Biomedical subjects
Publications and source records attributed to J S Kobayashi.
HIV-AIDS medical care systems that do not have full integration of mental health, alcohol, and substance use services--including the key components of prophylaxis, medication adherence, and outpatient symptom management--risk less-than-optimal outcomes. This chapter provides a model for integrated treatment.
The issues of emotional adjustment to AIDS have been inextricably linked to medical advances in fundamental knowledge about the human immunodeficiency virus and its potential therapies. In 1987 patients were struggling with the advantages and disadvantages "to do or not to do AZT (zidovudine)," whereas the choices imposed by combination therapies and the protease inhibitors in 1997 are fundamentally different and are occurring in an evolving context created by a number of striking medical advances, expanding populations, the availability of environmental support, and changing public sentiments. As the psychiatric treatment of HIV-positive individuals shifts increasingly from "AIDS specialists" to the wider therapeutic community, it is important that the therapist who has had relatively little experience with this population not assume that contemporary issues and concerns of the seropositive patient, or the patient with AIDS, are essentially those discussed widely in the earlier years of the epidemic. Patients living with this virus for a number of years have traveled a long and arduous journey and will experience more empathy from a therapist who has some knowledge of that path. Awareness of the evolution of emotional adjustment, counseling, and ethical issues of AIDS should amplify the general fund of knowledge required for good clinical management of the person living with AIDS.
The current health care reform movement offers unique opportunities to address the issue of futile care. Possible solutions include the widespread use of advance directives, particularly durable power of attorney and cardiopulmonary resuscitation directives; the establishment of regional consortia for developing guidelines for the reasonable termination of care; and the use of patient registries and structured outcome studies to identify patients for whom treatment is likely to be futile. In addition to developing guidelines, regional consortia can serve as monitors for insurers or managed care plans that may attempt to limit care inappropriately.
We report two children with choreoathetoid cerebral palsy who had intermittent, severe, paroxysmal episodes of ballismus in response to febrile illnesses. These episodes lasted for hours and were difficult to control, requiring large doses of haloperidol or phenytoin. Differentiation from seizures triggered by fever was readily made by concurrent electroencephalographic recordings.
Birth asphyxia is a major cause of neonatal mortality and morbidity. It remains difficult to predict accurately neurologic outcome among survivors, particularly infants with moderate hypoxic-ischemic encephalopathy. Visual evoked potential (VEP) is a reproducible measure of cortical function and reflects acute changes in central nervous system status secondary to asphyxial insult. We performed serial VEPs on 36 term infants with documented birth asphyxia to investigate the relationship between VEPs and neurodevelopmental outcome at 18 months of age. Fourteen infants were neurologically intact at subsequent examination; all had normal VEPs during the first week of life. Twenty-two infants had died or were significantly handicapped at 18 months of age; 20 had abnormal VEPs persisting beyond day 7 of life. Abnormal VEPs accurately predicted abnormal outcome (100%) and were both sensitive (91%) and specific (100%). In 20 infants who were classified as moderately asphyxiated according to the criteria of Sarnat and Sarnat, even greater accuracy, sensitivity, and specificity (all 100%) were observed. VEPs demonstrate good correlation with neurodevelopmental outcome in term infants with birth asphyxia and provide accurate prognostic information useful in the clinical management of these infants.