PubMed Health⌕ Search

Biomedical subjects

D Faust

Publications and source records attributed to D Faust.

At least 37 records · Page 2Linked to original sources

Caring for the severely asthmatic child and family. I. The rationale for family systems integrated medical/psychological treatment.

Comprehensive care for the severely asthmatic child includes psychological as well as medical treatment. Family therapy is a recognized modality of therapy. Investigations have examined the role of emotion and asthma as well as psychosomatic asthma. Pharmacological treatment of beta 2-agonist and cromolyn prior to disciplining the child prevents psychosomatic asthma secondary to crying or shouting. Adherence to multiple asthma therapeutic modalities is imperative, and a psychological and medical team can address these important clinical issues in a high-risk population.

Asthma↗

An economic evaluation of short-term inpatient rehabilitation for children with severe asthma.

BACKGROUND: The cost of asthma care in the United States in 1990 has been estimated to be 6.2 billion dollars. The greatest proportion is due to hospital care. OBJECTIVE: We report changes in estimated medical charges of 59 children with severe asthma 1 year before inpatient rehabilitation and over a 4-year follow-up period. METHODS: Asthma resource use (e.g., hospital, physician, medication) was identified before and after inpatient rehabilitation. Estimated charges were assigned. This was done retrospectively for the 1-year period before rehabilitation, prospectively during rehabilitation, and over a 4-year follow-up period. Patients served as their own controls. There was no control group. RESULTS: When median asthma resource use 1 year before rehabilitation was compared with that during the first, second, third, and fourth years of follow-up, there was a reduction in median hospitalization and median emergency care. Compared with mean total medical charges the year before rehabilitation, reductions in mean total medical charges were 56.7% at the completion of the first year (excluding charges for rehabilitation), 70.5% at second year, 74.6% at third year, and 77.5% at fourth year. Over the 4-year postrehabilitation period, the discounted cumulative net savings was $29,605. The discounted cumulative net savings surpassed the mean rehabilitation charge during the early months of the fourth year of the postrehabilitation period. CONCLUSION: Inpatient rehabilitation was significantly associated with a reduction in estimated total medical charges over a 4-year follow-up period.

Adolescent↗

Density-dependent regulation of cell growth by contactinhibin and the contactinhibin receptor.

BACKGROUND: The number of cells within mammalian tissues is maintained by growth-stimulating and growth-inhibiting mechanisms, with inhibitory signals being superimposed over growth stimuli. This is reflected, in the culture of normal adherent cells, by the phenomenon of density-dependent inhibition of growth: cells cease proliferation after becoming a confluent monolayer. We have shown previously that a plasma membrane glycoprotein, contactinhibin, is a major effector of negative growth regulation. Although transformed cells express contactinhibin in a functionally active form, they are not growth-inhibited, suggesting that the defects that lead to their aberrant growth are located 'downstream' of contactinhibin. RESULTS: Here, we provide evidence that a 92 kD plasma membrane protein, which we call CiR, binds specifically to contactinhibin and acts as a receptor mediating the contact-dependent inhibition of growth of cultured human fibroblasts. When polyclonal antibodies against CiR were introduced into cells using liposomes, confluent cells were released from density-dependent growth control. By contrast, cross-linking CiR that is localized to the plasma membrane, using anti-CiR antibodies, led to growth inhibition, suggesting that CiR is a signalling molecule and implicating CiR oligomerization in signal generation. This conclusion is supported by the finding that binding of contactinhibin by CiR is strongly dependent on the local concentration of both molecules and has a sharp threshold. When CiR was isolated by immuno-precipitation under conditions favouring phosphorylation, it was hyperphosphorylated on serine and threonine residues and had reduced contactinhibin-binding capacity; the binding capacity of CiR was restored after treatment with potato acid phosphatase. Fibroblasts transformed with simian virus 40 had reduced CiR expression, higher CiR phosphorylation levels, and a strongly reduced capacity of CiR to bind to contactinhibin. Phosphatase treatment of the CiR isolated from transformed cells only partially restored its contactinhibin-binding capacity. CONCLUSIONS: Homeostasis is the net result of a highly balanced network of growth-stimulating and growth-inhibitory signals. We have shown that density-dependent inhibition of growth in vitro is mediated by the interaction of contactinhibin with a 92 kD plasma membrane glycoprotein, CiR, the contactinhibin-binding capacity of which is regulated by phosphorylation.

Cell Count↗

The detection of deception.

