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Biomedical subjects

D R Patterson

Publications and source records attributed to D R Patterson.

At least 55 records · Page 3Linked to original sources
PubMed1989

Frequency of use and rated effectiveness of cognitive and behavioural coping responses to burn pain.

Cognitive and behavioural pain control coping techniques were studied in a sample of burn clinic outpatients. Forty-four subjects of generally low socioeconomic status were recruited for the study. TBSA average 8 per cent, the mean subject age was 38.1 years, and subjects reported experiencing pain during half their waking hours the previous week. The Burn Pain Questionnaire (BPQ) was used to assess the reported frequency of use and effectiveness of eight behavioural and seven cognitive coping strategies for average and severe levels of pain. The BPQ was also used to assess pain duration as a correlate of the efficacy of coping techniques. The results indicated that three behavioural techniques (listening to TV/radio/stereo, sleeping, talking about pain) and one cognitive technique (thinking about something else) were rated as effective by the majority of subjects for average levels of pain. None of the techniques were rated by subjects as useful with sever pain. Use of two behavioural approaches (use of TV/radio/stereo, talking) and two cognitive approaches (concentrating attention, imagining self elsewhere) were significantly correlated with increased pain duration. Results are discussed in terms of tailoring psychological pain control techniques to the individual needs of the patient.

Adaptation, Psychological↗
PubMed1989

Hypnotherapy as an adjunct to narcotic analgesia for the treatment of pain for burn debridement.

This paper presents a hypnotherapeutic intervention for controlling pain in severely burned patients while they go through dressing changes and wound debridement. The technique is based on Barber's (1977) Rapid Induction Analgesia (RIA) and involves hypnotizing patients in their rooms and having their nurses provide posthypnotic cues for analgesia during wound cleaning. Five subjects who underwent hypnotherapy showed reductions on their pain rating scores (Visual Analogue Scale) relative to their own baselines and to the pain curves of a historical control group (N = 8) matched for initial pain rating scores. Although the lack of randomized assignment to experimental and control groups limited the validity of the results, the findings provide encouraging preliminary evidence that RIA offers an efficient and effective method for controlling severe pain from burns.

Adult↗
PubMed1986

Neuroleptic-induced tics in two hyperactive children.

Two hyperactive boys who had developed motor and phonic tics during stimulant treatment reacted similarly to low doses of haloperidol and thioridazine. Neuroleptic-induced tics may be a consequence of presynaptic dopamine blockade.

Antipsychotic Agents↗
PubMed1985

Neuropharmacologic and neuropathologic effect of fenvalerate in mice and rats.

B6C3F1 mice and Sprague-Dawley rats displayed the characteristic signs of pyrethroid intoxication following single oral doses ranging from 56 to 320 and 133 to 1000 mg/kg fenvalerate, respectively. The LD50s for mice and rats were 180 and 776 mg/kg, respectively, with corn oil as the vehicle. Signs of neurologic deficit such as splayed gait, tremors, ataxia, and hind limb incoordination were observed at doses of greater than or equal to 100 mg/kg (mice) and greater than or equal to 133 mg/kg (rats) within 1-8 hr after dosing. These signs had disappeared in most animals within 72 hr. Slight peripheral nerve fiber damage was detected in surviving mice and rats sacrificed 10 days after dosing. The incidence and severity were dose related at doses greater than or equal to 56 and greater than or equal to 180 mg/kg; however, even at lethal doses, evidence was lacking for the presence of nerve lesions in several animals. Thus two distinct neurologic effects were observed: a reversible ataxia/incoordination and a neuropathologic effect manifested as sparse axonal damage in peripheral nerve.

Animals↗
PubMed1984

Chronic toxicity and carcinogenicity evaluation of fenvalerate in rats.

Groups of 93 male and 93 female Sprague-Dawley rats were fed diets containing 1, 5, 25, and 250 ppm fenvalerate for up to 2 yr. The control group consisted of 183 males and 183 females. Approximately 10 treatment and 20 control rats/sex . group were killed at intervals of 3, 6, 12, and 18 mo. When body weights, food consumption, hematology, clinical chemistry and organ weights did not reveal a treatment effect, two additional groups of 50 males and 50 female rats were placed on 0 or 1000 ppm fenvalerate diets and maintained for 2 yr. Body weight was decreased and organ/body weight ratios were increased in brain, liver, spleen, kidneys (females), heart (females), and testes (males) in the 1000 ppm group. Mammary and pituitary tumors were commonly observed, along with a variety of other tumors occurring randomly among all control and treatment groups. No statistically significant differences in the number and type of neoplasms were observed except for mammary tumors in females in the main study. These effects were judged not to be toxicologically significant, since mammary tumor incidences did not exceed expected incidences in aged female Sprague-Dawley rats, time to tumor appearance was unchanged, and no shift in percent benign versus malignant tumors occurred. Sarcomas identified in the subcutis and dermis in 5/51 1000-ppm-treated males were also identified in 2% (1/50), 2% (2/102), and 0-6% of concurrent, original, and historical controls, respectively. Microscopic examination did not reveal any treatment-related lesions. The no-observable-effect level was determined to be 250 ppm.

