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Biomedical subjects

H R Searight

Publications and source records attributed to H R Searight.

35 records · Page 2Linked to original sources
PubMed1992

Borderline personality disorder: diagnosis and management in primary care.

Patients with borderline personality disorder frequently present to primary care physicians. However, the personality disorder, while complicating medical treatment, is often undetected. Symptoms and clinical presentations of this disorder are described. Common co-morbid psychiatric conditions associated with borderline personality disorder include depression and substance abuse. Physically self-damaging behaviors are also common among patients with this disorder. Guidelines for managing these patients in the hospital and ambulatory care clinic are provided.

Adult↗
PubMed1992

Screening for alcohol abuse in primary care: current status and research needs.

Alcohol dependence and abuse are current problems for about 10% of the American population. Patients with alcohol involvement are over-represented in primary care settings. However, a number of these patients may not be detected as being alcohol abusing/dependent by their physicians. Current alcohol screening measures are reviewed. It is likely that a systematic combination of psychosocial self-report data and biomedical information can improve detection of alcohol-abusing patients. Future directions for primary care research include further development of psychosocial screening measures, determining common clinical presentations of alcohol-abusing patients, and evaluating the effectiveness of brief counseling and physician education.

Alcoholism↗
PubMed1992

Assessing patient competence for medical decision making.

Competence frequently becomes an issue when a patient refuses a recommended surgical procedure or medication, refuses a placement option such as a nursing home or threatens to leave the hospital against medical advice. Physicians often struggle to balance the patient's right to self-determination and informed consent with their own mission to provide patients with optimal treatment. At present, few guidelines exist to assist physicians in making competence determinations. Legal precedents and conceptual issues in evaluating competence are reviewed. A protocol for assessing competence is presented.

Comprehension↗
PubMed1991

The community competence scale as a measure of functional daily living skills.

Competence assessment is of growing interest to administrators and clinicians who work with deinstitutionalized psychiatric and geriatric populations. A new instrument, the Community Competence Scale (CCS), is a multiscale structured interview administered in a similar manner to the Wechsler Intelligence Scales. The CCS requires the subject to answer questions and perform tasks which are proximal corollaries of daily living skills. The psychometric properties of the CCS are reviewed. Results of studies involving administration of the CCS to deinstitutionalized psychiatri patients and geriatric patients are presented. The available data suggest that the CCS has considerable value as a preplacement screening instrument for determination of residential settings for chronic psychiatric patients. Since the original CCS requires between 60 and 90 minutes for administration, several recent studies have focused upon development of a short form. The results of this research effort are described. In sum, the CCS appears to demonstrate considerable value as a tool to aid decision making about community placement, social skills training and clinical competence determinations.

Activities of Daily Living↗
PubMed1991

Family conflict and adolescent adjustment in intact, divorced, and blended families.

This study examined two contrasting views of how parental marital status relates to the long-term adjustment of children. The physical wholeness position views divorce and subsequent remarriage and the blending of families as salient explanatory variables that adversely affect children's later adjustment through the physical dissolution of the nuclear family; the psychological wholeness position views perceived current family conflict as the critical variable that influences adjustment, regardless of parental marital status. Results of analyses on White adolescents (N = 917) fail to support the physical wholeness position; rather, results support the psychological wholeness position. Adolescents' adjustment was related to level of perceived family conflict.

Adaptation, Psychological↗
PubMed1991

The reliability of the Family-of-Origin Scale for adolescents.

The Family-of-Origin Scale (FOS), a 40-item, ten-subscale measure of family processes, exhibits promise for assessing adolescents' perceptions of family health. While initial research has suggested that the instrument demonstrates factorial validity, the reliability of the FOS for adolescents has not been established. The present study involved administering the FOS to 88 adolescents on two occasions, with a two-week interval between testings. The global FOS index and ten subscale scores demonstrated high test-retest reliability. Internal consistency reliability for the instrument was also high. When taken together with previous research, the current study's results suggest that the FOS for adolescents is psychometrically sound.

Adaptation, Psychological↗
PubMed1990

The relation of the Halstead-Reitan neuropsychological battery to functional daily living skills in geriatric patients.

This study investigated the nature of the relationship between neuropsychological tests, the Halstead-Reitan Battery, and a measure of everyday living ability, the Community Competence Scale. The sample consisted of 40 geriatric patients referred for suspected dementia. The results indicated that neuropsychological tests were moderately predictive of measures of functional daily living skills. Although some specific neuropsychological measures, or combination of measures, were more predictive of particular functional daily living skills, their relationship did not necessarily follow logical or theoretical expectations. Thus, while it may be safe for neuropsychologists to make predictions about a patient's global capacity to function independently, predictions regarding specific functional daily living skills may be unwarranted.

Journal Article↗
PubMed1989

Correlation of two competence assessment methods in a geriatric population.

A 10-subscale version of the Community Competence Scale, a structured interview, and the Scale of Competency in Independent Living Skills, a rating scale completed by a relative, were administered to 40 geriatric patients with suspected dementia. While the two assessments of competence appear to examine a common global domain, individual correlations between subscales of the two measures were only moderate. The findings provide limited support for the construct of competence.

Activities of Daily Living↗
PubMed1989

Relation of cognitive functioning to daily living skills in a geriatric population.

