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Biomedical subjects

H Diamond

Publications and source records attributed to H Diamond.

At least 19 recordsLinked to original sources

Stepwise regression of psychosocial problems on global impairment ratings.

Calculated the correlations between the severity ratings for 27 psychosocial problems and global impairment ratings of daily functioning for 109 men and 206 women admitted to the outpatient services of a community mental health center. Controlling for sex and total number of problems rated, a stepwise regression analysis indicated that global impairment estimates were related to problems that represented thought processes, affect, and role functioning. The severity ratings for the thought process problems contributed the most variance (14%) toward the explanation of the global impairment ratings.

Adult

The clinical significance of Raynaud's phenomenon in systemic lupus erythematosus.

In a prospective study of 226 patients with systemic lupus erythematosus (SLE), 91 patients (40%) had Raynaud's phenomenon. These patients were compared to 135 patients without Raynaud's phenomenon. Patients with Raynaud's phenomenon had a greater incidence of arthritis (P less than 0.02), malar rash (P less than 0.003), and photosensitivity (P less than 0.03), and a lesser incidence of severe renal disease as manifested by serum creatinine over 3.0 mg/dl (P less than 0.007) or creatinine clearance below 60 ml/minute. Patients with Raynaud's phenomenon were less likely to have severe, life threatening disease and received a lower average monthly (P less than 0.01) and a lower peak daily corticosteroid dose (P less than 0.01). Fourteen patients (16%) with Raynaud's phenomenon died, compared to 41 without (30%) (P less than 0.03). Raynaud's phenomenon in patients with SLE is associated with milder disease and may be regarded as a favorable prognostic sign.

Adrenal Cortex Hormones

Prediction of multiple visits by a community mental health center's psychiatric emergency home visiting team.

Ten psychosocial characteristics of 442 patients treated by a psychiatric-emergency home visiting team were studied to determine whether or not those variables were related to further calls for emergency home visits. Changes in the patients' clinical conditions between first and second visits were also assessed. There were no significant changes between first and second visits, and only the display of bizarre behavior during the first visit was positively related to the number of subsequent visits. The implications of these findings for psychiatric-emergency team crisis intervention are discussed.

Community Mental Health Services

Pulmonary function in scleroderma.

Pulmonary function tests were performed in 45 patients with scleroderma. Thirteen patients (29%) were found to have restrictive disease, 12 patients (27%) were found to have obstructive disease, and 19 patients (42%) had small airway disease (SAD). Smoking did not seem to be a factor underlying either obstructive or small airway disease in these patients. A low diffusing capacity was most common in patients with restrictive disease and rarely the only abnormality in pulmonary function. SAD was usually found in patients who had normal chest radiographs and no pulmonary symptoms and was often the only abnormality. SAD is therefore an early and sensitive indicator of pulmonary involvement in scleroderma.

Adult

Colchicine in the treatment of scleroderma.

We treated 10 patients with well established scleroderma with colchicine in the highest tolerated dose for one year. We could determine no clinical or laboratory improvement in any patient. Progression of disease was suggested by the development of new skin ulcers and telangiectasia, by an increase in musculoskeletal complaints, and by a significantly diminished ability to make a fist. In addition, there was deterioration of pulmonary function as demonstrated by a statistically significant fall in FEV1, and diffusing capacity. Colchicine was not of value in the treatment of scleroderma in this group of patients.

Adult

Effect of vasopressin on uric acid excretion: evidence for distal nephron reabsorption of urate in man.

