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Biomedical subjects

D R Patterson

Publications and source records attributed to D R Patterson.

At least 37 records · Page 2Linked to original sources
PubMed1996

Hypnosis in the treatment of patients with severe burns.

Burn injuries are a frequent form of trauma, the care for which typically involves repeated, intrusive procedures and acute, excruciating levels of pain. Although research in the use of hypnosis with burn patients is largely anecdotal there is emerging evidence that the burn unit may be one of the most useful arenas for the clinical application of this technique. The acute, identifiable nature of burn care procedures and the emotional state of patients in trauma care both provide an often receptive setting for the use of this intervention.

Burns↗
PubMed1996

Hypnosis as an adjunct to medical care in the management of Burger's disease: a case report.

Burger's disease is a peripheral vascular disorder characterized by constricted blood flow, ischemic pain, and necrotizing tissue processes. This report describes the application of a brief hypnosis intervention in conjunction with standard medical procedures to increase peripheral blood flow in a patient with advanced Burger's disease. Using suggestions for foot warming and increased blood flow, substantial increases in surface foot temperature were obtained prior to and following an epidural sympathectomy. As a result, the procedure contributed to keeping necrotic tissue loss to a minimum, decreasing ischemic pain, and hopefully preventing the need for amputation. Treatment gains were maintained through discharge and at two month follow up. The results suggest that hypnosis may serve as a parsimonious, yet efficacious adjunct to standard medical care in the management of reduced peripheral blood flow in patients with Burger's disease. Further, it illustrates the feasibility of hypnosis as an adjunct treatment in busy, inpatient hospital settings.

Humans↗
PubMed1995

Pain, coping, and adjustment in patients with burns: preliminary findings from a prospective study.

We prospectively examined the associations between procedural pain during hospitalization and coping and adjustment 1 month postdischarge in 43 patients treated at a major regional burn center for burns extensive enough to require at least 5 days of daily wound debridement procedures. Both patients and nurses provided ratings of patient pain, which were summarized and aggregated across a 5-day period. Results indicated that those subjects with higher pain scores also reported poorer adjustment as measured by scores on the Brief Symptoms Inventory and the Sickness Impact Profile. Moreover, these associations remained significant after partialling out the effects of preburn adjustment. Hierarchical regression analyses revealed evidence that seeking social support had a moderating effect on the association between pain and scores on a measure of posttraumatic stress disorder.

Adaptation, Psychological↗
PubMed1995

Undifferentiated somatoform idiopathic anaphylaxis: nonorganic symptoms mimicking idiopathic anaphylaxis.

BACKGROUND: Northwestern University's Division of Allergy and Immunology has had experience with the diagnosis and treatment of more than 350 patients with idiopathic anaphylaxis (IA). In 1992 we reported a group of patients with IA whose presentations mimicked IA, but IA and other organic causes were later excluded. Psychologic factors were suspected as the underlying problem. These patients were classified as IA-variant. Management of these cases was extremely difficult. There was significant morbidity and high and unnecessary costs. OBJECTIVE: We aim to distinguish the nature of this disease and to highlight the evaluation and treatment of this group of patients. METHODS: Their cases are reviewed and reported. RESULTS: Common features included (1) presenting symptoms mimicking IA, (2) no objective findings that correlated with 1, (3) no response to the therapeutic regimen for IA, (4) meeting the Diagnostic and Statistical Manual of Mental Disorders criteria for undifferentiated somatoform disorder, and (5) significant wasted health care expenditure. CONCLUSIONS: This group of patients were better defined as having undifferentiated somatoform-IA. An algorithm was proposed to expedite the diagnosis of the disease so that with early recognition of the disease, unwarranted repetitive consultations, tests, and inappropriate therapy can be avoided.

Adult↗
PubMed1994

Coping and emotional attributions following spinal cord injury.

Ways of Coping Checklist-Revised protocols gathered from 35 persons with spinal cord injuries on admission to an in-patient rehabilitation unit were cluster analysed using Ward's method. A two-cluster solution was produced reflecting patterns of coping similar to Lazarus und Folkman's (1984) emotion- and problem-focused dichotomy. These patterns of coping were validated against sets of demographic/medical and emotional adjustment/attribution variables gathered on discharge. Results showed that a group of subjects using emotion-focused coping styles reported greater ratings of depression. These subjects focused less on physical and therapy progress to promote positive feelings and focused more on thoughts about the accident. There was also a trend for physical setbacks to contribute to negative mood in these patients. This pattern was associated with having been readmitted to hospital. The clinical and research implications of the study are discussed.

Activities of Daily Living↗
PubMed1993

Psychological effects of severe burn injuries.