A modified version of the Community Competence Scale was administered along with the Wechsler Adult Intelligence Scale--Revised (WAIS--R) to 40 geriatric patients with suspected dementia. Scores on the Competence Scale, a measure of functional daily living skills, were correlated .72 with Full Scale IQs and .77 with Verbal IQs and moderately correlated (.55) with Performance IQs. A number of significant correlations were found between WAIS--R subtests and subscales of the competence instrument. Means and standard deviations for the 10 Competence subscale and total scores are presented.

Activities of Daily Living↗
PubMed1988

Client characteristics as determinants of intervention modality and therapy progress.

The relationship between client characteristics and assignment to family or individual therapy and therapy progress was examined in 131 child cases. Assignment to family therapy was related to help-seeking variables, suggesting that the recommendation followed a therapeutic rationale. History of prior services and client's race were both associated with levels of progress, with results indicating benefits from previous therapy but problems of "fit" between traditional mental health services and minority families.

Adolescent↗
PubMed1988

The paradox of psychiatric deinstitutionalization: historical perspective and policy implications.

Deinstitutionalization has, in effect, resulted in the creation of new forms of asylum for the mentally ill. Rather than being generated in a planful, humanitarian manner, the reduction in the census of state hospitals has been governed by federal health and welfare programs not designed for the mentally ill. By relying upon Medicaid and SSI, states were able to shift their financial burden for the mentally ill to the federal government. Reliance upon Medicaid has resulted in nursing homes playing a major role in psychiatric care. SSI stipends are not adequate to cover rising housing costs--even in low-income areas. As a result, large numbers of the mentally ill are among the populations of homeless persons in the United States.

Deinstitutionalization↗
PubMed1986

The community competence scale in the placement of the deinstitutionalized mentally ill.

Little systematic research has been directed towards the determination of appropriate residential placements for deinstitutionalized psychiatric patients. A previous study suggested that the Community Competence Scale (CCS), a 124-item multiscale instrument, had potential utility for community placement decisions. In the present study, the CCS was administered to 52 deinstitutionalized patients placed in an urban boarding home, a rural boarding home, and urban apartments. No significant differences on the CCS occurred attributable to urban vs. rural setting; accordingly, the urban and rural boarding home groups were combined. The CCS discriminated between patients placed in boarding home and apartment settings after variability between the groups associated with age and diagnosis had been removed. The CCS discriminated more effectively between the groups than did prior hospitalization, subsequent rehospitalization, or the Social Competence Scale (SCS). The CCS was significantly positively correlated with the SCS and significantly negatively correlated with previous hospitalization and age.

Adult↗
PubMedDate not supplied

Psychiatric deinstitutionalization: the possibilities and the reality.

There is a substantial research data base which indicates that the majority of the chronically mentally ill can function outside of institutional settings. A number of community support programs have been implemented and positively evaluated. However, despite this evidence, large-scale deinstitutionalization of these patients has not occurred. Instead, patients have been relocated to new institutional placements such as nursing homes and single-room only hotels (SRO's). The role of Medicaid and Supplemental Security Income (SSI) in mental health care appears to have contributed to limited placement options. In addition, deinstitutionalization has created ambiguity around the degree of dependence and social role status of these patients. Recommendations are made to provide the deinstitutionalized mentally ill with a viable social role using existing financial resources.

Activities of Daily Living↗
PubMedDate not supplied

Remembering and interpreting informed consent: a qualitative study of drug trial participants.

BACKGROUND AND OBJECTIVES: Federal regulations require that research subjects provide informed consent for their participation in biomedical research. Before giving consent, subjects are presented with information about study procedures, risks, benefits, and alternatives. Although investigators have assessed subjects' retention of consent material, little is known about how participants view methodologic dimensions of biomedical research, such as placebos and randomization, or the distinction between medical treatment in a research protocol versus personal health care. These issues were examined with a qualitative interview study. METHODS: Research interviews were conducted with 14 subjects who had recently completed their participation in one of two drug trial studies. The interviews were tape-recorded and transcribed. The transcripts were analyzed and coded for thematic content. RESULTS: Participants showed a thorough understanding of important study elements, such as randomization and placebos. They described primarily altruistic motives for participating in the drug trial. There was evidence that subjects might not make a clear distinction between personal medical care and treatment in a research protocol. CONCLUSIONS: Participants viewed their involvement in research very positively. They understood most important methodologic dimensions. The findings, however, suggest that the consent process should include greater attention to the distinction between research and clinical practice.

Adult↗
PubMedDate not supplied

The Deaconess Informed Consent Comprehension Test: an assessment tool for clinical research subjects.

We developed an instrument to assess comprehension of informed consent information among 275 adults entering one of four ambulatory trials. At the conclusion of trial enrollment, subjects rated their understanding of the information presented and completed the Deaconess Informed Consent Comprehension Test (DICCT). Subjects completed the vocabulary subtest of the revised Weschler Adult Intelligence Scale (WAIS-R) and the reading subtest of the revised Wide Range Achievement Test (WRAT-R). The DICCT for 50 subjects was scored by 2 blinded investigators. Interrater agreement was 0.84 (df = 49, p < 0.001). To investigate the DICCT's potential validity, its scores were correlated with WAIS-R vocabulary scores (r = 0.44, df = 199, p < 0.01) and WRAT-R reading scores (r = 0.39, df = 268, p < 0.01). Understanding of consent information was rated as thorough by 70% of subjects. The mean +/- SD DICCT score was 20.4 +/- 3.9. The DICCT is a reliable instrument to assess comprehension of informed consent information. There is preliminary evidence for the scale's validity. The subjects believed that they had greater understanding of study information than was shown by the DICCT.

Adolescent↗