In clinical situations patient honesty and self-interest usually coincide; however, in legal circumstances patients may be motivated to deceive and may be skilled in doing so. Research raises doubts about the capacity of health professionals to detect malingering, particularly when there is less known about conditions or expected symptom patterns, more definitive tests are lacking or require patient cooperation, and diagnosis depends substantially on patient self-report. Given the lack of systematic feedback about our judgmental accuracy when deciding the presence or absence of malingering, clinical experience per se provides an inadequate means for identifying and correcting erroneous practices and for determining just how confident we ought to be in our subjective impressions. Thus, in the appraisal of malingering, it is dangerous to place too much dependence on subjective confidence. Methods are discussed that can supplement medical examination and increase the accuracy of malingering detection.

Diagnosis, Differential↗

Modulation of mRNA expression and secretion of C1q in mouse macrophages by anti-inflammatory drugs and cAMP: evidence for the partial involvement of a pathway that includes cyclooxygenase, prostaglandin E2 and adenylate cyclase.

Isolated BALB/c mouse thioglycollate-elicited (inflammatory) peritoneal macrophages release at least 10 times more C1q than do isolated resident peritoneal macrophages. Addition of non-steroidal anti-inflammatory drugs (NSAID) to thioglycollate-elicited macrophages in culture inhibited the release of C1q and reduced levels of C1q-specific mRNA. Contrastingly, the NSAID were found to enhance C1q-specific mRNA levels in resident macrophages, although no increase in C1q levels secreted was observed. This suggests that the response of macrophages to NSAID, with respect to C1q synthesis, reflects the developmental stage of the macrophage. The gold salt auranofin (AFN) was found to enhance markedly C1q synthesis at both transcriptional and secretory levels in thioglycollate-elicited macrophages whilst, conversely, AFN reduced mRNA levels in resident macrophages. This indicates that AFN and the NSAID may work via the same or similar biochemical pathway, but with opposing effects. The glucocorticoid hydrocortisone (HC) greatly enhanced C1q-specific mRNA levels in both thioglycollate-elicited and resident macrophages, although no parallel increases in C1q secreted were observed. The data on inhibition of C1q biosynthesis by NSAID in thioglycollate-elicited macrophages are supported by the enhancement of C1q biosynthesis following addition of prostaglandin E2 (PGE2) or dibutyryl cyclic AMP (dBcAMP) to the cultures. From these experiments, it is concluded that C1q biosynthesis is controlled, at least in part, by a pathway involving cAMP.

Adenylyl Cyclases↗

Integrating the cognitive mental status examination into the medical interview.

The frequency of cognitive deficits in medical patients makes the cognitive mental status evaluation an important component of the medical interview. This paper helps delineate the clinical situations in which formal cognitive mental status questioning is indicated. We address the critical issues involving the doctor-patient interaction in order to facilitate the evaluation of mental status without alienating the patient or introducing artificial and unnecessary questions. We review more specifically the areas of attention, memory, language, constructional ability, and higher cognitive functions. Finally, we address issues of referral for further evaluation.

Attention↗

Forensic neuropsychology: the art of practicing a science that does not yet exist.

Despite its future promise, neuropsychological evidence generally lacks scientifically demonstrated value for resolving legal issues, and thus, if admitted into court, should be accorded little or no weight. In support of this contention, examples of problems and limits in forensic neuropsychology are described. These include contrasts between the clinical and forensic context; the base-rate problem; lack of standardized practices; problems assessing credibility or malingering; difficulties determining prior functioning, limits in the capacity to integrate complex data; and the lack of relation between judgmental accuracy and education, experience, or credentials. Some possible counterarguments are also addressed.

Activities of Daily Living↗

To say it's not so doesn't prove that it isn't: research on the detection of malingering. Reply to Bigler.

Research that directly examines clinicians' capacity to detect malingering creates doubt about their success in this endeavor and about confident self-appraisals of detective abilities. We argue that Bigler's counterassertions lack supportive evidence or conflict with research on such topics as clinicians' level of training and experience and their judgmental accuracy. We further note that lack of both base rate information and definitive outcome information compound doubts about clinicians' capacity to detect malingering.

Child↗

Clinical versus actuarial judgment.

Professionals are frequently consulted to diagnose and predict human behavior; optimal treatment and planning often hinge on the consultant's judgmental accuracy. The consultant may rely on one of two contrasting approaches to decision-making--the clinical and actuarial methods. Research comparing these two approaches shows the actuarial method to be superior. Factors underlying the greater accuracy of actuarial methods, sources of resistance to the scientific findings, and the benefits of increased reliance on actuarial approaches are discussed.

