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Biomedical subjects

T J Craig

Publications and source records attributed to T J Craig.

At least 73 records · Page 4Linked to original sources
PubMed1993

An audit of hypertensive care in general practice.

This mainly urban based study of hypertensive care in general practice consisted of 5,400 patients of these 287 individuals were diagnosed as being hypertensive, a practice prevalence of 5.31%. Among those between 30-80 years (2456 patients) there were 265 hypertensives, a prevalence of 10.8%. The overall male: female ration was 1:1.8. Hospitals were involved in the management of 53.9% of the hypertensives. The use of WHO criteria to make the diagnosis had increased from 38.6% to 59% over the past five years. The completence of history taking and relevant investigations was suboptimal, 78.9% of the hypertensives had their BP checked in the previous year. Management of hypertension is similar to other practices who have performed audits. There is room for improving standards in all clinical activities relating to hypertension.

Adult↗
PubMed1992

Bird antigen persistence in the home environment after removal of the bird.

Hypersensitivity pneumonitis (HP) secondary to bird exposure is treated with glucocorticosteroids and avoidance. Despite therapy, symptoms may persist for a prolonged time. Just as cat antigen, Fel d 1, may persist for greater than 20 weeks after cat removal, there may be persistent bird antigen to explain prolonged symptoms in bird HP. It was the intent of this study to determine household distribution and persistence of bird antigen after removal of the bird from the patient's home. The homes of patients with birds were followed serially after bird removal with multiple samples collected using a hand-held vacuum cleaner. Bird antigen levels were determined by an inhibition enzyme-linked immunoassay. In five homes the antigen declined gradually despite extensive environmental control measures, with high levels still detectable at 18 months in one home. This data suggests that high levels of bird antigen can be detected for prolonged periods of time after bird removal and environmental cleanup. The antigen may account for the persistence of disease in some patients with HP. In severe HP, the preferred therapy may be temporary relocation of the patient away from the room in which the bird was housed, in addition to corticosteroids, until the patient's environment is demonstrated to be relatively bird antigen-free.

Air Pollution↗
PubMed1991

Tracheobronchitis due to Corynebacterium pseudodiphtheriticum.

We have presented a case of tracheobronchitis due to C pseudodiphtheriticum in a patient with COPD who was treated with prednisone and apparently was not otherwise immunocompromised. Chronic lung disease seems to predispose to infection with C pseudodiphtheriticum; it can also occur in the immunocompetent host. This organism, when isolated in pure culture, should not be dismissed as a contaminant, but must be considered a possible etiologic agent. Sensitivity of diphtheroids to antibiotics is extremely variable. We believe vancomycin should be used in respiratory tract infections caused by diphtheroids, including C pseudodiphtheriticum, until the results of in vitro antibiotic susceptibility tests are available.

Anti-Bacterial Agents↗
PubMed1991

Planning for community care: the Community Placement Questionnaire.

The article reviews methodological issues relating to planning surveys of long-stay populations and describes the development of an assessment instrument, the Community Placement Questionnaire, designed to aid planning for long-stay patients resident in hospitals scheduled for rundown or closure. Reliability and validity data are presented and the advantages and limitations of the instrument are discussed.

Adult↗
PubMed1991

Neuroleptic use, parkinsonian symptoms, tardive dyskinesia, and associated factors in child and adolescent psychiatric patients.

OBJECTIVE: The authors' goal was to determine the prevalence of and risk factors for neuroleptic-induced movement disorders in a group of psychiatrically hospitalized children and adolescents. METHOD: They evaluated the presence or absence of parkinsonism, tardive dyskinesia, and akathisia in 104 children and adolescents who were in residence in or admitted over a 6-month period to a state-operated child psychiatric center. They applied a standardized, structured assessment procedure used in research on adult and geriatric psychiatric patients and the mentally retarded. RESULTS: The prevalence of parkinsonism among the 61 subjects at risk was 34% and was significantly associated with longer neuroleptic treatment periods immediately before evaluation. The prevalence of treatment-emergent tardive dyskinesia among the 41 subjects at risk was 12% and showed no association with quantitative neuroleptic treatment variables. However, patients with tardive dyskinesia were significantly more likely to have a family history of mental illness and significantly less likely to have a history of assaultive behavior. A pattern of complex pharmacological responses for parkinsonism and tardive dyskinesia, some of which are not typical of those most commonly reported in adults, was seen in this group of young patients. CONCLUSIONS: The study data highlight the acute sensitivity of the neuroleptic-treated child and adolescent to the development of parkinsonism, the possible role of certain patient characteristics in the vulnerability to develop tardive dyskinesia, and the possibility that neuroleptic-induced side effects experienced by children and adolescents differ in some ways from those experienced by adults. The data further strongly support the need for systematic monitoring of neuroleptic-treated child and adolescent patients for a full range of side effects.