Severe burn injuries provide researchers with an opportunity to study the effects of painful but usually transient trauma on psychological functioning. To that end, this article presents a review of the 3 main areas of this body of literature: (a) premorbid characteristics of people who sustain severe burn injuries, (b) psychological reactions during hospitalization, and (c) long-term adjustment. The general implications of these studies are discussed and then used to illuminate the circumstances under which individuals suffer the most from this type of trauma, the effects of such injuries on personality function, and how meaningful units of measurements can be defined. Potential clinical applications are also described.

Adaptation, Psychological↗
PubMed1993

Overview of the tolerability profile of clarithromycin in preclinical and clinical trials.

Results of studies conducted to characterise local, systemic, reproductive, and mutagenic effects indicate that the new macrolide antimicrobial clarithromycin is well tolerated within reasonable multiples of the intended clinical dose. No adverse effects of clarithyromycin on male or female fertility, perinatal, or postnatal reproduction were indicated by data from rabbits, mice, rats and macaques. No evidence of mutagenic potential was revealed from various in vitro and in vivo study methodologies. Evidence of low potential for ototoxicity, oculotoxicity, hepatotoxicity and nephrotoxicity was provided in studies involving rats, dogs and primates. In agreement with studies with other macrolides, venous irritation potential for the intravenous lactobionate salt formulation was substantial in rabbit studies. In addition, the safety profile of this agent has been evaluated on the basis of adverse reactions and abnormal laboratory values seen in phase I, II and III international clinical trials conducted in adults. The most frequently reported adverse reactions occurring in 3768 patients receiving clarithromycin in phase II and III trials were nausea (3.8%), diarrhoea (3.0%), abdominal pain (1.9%) and headache (1.7%). Adverse reactions were not serious and were usually rapidly reversible. The incidence of adverse reactions did not vary with gender, race or age. Adverse reaction rates were comparable to or less than those of comparator beta-lactams and macrolides. Overall, clarithromycin appears to be a safe and well-tolerated macrolide antimicrobial agent.

Animals↗
PubMed1993

Buflomedil: one-year oral safety evaluation in rats.

Buflomedil was given as a dietary mix to Sprague-Dawley Rats for one year at dosages of 0, 25, 75, and 400 mg/kg/day. Each group contained thirty rats of each sex, of which 10/sex/group were preassigned to a withdrawal period of 3 months following the 1-year drug administration period. There were no treatment-related deaths or clinical signs. Dosage-related decreases in body weight gain occurred during the 1-year treatment period. Food consumption was comparable to controls, except for a 10% decrease in high-dosage males during the first week of treatment. During the withdrawal period, body weight gain was higher than controls in all drug-treated groups. Hematocrit (PCV) and hemoglobin were slightly decreased during week 52 in high-dosage males; hematology values were comparable to controls during weeks 13 and 26 and at the end of the withdrawal period. There were no treatment-related changes in blood biochemistry. Urine pH was decreased in females at 75 mg/kg/day and in both sexes at 400 mg/kg/day. Discolored urine was observed in males at 75 mg/kg/day and in both sexes at 400 mg/kg/day. Urine pH and color were comparable to controls after the 3-month withdrawal period. There were slight decreases compared to controls in urine volume at all dosages in females during week 52; these changes were still evident in the mid- and high-dosage groups at the end of the withdrawal period. The only possibly treatment-related observation at necropsy was dirty tails at the end of the treatment period in the high-dosage group which may have been related to the discolored urine. Liver and kidney weights were slightly increased in males at 400 mg/kg/day at the end of the 1-year treatment period; these changes were not evident after the 3-month withdrawal period. There were no treatment-related histopathological changes. The changes observed were thought to result from either pharmacologic activity or physiological adaptation to compound administration or were marginal in severity. None were considered toxicologically significant. Therefore, the no-toxic-effect dosage was 400 mg/kg/day which is 40 times the maximum clinical dosage.

Animal Feed↗
PubMed1993

Fluid shifts induced by the administration of 7.5% sodium chloride in 6% dextran 70 (HSD) in dehydrated swine.

This study determined the effects of HSD administration on fluid distribution, following dehydration in Female Yucatan micro pigs. Dehydration at 33 degrees C resulted in: significantly increased core temperature (37.2 +/- 0.2 (mean +/- SE) to 39.0 +/- 0.1 degrees C), and decreased (4.4 +/- 0.4%) body weight and plasma volume (PV, 43 +/- 2 to 37 +/- 1 ml/kg). HSD but not saline administration resulted in significant increases (over postdehydration levels) in PV (46 +/- 3 ml/kg), sodium concentration (141 +/- 1 to 150 +/- 2 mEq/L), and osmolality (291 +/- 2 to 307 +/- 11 mOsm). Following return of water to the animals, these values returned to baseline levels. Since insensible (respiratory and transdermal) water loss for the 24 hr at 23 degrees C was 714 +/- 64 ml, and for the 24 hr at 33 degrees C was 653 +/- 64 ml, increasing the ambient temperature did not result in increased dehydration in swine. HSD administration restored PV to baseline levels despite prior water loss dehydration.

