Biomedical subjects
R Rogers
Publications and source records attributed to R Rogers.
Laparoscopic Surgery: A View From the Head of the Table.
Impressive advances in laparoscopic surgical technique have taken place, especially since the late 1980s. These developments have motivated patients as well as surgeons, institutions, and payers; accordingly, the variety and frequency of these procedures have vastly increased. In the rush to expand the frontiers of laparoscopic surgery, we must not lose sight of the potential pitfalls resulting either from the physiological effects of the procedure itself or from the influence of underlying disease processes.
An overview of the information management and technology strategy for the National Health Service in the UK.
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Reliability of subjective estimates of exercise capacity after total repair of tetralogy of Fallot.
Sixty-nine patients (age 10 +/- 3.5 years, median 9.7 years) operated on for tetralogy of Fallot, underwent exercise testing 5.1 +/- 2.5 years after total correction. Aerobic capacity was assessed by the ventilatory threshold method. After the exercise test, parents completed a validated standardized questionnaire to evaluate the habitual level of physical activity of their child. They were then asked to place their child into one of three groups, describing their child's activity level, compared to normals (below average, average and above average). In the average and above-average groups, 73% and 65% of the patients were misclassified when compared to objective exercise testing. However, in the below-average group, no misclassifications were found. Subjective estimates of activity level, and consequently exercise tolerance, were poorly associated with objective measurements of exercise performance in these patient groups. Our results question the reliability of self-reported estimates of physical activity level and consequently exercise capacity in children after surgical correction of tetralogy of Fallot.
Genital examination under ketamine sedation in cases of suspected sexual abuse.
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Malingered and Defensive Response Styles on the MMPI-2: An Examination of Validity Scales
The MMPI and more recently the MMPI-2 have been held to be the clinical standard for assessing both fake-good and fake-bad response styles. In a contrasted-groups design, we compared simulators under fake-good (n = 67) and fake-bad (n = 58) instructions to controls (n = 90) and psychiatric patients (n = 95) under standard instructions. For fake-good profiles, we found that F-K < -12 had a hit rate of 80.6% and was partly supported by earlier research (Austin, 1992). For fake-bad profiles, F > 89 and F-K > 7 were the optimum cutting scores with hit rates of 86.2% and 87.0%, respectively. Unfortunately, previous research fails to confirm these cutting scores and leading proponents of the MMPI-2 substantially disagree on what methods to employ. Therefore, we recommend in cases of suspected malingering that the MMPI-2 be used only for screening purposes.
Detecting malingered and defensive responding on the MMPI-2 in a forensic inpatient sample.
The purpose of this study was to examine the effectiveness of the various validity scales and indices on the MMPI-2 to detect malingered (fake-bad), and defensive (fake-good) responding. The entire sample consisted of 165 college students who completed the MMPI-2 under one of three conditions--fake-bad, fake-good, or respond honestly--and 173 forensic inpatients who completed the test as part of a routine evaluation. To detect faking-good and faking-bad, cutting scores for the validity scales and indices were established from the fake-good and fake-bad groups and were compared to the honest and patient groups. Corresponding sensitivity and specificity rates were then determined. Four validity indicators appeared to be moderately effective-at detecting fake-bad profiles: F, F--K, the MMPI-2 version of revised Gough Dissimulation Scale, and Wiener's Obvious-Subtle index, whereas the fake-good indicators were much less effective--only F--K and the Obvious-Subtle index appeared to have moderate utility.
HIV and AIDS: when care is for the whole family.
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Make them fight for a place at the table: how to take on the insurance industry. Interview by David Dyssegaard Kallick.
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Classification of death in patients under antiarrhythmic treatment.
In the evaluation of antiarrhythmic treatment, total mortality and total cardiac mortality are the only endpoints difficult to misclassify. End-stage cardiac failure competes with "suddenness" in many instances of sudden arrhythmic death. This observational study reports on 23 deaths in a group of 129 patients under antiarrhythmic treatment. In the 21 cases of cardiac death, with respect to the notion "sudden arrhythmic death," classification was problematic in 6 patients. According to different interpretations, the number of deaths listed as "sudden" could vary between one and six. A concise description of cause and circumstances of death, is presented.
Coordination of Cl- secretion and contraction by a histamine H2-receptor agonist in guinea pig distal colon.
