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At least 685 records · Page 38Linked to original sources
PubMed1988

New concepts in the diagnosis and management of depression.

The diagnosis and therapy of the depressive disorders has entered a new era in the 80s. Though primarily driven by breakthroughs in the neurosciences, such as neuroendocrinology, neurochemistry, and psychopharmacology, the increased sophistication of our diagnostic procedures and therapies of these disorders is by no means limited to the biomedical laboratory. A move away from preconceived concepts of the causes and course of depression has ushered in an era of empirical investigation of the clinical presentation and clinical course of the depressive disorders. This empirical approach has contributed to a new wave of epidemiologic investigations. The psychiatrist's diagnostic and therapeutic approach to the depressive disorders, more so than with any other primary psychiatric disorder, closely parallels the approach of physicians from other specialties, and has thereby increased the bond between psychiatry and the other medical specialties. Some caution, however, must be expressed. First, depressive disorders are considered by many primary care physicians to be easily understood and managed, or to be unworthy of serious attention. The requirement for specialty care in the management of treatment-resistant depressive disorders is as essential as the requirement for the coronary care unit in treating the unstable cardiac patient. In addition, the movement toward the medical management of the depressive disorders should not bias the clinician to the point that he neglects these illnesses and the patients who suffer them. We may view the depressive disorders as being primarily of biomedical causes, but patients still interpret their depressive symptoms within the context of their values, their lifestyles, and the events that impact them.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidepressive Agents↗
PubMedDate not supplied

[Theoretical studies of the electrostatic interactions in aspartic proteinases, intramolecular interactions in pepsin and penicillopepsin].

A semi-empirical approach has been used to estimate the intramolecular electrostatic interactions in pepsin and penicillopepsin. The pH-dependence of the free energy electrostatic term was calculated, and the pH-dependence of the domain interactions has been estimated. As it was shown, the contribution of electrostatic interactions is rather small for the stabilization of the native structure. At the same time the electrostatic repulsion between domains increases with the increase of pH. The later can be the cause of the alkaline denaturation of pepsin and domain mobility.

Aspartic Acid Endopeptidases↗
PubMed1988

On truth telling and the diagnosis of Alzheimer's disease.

Whether to inform patients that they have Alzheimer's disease can be a vexing issue. Two approaches to medical ethics may be used to address this issue: one takes a strong rights-oriented position; the other takes a best-outcome position. The interests that patients have in knowing relate to both schools of thought. The authors surveyed 224 adult patients who were waiting to see their physicians. The findings showed that over 90 percent of patients want to be told of the diagnosis. Reasons for wanting to be told included making plans for care, obtaining a second opinion, and settling family matters. No demographic markers could be used to predict who would not be told. Even though several patients indicated that reading a case description made them feel suicidal, reactions to not being told are generally negative. Following either ethical approach leads to the conclusion that patients ought to be told. Subjects' interests in whom else should be told were also recorded, raising questions of confidentiality.

Adult↗
PubMed1988

Clinical and scientific aspects of the Ulm process model of psychoanalysis.

Theories of the psychoanalytic process inevitably influence the clinician's handling of the treatment. Investigations in the private theories of analysts point to the anchoring of these process conceptions in the personal experience of the analyst; therefore a normative, ideally constructed process model does not correspond to what is found when empirical studies are performed. For many reasons of social interactionism criticism applies also to so-called natural process conception which maintains that the process of working through has to pass ontogenetic phases from early to late. Though the concept of phase, known also as focus, is a very helpful notion, its empirical foundation is yet very weak. The paper describes empirical approaches to identify focal phases which are the basis of the Ulm process conception.

Adult↗
PubMed1986

Laboratory support for choosing and monitoring antimicrobial therapy in severely ill patients.

The microbiology laboratory plays an important role both in choosing initial antimicrobial therapy and in monitoring such therapy during the course of treatment. In septicemic patients who have few, if any, clinical findings suggesting a specific etiologic diagnosis, it is useful to know the antibiotic susceptibility patterns for the given hospital or community. This type of empiric approach to therapy might require a larger variety of antibiotics than that usually considered for treatment of infected neutropenic patients. In the absence of neutropenia, there is perhaps more latitude in the initial choice, and single-drug therapy often can be considered. While patients are receiving antibiotics that should be appropriate for an identified pathogen, several laboratory procedures can be used to monitor this treatment. Antibiotic synergism studies may be useful in neutropenic patients, as well as assays of serum bactericidal activity. The serum bactericidal activity may be useful also in monitoring therapy for bacterial endocarditis or for osteomyelitis, especially when oral or home therapy is considered. Similarly, drug levels may be measured by a variety of techniques to ensure appropriate serum concentrations and to minimize drug toxicity. In addition, the preclinical evaluation of antibiotics alone and in combination can be used in guiding the design of clinical studies of these drugs in certain patient groups, such as neutropenic patients.

