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Biomedical subjects

J R McCartney

Publications and source records attributed to J R McCartney.

At least 19 recordsLinked to original sources
PubMed1998

Confirmed abuse cases in public residential facilities for persons with mental retardation: a multi-state study.

Data regarding cases of confirmed abuse or neglect in large state-operated facilities in 6 states were collected and analyzed. Neglect and physical abuse were the most common abuse types. Incidents occurred more frequently on the afternoon-early evening shift, particularly between 3 and 6 p.m., and more frequently in residential than in nonresidential areas. In-transit activities were found to be relatively risky. The major risk factors for victims were maladaptive behavior and previous abuse victimization. Staff perpetrators were more likely to be males, assigned to the afternoon shift, newer employees, and previous perpetrators. Abuse reporters tended to be newer employees, and the likelihood of reporting abuse was increased by recent related inservice. The findings should assist administrators in focusing abuse prevention efforts.

Adult↗
PubMed1997

The multisite field trial of the consultation-liaison psychiatry assessment instrument.

A multisite field trial was conducted at 11 institutions to test the clinical reliability of a 29-item consultation-liaison (C-L) psychiatry assessment instrument. Twenty-five raters viewed videotapes of two "trainees" conducting clinical interviews with a simulated patient. One trainee was a medical student, the other was a fellow in psychiatry. Raters completed the 29-item assessment instrument for each trainee. The mean value scores reflected the skill of each trainee. The medical student had a mean score of 1.93, whereas the C-L fellow had a mean score of 3.13 which parallels the expected level of skill for the two interviewers. Eighty-six percent of the items (25/29) had a standard deviation (SD) of less than 1.0. Each of the remaining four items (14%) had a SD minimally greater than 1.0. These results reflect clear wording of items with measurable parameters defined for assessing trainees' skills. The authors present different uses for the assessment instrument, including giving feedback to trainees regarding interviewing techniques and skills; setting "gold" and "lead" standards for clinical C-L interviewing skills; and training supervisors in evaluation using a standardized assessment instrument.

Curriculum↗
PubMed1997

Recognition and treatment of depressive disorders by internal medicine attendings and housestaff.

Depression is underdiagnosed and undertreated by nonpsychiatric practitioners. Research suggests improvement is needed in the recognition and treatment of depressive disorders by primary care physicians. This study was undertaken to better understand internists' ability to recognize depressive disorders, choice of appropriate medications, dosage, and treatment patterns. Questionnaires were distributed to 45 internal medicine attendings, 45 internal medicine housestaff, and 32 adult psychiatry residents. Each questionnaire contained four vignettes: major depressive disorder (MDD), MDD with melancholic features, MDD with atypical features, and MDD with psychotic features. Eleven questions per case covered diagnoses, management, and treatment. Data analysis with intragroup comparisons on 20 internal medicine attendings, 33 internal medicine housestaff, and 32 psychiatry residents suggested that many internal medicine attendings and housestaff had difficulty in recognizing major depression and its subtypes. Although the findings indicated that internists would initiate pharmacological treatment, they frequently made incorrect or questionable pharmacological choices. Psychiatric referral or consultation was often endorsed. Our findings among internists are consistent with previous research examining other primary care physicians suggesting that depression is underdiagnosed and undertreated.

Adult↗
PubMed1997

Sexual violence, post-traumatic stress disorder and dementia.

Little is known of Post-Traumatic Stress Disorder (PTSD) in older people. No literature exists on this disorder in older women exposed to sexual assault. A case of apparent PTSD in a demented woman raises questions of the anatomy and phenomenology of this disorder. Difficulties in diagnosis in a demented population may cloud the issues or prevent a proper therapeutic outcome.

Aged↗
PubMed1996

Overdiagnosis of depression in the general hospital.

To test the hypothesis that depression is often inaccurately detected in medical settings, we examined the psychiatric consultations performed at two medical-surgical teaching hospitals. All records for the 4396 consultations seen in a 3-year period were retrospectively reviewed. Consultations were categorized by the reason for referral. These reasons were compared with the consulting psychiatrist's diagnosis. Diagnoses were grouped into "Depressed" and "Not Depressed" categories, depending on whether the psychiatric diagnoses implied any form of depressive illness (alone or in combination with other diagnoses). The majority of the referrals for psychiatric consultation (about 25% and 30% at the respective sites) were for presumed depression. Of these referrals for depression, approximately 40% were judged by the consultant to have no depressive diagnosis. Of the referrals for depression judged not to be depressed, the majority had other undiagnosed illnesses, particularly delirium, dementia, and anxiety disorders. The authors conclude that although numerous studies report that depression is unrecognized in medical patients, it may also be inappropriately suspected. This is of most concern when the presumption of depression delays other medical, neurological, or psychiatric evaluation.

