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Biomedical subjects

T B Mackenzie

Publications and source records attributed to T B Mackenzie.

At least 55 records · Page 3Linked to original sources
PubMed1982

Yield of psychiatric consultants' recommendations for diagnostic action.

The results of diagnostic measures proposed by psychiatric consultants were examined in a retrospective study of 793 medical records. Of 302 recommendations implemented by consultees, 137 yielded abnormal findings. Abnormalities were widely distributed among laboratory determinations, diagnostic procedures, and psychological tests. Highest yields were associated with EEGs, thyroid function studies, vitamin B12 and folate levels, and the Minnesota Multiphasic Personality Inventory. Two thirds of cases with one or more implemented recommendation were found to have an abnormal result. These findings suggest that consultees may curtail medical examinations of patients with psychiatric symptomatology. The outcomes demonstrate the merits of the diagnostic recommendations offered by psychiatric consultants and underscore the advantages conferred on patient and consultee by a consultant with a firm base on medical knowledge.

Electroencephalography↗
PubMed1982

Cardiac effects of lithium therapy in man: a review.

The literature concerning possible cardiotoxic effects of lithium therapy in man is reviewed. Reports indicate a high frequency of electrocardiographic T wave morphology changes with lithium therapy. Therapeutic and toxic levels of lithium have infrequently been associated with serious cardiac dysfunction. Of particular concern are cases of sinus mode dysfunction or sinoatrial block and the appearance or aggravation of ventricular irritability. The incidence of cardiac complications may increase with age. The necessity or cardiac screening and monitoring of patients receiving lithium is discussed.

Arrhythmias, Cardiac↗
PubMed1981

An interdisciplinary comparison of consultation outcomes. Psychiatry vs cardiology.

Responses to cardiologists' and psychiatrists' recommendations for drugs and diagnostic actions were compared in a retrospective study of 788 consultations. Variables significantly related to outcome achieved by cardiologists and psychiatrists were identified; similarities among these variables were evident only for the drug recommendations. Cardiologists' recommendations achieved a higher rate of concordance than psychiatrists' for both drugs and diagnostic actions. For drug recommendations, the interservice discrepancy in concordance was directly related to differences in timing of the consultations and incidence of recommendations to start a drug. For diagnostic recommendations, however, the difference was directly related to the consultants' service. The following factors may explain the less favorable outcome for psychiatrists' diagnostic recommendations: (1) the reasons for seeking psychiatric consultation, (2) the consultees' expectations, and (3) the skill of the psychiatrists in offering these recommendations.

Cardiology↗
PubMed1981

Effects of caffeine withdrawal on isoproterenol-stimulated cyclic adenosine monophosphate.

The effect of short-term caffeine withdrawal on lymphocyte beta-adrenoceptor sensitivity was studied in seven men who had been drinking coffee daily for at least 3 mo before the study. The ratio of cyclic adenosine monophosphate production after in vitro incubation with isoproterenol and a blank was used to assess receptor sensitivity. There was a reduction in sensitivity to isoproterenol but not to prostaglandin E1 3 days after caffeine withdrawal. The mechanism of this effect is not clear, but may represent a biochemical correlate of caffeine-withdrawal syndrome.

Adrenal Medulla↗
PubMed1981

Consultation-liaison outcome evaluation system, Part I. Teaching, applications.

Designed to assess clinical outcomes quantitatively, the Consultation-Liaison Outcome Evaluation System, Part I, includes methodologies to measure the frequency of and concordance with recommendations made by psychiatric consultants in three areas: recommendations for psychotropic medication, recommendations for diagnostic action, and representation of psychiatric diagnoses. Using these parameters, the performance of three psychiatric trainees was monitored for a 6-month period. The outcome obtained by the trainees were compared with normative rates achieved by a group of previous psychiatric consultants. The comparison provides a unique perspective on the trainees' progress with several teaching implications. First, it focuses clinical teaching on comprehensive and objective measures to trainee's performance, Second, it assists in curriculum design. Third, it emphasizes to trainees the necessity of altering one's clinical behavior based on results achieved. Finally, it suggest that clinical accountability can contribute to the teaching of clinical excellence.

Curriculum↗
PubMed1981

The effectiveness of cardiology consultation. Concordance with diagnostic and drug recommendations.

In an effort to characterize the effectiveness of cardiology consultation, the outcomes of consultants' recommendations for diagnostic actions and cardiac drugs were quantitatively examined in 394 cases. Drug recommendations were made more frequently (49 percent) than diagnostic recommendations (38 percent) and were associated with a higher rate of concordance (82 percent to 64 percent). Recommendations to start therapy with a drug, especially an antihypertensive or an antianginal, were associated with a lower concordance rate than recommendations to continue or discontinue drug therapy. Consultees' responses to recommendations for diagnostic action did not vary significantly according to the type of action suggested. Nonconcordance with diagnostic suggestions was particularly high when a service made a large number of consult requests. Concordance was increased if the consultant left a follow-up note. Consultees' responses to drug and diagnostic recommendations were independent of one another. The study represents the first systematic assessment of cardiology consultation activities and provides a methodology for subsequent studies.