Agranulocytosis↗
PubMed1986

Treating respiratory infections in the era of cost control.

The treatment of lower respiratory tract infections will undoubtedly be affected by cost-control measures. Probably the most important change in the diagnosis and treatment of bronchitis and pneumonia will be a more empiric approach. A basic knowledge of likely pathogens, plus the clinical judgment to provide treatment modifications for patients susceptible to unusual pathogens, will usually assure a successful outcome.

Adult↗
PubMed1982

Application of response surface methodology to the assay of gamma-glutamyltransferase.

Response surface methodology (RSM) offers an empirical approach to the study of clinical enzyme assays. Variables such as pH, which are difficult to characterize by using theoretical enzyme kinetics, are easily included in RSM formulations. In this investigation, we studied with RSM the change in the measured activity of gamma-glutamy-transferase (EC 2.3.2.2) as a function of changes in concentrations of donor (gamma-glutamyl-3-carboxy-4-nitroanilide) acceptor (glycylglycine), and pH. The study defined large ranges for these variables over which maximum enzyme activity is obtained: donor 6.6 to 10.2 mmol/L, acceptor 129 to 250 mmol/L, and pH 7.8 to 8.5. The RSM regression polynomial was as accurate as a previously determined enzyme kinetic equation for predicting the transferase activity from given reagent substrate concentrations. Although not yielding a mechanistic understanding of an enzyme assay, RSM studies do produce an operational understanding of how an assay functions.

Clinical Enzyme Tests↗
PubMedDate not supplied

Fractionation in radiotherapy (review).

The methods by which radiation treatment has been administered since the original discoveries concerning the properties of ionising radiation are reviewed on a historical basis. The criteria, together with their limitations, that have influenced the empirical approach to fractionation in radiotherapy are identified and critically assessed. The necessity for classifying fractionation into component parts, so as to avoid confusion, such as time, dose and fractions factors is stressed, as is the correct evaluation of the complex biological consequences of the physical events. The different mechanisms, and their varying inter-relationships, responsible for acute and late normal tissue radiation damage are considered and shown not to relate solely to the time factor. Reports from the literature are used to illustrate these points.

Animals↗
PubMed1982

Measurement of quality of life: current state of the art.

In recent years several investigators have developed procedures for measuring the quality of life of individuals. This paper focuses on an empirical approach to defining the main determinants of quality of life and the development and application of procedures for surveying the importance of each component in representative samples of 3 age groups of Americans. These age groups included those persons 30, 50, and 70 years of age. The survey also included reports by these persons concerning the extent to which their needs and wants were met with respect to each of these components. By using the critical incident technique it was found that there were 15 components that included all of the 6,500 activities and experiences reported by a wide variety of Americans from various geographic areas as contributing either positively or negatively to their quality of life. In the survey of 500 men and 500 women at each of the 3 age levels it was found that the 5 dimensions they most frequently described as important included: health, children, understanding yourself, work, and spouse. The 5 dimensions for which they reported their needs and wants were least well met were: participating in government, active recreation, learning and education, creative expression, and helping others. The 5 dimensions that correlated most highly with their reports of overall quality of life at present were: material comforts, work, health, active recreation, and learning and education. Suggestions are made for revising these procedures for use with persons with a disability to improve their quality of life.

Adult↗
PubMed1984

[Behavior therapy in pediatrics].

30-40% of children presented to pediatricians are afflicted with psychophysiological, behavioral and learning disorders. The child behavior therapy is an empirical approach of understanding and treating these complaints. Many tables and examples demonstrate the basics of learning theory as well as behavior therapy methods derived from behavior analysis. The review closes by reporting the hypothetical issues and objects of behavior therapy und its significance for pediatrics. The bibliography refer to recent trends of child behavior therapy.

Behavior Therapy↗
PubMed1983

Upper extremity replantation.

The most important determinants of the functional ability of an amputated part are proper patient selection and the recognition of vascular compromise. Ideally, a well-performed anastomosis should need no pharmacologic assistance, but the ideal is often the exception. The authors present an empirical approach to use of anticoagulation medication.

Amputation, Traumatic↗
PubMed1980

Applications of light scatter to separation of stem cells.

A case is presented for light scatter as a potentially important discrimination parameter for electronic sorting of hemopoietic stem cells. Examples are presented of application of light scatter to sorting of primitive hemopoietic cells from bone marrow, thymus, and fetal yolk sac, using simple empirical approaches and a cell sorter equipped with a standard fixed-angle detector. Cells sorted in this way were ultrastructurally indistinguishable from stem cells observed in whole tissue sections or unfractionated suspensions and remained viable under culture conditions. Cells were further sorted into proliferative and nonproliferative stages whose morphologies were those expected for primitive and mature cells, respectively. Light scatter was a more specific marker for primitive thymocytes than binding of peanut agglutinin. Cells sorted from fetal yolk sac suspensions were ultrastructurally similar to candidate pluripotential stem cells of bone marrow. Therefore, where sorting rather than positive identification is the primary objective of flow analysis and histochemical correlations can be established after sorting, viable stem cells can be sorted from the simple hemopoietic tissues in high and verifiable purity. Sorting of pure stem cells from marrow will require an additional parameter for which an additional angle of light scatter may suffice.

