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Biomedical subjects

F M Mai

Publications and source records attributed to F M Mai.

At least 19 recordsLinked to original sources
PubMed1999

Clinical rating of compliance in chronic hemodialysis patients.

OBJECTIVE: To develop a clinical rating scale of treatment compliance for use in chronic hemodialysis patients and to test its reliability and validity. METHOD: Forty-eight of 65 patients undergoing hemodialysis treatment at the Ottawa General Hospital during June 1994 met criteria for inclusion and completed the study. Patients underwent a 10-15-minute interview, with 1 of 2 independent clinical interviewers, regarding diet, fluid intake, prescribed medication usage, smoking, alcohol or drug use, and hemodialysis treatment attendance. Following each interview, a predesigned 3-point rating scale evaluating compliance in each of 6 domains (yielding an 18-point total score) to the treatment regimen was completed. Compliance ratings on 10 patients assessed independently by both interviewers were used to establish scale reliability. Criterion validity was assessed by correlating compliance scale scores with 3 biological measures (weight gain [kg], K+ [mmol/l], and PO4 [mmol/l]). RESULTS: Reliability between clinical interviewers using the overall compliance scale score (Intraclass correlation coefficient = 0.825) as well as component subscales was high (kappa values, 0.33-1.00). Biological measures of compliance correlated well with each other but poorly with clinical ratings (range 0.01-0.16). Biological measures identified compliance as being poorer than that found with the clinical interview scale. CONCLUSIONS: The Compliance Rating Scale (CRS) was shown to be reliable but was not well-validated against selected biological measures. Discrepancies between these 2 methods of assessing compliance may be due to differing underlying compliance constructs or patient or interviewer biases. The CRS has value as a patient education tool in that it can be used to instruct patients regarding the benefits of adhering to the treatment regimen.

Chronic Disease↗
PubMed1995

"Hysteria" in clinical neurology.

Hysteria is an ancient word for a common clinical condition. Although it no longer appears in official diagnostic classifications, "hysteria" is used here as a generic term to cover both "somatoform" and "dissociative" disorders as these are related psychopathological states. This paper reviews the clinical features of four hysterical syndromes known to occur in a neurologist's practice, viz conversion, somatization and pain disorders, and psychogenic amnesia. The presence in the clinical history of a multiplicity of symptoms, prodromal stress, a "model" for the symptom(s), and secondary reinforcement all suggest the diagnosis, and minimise the need for extensive investigations to rule out organic disease. Psychodynamic, behavioral, psychophysiologic and genetic factors have been proffered to explain etiology. Appropriate treatment involves psychotherapeutic, behavioral and pharmacological techniques. A basic requirement is to avoid errors of commission such as multiple specialist referrals and invasive diagnostic and treatment procedures. Hysteria is a remediable condition if identified early and managed appropriately.

Amnesia↗
PubMed1995

Psychiatrists' attitudes to multiple personality disorder: a questionnaire study.

OBJECTIVE: To assess the attitudes of a random sample of Canadian psychiatrists to Multiple Personality Disorder (MPD) and assess the relative prevalence of the condition in three comparable cities in Ontario. METHOD: A questionnaire was sent to all psychiatrists who were members of the Canadian Psychiatric Association and who were resident in Ottawa, Kingston and London. Questions were asked on the respondent's personal clinical experience of MPD and his/her attitude to this condition. Some personal and demographic questions were also included. RESULTS: 180 out of 294 questionnaires (61.2%) were returned. The existence of MPD was doubted by 27.8% of psychiatrists who responded to the questionnaire, with a significantly higher proportion in London than in Kingston or in Ottawa. A substantial majority in all three cities agreed that media publicity and the psychiatrist's own belief system affected the prevalence of MPD. CONCLUSION: These results confirm that there is a split in the profession regarding belief in the existence of MPD as a diagnosis.

Attitude of Health Personnel↗
PubMed1993

Effects of treatment and alternative care on length of stay on a general hospital psychiatric unit--results of an audit.

Quality controls are becoming an important part of our health care system. A medical audit is one way of evaluating quality of care, and this paper describes the results of an audit conducted to investigate the reasons for a prolonged stay on a psychiatric inpatient unit. The results showed a decrease in the mean length of stay over a five year period, although the figure remained substantially above provincial norms. A review of the hospital charts of a random sample of one in six patients whose hospital stay exceeded 30 days was carried out. It revealed that in 50.0% of cases the reasons were "medically acceptable," in 10.3% the reasons were "medically unacceptable" and in 39.7% the reasons were "social and administrative" and beyond the control of the treating psychiatrist. The implication of these results are discussed.

Adult↗
PubMed1993

Psychiatric aspects of heart transplantation.

There are many practical psychiatric, social, and ethical problems which accompany heart transplantation. These include pre- and postoperative anxiety and depressive conditions, post-operative delirium, and social and family dysfunctional syndromes. This paper reviews the literature critically in the following five areas: pre-transplant evaluation, coping with surgery, postoperative sequelae, rehabilitation, and management. Although most recipients have a good outcome from the physical and psychiatric points of view, a substantial minority experience family conflicts and sexual dysfunction after surgery. An average of 45% of patients from all studies returned to full-time employment. The distinctive role and contribution of the psychiatrist on the transplant team is discussed and important areas for future research are outlined.

Adaptation, Psychological↗
PubMed1992

A Canadian medical-psychiatric inpatient service.