Administration, Oral↗
PubMed1982

Diffuse esophageal spasm in patients with undiagnosed chest pain.

Many previous studies have shown diffuse esophageal spasm (DES) to be an infrequent clinical disorder. Over a 15-month period, 122 patients were evaluated by low-compliance pneumohydrolic esophageal manometry. The patients were referred for obscure undiagnosed chest pain. Diffuse esophageal spasm or its variance was found in 22 patients (18%). All patients had chest pain and 77% had associated solid and liquid food dysphagia. Medical therapy included treatment with a combination of anticholinergic medications, short- and long-acting nitrates, mild sedatives, and dietary adjustments. Follow-up clinical evaluation have been obtained in 73% of patients: medical treatment alone has been successful in impressively relieving symptoms in 10 patients, two have benefited from repeat pneumatic dilatations, and one patient has improved after pneumatic dilatation and subsequent Heller myotomy. A combination of accurate clinical history, endoscopy, barium swallow, and esophageal manometry should allow a reliable diagnosis of DES with a good chance of successful medical therapy.

Esophageal Diseases↗
PubMedDate not supplied

Describing and predicting the nature of procedural pain after thermal injuries: implications for research.

A prerequisite for studying and treating burn-related pain is the establishment of a good understanding of the nature of burn-related pain. However, in most investigations of pain, researchers have failed to examine pain over time or to create summary scores that capture differences in the nature of the pain experiences of individual patients. For 10 consecutive days, 47 patients treated for burn injuries reported on three aspects of procedural pain: worst pain, sensory pain, and affective pain. Three summary pain scores were constructed for each pain dimension: average pain, variability in pain, and linear change in pain. The authors found considerable variability in pain reports from the same patient and from different patients. Analyses indicated that pain reports decreased over time and that patients who had more trait anxiety reported more pain. Patients with larger burn injuries tended to report more affective pain and tended to have a pattern of high and low pain reports that differed from patients with less severe burn injuries. These findings suggest that adequate assessment of burn pain must occur frequently over the course of a single day, as well as for the duration of each patient's care.

Adult↗
PubMedDate not supplied

The management of self-inflicted burn injuries and disruptive behavior for patients with borderline personality disorder.

One of the greatest behavioral and ethical challenges faced by a burn team is the treatment of a patient whose burn injury is the result of parasuicidal behavior. Parasuicidal behavior is defined as intentional self-injurious behavior that, although not fatal, may result in tissue damage or risk of death. There are a number of reasons, usually psychiatric, that patients engage in parasuicidal behavior; however, our contention is that the majority of these patients have a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis II diagnosis of borderline personality disorder. We describe the nature of borderline personality disorder and how it leads to disruptive behavior, including self-harm behavior, on the burn unit, We also argue that if staff members fail to recognize the borderline personality disorder diagnosis, it will lead to responses from staff that can heighten disruptive behavior. We present a series of recommendations for treating such patients with burns and an illustrative case report.

Adult↗
PubMedDate not supplied

Hypnotherapy as a treatment for pain in patients with burns: research and clinical considerations.

Hypnotherapy has increasingly been included in the management of burn patients, particularly in the area of acute pain. To better understand such issues as (1) overall efficacy of hypnotherapy to alleviate acute burn pain, (2) instances in which hypnotherapy is contraindicated, (3) interaction of hypnotherapy with medication, (4) standard induction techniques to use with various age groups, (5) role of nursing and other staff in facilitating hypnotic effects, and (6) future methodological directions, we examined the clinical and methodological merits of recent studies of hypnoanalgesia. Through a computer search of the medical literature and cross-referencing recent bibliographies, we were able to find 17 studies in which hypnotherapy was applied to the management of burns. The literature generally supports the efficacy of this approach to reduce burn pain; however, little else can be concluded from these studies. Several recent studies have applied hypnotherapy to aspects of burn care other than pain using excellent experimental designs. It is suggested that future studies of acute pain management follow suit.

Acute Disease↗
PubMedDate not supplied

Patient self-reports three months after sustaining a major burn.