1. When changes in urine flow rate were induced by vasopressin administration in eight subjects, urate excretion decreased by a mean of 14% and was positively correlated with urine flow rate (r = 0.88, P less than 0.01). The effect of vasopressin on urate excretion was not influenced by prior changes in extracellular fluid volume. 2. Mannitol administration in a dose sufficient to prevent vasopressin-induced alterations in urine flow rate blocked the effect of vasopressin on urate excretion. 3. Alterations in urate excretion produced by changes in extracellular fluid volume could be distinguished from the urate-retaining effect of vasopressin-mediated decrease in urine flow. Urate retention after vasopressin was entirely attributed to a decrease in pyrazinamide-suppressible urate excretion, consistent with either decreased secretion or enhanced post-secretory reabsorption of urate. 4. Since diminished urine flow rate in the distal part of the nephron is more likely to lead to enhanced reabsorption of urate, these results provide additional evidence for urate reabsorption in the distal part of the nephron.

Adult

Peer review of prescribing patterns in a CMHC.

Monitoring the prescribing patterns of psychiatrists is a challenging and now necessary professional responsibility. The authors describe a peer review and feedback system in a decentralized CMHC, linked to continuing education in psychopharmacology, that made staff psychiatrists familiar with the state of the art and accountable for practice within its guidelines. Data are presented that confirm shifts from polypharmacy toward more appropriate use of psychotropic medications.

Community Mental Health Services

Influence of volume expansion, serum sodium, and fractional excretion of sodium on urate excretion.

The relative contributions of volume expansion and increased fractional excretion of sodium to the uricosuria of saline infusion were assessed in 19 subjects by volume expansion with rapid infusion of 21 of hypertonic saline (3%), isotonic saline (0.9%), or hypotonic saline (0.45%). Urate excretion increased 385 mug/min (P less than 0.01) with hypertonic, 145 mug/min (P less than 0.05) with isotonic saline, and 294 mug/min (P less than 0.001) with hyptonic saline. When 150 meq of sodium chloride was administered as appropriate volumes of hypertonic, isotonic of hypotonic saline, the magnitude or uricosuria was correlated with volume load (r = 0.66, P less than 0.002). fractional excretion of sodium correlated with infusion volumes for all studies taken together (r = 0.35, P greater than 0.1). The relationship between fractional excretion of sodium and fractional excretion of urate was entirely attributed to their correlation with infusion volume. Both post-pyrazinamide urate excretion and pyrazinamide suppressible urate excretion increased with volume expansion.

Adolescent

Naproxen and aspirin in rheumatoid arthritis: a multicenter double-blind crossover comparison study.

One hundred nineteen adults with active definite or classical rheumatoid arthritis were studied in a multicenter double-blind crossover study of naproxen (500 mg/day) and aspirin (3.6 Gm/day). Each drug was given in sequence for a six-week study period. Patients already receiving corticosteriod and/or gold therapy were maintained at constant dose throughout the study, but analgesics and other nonsteroidal antiinflammatory agents were discontinued at baseline. Objective and subjective evaluations by both investigator and patient were carried out at two-week intervals. No significant difference in global evaluation of efficacy or individual measures of efficacy was observed between aspirin and naproxen therapy, although physicians' global evaluation tended to favor naproxen. Sedimentation rate was lower on aspirin (naproxen 43.1 mm/hr; aspirin 38.7 mm/hr; P=0.02). Naproxen, 250 mg twice daily, was significantly better tolerated than aspirin, 900 mg four times daily. Mild, moderate, and severe side effects were less frequent with naproxen. The incidence of heartburn was significantly lower on naproxen, and significantly fewer patients terminated their six-week study period on naproxen than on aspirin. There were no significant deviations from baseline values in hematocrit, white cell or differential counts, or in tests of renal and hepatic function during the course of the study.

Anti-Inflammatory Agents

Prednisone and azathioprine compared to prednisone plus low-dose azathioprine and cyclophosphamide in the treatment of diffuse lupus nephritis.

A 1-year double-blind crossover study comparing prednisone and azathioprine to prednisone plus low-dose azathioprine and cyclophosphamide was carried out in 14 patients with diffuse lupus nephritis. Low-dose triple therapy had no apparent therapeutic advantage over prednisone plus azathioprine. Cyclophosphamide-induced ovarian failure and hematuria were not avoided by its use in low dose.

Adolescent