Patients with both psychiatric and medical illnesses present complex and, at times, difficult diagnostic and management problems. Medical-psychiatric units designed to provide integrated medical and psychiatric care have been established in the United States. This paper describes the development and structure of such a unit established at a Canadian general hospital, using psychiatric facilities and resources already in place. A one year review of the characteristics of patients discharged from the service found that their mean length of stay was similar to that of inpatients discharged from the general adult inpatient services, but shorter than that of patients discharged from the psychogeriatric service. Many of these patients had neurological conditions; coexisting affective disorders, substance abuse, organic mental syndromes and somatoform disorders were diagnosed frequently. We believe that a medical-psychiatric inpatient unit can provide integrated care to patients who might otherwise receive less than adequate care.

Adult↗
PubMed1990

Psychosocial adjustment and quality of life following heart transplantation.

This article describes the pre-operative psychosocial and quality-of-life adjustment of a consecutive series of 27 heart transplant recipients and the adjustment of the 24 survivors at 12 months follow-up. Pre-operatively, 14 had a psychiatric diagnosis and this figure had dropped to five at 12 months follow-up. Those patients without a psychiatric diagnosis preoperatively had not developed one at follow-up. There was a significant correlation between pre-operative psychiatric diagnosis and a rating of poor medical compliance. Ratings of physical activity, employment and questionnaire ratings of psychological adjustment also showed highly significant improvement at follow-up and the majority of patients were active sexually. It is concluded that heart transplantation in selected subjects with terminal heart disease results in a substantial improvement in psychosocial adjustment and quality-of-life 12 months following surgery.

Activities of Daily Living↗
PubMed1988

A controlled study of the effects of a supervised cardiovascular fitness training program on the manifestations of primary fibromyalgia.

Forty-two patients with primary fibromyalgia were randomized into a 20-week program consisting of either cardiovascular fitness (CVR) training or simple flexibility exercises (FLEX) that did not lead to enhanced cardiovascular fitness. Patients were supervised by the same medical fitness instructors. Patients in neither group had contact with members of the other group, and were blinded as to the exercise taught to the alternative group. Groups met for 60 minutes 3 times each week. The compliance rate was 90%. Thirty-eight patients completed the study (18 with CVR training and 20 with FLEX). Blind assessments (standardized in preliminary trials to achieve acceptable inter-rater agreement) were performed by the same 2 examiners. After 20 weeks, patients receiving CVR training showed significantly improved cardiovascular fitness scores compared with those receiving FLEX training (t[35] = -4.22, P less than 0.003). Logistic regression analysis showed clinically and statistically significant improvements in pain threshold scores, which were measured directly over fibrositic tender points, in patients undergoing CVR (t[35] = 2.21, P less than 0.04). There was also a trend toward improvement in pain scores (visual analog scale) in the CVR group, but this did not reach statistical significance. There was no improvement in the percentage of body area affected by fibrositic symptoms or the number of nights per week or hours per night of disturbed sleep (self-report inventories). However, compared with the FLEX group, the CVR-trained patients improved significantly in both patient and physician global assessment scores.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Beaumont's contribution to gastric psychophysiology: a reappraisal.

William Beaumont's monograph on the physiology of digestion which was first published in 1833, has become a classic in its field. In a series of experiments over a 10 year period on Alexis St. Martin, a 19 year old Canadian voyageur with a traumatic gastric fistula, Beaumont was the first to describe many important aspects of the digestive process. In two of the 238 experiments Beaumont noted gastric physiological changes induced by emotional arousal, these being bile reflux and delayed gastric emptying. Elsewhere in the book, but not in experimental context, Beaumont referred to non-specific changes in coloration and secretion of the mucous membrane induced by emotion. Modern gastric psychophysiological research has shown that emotional arousal increases, and withdrawal decreases, gastric acid secretion. It has also been shown conclusively that emotion can cause a reflux of bile into the stomach and it may delay gastric emptying. Although the main thrust of Beaumont's work was physiological, he must be credited with being the first investigator to draw attention to the role of emotional arousal in the digestive process.

Adult↗
PubMed1986

Psychiatric aspects of heart transplantation: preoperative evaluation and postoperative sequelae.

The contribution of a liaison psychiatrist to a cardiac transplant programme is described. Ninety one patients were referred to the transplant unit for assessment over four years, and of these, 86 were assessed by the psychiatrist. A high prevalence of preoperative anxiety and depression was found. Thirty four transplants were performed on 33 patients during the study and 22 patients survived. Six patients developed transient delirious episodes during the first 10 postoperative days, three showed symptoms of considerable anxiety, and three developed social and behavioural problems during the convalescent period. Subjects with higher scores on the somatic scale of the general health questionnaire showed increased postoperative mortality. In conclusion, the liaison psychiatrist is useful in evaluating and managing heart transplant patients before and after operation.

Anxiety Disorders↗
PubMed1986

Graft and donor denial in heart transplant recipients.

Eighteen of 20 survivors of a heart transplant used denial as a coping mechanism. In seven of the subjects, denial was expressed toward the graft, in five it was toward the donor, and in six it was toward both. Other feelings expressed at the time of discharge were euphoria, gratitude, curiosity, ambivalence, guilt, anxiety, and a feeling of a change in body image. The author suggests that denial serves a protective and adaptive function in heart transplant recipients.

Adaptation, Psychological↗