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Biomedical subjects

John Holmes

Publications and source records attributed to John Holmes.

14 recordsLinked to original sources
PubMed2006

The management of behavioural and psychiatric symptoms in delirium.

Delirium is a common and usually reversible syndrome occurring during a period of physical illness. It is most common in children and the elderly. The primary treatment of delirium focuses on the underlying cause, but behavioural and psychiatric symptoms are sometimes of sufficient severity to treat. If behavioural and environmental interventions are ineffective, psychotropic medication may be needed. This paper reviews the drugs commonly used in the management of behavioural and psychiatric symptoms in delirium, and suggests the need for further trials.

Antipsychotic Agents↗
PubMed2005

Individualized survival curves improve satisfaction with cancer risk management decisions in women with BRCA1/2 mutations.

PURPOSE: Women with BRCA1/2 mutations are faced with complex decisions about breast and ovarian cancer risk management. This study was conducted to determine the effect of a tailored decision support system (DSS) that provides individualized survival and cancer incidence curves specific to expected outcomes of alternative management strategies. PATIENTS AND METHODS: This was a double-blind, randomized controlled trial of 32 women with BRCA1/2 mutations. Primary outcome measures were decision satisfaction, cancer anxiety, perceptions of cancer risk given alternative management strategies, and management decisions. RESULTS: Twenty-seven women completed a 6-week follow-up. Women in the intervention arm (n = 13) reported significantly higher decision satisfaction at follow-up than women in the control arm (n = 14; adjusted mean difference, 9.7; P < .0005). The effect of the DSS was greater among women with low cancer anxiety at baseline than women with high cancer anxiety at baseline (P = .01 for interaction). However, the DSS did not significantly alter cancer anxiety at follow-up, perceptions of cancer risk given alternative management strategies, or management decisions. CONCLUSION: The presentation of individualized survival and incidence curves for alternative management options improves satisfaction about cancer risk management decisions among women with BRCA1/2 mutations without increasing anxiety or changing management decisions. The benefit of the DSS is greatest among women with relatively low cancer-related anxiety at baseline.

Adult↗
PubMed2005

Provision of care for older people with co-morbid mental illness in general hospitals: general nurses' perceptions of their training needs.

INTRODUCTION: There are high levels of co-morbid mental illness amongst older people in general hospitals; this study explored the training needs of general nurses to care for this group. METHOD: Focus groups with general nurses were analysed using framework analysis. FINDINGS AND CONCLUSION: Nurses wanted training, but did not believe that training alone was sufficient to improve care, expressing that more integrated working between acute and mental health services was also needed. Liaison mental health services provide a way to deliver both training and a more integrated service.

Aged↗
PubMed2005

A cluster of thyrotoxicosis associated with consumption of a soy milk product.

OBJECTIVE: To determine whether a New Zealand cluster of thyrotoxicosis with low uptake on scintiscan was associated with soy milk consumption. METHOD: A case-control study was conducted, with controls matched by age, sex, and region. RESULTS: All cases (5/5) and one control (1/30) consumed soy milk before the index date. The cases all drank a brand of soy milk that had unexpectedly high levels of iodine. In a simple unmatched unadjusted analysis, the lower bound of the 95% confidence interval for the odds ratio was 19. CONCLUSION: This cluster was associated with consumption of a soy milk product. The thyrotoxicosis was probably due to iodine-induced thyrotoxicosis. IMPLICATIONS: This investigation raises issues about quality control in manufacturing processes and the monitoring of food products for their safety. It also raises issues about public and health professional awareness of the potential health effects from food additives in some processed foods.

Case-Control Studies↗
PubMed2004

Capacity and coercion: dilemmas in the discharge of older people with dementia from general hospital settings.

Discharge planning of older people with dementia can present difficult ethical dilemmas to the general hospital clinician. These difficulties may be particularly pronounced for those who are moderately severely affected and for whom hazards are anticipated on discharge home. In many cases the wishes of the individual to return home may differ markedly from those of health care professionals, carers or relatives. In order to reduce these tensions and preserve the choice of the individual as far as possible, we try to put into context a number of different issues. We discuss some of the misconceptions regarding the legal powers available in these situations, the limited and sometimes confusing issue of capacity and the role of Community Mental Health Teams in preserving autonomy and independence of older people with dementia in their own homes.

Aged↗
PubMed2003

A UK survey of psychiatric services for older people in general hospitals.

BACKGROUND: Psychiatric illness is common in older people in general hospitals, but little is known of the service models operating in the UK, or of the views of old age psychiatrists regarding service provision in this area. We set out to determine the range of UK old age psychiatry service models for older people in general hospital wards, and the opinions of clinicians on future service priorities and development. METHOD: A postal questionnaire survey of old age psychiatrists providing psychiatric services to older people in general hospital wards. RESULTS: 73% of services were provided through a generic, sector-based, consultation psychiatry model. The remaining 27% employed a range of general hospital-based liaison psychiatry services for older people, involved in proactively seeking referrals and educating general hospital staff. Those providing a generic sector-based model were significantly slower at responding to referrals. 89% of respondents were unhappy with their service to older people in general hospital wards, with only 11% preferring the generic sector-based model. Organisational barriers to change identified included the management of mental health care and physical care by different organisations. Training, both of psychiatric staff in this specialist area, and of general hospital staff in the detection and basic management of common psychiatric conditions in the general hospital setting, was felt to be necessary. CONCLUSIONS: The management of co-morbid psychiatric and physical illness in older people is an important issue for health services. Old age psychiatrists are unhappy with the prevalent, reactive, consultation-based model, preferring a range of liaison psychiatry models based in the general hospital. The most important barriers to service development in this area were the separate managerial arrangements for psychiatric and physical care services, and a lack of evidence for effective old age psychiatry services in this setting.

Aged↗
PubMed2003

Residents' perspectives on the use of the Internet to improve infectious disease reporting.

Reports of infectious diseases to local and state public health agencies are often delayed and incomplete. Some of the clinicians charged with the responsibility for making notifications encounter various difficulties in reporting. These may include heavy patient loads that make it easy to forget to file reports, or cumbersome disease reporting mechanisms and systems. For some percentage of practitioners, knowledge of what and when to report infectious diseases is less than optimal. However, it is not clear how reporting methods or systems could be designed or improved, owing to lack of data on physicians' knowledge and views about them. We conducted a survey of resident physicians at three university teaching hospitals in Pennsylvania to ascertain their knowledge about reporting timeframe and responsibility, as well as their attitudes toward various methods to enhance disease reporting.

Attitude of Health Personnel↗
PubMed2003

Computer games may be good for your health: shifting healthcare behavior via interactive drama videogames.

There is increasing evidence that interactive learning systems have an important role in reducing health risks and improving general health status. This theater style demonstration is aimed at harnessing people's passions for videogames and the movies, and a major purpose of this research is to explore alternative ways for a game generator to help authors to introduce entertainment and free play as well as learning by teaching into role playing games and interactive dramas that are behavioral interventions in disguise.

Health Behavior↗
PubMed2002

Computer games may be good for your health.

Computer-based games and interactive simulators have matured to the point where they can have a significant impact on healthcare behavior decisions. Initial results from using one such game (Heart Sense) indicate that it can improve recognition of heart attack symptoms and shift behavioral issues so as to reduce pre-hospitalization delay in seeking treatment--thereby reducing myocardial infarction mortality and morbidity.

Computer Simulation↗