Agglutination↗
PubMedDate not supplied

[Economic aspects of health care for the elderly].

Group-specific analysis of health care in the Federal Republic of Germany is in its infancy. Health care of the elderly is discussed in regard to health status, utilization, expenditures and financing. The empirical approach offers results that are of importance in a policy context, in particular if they are further developed by an interdisciplinary effort in health services research. The results, if published regularly, provide answers to the question whether supply and utilization of health services correspond with the need of the elderly.

Aged↗
PubMed1995

Nathan Zuntz (1847-1920)--a German pioneer in high altitude physiology and aviation medicine, Part II: Scientific work.

For over 52 years, the work of Nathan Zuntz (1847-1920) covered an amazingly wide spectrum of research fields; metabolism, nutrition, respiration, blood gases, exercise, and high altitude physiology were the main themes. Zuntz achieved fame for his invention of the Zuntz-Geppert respiratory apparatus in 1886 and the first Laufband (treadmill) in 1889. To this experimental setup Zuntz later added an X-ray apparatus in 1914 to determine the changes in heart volume during exercise. Moreover, he constructed a climate chamber to study exercise under varying and sometimes extreme climates. For field studies Zuntz invented a transportable Gasuhr (dry gas measuring device). Zuntz was the first to describe the difference between laboratory data gained in a hypobaric chamber and the measurements at high altitude. He found that the barometric formula is not applicable in the field. Two balloon expeditions in 1902 by Zuntz and his pupil, v. Schroetter, marked the step from terrestrial physiology towards aviation medicine. An outline of the development of scientific aviation in Berlin from 1880-1918 elucidates how closely the aviation union, army, and scientific departments were connected with and dependent upon each other. In cooperation with these institutions Zuntz and v. Schroetter constructed an oxygen supply system and planned a pressure cabin for extreme altitudes above 10,000 m, a forerunner of modern systems in aviation and astronautics. In 1912, Zuntz and v. Schroetter each published papers on aviation medicine, both publications internationally unique in style and extent. Zuntz's work in its empirical approach was the counterpart to the established formal mathematical-physical reductionism of the German Physiological Society.(ABSTRACT TRUNCATED AT 250 WORDS)

Aerospace Medicine↗
PubMed1995

L5 vertebral compression fracture: a series of five cases.

OBJECTIVE: The purpose of this paper is to discuss five cases of L5 vertebral compression fracture (VCF), illustrating the epidemiology, clinical presentation and radiographic appearance of the fracture at this uncommon site. Additionally, an empirical approach to conservative management of L5 VCFs is also discussed. DESIGN: A series of five cases. SETTING: Private chiropractic clinic. CONCLUSIONS: Compression fractures at the L5 level are rare; however, this problem should be considered in postmenopausal women who suffer from low back pain and in young men with a history of trauma. Conservative treatment options, including both passive therapy and exercise, can be beneficial in the management of this condition.

Adult↗
PubMed1995

Preserving the physician-patient relationship in the era of managed care.

Even without comprehensive health care reform legislation, the US health care system is undergoing significant changes. Probably the most important change is the expansion of managed care with significant price competition. One of the major concerns about this change is the effect of managed care on the physician-patient relationship. To provide a normative standard for evaluating the effect of changes, we need an ideal conception of the physician-patient relationship. This ideal can be summarized by six C's: choice, competence, communication, compassion, continuity, and (no) conflict of interest. For the 37 million uninsured Americans there is little chance of realizing the ideal physician-patient relationship, since they lack the choice of practice setting and physician, receive care in a rushed atmosphere that undermines communication and compassion, and have no continuity of care. While many insured Americans may believe they have an ideal physician-patient relationship, the relationship is threatened by lack of a regular assessment of competence, by financial incentives that undermine good communication, and by the persistence of conflict of interest. The shift to managed care may improve the choice of practice settings, especially in sections of the country that currently lack managed care; increase choice of preventive services; make quality assessments more routine; and improve communication by making greater use of primary care physicians and nonphysician providers. However, the expansion of managed care and the imposition of significant cost control have the potential to undermine all aspects of the ideal physician-patient relationship. Choice could be restricted by employers and by managed care selection of physicians; poor quality indicators could undermine assessments of competence; conductivity requirements could eliminate time necessary for communication; changing from one to another managed care plan to secure the lowest costs could produce significant disruption in continuity of care; and use of salary schemes that reward physicians for not using medical services could increase conflict of interest.

Conflict of Interest↗