Animals↗
PubMed1992

Agitation and restlessness after closed head injury: a prospective study of 100 consecutive admissions.

Agitation and restlessness are two of the most striking and problematic behaviors for patients with traumatic brain injury (TBI), their caregivers, and their families. These behaviors are often treated with physical and chemical restraints which have potentially harmful side effects. There are, however, few prospective studies which clearly define agitation and restlessness in a representative sample of TBI patients. Subjects for this study were 100 consecutive patients with traumatic, closed head injury (CHI) admitted to a regional Level I Trauma Center with a Glasgow Coma Scale score of less than 8, who had more than one hour of coma, and who required more than one week of hospitalization. Agitation was defined as episodic motor or verbal behavior which interfered with patient care or clearly required physical or chemical restraints to prevent damage to persons or property. This variable was rated on the Overt Aggression Scale, a 16-item scale, in four categories: verbal aggression; physical aggression against objects; physical aggression against self; or physical aggression directed at others. Systematic direct observations, caregiver interviews, and chart reviews were used to determine the frequency and duration of agitation. Patients were also monitored for restlessness, which was defined as behavior that interfered with staff or required some action by staff, such as change of activity, but either did not meet the severity criteria for agitation, or was continuous. Only 11 of the 100 subjects exhibited episodic agitation which met the criteria. Eight subjects were agitated for one week, one for two weeks, one for three weeks, and one for four weeks. Only one subject went directly from being unresponsive to being agitated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Effects of a GnRH agonist on fertility following administration to prepubertal male and female rats.

Leuprolide, a GnRH agonist, was administered daily to male and female rats for 90 days. Animals were sexually immature (25 days old) at the outset. Dosages were 20 and 200 micrograms/kg/day. Five males and five females were euthanized on Day 91. Sex organs were weighed and evaluated for histopathologic changes. These procedures were repeated 140 days later. Following a recovery period lasting 45 days (onset of normal-appearing estrous cycles) in females and 140 days (two spermatogenic cycles) in males, the fertility of these rats was assessed by mating with untreated animals. Treated males gained less weight while treated females gained more weight than controls. Weights of primary and secondary sex organs were reduced below control, but returned to normal following 140 days of recovery. Treated males were fertile and produced normal litters. Reproductive performance of low-dosage (20 micrograms/kg/day) females was normal 45 days after treatment cessation, but half of the high-dosage (200 micrograms/kg/day) females failed to become pregnant. However, reproductive performance of this group compared well with control performance after an additional 6 weeks of recovery. Atrophic changes were noted in male and female sex organs. Following 140 days of recovery, ovaries, uterus, vagina, prostate, and seminal vesicle were normal. Although testes and epididymides showed partial recovery at this time, multifocal or segmental atrophy and mineralization were noted in portions of some seminiferous tubules.

Animals↗
PubMed1992

Hypnosis for the treatment of burn pain.

The clinical utility of hypnosis for controlling pain during burn wound debridement was investigated. Thirty hospitalized burn patients and their nurses submitted visual analog scales (VAS) for pain during 2 consecutive daily wound debridements. On the 1st day, patients and nurses submitted baseline VAS ratings. Before the next day's would debridement, Ss received hypnosis, attention and information, or no treatment. Only hypnotized Ss reported significant pain reductions relative to pretreatment baseline. This result was corroborated by nurse VAS ratings. Findings indicate that hypnosis is a viable adjunct treatment for burn pain. Theoretical and practical implications and future research directions are discussed.

Adolescent↗
PubMed1992

Driving evaluation after traumatic brain injury.

Traumatic closed head injury results in a variety of cognitive and behavioral deficits that may be difficult to assess fully. Adequately evaluating driving safety is a common and important problem for health care professionals. The purpose of this study was to examine the relationship between standardized measures of cognitive function and measures of driving performance in patients with closed head injuries and in their age-matched relative or friend cohorts. Thirteen patients were evaluated. They had each sustained a closed head injury (followed by more than 1 h of coma) 3 to 6 months before testing. Their scores were analyzed along with those of seven cohorts. Assessments of cognitive function and behind-the-wheel driving performance were conducted by examiners blinded to subjects' group membership and medical condition. There was a significant relationship (r = 0.44) between the sum of rated scores of the Tactual Performance Test and Trail Making Test and the global pass/fail ratings of the behind-the-wheel driving test, but it was not related to the driving performance score. The difference between the verbal and performance IQs, and the difference between the block design and other performance tests of the Wechsler Adult Intelligence Scale-Revised were also not significantly related to driving performance. These results suggest that tests of cognitive function alone are not adequate to predict driving performance, and should be used along with standardized driving performance evaluations before recommendations are made.

