Craniofacial development: knockout mice take one on the chin.
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Animals↗
Biomedical subjects
J Richman
Publications and source records attributed to J Richman.
A 67-year-old woman with a progressive gait disturbance.
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Aged↗
Jokes as a projective technique: the humor of psychiatric patients.
Jokes were obtained from psychiatric patients during the course of diagnostic testing and interviewing. The material was subjected to a content analysis which included the nature of the main characters and their relationships, the situations presented, and the major overt and concealed themes. This paper discusses and gives examples of the projective and psychodynamic value of humor in professional practice. The jokes helped in the understanding of diagnosis, symptoms, and basic conflicts. They provided guidelines for treatment and the treatment plan. They depicted the struggles of the participants to cope with relationships, problems, crises, and change. None of these struggles were unique to patients. Jokes cut through professional distinctions and diagnostic classifications, and present the person behind the label. They reflect the nature of the self especially in its more troubling and problematic aspects; yet they also reveal the healthy and intact part of the person. Jokes were valuable as a projective method because they constituted a non-threatening vehicle for revealing otherwise threatening and concealed truths about the person; they communicate those aspects of the human condition that are most anxiety provoking; and last, but not least, they end the interview on an enjoyable and positive note.
Adult↗
Results of a program to improve the process of inpatient care of adult asthmatics.
OBJECTIVE: To assess the effectiveness of a program to improve care of adult patients hospitalized for asthma. DESIGN: Retrospective analysis of patient and house staff education, patterns of medication use, spacer use, peak flowmeter use, and length of stay before and after team intervention. SETTING: A 960-bed teaching hospital in New York City. PATIENTS: All patients admitted to the hospital with a primary diagnosis of acute asthma exacerbation for 2 separate similar calendar periods, 1 year apart, before and after program intervention. We excluded patients who were hospitalized for less than 24 h or greater than 10 days. The preintervention group comprised 61 patients and the postintervention group 65 patients, well matched in their demographic characteristics and severity of disease. INTERVENTIONS: Using a team approach, we analyzed the process of inpatient treatment of asthma exacerbation, identified root causes for quality deficiency, and implemented specific improvements in the process. These included dedicated nurses who focused on the education of care providers and patients, a personalized attending-intern educational approach, and improvement in the supply and delivery of spacers, peak flowmeters, and medications to the patients. RESULTS: There was a significant increase in use of spacers, peak flowmeters, and inhaled corticosteroids. Systemic corticosteroid and methylxanthine use declined. Length of stay was reduced without increasing early hospital readmission rates. CONCLUSIONS: This program improved the treatment process of adults hospitalized for asthma.
Acute Disease↗
Varus migration of PCA stems.
Forty-seven patients with cementless, porous-coated anatomic hip replacements were evaluated after a minimum 2-year follow up with specific attention to varus migration of the stem. A cadaver study was done to define a relationship between projected size of the lesser trochanter seen radiographically, rotation of the femur, and stem position. Seven (15%) of the stems migrated into varus with the distal tip moving laterally. Thigh pain occurred in patients with varus migration and those with no change in stem position. A lower percent canal fill was seen on the lateral radiograph (P < .001) and larger average width of radiodense lines in zone 1 superolateral, and zone 6, midstem medial (P < .005) in the patients with varus migration. Poor distal stability associated with a lower percent canal fill at the stem tip seen on the lateral radiograph may result in varus migration.
Biomechanical Phenomena↗
The lifesaving function of humor with the depressed and suicidal elderly.
This article describes situations where laughter or humor occurred during therapy with depressed and suicidal patients. Therapeutic humor is associated with five principles: (1) a positive doctor-patient relationship includes the freedom to be humorous; (2) the humor is life affirming; (3) the humor increases social cohesion; (4) the humor is interactive; (5) the humor reduces stress. The application of these principles is based upon a knowledge of the required interventions and an awareness of when humor is or is not appropriate. The main effects are symptom relief and increased cohesion. Recommendations are made to health practitioners for the optimal use of humor.
Aged↗
The cloning and expression of a human creatine transporter.
