 40). Although moderately effective with naive simulators, the validity scales evidenced only modest positive predictive power with their sophisticated counterparts. Therefore, we performed a two-stage discriminant analysis that yielded a moderately high hit rate (> 80%) that was maintained in the cross-validation sample, irrespective of the feigned disorder or the sophistication of the simulators.
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