Biomedical subjects
Richard Abrams
Publications and source records attributed to Richard Abrams.
Postictal Delirium (and Recovery From Melancholia) After Left-Unilateral ECT.
Postictal delirium was observed after left-unilateral ECT in a fully dextral man whose melancholia entirely remitted with seven treatments. These findings suggest that it is premature to attribute either the syndrome of postictal delirium or the beneficial effects of ECT in melancholia primarily to right hemisphere mechanisms.
An Auditory Representation of ECT-Induced Seizures.
Seizure monitoring using an auditory representation of the electroencephalogram (EEG) was tested in 82 consecutive electroconvulsive treatments (ECTs). It was found to have high interrater and intrarater reliability and high validity against the paper EEG standard.
A Hypothesis to Explain Divergent Findings Among Studies Comparing the Efficacy of Unilateral and Bilateral ECT in Depression.
This article explains divergent reports on the relative efficacy of unilateral and bilateral electroconvulsive therapy (ECT) by hypothesizing a therapeutic effect of both seizure and electrical stimulus, with the seizure's effect based on its intensity and generalization. The effect of the stimulus is normally obscured by the seizure but emerges with reduced electrical dosage or elevated threshold. These circumstances favor a therapeutic advantage for bilateral ECT, which introduces more electrical charge into a larger and differently distributed volume of brain and induces greater seizure generalization, more diencephalic stimulation, and a relative decrease in left relative to right hemisphere electroencephalographic (EEG) frequencies.
A Prospective Follow-Up Study of Cognitive Functions After Electroconvulsive Therapy.
The authors studied primarily nonmemory cognitive functioning in a sample of 13 melancholic patients tested prior to electroconvulsive therapy (ECT) and at various intervals during a 1-2 year post-ECT follow-up period. Compared with 13 age-matched normal controls, the patients performed significantly worse at baseline and immediately after the sixth ECT, but were not significantly different at the 30-day, 6-month, and 1-2 year assessments. At 1-2 years post-ECT, cognitive impairment among patients was substantially and significantly less than observed pre-ECT.
Electroconvulsive Therapy and Prolactin Release: Relation to Treatment Response in Melancholia.
Serum prolactin levels 15 min after each of four consecutive electroconvulsive treatments (ECTs) in 16 male melancholics fell from the first to the fourth treatment. A larger mean prolactin response to ECT correlated with a slower treatment response, as measured by global outcome ratings after six ECTs and the total number of ECTs administered, both blind to prolactin levels. These findings were independent of baseline prolactin levels or treatment electrode placement; they are consistent with the hypothesis that ECT increases postsynaptic dopamine receptor sensitivity. Although intriguing, they await confirmation in a larger sample.
Electroconvulsive Therapy and Prolactin Release: Effects of Stimulus Parameters.
We report a study of electroconvulsive therapy (ECT) induced prolactin release in nine patients as a function of treatment electrode placement, stimulus energy, and seizure length. Only electrode placement differentially affected prolactin release, with bilateral ECT yielding larger increments over baseline than unilateral ECT.
Out of the blue: the rehabilitation of electroconvulsive therapy.
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Organizational and cultural changes for providing safe patient care.
OBJECTIVE: To describe an approach and experience with fostering a culture of patient safety. METHODS: (1) Organizational Change-The Department of Medicine established a patient safety committee (PSC) and charged it with reviewing adverse events. (2) Cultural Change-PSC sponsors and participants work to promote a culture of collaboration, study, learning, and prevention versus a culture of blame. (3) Collaboration-The PSC includes chief residents and members from medical informatics, nursing, pharmacy, quality assurance, risk management, and utilization management. (4) Evolution-The duties of the PSC progressed from merely learning from adverse event reports to implementing patient safety and quality improvement projects. (5) Standardization-The PSC uses standard definitions and procedures when reviewing cases of adverse events, and when conducting patient safety and quality improvement projects. RESULTS: (1) Developed an online adverse event reporting system, shortening the average report collection time by 2 days and increasing the number of adverse events reported. (2) Established a model for change using (a) safety rounds with residents, (b) e-mail safety alerts, and, in some cases, (c) decision alerts using electronic order entry. These changes in culture and capability led to improvements in care and improved financial results. CONCLUSIONS: Senior management support of a culture of learning and prevention and an organizational structure that promotes collaboration has provided an environment in which patient safety initiatives can flourish by providing not only safer and higher quality patient care but also a positive financial return on investment.
Determining medical error. Three case reports.
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