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Biomedical subjects

D C Ray

Publications and source records attributed to D C Ray.

17 recordsLinked to original sources
PubMed1992

Effects of perceived responsibility on help-seeking decisions among elderly persons.

This study sought to clarify why elderly adults underutilize mental health services. One hundred ten elderly individuals were asked to imagine experiencing symptoms described in a vignette and to appraise their responsibility for the problem and for its solution, their willingness to seek help, and their preference among sources of help. Results indicated that perception of problems as either medical or psychological significantly affected how elders appraised responsibility. Although attributions were unrelated to help-seeking for medical problems, elderly persons feeling responsible for psychological problems were more likely to seek help for them. Perceived responsibility predicted the sources of help (e.g., social network, physicians, mental health workers) selected by elders who believed that their problems were medical, but not for problems thought to be psychological. A discussion of the reasons for their underutilization of mental health services is presented, with an emphasis on the practical implications of the results.

Aged↗
PubMed1991

Effect of adrenaline on plasma concentrations of bupivacaine following lower limb nerve block.

Twenty-two patients undergoing total knee arthroplasty received combined sciatic plus femoral "3 in 1" blocks as adjuncts to general anaesthesia. Eleven patients received 0.375% bupivacaine 45 ml (168.75 mg) with adrenaline 1 in 200,000 and the remaining 11 received plain solution according to a previously prepared, randomized list. The mean maximum plasma bupivacaine concentration was significantly greater with plain solution than when adrenaline was added (1.66 micrograms ml-1 compared with 0.98 micrograms ml-1) (P less than 0.05). Bupivacaine concentrations were greater at all times in the plain group compared with the group receiving adrenaline. These differences were statistically significant at 10, 15 and 20 min (P less than 0.05). The greatest peak concentration recorded was 3.13 micrograms ml-1 in one patient receiving plain bupivacaine. No patient developed signs of systemic toxic effects. Peak plasma concentrations were related inversely to body weight in patients receiving solution containing adrenaline (P less than 0.005), but no relationship existed in patients who received plain solution.

Adult↗
PubMed1991

Halothane hepatitis.

The historical background, clinical features, morphology, epidemiology and aetiology of halothane hepatitis have been presented. Animal models of halothane hepatotoxicity have been described, although their application to humans is of doubtful significance. Two, probably distinct, forms of liver damage associated with halothane have been identified. The much more common mild form may result from reductive biotransformation of halothane, possibly influenced by genetic factors, or reduced liver oxygenation, whereas the rare fulminant form is most likely to be immune-mediated. The role of altered calcium homeostasis has not yet been established. In addition, a common mechanism for liver dysfunction associated with halogenated volatile anaesthetic agents has been proposed. The hepatotoxicity of enflurane cannot be excluded; while hepatic dysfunction after isoflurane or nitrous oxide is considered unlikely, further attention is necessary. It is too soon to comment on the hepatotoxic potential of sevoflurane or desflurane.

Anesthesia, General↗
PubMed1990

A disposable blood pressure cuff. An assessment of its accuracy.

An empty 500-ml infusion bag was used as the cuff for a Lifestat 100 oscillotonometer. The systolic and mean blood pressures obtained in 40 subjects were not significantly different from those measured with a standard cuff. The diastolic pressure was unrelated between the two cuffs. The empty bag is a cheap and hygienic option in patients who present a high infection risk.

Blood Pressure↗
PubMed1989

Effect of nicardipine infusion on the release of glutathione S-transferase following halothane anaesthesia.

To assess the possible protective effect of calcium channel blockade on hepatic function after halothane anaesthesia, 80 patients were allocated randomly to receive an i.v. infusion of either nicardipine or normal saline. Plasma concentration of glutathione S-transferase B1 subunits (GST) was measured as a sensitive index of hepatic damage. Data from 53 patients were analysed. Plasma GST concentration increased significantly at 3 and 6 h after induction of anaesthesia in the placebo group (P less than 0.01), and at 3 h (P less than 0.01) and 6 h (P less than 0.05) in the nicardipine group. The administration of nicardipine resulted in a greater increase in plasma GST concentrations at 3 h than did placebo (P less than 0.05), mainly because of a greater increase in males than in females. The increase in GST at 3 h was related inversely to plasma concentration of nicardipine both at the end of the exponential infusion (P less than 0.01) and at 2 h after induction (P less than 0.05), when males had lower plasma nicardipine concentrations than females (P less than 0.05). Calcium channel blockade with nicardipine in the dose administered was not shown to reduce liver dysfunction after halothane anaesthesia.

Adolescent↗
PubMed1989

Preoperative cimetidine does not prevent subclinical halothane hepatotoxicity in man.

To assess the influence of pretreatment with cimetidine on changes in hepatocellular integrity after halothane anaesthesia, 53 patients were allocated randomly to receive either cimetidine 1600 mg orally or placebo tablets before anaesthesia. Plasma concentrations of glutathione S-transferase (GST) were measured as an index of hepatic damage. Data from 45 patients were available for analysis. Plasma GST concentration increased significantly 3 h after induction of anaesthesia in both groups (P less than 0.01, both groups) and at 6 h in the cimetidine group (P less than 0.05). Pretreatment with cimetidine did not influence the magnitude of increase in GST concentration. There was no difference between the groups in the frequency of abnormal GST concentrations at any time. Cimetidine does not appear to prevent release of GST from the liver by halothane anaesthesia in man.

