Biomedical subjects
E D Myers
Publications and source records attributed to E D Myers.
Out-patient compliance with antidepressant medication.
A total of 89 depressed out-patients were randomly allocated to one of three groups: group A received one dose of antidepressant medication at night; group B received three doses of medication during the day; group C were allowed to choose either A or B above. Compliance with medication was assessed at three, six, nine and 12 weeks by interrogation and pill count; at the same time, depression and side-effects were rated. No overall significant difference was found between doctor-prescribed and patient-chosen regime, or between once-a-day and three-times-a-day dosage. However, compliance was significantly better in those patients who were allowed to choose, when they selected the three-times-a-day regime. There was a significant decline in compliance for all regimes over the 12 weeks. There was no evidence that better compliance produced a better therapeutic result, and possible reasons are given for this finding.
The effect of oral dextroamphetamine on plasma cortisol in major depressive disorder.
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Predicting repetition of deliberate self-harm: a review of the literature in the light of a current study.
Three hundred and sixty-five patients exhibiting deliberate self-harm (DSH) were rated for DSH repetition on the six-item predictive scale of Buglass & Horton and on a five-point predictive scale developed from a previous study by the author. The Buglass & Horton scale was more sensitive and more specific overall and for female patients, but the five-point scale predicted better for males, especially those aged under 35. The results are discussed in relation to previous work on the prediction of DSH repetition.
Predicting the response of depressed patients to biological treatment: the dexamethasone suppression test versus clinical judgement.
A dexamethasone suppression test (DST) was carried out in a heterogeneous sample of 174 depressed patients. In a subsample of 130 patients in whom biological antidepressive treatment had been commenced either because of an initial clinical judgement of 'endogenicity' or because of subsequent evidence of DST non-suppression, the response to treatment was globally assessed. The results showed no significant differences between the two groups in the numbers of patients responding favorably to treatment. The positive predictive value of DST non-suppression for a favourable response was no higher than that of clinical judgement, and there was little difference between the sensitivity and specificity of the two predictors.
The double stapling technique for low anterior resection of rectal carcinoma.
The double stapling technique (TA-55 and EEA staplers) was used to perform low anterior resections for rectal carcinomas in 79 patients (49 men, 30 women). The mean age was 66 years (range, 38 to 85 years). Curative resections were performed in 68 patients, and palliative resections in 11 patients. The mean level of the cancer from the dentate line was 9 cm (range, 5 to 16 cm). The mean follow-up has been 29 months (range, four to 58 months). Perioperative mortality was 2.5 percent (two patients). Technical problems related to the stapling technique occurred in 6 percent (five patients). The clinical anastomotic leak rate was 8 percent (six patients). There were 11 local recurrences among 68 curative resections (16 percent). Local recurrence according to individual surgeon showed marked variability (range, 0-43 percent, P greater than 0.05). There were no differences in location, differentiation, or stage in those that recurred. The mean distal resection margin for the recurrent cancer group was 3.0 cm and for the nonrecurrent group, 2.9 cm. Disturbances of continence were seen commonly (56 percent) in the first three months after surgery, but 85 percent of patients became fully continent with an acceptable bowel habit at later follow-up. The double stapling technique is useful for the restorative resection of suitable mid and low rectal cancers. The anastomotic leak rate, local recurrence rate, and functional results are acceptable.
Information, compliance and side-effects: a study of patients on antidepressant medication.
A study was carried out to elucidate whether the improved compliance associated with the provision of verbal and written information about a prescribed drug is due to the specific information or to a non-specific attention-placebo effect. 120 depressed outpatients were prescribed dothiepin and randomly allocated to one of three groups: Group A were given verbal and written information about side-effects; Group B were given verbal and written information about beneficial effects; Group C were told only that the drug was being given to treat their depression and received no written information. Compliance with medication was assessed at 3 weeks and 6 weeks by interrogation and by pill count. At the same time, side-effects were enquired for and their occurrence or non-occurrence noted. No significant differences were found between the groups in the rates of compliance at either 3 weeks or 6 weeks. When Groups A and B were combined to give a total 'information' group and compared with Group C--the 'no-information' group--the rate of compliance at 3 weeks was significantly higher (P less than 0.05) in the 'information' group. No significant differences were found between the groups in the rates of reported side-effects at either 3 weeks or 6 weeks. When Groups A and C were combined and compared with Group B (information about beneficial effects), side-effects were found to be reported significantly less frequently (P less than 0.05) in the latter at 6 weeks. Of 175 compliance estimates, 97.7% gave concordant results for estimation by interrogation and by pill count.(ABSTRACT TRUNCATED AT 250 WORDS)
Serial dexamethasone suppression tests in male chronic schizophrenic patients.