Adolescent↗
PubMed1996

The effect of cimetidine and ranitidine on cognitive function in postoperative cardiac surgical patients.

OBJECTIVE: To compare the incidence of delirium in postoperative cardiac surgical patients treated with either cimetidine or ranitidine. METHOD: Cardiac surgery patients were randomized to receive either cimetidine or ranitidine postoperatively. Each patient underwent three Mini-Mental Status Examinations (MMSE) and the medical record was reviewed for pertinent past medical history, laboratory data, and evidence of delirium on three occasions: one day preoperatively (before H-2 blocker was given), in the early postoperative period (while receiving the H-2 blocker); usually two days postoperatively on the day of hospital discharge (several days after the H2 blocker had been discontinued). RESULTS: Overall, both groups in the early postoperative period showed a significant decrease in the MMSE score (27.11 +/- 4.44 to 25.38 +/-2.87, mean +/- SD; t = 5.16, p < .0005), which resolved by the time of hospital discharge. There was no significant difference between cimetidine and ranitidine. Both age and preoperative MMSE score were strongly associated with the development of delirium. CONCLUSIONS: We found no significant difference between cimetidine's versus ranitidine's effect upon cognitive functioning in the postoperative cardiac surgical patient. This was true even when controlling for age and length of stay.

Adult↗
PubMed1995

Recognition, assessment, and treatment of anxiety in the critical care patient.

A multidisciplinary group of experts involved in the treatment of critically ill patients participated in a workshop conference designed to develop practice recommendations for the recognition, assessment, and treatment of anxiety in the critical care environment. Anxiety was identified as a ubiquitous problem in critical care that may interfere with healing and recovery. The faculty agreed that clinicians should be familiar with the signs and symptoms of anxiety and should be able to determine when interventions are necessary. Whenever possible, nonpharmacologic methods for anxiolysis should be incorporated into intensive care protocols. Intensive care personnel should be trained in those interventions that require specialized expertise, and they should become familiar with the drugs available for the treatment of anxiety. Protocols for determining the best agents to be used in a given setting and their most appropriate method of administration should be established. Pharmacologic and nonpharmacologic treatments are not mutually exclusive but should be complementary. Finally, procedures for obtaining psychiatric consultation, when necessary, should be in place.

Adaptation, Psychological↗
PubMed1994

Anxiety and delirium in the intensive care unit.

To be in respiratory distress is to be anxious. To be mechanically ventilated is to be grossly uncomfortable at best. To undergo weaning in the presence of possible severe respiratory compromise, again, inevitably is anxiety provoking. Assessment of the contributing causes of agitation is essential if patients are to be managed properly. Personality factors may make different contributions to agitation, and necessitate different management approaches. One patient seeks control and another regresses to dependency more easily. Delirium, a common base for agitation, cannot be reassured away or resolved by anxiolytic agents; its root causes need to be corrected before a favorable outcome will ensue. Effective management takes a sophisticated, multidisciplined team, skilled in the physiologic and psychological management of patients. The purpose of a respiratory intensive care unit is to restore respiratory effort and integrity. The anxious patient has difficulty cooperating with weaning and respiratory toilet. The delirious patient cannot cooperate with anything. Until these agitated behaviors are differentiated and resolved, the patient remains at respiratory risk.

Anti-Anxiety Agents↗
PubMed1990

Abuse of persons with mental retardation: characteristics of the abused, the abusers, and the informers.

Data from confirmed incidents of abuse in public residential facilities were analyzed. Among the findings were that the number of confirmed incidents of abuse were relatively small, that direct care staff members committed and reported most incidents of abuse, and that most incidents of abuse occurred on the second shift. Abused residents were similar to the general resident population on basic demographic variables, but more abused residents were in the upper IQ and adaptive behavior levels. Abuse committers were more often males than females. Some tentative recommendations were given for reducing resident abuse in public residential facilities.