Short-circuit current (Isc) was measured simultaneously with muscle tension recorded in the longitudinal or circumferential axis from strain-gauge transducers sutured to the serosal surface of whole thickness segments of distal colon from guinea pigs. Isc and the amplitude and frequency of small-amplitude phasic contractions were stable for several hours. The histamine H2-receptor agonist dimaprit (5-10 microM) evoked recurrent increases in Isc at a frequency of 0.32-0.37 cycles/min. Associated with each cyclical Isc response was an increase in muscle tension indicative of large-amplitude phasic contractions. Recurrent cycles of Isc and associated large-amplitude phasic contractions were abolished by 10 microM cimetidine. In the presence of dimaprit, severing the neural connections between the myenteric and submucosal plexuses abolished the large-amplitude phasic contractions but not cyclical Isc. The results suggest that coordination of cyclical secretion and large-amplitude contraction during chronic activation of histamine H2 receptors requires intact neural connections between the submucosal and myenteric plexuses. The findings provide potential mechanisms to explain altered motility and ion transport during inflammatory diseases or allergic responses to food antigens.
Feigning schizophrenic disorders on the MMPI-2: detection of coached simulators.
The Minnesota Multiphasic Personality Inventory (MMPI) and, more recently, its revised version (the MMPI-2) have represented the "gold standard" in the psychometric assessment of malingering and other response styles. In this study, we provide a stringent test of the MMPI-2 validity indices and their ability to detect feigned schizophrenia in four groups of simulators (n = 72). Simulators were randomly assigned to one of four conditions: (a) coached on symptoms of schizophrenia, (b) coached on strategies for the detection of fakers, (c) coached on both symptoms and strategies, or (d) uncoached. Simulators were compared to subjects responding under an honest condition (n = 13) and a comparison group of schizophrenic inpatients (n = 37). We found knowledge of strategies alone allowed many simulators (i.e., one third or more, depending on the validity indices) to elude detection. In contrast, knowledge of the disorder appeared less useful to simulators in avoiding detection. Coaching on both strategies and symptoms was not as effective as strategies alone. Consistent with previous studies, uncoached simulators were detected with moderately high levels of accuracy.
Feigning specific disorders: a study of the Personality Assessment Inventory (PAI).
The Personality Assessment Inventory (PAI; Morey, 1991) represents an important development in the assessment of psychopathology. We examined the usefulness of the Negative Impression (NIM) scale to detect naive (undergraduates with minimal preparation) and sophisticated (psychology graduate students with 1 week preparation) subjects simulating specific disorders. We found that the NIM cutting score (> 8) was highly effective with feigned schizophrenia, marginally effective with feigned depression, and ineffective with feigned generalized anxiety disorder. Sophistication did not appear to be relevant to successful feigning, although it did allow graduate students to achieve higher clinical elevations in simulating depression.
Faking specific disorders: a study of the Structured Interview of Reported Symptoms (SIRS).
An untested assumption of malingering research is that persons who feign mental illness will not attempt to fake a particular disorder, but will be content to fabricate non-specific and possibly global psychiatric impairment. We tested the effectiveness of the Structured Interview of Reported Symptoms (SIRS) to detect feigning of three diagnostic groupings: schizophrenia, mood disorders, and PTSD on 45 psychologically knowledgeable correctional residents. We found that the SIRS maintained its powers of discrimination with respect to clinical samples. Similar research on faking specific disorders is needed on the MMPI-2 and other psychological measures.
Diversion of mentally disordered offenders: a legitimate role for clinicians?
Consultations to the courts often extend beyond criminal competencies and may include implicit statements regarding the diversion of mentally disordered offenders to treatment facilities. Arguments for diversion are based on humanitarian interests and treatment needs. Arguments opposing diversion recommendations emphasize (a) the variability of opinions regarding treatability, (b) the lack of sufficient outcome data, and (c) the potential for negative consequences in offering unsolicited opinions on diversion. Initial data from 271 pretrial evaluations underscore the range in psychiatric use of diversion recommendations, although inpatient referrals in particular appear to be based on clinical status.
Psychiatrists and the parameters of expert testimony.
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The measurement of insanity: debating the merits of the R-CRAS and its alternatives.
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