Adolescent↗
PubMed1992

The treatment of agitation during initial hospitalization after traumatic brain injury.

Agitation after traumatic brain injury is disruptive for patient care, distressing, and difficult to treat. The use of propranolol has been advocated to control agitation after brain injury. It reportedly lacks some of the deleterious cognitive and emotional effects of other medications and physical restraints. This study was designed to test if propranolol is effective in reducing agitated behavior. Subjects had traumatic closed-head injury treated at a combined Level I Trauma Center and Rehabilitation Center. Twenty-one subjects met the criteria of agitation and were treated with propranolol or placebo in a double-blind fashion. The intensity of agitation was significantly lower in the treatment group although the number of episodes were similar. The use of restraints was also significantly lower in the treatment group. The results support the effectiveness of propranolol in reducing the intensity of agitation during the initial hospitalization after closed-head injury.

Aggression↗
PubMed1991

Quinolone toxicity: methods of assessment.

The newer quinolones, the fluoroquinolones, are represented by norfloxacin, ciprofloxacin, ofloxacin, and newer agents such as temafloxacin. These agents represent an improvement over their quinolone counterparts in many ways, including a wider spectrum of antimicrobial activity, improved pharmacokinetic properties, clinical efficacy against a wider range of diseases, and fewer and less severe adverse effects. The focus of preclinical evaluation of fluoroquinolone toxicity is guided by earlier data gathered from the quinolones on the juvenile joint, the kidney, the eye, and the central nervous system (CNS). Animal studies with the fluoroquinolones (norfloxacin, ciprofloxacin, ofloxacin, and temafloxacin) show similar arthropathic damage to the joints of young animals as did the earlier investigations with quinolones. Effects on the kidney that have been reported with quinolones and fluoroquinolones include mild interstitial nephritis, occult blood in urine, decreased renal function, increased renal weight, and crystalluria. These effects are not believed to be a direct toxic effect, but secondary to precipitation of foreign material in the kidney with a neutral or alkaline urine. Because human urine is not normally alkaline, related toxicities should theoretically not be a problem, and clinical data to date generally support this thesis. Ocular toxicity consisting of lenticular opacities in rats and dogs, electrical and histopathologic changes in cats, and electrical changes in dogs have been reported after fluoroquinolone administration; this toxicity does not appear to be a problem in human use. CNS effects have been noted in both animals and humans. Convulsions have been observed with concomitant administration of enoxacin and fenbufen.

4-Quinolones↗
PubMed1991

Potentially fatal asthma: the problem of noncompliance.

In spite of available pharmacologic therapy that controls even the most severe cases of asthma, the mortality rate from asthma continues to rise. Patients with potentially fatal asthma (PFA) must be identified and then treated in a manner that will prevent potentially fatal episodes of asthma. Such management will not result in control of patients with PFA when the patient is not compliant with the medical regimen. We report and classify ten PFA patients according to the apparent psychologic abnormality that resulted in, or contributed to the noncompliance. Some of these psychologic abnormalities in patients with PFA such as adolescent noncompliance, prednisonephobia or bipolar affective disorders may be responsive to a combination of medical and psychiatric management. Other psychiatric diseases that may occur in patients with PFA, such as antisocial personality disorders or schizophrenia, may have a poor prognosis even with combined medical and psychiatric care. The managing physician should be aware of the grave prognosis in such cases.

Adolescent↗
PubMed1991

The allergic patient who is noncompliant and abusive: dealing with the adverse experience.

The field of Allergy-Immunology is involved with the care of patients with chronic illness. The care of these patients is enhanced when the physician has established good rapport with the patient. The noncompliant, disruptive behavior of some patients can try the patience of even the most understanding physicians and, in turn, impede the delivery of care. Interactions with this type of patient may leave the physician with feelings of guilt, frustration, and helplessness. We review such an encounter with the purpose of describing how to deal with this type of patient and to guide the physician in responding to this adverse behavior. Such patients will usually require limits to be set on behavioral acting out for their own best interest. Further, it is often necessary to make continued care contingent on compliance with the ground rules set. The physician must be aware of his or her adverse feelings toward the patient and be able to interpret the behavior in the context of the psychiatric disorder so that appropriate psychologic help for the patient can be provided.

Administration, Inhalation↗