A human creatine transporter (hCRT-BS2M) cDNA clone was isolated from a human brainstem/spinal cord using a PCR and phage plaque hybridization based technique. This clone included an open reading frame of 1,905 base pairs(bp) within a 2,283bp cDNA. Northern blot hybridization detected the expression of corresponding mRNAs most prominently in the skeletal muscle, heart and kidney. Peptide sequence analysis of the hCRT-BS2M protein product revealed 12 putative transmembrane domains. The predicted protein sequence further demonstrates that the hCRT-BS2M has highly conserved amino acid identity with the other members of the sodium dependent plasma membrane transporter family. Transient expression of the hCRT-BS2M in COS-7 cells demonstrates sodium dependent [14C]creatine uptake with a KM value of 14.9 +/- 3.0 microM (n = 5) that is attenuated by creatine and selective structural analogues of creatine.
Amino Acid Sequence↗
Pulmonary function during and after total hip replacement. Findings in patients who have insertion of a femoral component with and without cement.
Eleven patients who had a femoral component inserted with cement and twenty-three who had a femoral component inserted without cement were studied prospectively for changes in the pulmonary shunt associated with total hip replacement. The levels of oxygen in the arterial blood and the platelet counts were measured preoperatively and each morning for three days after the arthroplasty. Levels of oxygen in the arterial blood were determined intraoperatively, once before and once after the femoral component was inserted. Intraoperative shunt values increased 28 per cent when a femoral component was inserted with cement (p < 0.05), but they did not change when cement was not used. The average postoperative shunt values were higher than the average preoperative shunt values for both groups of patients, but only the values on the second postoperative day after a procedure with cement were significantly higher (p < 0.05). The ability of the patient to tolerate an increase in pulmonary shunt should be assessed when the femoral component is to be cemented during total hip replacement.
Aged↗
The life review is alive and well.
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Aged↗
A rational approach to rational suicide.
Suicide is a reaction to internal and external sources of stress and the impact of life events. In the elderly these situations are prevalent in many who are not suicidal and instead choose life. They represent what may be called rational nonsuicide. They are far more frequent than rational suicide. Nevertheless, considerably more is written about rational suicide than its alternative. The reasons for this phenomenon are reviewed, and suggestions are made for a rational approach to the affirmation of life rather than its rejection, even to the very end.
Age Factors↗
Case consultation: Mary Catherine.
A case of the attempted suicide of a 66-year-old female is presented. Comment based on the chapters in this volume is presented. Specific topics of demographics, psychiatric-psychological, object relations, the attempt, and concluding comments provide an idiographic illustration of suicidal behavior in an older adult.
Aged↗
Results of a program to reduce admissions for adult asthma.
STUDY OBJECTIVE: To determine the effect of an outpatient program designed to reduce readmissions for asthma exacerbations among adults with asthma. DESIGN: Randomized patient selection with crossover. SETTING: Bellevue Hospital, New York City, New York. PATIENTS: We identified 104 adult asthmatics who had previously required multiple hospitalizations for asthma attacks. Forty-seven patients were randomly assigned to an intensive outpatient treatment clinic and 57 patients continued to receive their previous outpatient care. Nineteen patients from this latter group were then crossed to the intensive outpatient therapy clinic. INTERVENTIONS: Attenders of the intensive outpatient treatment program were treated with a vigorous medical regimen and educational program. Emphasis was placed on teaching patients aggressive self-management strategies in case of marked asthma exacerbation. MEASUREMENTS AND MAIN RESULTS: The main measurement used to determine efficacy of the study program was readmission rate and hospital days used. Prospective comparison of treated compared with untreated patients indicated that program enrollment resulted in a threefold reduction in readmission rate and a twofold reduction in hospital day use rate (P less than 0.004 and P less than 0.02, respectively). Using retrospective data with patients serving as their own controls, we found a threefold reduction in readmission rate and in hospital day use (P less than 0.003) during a 32-month follow-up period. A similar magnitude of reduction in hospital utilization was found when patients were crossed over to the intensive treatment group (P less than 0.004). CONCLUSIONS: By using a vigorous medical regimen and intensive educational program, we were able to decrease hospital use among a group of adult asthmatics who had previously required repeated readmissions for acute asthma exacerbations.