Adolescent↗
PubMed1989

Haemodynamic responses to nicardipine in humans anaesthetised with halothane.

The haemodynamic effects of an infusion of nicardipine were studied noninvasively before, during and after halothane anaesthesia in man, using a simple technique to achieve constant plasma drug concentrations. Eighty patients were randomly allocated to receive an intravenous infusion of either nicardipine or normal saline. Systolic and diastolic arterial pressures were significantly lower and heart rate significantly higher throughout the infusion than before infusion (p less than 0.001, all variables) in those patients who received nicardipine. The hypotension induced by nicardipine was not affected by induction of anaesthesia; halothane significantly reduced the nicardipine-induced tachycardia (p less than 0.001). Nicardipine caused no cardiac rhythm disorders. This technique for the intravenous administration of nicardipine achieves appropriate stable plasma concentrations, is devoid of severe haemodynamic disturbance and appears to be safe to use during halothane anaesthesia in patients with normal left ventricular function.

Adolescent↗
PubMed1988

Plasma glutathione S-transferase concentration as a measure of hepatocellular integrity following a single general anaesthetic with halothane, enflurane or isoflurane.

The plasma concentration of hepatic glutathione S-transferase (GST) was measured in matched groups of patients who received halothane, enflurane or isoflurane anaesthesia for elective minor surgery. The GST concentrations increased significantly at 3 h after anaesthesia in patients who received halothane or enflurane, but not in patients who were given isoflurane. A secondary increase in GST concentration, at 24 h, was seen in a small number of individuals who received halothane or enflurane. Abnormal GST concentrations were found in 50% of patients following halothane anaesthesia, 20% following enflurane and 11% after isoflurane. The small but significant increases in GST concentrations in patients receiving halothane or enflurane suggests an impairment of hepatocellular integrity following the administration of these anaesthetics. In contrast, isoflurane anaesthesia did not appear to be associated with this effect.

Adult↗
PubMed1988

Continuous intravenous morphine for pain relief after abdominal surgery.

We studied prospectively 247 consecutive patients given morphine by continuous intravenous infusion for 24 h to provide pain relief following elective abdominal surgery. Using a dose of 1 mg/kg supplemented by additional intramuscular morphine 5 mg as necessary, only 26% required more than two additional intramuscular doses for discomfort. In 71 patients, the infusion was discontinued temporarily, mostly because of low respiratory rates. These patients were older (P less than 0.01), and their mean respiratory rate over the 24 h was significantly less (P less than 0.001) than those in whom the infusion was continuous. The technique was inexpensive, easy to use in a general surgical ward, and safe provided certain rules were observed.

Abdomen↗
PubMed1986

Psychiatric consultation in somatization disorder. A randomized controlled study.

The per capita expenditure for health care of patients with multiple physical symptoms but no apparent physical disease (somatization disorder) is up to nine times the average per capita amount. We conducted a randomized controlled trial to determine whether psychiatric consultation would reduce the medical costs of these patients, without effecting a substantial change in patient outcome. Thirty-eight patients were randomly assigned to treatment or control groups and studied prospectively for 18 months. Treatment consisted of a psychiatric consultation and suggestions on management given to primary physicians. After nine months, the control group was crossed over to receive treatment with the same intervention. After the psychiatric consultation, the quarterly health care charges in the treatment group declined by 53 percent (P less than 0.05). In contrast, the charges in the control group showed wide variations but no overall change. The quarterly charges in the control group were significantly higher than those in the treatment group (P less than 0.05). After the control group was crossed over to receive treatment, their quarterly charges declined by 49 percent (P less than 0.05). The reductions in expenditures in both groups were due largely to decreases in hospitalization. We conclude that psychiatric consultation in the care of patients with somatization disorder reduced subsequent health care expenditures without inducing changes in health status or patients' satisfaction with their health care.

Adult↗
PubMed1986

Patients with multiple unexplained symptoms. Their characteristics, functional health, and health care utilization.

To define groups of patients with inappropriately high health care utilization better, we have studied a group of 41 chronically ill patients to determine their characteristics, symptoms, functional health status, and amount of health care utilization. This group had somatization disorder diagnosed by specific criteria. They can be easily recognized by primary care physicians by their multiple complaints, negative physical examination results, and a history of multiple medical examinations. We found them to be functionally disabled, spending an average of seven days ill in bed each month. They perceived themselves as severely ill and were willing to undergo multiple hospitalizations, diagnostic studies, and operations. Their health care charges were extraordinary, averaging $4,700 annually. The physician can most effectively treat these patients by scheduling regular visits, relying on physical examinations rather than diagnostic studies, and avoiding costly hospitalizations.

Adult↗
PubMedDate not supplied

Stress and coping with scoliosis: psychological effects on adolescents and their families.

The psychological, functional, and family impact of brace treatment for idiopathic scoliosis was assessed in a cross-sectional follow-up study. Eighty-four percent of parents described the initial bracing period in stressful terms. Establishing a daily routine facilitated coping with bracewear treatment. While bracewear did not necessarily affect participation in many common activities, subjects perceived limitations in sports, physical activities, and social events. There was no evidence of overt psychopathology among the subjects, although the initial bracewear period was associated with lower levels of self-esteem. Recommendations that can minimize the stresses attendant to bracewear treatment are given.

Adaptation, Psychological↗