The author performed weekly dexamethasone suppression tests on five nondepressed male chronic schizophrenic patients over 12 weeks. Nonsuppression occurred three times in two patients, twice in two patients, and once in one patient.
A modified technique for long-term transverse colostomy.
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Subsequent deliberate self-harm in patients referred to a psychiatrist: a prospective study.
One thousand and five patients referred to a psychiatrist were questioned, during a routine clinical interview, about current and previous suicidal ideas and previous suicide behaviour; they were also specifically asked what made life worth living for them at the time. In a four-year case-record follow-up 102 patients (10.1 per cent) were found subsequently to have attempted deliberately to harm themselves. Such deliberate self-harm (DSH) was significantly associated with female sex, with age below 35, and with evidence of suicidal ideation and/or behavior at the time of and/or before the initial referral. To the question, "What makes life worth living for you at the present time?" a significant number of subsequent life-harmers had answered 'Nothing' or 'Not much' while a significant number of subsequent non-self-harmers had answered "Spouse and children" or "Family". The results suggest that the answers to questions about current and previous suicidal ideas and behaviour and perceptions of what makes life worth living may be useful in the prediction of deliberate self-harm.
Patient package inserts.
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Knowledge of side effects and perseverance with medication.
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The effect of forewarning on the occurrence of side-effects and discontinuance of medication in patients on dothiepin.
Dothiepin was prescribed for 100 depressed out-patients alternately allocated to one of two groups. Patients in Group A were forewarned about side-effects and patients in Group B were not forewarned. None of the patients had previously received dothiepin. After two weeks the patients were questioned regarding side-effects and continuance with medication. Eighty-nine patients were included in the final analysis. The results failed to confirm the hypotheses that forewarning patients of side-effects causes a greater number of patients to complain of such effects, or that where patients experience side-effects, forewarning is associated with any less frequent discontinuance of therapy. Compared with a previous study with amitriptyline, the results of this study are much closer to statistical significance. This may be due to the lower overall incidence of side-effects with dothiepin and calls for further work with a larger sample of patients.
Age, persistence and improvement in an open out-patient group.
The ages of 87 patients attending an open out-patient group in a general hospital psychiatric out-patient department are analysed in relation to persistence with treatment. A highly significant correlation (p smaller than .001) is obtained between increasing age and continued attendance, and a significantly greater number are found to attend for six months or more in the age-range 37-47 than at other ages. In a sub-group of 35 patients, all of whom had attended more than four sessions and had returned a questionnaire, significant correlations are obtained between age and symptomatic improvement (p smaller than .05) and between continued attendance and improvement in interpersonal relationships (p smaller than .05).
The effect of forewarning on the occurrence of side-effects and discontinuance of medication in patients on amitriptyline.
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Prophylactic lithium in recurrent affective disorders.
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Treatment of pneumatosis cystoides intestinalis with high FIO2: report of two cases.
We have successfully treated two patients with symptomatic pneumatosis cystoides intestinalis using a high FIO2 delivered by face mask, with administration interrupted at meal times. While we advocate oxygen therapy for this disease, caution must be taken to avoid the complications of high PaO2, namely proliferative and fibrotic lung changes. Close attention should be paid to the development of increasing cough, dyspnea and shortness of breath. As the frequency of the diagnosis of pneumatosis cystoides intestinalis increases, the success of high inspired oxygen as therapy should be recognized.
The relationship between bone marrow sideroblasts and iron deficiency in chronically hemodialyzed uremic subjects.
Bone marrow sideroblast counts were found to be persistently depressed to between 0 and 30 per cent in 24 uremic patients with residual renal tissue undergoing chronic dialysis therapy. Marrow sideroblastopenia notwithstanding, sideroblast counts in these subjects correlated well with iron balance, being respectively 6.6 +/- 0.8 (S.E.M.) per cent in iron depleted, and 18.2 +/- 1.7 per cent in iron-repleted individuals (p less than 0.0005). Following bilateral nephrectomy a persistent relative marrow sideroblastosis developed, counts reaching values of 46.5 +/- 3.1 per cent on average. It is suggested that this sideroblastosis is a response to reduced heme synthesis and reflects the iron removal function of ferritin granules within erythroid cells.