Adult↗
PubMed1987

Postoperative hospital course of patients with history of severe psychiatric illness.

The postoperative hospital course of 54 patients with a past history of psychiatric illness was studied through chart review. Both chronic schizophrenics and chronic depressives tolerated surgical procedures well, without any unusual difficulties or exacerbation of psychiatric illness. They represented no management problems. Patients with acute, severe upset in the preoperative period (regardless of diagnosis) presented most of the management problems postoperatively.

Humans↗
PubMed1987

Sexuality and the institutionalized elderly.

Sexuality is considered to be among the more disturbing sexual problems in skilled nursing facilities. Staff attitudes and beliefs often lead to discomfort in dealing with the continued sexual interests of patients. It is clear that if sexuality has been an important part of self-image and of coping, then it remains important. Staff reaction to two cases is used to illustrate the need for programmatic interventions with staff, residents, and families.

Aged↗
PubMed1987

Mentally retarded and nonretarded subjects' long-term recognition memory.

Mentally retarded and nonretarded teenagers' long-term recognition for faces was compared. Initially, subjects viewed 255 face pictures, with multiple exposures of some pictures provided to equate immediate memory for the groups for a portion of the data. The majority of the subjects were then tested immediately and after 1 day and 1 week using a forced-choice method. The retarded subjects performed at a lower overall level than did the nonretarded subjects, there was significant memory loss across the retention intervals, and there was no differential memory loss between the groups. A 6-month follow-up retention test revealed no further memory differences. Results suggest that long-term memory is unrelated to intelligence level.

Adolescent↗
PubMed1986

Consultation-liaison psychiatry and the teaching of ethics.

Medicine has undergone a technological explosion which presents physicians with an increased need to make difficult ethical decisions. This has been met by an equivalent development in American medical schools of efforts to teach the ethics of medical practice. The courses vary widely from school to school. It is recommended that a core curriculum of basic theory be taught in preclinical years, followed by case-centered teaching in clinical years and residency. Only with real cases can the influence of the doctor-patient relationship be appreciated. Teaching of ethics cannot be divorced from the clinical reality of the doctor-patient relationship. The emotional needs of both enter into all decisions. It is offered that consultation-liaison psychiatry, which addresses the needs of both, is an ideal focus for such teaching.

Adult↗
PubMed1986

Complex partial status epilepticus presenting as gelastic seizures: a case report.

A middle-aged man, who presented to the emergency room because of bizarre outbursts of laughter, was found to be in partial complex status epilepticus. His seizure disorder had been misdiagnosed, at various times, as a variety of "functional" psychiatric disorders. Despite proper diagnosis and aggressive treatment, management was difficult, being complicated by postictal agitation and confusion, postictal psychosis, and interictal compulsive and paranoid personality features. This case is described, and issues of diagnosis and management in partial complex epilepsy are briefly discussed. The importance of not overlooking organic and especially epileptic factors, despite the presence of prior psychiatric illness, psychologic contributors, and environmental stressors, is emphasized.

Electroencephalography↗
PubMed1986

The Framingham Type A Scale and severity of coronary artery disease.

The relationship between scores on the Framingham Type A Scale (FTAS) and angiographic severity of coronary artery disease (CAD) was examined in a sample of 50 patients undergoing diagnostic cardiac catheterization. Age and family history of coronary heart disease (CHD) were positively related to CAD severity. Contrary to prediction, the FTAS demonstrated a non-significant, inverse relationship with CAD. However, FTAS-defined Type As with at least some CAD were younger than Type Bs with CAD. This inverse relationship between FTAS scores and age was not found in patients without CAD. Thus, though the FTAS was related to a younger clinical presentation requiring catheterization, it was not associated with the severity of CAD.

Adult↗
PubMed1986

Physicians' assessment of cognitive capacity. Failure to meet the needs of the elderly.

The major task of medicine with the geriatric population is to assist with the promotion of a vigorous quality of life and maintenance of function. The key to functioning is cognitive capacity. Evidence is offered that physicians are still not assessing their patients' intellectual functioning, despite its importance not just for coping, but also for the very maintenance of life. Dementia and delirium are too frequently missed. Deficits in attitude, skill, and knowledge all contribute to this failure. It must be addressed in medical education, both in medical school and in postgraduate medical education.

Aged↗