Actuarial Analysis↗

Improving the accuracy of clinical judgment.

Diagnostic reasoning in psychiatry is as intricate as it is risky (Elstein et al. 1978; Fitzhenry-Coor 1986; Fitzhenry-Coor and Nurcombe 1983; Gauron and Dickinson 1965; Sandifer et al. 1970; Kendell 1973; Nurcombe and Fitzhenry-Coor 1982). During the clinical encounter, the clinician elicits, notes, and verifies pertinent clinical cues. Early in the encounter, from an assembled but incomplete pattern of data, an array of diagnostic hypotheses is generated. Subsequently, in the light of evidence systematically gathered, each diagnostic possibility is progressively refined or deleted until the diagnostic conclusion is reached. The validity of the clinical endeavor, thus, depends upon the pertinence of the hypotheses generated, for it is upon them that deductive reasoning will hinge. It also depends upon the reliability of the history, signs, and investigations that constitute the evidence gathered for or against each of the hypotheses. The purpose of this paper is to propose systematic strategies based on principles of probability and empirical research, with the aim of sharpening clinical reasoning.

Diagnosis, Differential↗

The development and initial validation of a sensitive bedside cognitive screening test.

Brief bedside cognitive examinations such as the Mini-Mental State Examination are designed to detect delirium and dementia but not more subtle or delineated cognitive deficits. Formal neuropsychological evaluation provides greater sensitivity and detects a wider range of cognitive deficits but is too lengthy for efficient use at the bedside or in epidemiological studies. The authors developed the High Sensitivity Cognitive Screen (HSCS), a 20-minute interview-based test, to identify patients who show disorder on formal neuropsychological evaluation. An initial study demonstrated satisfactory test-retest and interrater reliability. The HSCS was then administered to 60 psychiatric and neurological patients with suspected cognitive deficits but without gross impairment, who also completed formal neuropsychological testing. Results of both tests were independently classified as either normal, borderline, or abnormal. The HSCS correctly classified 93% of patients across the normal-abnormal dichotomy and showed promise for characterizing the extent and severity of cognitive dysfunction.

Adolescent↗

The expert witness in psychology and psychiatry.

The involvement of psychologists and psychiatrists within the legal arena continues to grow rapidly but remains highly controversial. Extensive research on clinical judgement provides a scientific basis for clarifying the growing disputes about the values of such professional activities. Studies show that professionals often fail to reach reliable or valid conclusions and that the accuracy of their judgements does not necessarily surpass that of laypersons, thus raising substantial doubt that psychologists or psychiatrists meet legal standards for expertise. Factors that underlie the research findings and implications for courtroom testimony are discussed.

Expert Testimony↗

Prediction of the effects of mild head injury: a message about the Kennard Principle.

We surveyed assumptions with regard to the relation between age and outcome of head injury (a.k.a. the "Kennard Principle"). Two groups (N = 120) of practicing clinicians were sent background information about a mild to moderate head injury in which only the age of the patient varied and were asked to predict likely outcome (degree of impairment). Predicted outcome differed significantly, with an adolescent case judged much more likely to have serious impairment than a child case. Implications of the (mis)application of the Kennard Principle are discussed.

Adolescent↗

Clinical utility of the MMPI in the evaluation of adolescent suicide attempters.

MMPI profiles of female adolescents hospitalized on a general pediatrics floor following a suicide attempt were compared to a control group of medically hospitalized, female adolescents referred for psychiatric evaluation. The suicide attempters had only a lower score on the K scale when compared to the control group. Results do not suggest that a single MMPI profile differentiates suicide attempters from a comparison group of adolescents with emotional difficulties. Implications of these findings are discussed.

Adolescent↗

Moderately elevated blood lead levels: effects on neuropsychologic functioning in children.

Investigations of moderately elevated lead levels and children's cognitive functioning have yielded conflicting results, although studies showing no effects used measures of limited sensitivity and breadth. In this study, a comprehensive neuropsychologic battery was used to determine whether deficits would be revealed. An experimental group of 15 children with a past history of moderately elevated lead levels, but subsequently without increased lead levels for at least a year, were compared with a control group matched by residential area, socioeconomic status, parental IQ, age, and gender. The experimental groups' performance was lower on the battery overall and on measures of motor skill, memory, language, advanced spatial functions, and concentration. The results suggest that exposure to moderately elevated lead levels exerts significant and nontransient effects on cognitive functions.

Child↗