Adult↗
Comparison of ofloxacin, gentamicin, and tobramycin concentrations in tears and in vitro MICs for 90% of test organisms.
Concentrations of three anti-infective agents in tear film were monitored after one topical application in rabbits. Ofloxacin concentrations exceeded the MIC for 90% of the organisms tested (MIC90) (gram-negative and gram-positive organisms) for 240 min. Tobramycin concentrations exceeded the MIC90 for 10 min. Gentamicin concentrations exceeded the MIC90 for 20 min for gram-positive organisms and 120 min for gram-negative organisms.
Animals↗
Irlen lenses: a critical appraisal.
The purpose of this paper is to assess the credibility of the Irlen lenses, Irlen's hypotheses, and the scotopic sensitivity syndrome. The analysis includes a review of 13 pro and con research papers. Of special interest is the dichotomy which developed between researchers who were Irlen participants and the professional and scientific community who required less disputable evidence. Even the former, however, failed to find scientific support for Irlen's concept of dysfunction in the discharge rate of the retinal receptor cells. Furthermore, in the absence of any evidence that it is a separate and distinct entity, it appears that the scotopic sensitivity syndrome is, in fact, a symptom complex which results primarily from various refractive, binocular, and accommodative disorders. Some of the papers which support Irlen's hypotheses provide reason to believe that there is a strong placebo effect.
Dyslexia↗
Gender differences in the perception and utilization of social support: theoretical perspectives and an empirical test.
The authors contend that women are the more supportive, nurturing and affectively-connected sex. They argue that these gender differences result from socialization experiences which may be modified by social and occupational roles. Theoretical perspectives and research addressing this proposition are reviewed. Empirical data on support-eliciting and support-providing behaviors in a cohort of medical students are then provided to test their thesis. The data suggest that women have developed a greater sensitivity to the needs of themselves and others, leading to a greater capacity to provide support and a greater dependence upon social support for psychological well-being. Personality and developmental factors that may account for these differences are examined. The implications of these findings for gender differences in mental health are discussed.
Adult↗
Unfinished business may make poor caregivers.
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Aged↗
Parental adjustment to intrapartum and delivery room loss. The role of a hospital-based support program.
Perinatal loss prompts a unique bereavement for parents and their families that is unlike the mourning process experienced at the death of other loved ones. The Support Center For Perinatal and Childhood Death has developed a comprehensive program to provide support, counseling, and information to families who experience miscarriage, stillbirth, fetal anomalies, and therapeutic abortion for genetic or congenital abnormalities. The impact of perinatal loss is felt not only in the real loss of the wished-for child but also in the loss of self-esteem, the role of parent, and the loss of confidence in the ability to produce a healthy child. The emotional experience of miscarriage or stillbirth creates an atmosphere of despair and confusion for families anticipating a joyous event. The presence of a support counselor and medical caregivers at this time can help parents to navigate the crisis surrounding the loss in ways that promote a healthy grieving process and avert pathologic adaptations. Prenatal, intrapartum, and postpartum counseling opportunities are afforded to families as the situation and parental needs dictate. Services also are extended to other family members, with particular attention to surviving siblings who might be vulnerable to the consequences of unresolved or unacknowledged grief. Grief is experienced as a long-term process, which frequently emerges fully after discharge from the hospital and lasts well beyond the interest and stamina of supportive family members and friends. Support groups, which meet the specific needs of families who experience perinatal loss, contemplate subsequent pregnancy, or face the prenatal decision to terminate a genetically or congenitally compromised pregnancy, have been run successfully for a period of several years. Beyond the experience of intrapartum loss in the delivery room, the experience comes full circle for families who enter the delivery room again with a subsequent child. The expressed need for support in acknowledging the rekindled memories of prior loss at this poignant time are matched only by parents' needs to find reassuring ways of differentiating healthy newborns from the memory of those who died. It is often at the time of the subsequent birth that the memory of the lost child can take its proper place in the family. Stein expresses the essence of grief work and resolve: Mourning is not just feeling sad. It is the specific psychological process by which human beings become able to give up some of the feelings they have invested in a person who no longer exists, and extend their love to the living. Mourning is hard, emotional work.(ABSTRACT TRUNCATED AT 400 WORDS)
Adaptation, Psychological↗