As survival rates of patients with major burns increase, it is becoming more important to study the course and quality of their recovery. Few studies of the recovery of these patients exist that use a prospective design and standardized measures. This paper describes a preliminary study of the self-reported health of patients three months after sustaining a major burn. An initial analysis was conducted on selected data gathered from 29 patients as part of a more comprehensive, prospective study of burn rehabilitation outcome. Measurements analyzed included the Sickness Impact Profile (SIP), the Health-Specific Locus of Control Scale (HLC), and the total body surface area burned (TBSA). Findings showed that TBSA was related to the degree to which patients perceived they had control over their health, but few correlations were found between TBSA, and HLC scale, and the SIP scale. On the SIP, most patients reported few or no problems, but a significant minority reported major problems in one or more areas of their lives. The problems that were reported tended to cluster in the areas of vocation and emotional adjustment. These results suggest that patients with major burns should not be considered a homogeneous group with respect to rehabilitation outcome.

Adaptation, Psychological↗
PubMedDate not supplied

Relating mental health and physical function at discharge to rehabilitation status at three months postburn.

Preinjury mental health is said to be a major predictive factor in the rehabilitation progress of burn patients. However, it is unclear which component of rehabilitation (emotional v physical) is predicted by this variable; furthermore, the predictive validity of preinjury mental health has not been compared with physical variables. The present study compared preinjury mental health, physical variables, and length of hospitalization in predicting the rehabilitation progress of 59 major burn patients at three-month follow-up. Preinjury mental health was assessed by the Rand Mental Health Form; physical status, by the Upper Extremity Index (standard measures of upper limb joint mobility); and hospital stay, by the number of days of acute hospitalization. These variables were assessed at the time of discharge. Three-month rehabilitation outcome was measured by the Sickness Impact Profile, a self-report inventory that evaluates patient outcome in 12 different areas. These areas were in turn placed in the categories of disability (ie, difficulties in functioning in activities of daily living; eating) handicap (ie, difficulties in functioning in general areas of living; employment) and mental health status. In predicting mental health status at three months, preinjury mental health was significantly correlated. In predicting physical disability, physical factors were found to be important. Conversely, physical status was not significantly related to mental health outcome, and preinjury mental health was not related to physical disability. The results indicate the importance of defining outcome when attempting to predict rehabilitation progress of burn patients.

Activities of Daily Living↗
PubMedDate not supplied

Post-traumatic stress disorder in hospitalized patients with burn injuries.

The degree to which patients hospitalized for a major burn displayed symptoms of post-traumatic stress disorder or met the full criteria for this disorder was assessed during the course of hospitalization. Fifty-four consecutive patients were screened weekly for symptoms of post-traumatic stress disorder. Sixty-three percent showed intrusive recollections of the initial trauma (partial diagnostic criteria) and 16 (29.6%) of the sample met full criteria for post-traumatic stress disorder at some point during the hospitalization. None of the patients met the full diagnostic criteria at discharge from the hospital, although one did at follow-up. Post-traumatic stress disorder was found to be related to patients' total body surface area burn, length of hospital stay, sex (female patients), and lack of responsibility for the injury. The results suggest that although post-traumatic stress disorder in patients with burn injuries generally resolves without interventions other than standard hospital care, it might be preventable if patients who are at risk for developing it receive appropriate psychologic treatment soon after the injury.

Adolescent↗
PubMedDate not supplied

Practical applications of psychological techniques in controlling burn pain.

Psychological techniques can serve as useful adjuncts to opioid drugs in the control of pain from severe burns. The lack of research on the use of such interventions may reflect our failure to realize how often we apply psychological principles in everyday management of burn pain. Psychological techniques with burn pain can be divided into cognitive (avoidant and reappraisal), preparatory (sensory and procedural), behavioral (respondent and operant), and hypnotherapy categories. The manner in which each of these types of interventions can be applied to patients in the burn unit is discussed.

Behavior Therapy↗
PubMedDate not supplied

Adjunctive interventions for burn pain control: comparison of hypnosis and ativan: the 1993 Clinical Research Award.

Thirty-two patients hospitalized for the care of major burns were randomly assigned to groups that received hypnosis, lorazepam, hypnosis with lorazepam, or placebo controls as adjuncts to opioids for the control of pain during dressing changes. Analysis of scores on the Visual Analogue Scale indicated that although pain during dressing changes decreased over consecutive days, assignment to the various treatment groups did not have a differential effect. This finding was in contrast to those of earlier studies and is likely attributable to the low baseline pain scores of subjects who participated. A larger number of subjects with low baseline pain ratings will likely be necessary to replicate earlier findings. The results are argued to support the analgesic advantages of early, aggressive opioid use via PCA or through careful staff monitoring and titration of pain drugs.

Adult↗