Adult↗
PubMed1980

Consultees' concordance with consultants' psychotropic drug recommendations. Related variables.

In an attempt to identify variables critical to consultees' concordance with the recommendations of psychiatric consultants for the use of psychotropic medications in a general hospital, the medical records from 394 psychiatric consultations were reviewed. Using quantitative concordance criteria, consultee response was examined as a function of 29 variables. These characterized the patient, the consultee, the consultant, and the consultation. Seven variables were found to be significantly related to concordance. Among these were the patient's history of exposure to psychotropic medications, the presence of multiple recommendations, specification of starting dosage, the category of psychotropic drug recommendation, and the timing of the consultation. The latter two variables emerged as most noteworthy. This work extends the investigation of consultees' responses to consultants' recommendations and anticipates the development of specific consultation strategies derived from quantitative outcome studies.

Attitude of Health Personnel↗
PubMed1980

Consultees' concordance with consultants' recommendations for diagnostic action.

Consultees' concordance with psychiatric consultants' recommendations for diagnostic action was studied retrospectively. Of 381 initial consultations reviewd, 110 (29 per cent) contained one or more recommendations for diagnostic action. Consultees' responses were rated concordant in only 53 per cent of these cases. This disturbing outcome, reflecting broad resistance to consultants' practice of making recommendations for diagnostic action, is attributed to consultees' use of a functional vs. organic dichotomy regarding psychiatric disorder. The functional category is argued to be perceived by consultees as a nonmedical entity. As the psychiatrist is invoked to deal with this nonmedical entity, he is seen in other than the medical mode and inconsistently afforded medical privilege. The work implies how wide the gap to medical credibility may be for psychiatric consultants and the need for new consultation strategies incorporating this cognizance.

Adolescent↗
PubMed1980

The appearance of mania following intravenous calcium replacement.

The appearance of mania in a 35-year-old woman following the rapid intravenous correction of hypocalcemia is described. The importance of physiological fluctuations of serum calcium in affective modulation is stressed. Caution in speed of replacement of deficiency states is recommended.

Adult↗
PubMed1980

Consultees' representations of consultants' psychiatric diagnoses.

In an attempt to characterize consultees' representations of consultants' psychiatric dagnoses, the authors reviewd the medical records from 190 psychiatric consultations in a general hopsital. Using specific outcome criteria, they rated 50% of representations as concordant and 39% as nonconcordant. Five variable,s icluding the primary medical diagnosis at discharge and the referring service, were significantly related to concordance. Surprisinlgy, concordance was independent of the psychiatric diagnosis, indicating theat consultees did not respond differentially to varying magnitudes and implications of the different disorders. This work raises the question of possible strategies to improve receptivity to psychiatric diagnoses in the consultation setting.

Attitude of Health Personnel↗
PubMed1980

Stress response syndrome occurring after delirium.

Psychiatric treatment of delirium usually focuses on behavioral management during the period of cognitive disturbance. Psychological sequelae have received less attention. The authors suggest that delirium represents a stressful life event that must be assimilated after the cognitive impairment has resolved. Such assimilation may be uniquely impaired because the patient lacks clear and correct information about the event. The authors propose that the psychiatric care of delirium include facilitation of the patient's efforts to obtain and assimilate information about the delirium after its resolution.

Delirium↗
PubMed1980

Thyroid-induced mania in hypothyroid patients.

This retrospective study, based on 18 case reports, describes an organic affective syndrome, manic type, occurring shortly after the initiation of thyroid replacement in hypothyroid patients. The symptomatology and homogeneity of the syndrome offers insight into the relationship between thyroid activity and affective disturbance. The patients experiencing mania showed concurrent psychopathology at the time of replacement therapy, frequently had a past history of personal or familial psychiatric disorder and were given dosages in the high range of normal. The potential morbidity of the manic state was considerable. These findings suggest that a group of hypothyroid patients at risk can be identified. In such a group, lower initial dosages and gradual increases in dosage may be indicated.

Adult↗
PubMed1979

Physicians' concordance with consultants' recommendations for psychotropic medication.

Physicians' concordance with the recommendations of psychiatric consultants regarding the use of psychotropic medications in a general hospital was retrospectively examined in an outcome study. Using medical records in a series of 200 consecutive consultations, the authors found 68% of all psychotropic recommendations resulted in physician responses rated concordant and 24% nonconcordant. Resultant concordance ratings are presented according to category of recommendation (that is, start, adjust, continue, or discontinue) and drug groupings. The data suggest that drug group is not a critical variable in physician concordance. Responses did differ by category of recommendation. Further study of physician concordance is desirable. The work suggests both the potential of and need for outcome studies in consultation work.

Humans↗