Adolescent↗
PubMed1991

New York under the Rivers decision: an epidemiologic study of drug treatment refusal.

OBJECTIVE: To determine the characteristics of cases of drug treatment refusal under the Rivers decision, which mandated court adjudication of such cases, the authors made a retrospective study of all applications for court review during 1 year in New York State inpatient facilities. METHOD: Sociodemographic and clinical characteristics of these 473 cases were compared with those of the 41,535 cases during the same period in which no court review was requested. RESULTS: A 1% prevalence of applications requesting court review for nonemergency administration of medication over objection was found. The patients who refused medication were more likely than the comparison patients to have a crime-associated commitment status, a diagnosis of schizophrenia, and fewer previous hospital days, and they were more likely to be discharged. Medication refusers for whom applications for court review were submitted had relatively longer hospitalizations than the rest of the patients. Almost one-third of the applications submitted were withdrawn before court hearings, yielding a 0.7% prevalence of court-reviewed applications. Ninety-two percent of these applications for medication over objection were approved with virtually no change in the requested orders. CONCLUSIONS: The study findings demonstrate that a front-end judicial determination of competency to refuse medication results in a time-consuming procedure which fails to ensure real due process or provide individualized alternative treatment. A two-tier system with in-house clinical review preceding judicial review is proposed to remedy the deficiencies of the current system.

Commitment of Persons with Psychiatric Disorders↗
PubMed1988

Late onset schizophrenia-like illness.

A chart review of 658 psychiatric inpatients aged 65 years or older with a clinical diagnosis of schizophrenia revealed 32 patients (4.8%) with onset of symptoms after aged 45 who met DSM-III criteria for schizophrenia (except age of onset). Clinical course and response to treatment revealed only 25% to follow an unequivocally schizophrenic pattern. Almost 20% demonstrated substantial affective symptomatology, whereas 15.6% had a brief psychotic episode with full remission, and 40.6% showed signs of organic deterioration. These results suggest that diverse underlying pathologic processes may present initially as late onset schizophreniform illness. The presence of depressive symptoms and assaultive behavior on admission predicted good treatment response while sensory deficits and development of signs of organicity were associated with poor treatment response.

Age Factors↗
PubMed1988

Pharmacoepidemiologic methods for identifying and quantifying behavioral effects of neuropharmacological agents.

The possibilities and limitations of the pharmacoepidemiologic methods of determining neuropharmacologic drug efficacy and safety in psychiatric patients are discussed in this review. Such methods can improve both the scientific evaluation and clinical practice aspects of our knowledge of these drugs by providing: (1) incidence rates of drug usage and adverse events from computerized information on large populations; (2) quantitative methods for risk-to-benefit assessments that incorporate multiple outcome measures, provide long-term effectiveness and safety data, and use statistical methods to distinguish drug-induced from illness-based behaviors; and (3) systematic epidemiologic approaches to resolving dilemmas that involve the political and social context in which neuropharmacological drugs are used.

Behavior↗
PubMed1987

Pharmaco-epidemiology in 136 hospitalized schizophrenic patients.

The authors surveyed pharmacotherapy in a group of 136 newly admitted patients with a DSM-III diagnosis of schizophrenia. They found that nine antipsychotic agents were used; the median daily dose (in chlorpromazine equivalents) was 1088 mg (mean +/- SD = 1428 +/- 1260 mg; range = 75-6186 mg). Women received greater mean daily doses of antipsychotics than men (1688 versus 1284 mg). Using a Cox model survival analysis, the authors found no statistical association between length of stay and the mean daily dose of antipsychotic medication. The mean daily dose of high-potency agents was 2.7 times greater than the dose of low-potency agents. The excess exposure to haloperidol alone resulted in 16.3% of the overall neuroactive drug costs.

Adolescent↗
PubMed1986

Cocaine precipitation of panic disorder.

The authors describe three patients whose panic disorder began during recreational use of cocaine and continued autonomously even after the drug was stopped. Theoretical and practical implications are discussed.

Adult↗
PubMed1985

Treatment patterns of young chronic schizophrenic patients in the era of deinstitutionalization.

A retrospective longitudinal treatment utilization study of 56 young chronic schizophrenic patients who began their treatment careers during the deinstitutionalization era was carried out covering all psychiatric services provided to each patient since first treatment. The group was primarily male and was characterized by histories of drug abuse and violence. Treatment utilization was heavy, discontinuous, and episodic with these patterns intensified for patients with histories of drug abuse. The majority of the group became "long-stay" hospital residents. The clinical and mental health policy implications of these findings are discussed and further research is suggested.

Adult↗