PubMed Health⌕ Search

Biomedical subjects

J F MacMillan

Publications and source records attributed to J F MacMillan.

8 recordsLinked to original sources
PubMed2001

Discharge of the asthmatic patient.

Asthma continues to be a challenging disease to treat in both the inpatient and outpatient settings. The growing database on therapeutic interventions at the time of transition from the acute to chronic phase of this disease is encouraging. Glucocorticoids and inhaled beta-agonists clearly reduce readmission and relapse. Other medications and educational interventions also appear effective. Still, no true discharge guidelines have been established. Multiple statements by consensus panels have recommended using FEV1 or PEFR as indicators of readiness for discharge, but this has not been prospectively validated from either the emergency department or inpatient setting. In contrast, some studies argue that pulmonary functions do not accurately predict relapse and readmission, so the usefulness of these discharge recommendations is debatable. Large studies, especially in the adult asthmatic population, are needed to validate these recommendation.

Adolescent↗
PubMed1992

Dangerous behaviour preceding first admissions for schizophrenia.

Of 253 patients in their first schizophrenic episode, 52 behaved in a way threatening to the lives of others before their admission to hospital. These 52 patients were studied from data collected at the time of their initial presentation. Despite a history of illness in excess of 1 year in 24 cases, and evidence that violence was motivated by psychotic symptoms in 23 cases, fewer than half of the patients were admitted to hospital as a direct result of their dangerous behaviour. Life-threatening behaviour was more common where the patient had been ill for longer, and where there were delusions of being poisoned.

Adolescent↗
PubMed1986

The Northwick Park Study of first episodes of schizophrenia. I. Presentation of the illness and problems relating to admission.

Patients referred over 28 months from nine medical centres for a trial of prophylactic neuroleptic medication following first episodes of schizophrenic illness (462) were assessed with the Present State Examination, WHO scales for disability, past history, and sociodemographic factors, and a rating of disturbed behaviour; 253 fulfilled the study criteria; of the 209 who did not, 54 did not meet the diagnostic criteria, 65 had a history of a previous episode, and in 15 the psychotic illness was found to have an organic basis. The interval between onset of illness and admission varied widely, but was often more than one year and associated with severe behavioural disturbance and family difficulty e.g. in arranging appropriate care. Current arrangements for initiating management of first schizophrenic illnesses are frequently unsatisfactory.

Adolescent↗
PubMed1986

A randomised controlled trial of prophylactic neuroleptic treatment.

Out of 253 patients fulfilling criteria for a first episode of schizophrenic illness, 120 entered a randomised placebo-controlled trial of maintenance neuroleptic medication on discharge; they were followed to relapse or loss to follow-up, for two years or to the end of the study. Of those on active medication, 46% relapsed, as did 62% of those on placebo; the most important determinant of relapse was duration of illness prior to starting neuroleptic medication. This finding might be because extended duration of symptoms before admission is more likely to be present in illnesses which in any case will have poor prognosis, or because susceptibility to relapse is reduced by early institution of treatment. The study provides no data on which a decision between these alternative explanations can be based.

Adolescent↗
PubMed1986

Short-term outcome in trial entrants and trial eligible patients.

Of 253 patients from nine medical centres identified with first episodes of schizophrenic illness, 17 did not achieve discharge during the period of trial recruitment. 120 entered a randomised controlled trial of neuroleptic medication and were followed-up, as were 116 who were eligible for the trial but did not enter it. Overall, 60% of the sample had relapsed within two years of discharge; age, sex, ethnic origin, duration of admission, social withdrawal before admission, and type of onset of illness were not significantly related to relapse. Relapse rates were lower on active trial or standard medication than placebo, but however assessed, outcome at this early stage was poor for many patients.

Adolescent↗
PubMed1986

Expressed emotion and relapse.

The relatives of 82 patients in a study of first episodes of schizophrenia were interviewed within six weeks of the index admission; 77 patients were subsequently discharged, and were followed to relapse or readmission. Analysis of relapse-free survival time was used to examine whether the components of 'expressed emotion' predicted relapse or response to neuroleptic medication: 'critical comments' by relatives was the only component present often enough to be used and was inversely related to 'social contact'. When preadmission duration of illness, and neuroleptic medication following discharge (identified previously as significant predictors of outcome) were taken into account, neither 'critical comments' nor 'social contact' were related to outcome nor to response to medication. The constellation of factors suggested as pathogenic was present only in a minority of cases: many patients lived alone and of those that were with families, most were not in high face-to-face contact with other members. The failure of the components of 'expressed emotion' to predict outcome or response to neuroleptic medication suggests that at best, such factors are weak predictors of liability to relapse. Their influence is unlikely to be comparable in magnitude to that of neuroleptic medication.

Adolescent↗
PubMed1981

Institutionalization and the defects of schizophrenia.

Patients conforming to the Feighner criteria for schizophrenia who had been discharged from hospital were traced after 5-9 years. They were assessed in terms of mental state and cognitive, behavioural and neurological functioning; the results of these assessments were related to information obtained from casenotes. The findings of this study of 120 discharged patients were compared with those of an earlier study of 510 in-patients with schizophrenia. When factors of age and duration of illness were taken into account, there was no difference between the two groups in terms of positive or negative schizophrenic features or behavioural performance, although the in-patients performed less well on cognitive tests. This study indicates that the deficits of chronic schizophrenia are an integral feature of the disease process, and that any effects of institutionalisation are relatively small.

Adult↗