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Biomedical subjects

L Kofoed

Publications and source records attributed to L Kofoed.

At least 19 recordsLinked to original sources
PubMed1999

Case series: clonidine has no systematic effects on PR or QTc intervals in children.

This study retrospectively examined the effects of clonidine, both alone and combined with psychostimulants, on the electrocardiograms (ECGs) of children and adolescents. Two pediatric cardiologists, blinded to treatment condition, examined pre- and posttreatment ECGs in 42 subjects treated with clonidine for attention-deficit/hyperactivity or tic disorder. While ECG variability was found, it did not appear to be related to any systematic effect of clonidine, either alone or in combination with psychostimulants. These data do not rule out the possibility of rare idiosyncratic reactions to clonidine with or without psychostimulants, though none occurred in this sample.

Adolescent↗
PubMed1998

Effectiveness of methylphenidate in Native American children with fetal alcohol syndrome and attention deficit/hyperactivity disorder: a controlled pilot study.

This pilot study was designed to assess the short-term effectiveness and side effects of methylphenidate in treating symptoms of attention deficit hyperactivity disorder (ADHD) in Native American children (5 to 12 years old) with documented fetal alcohol syndrome (FAS) or partial fetal alcohol syndrome. Using strict criteria for the diagnosis of FAS and ADHD, a randomized double-blind cross-over study of two placebos and a fixed dose of methylphenidate was completed in 4 Native American children in a residential school. Each treatment condition lasted 5 days, and daily observational outcome measures, the Conners Parent Rating Scale (CPRS-48), and the Conners Teacher Rating Scale (CTRS-39), were employed. Methylphenidate significantly improved scores of the Hyperactivity Index Scale on the CPRS-48 and the CTRS-39 but not the Daydreaming-Attention score on the CTRS-39. Side effects were similar to those traditionally found in other populations. The promising preliminary results suggest that a more definitive study of methylphenidate in Native and non-Native children with FAS and ADHD is warranted.

Adolescent↗
PubMed1996

"Video lottery" and treatment for pathological gambling. A natural experiment in South Dakota.

Four agencies which offer specialized treatment for pathological gambling provided data on the number of inquiries about gambling treatment and the actual number of gamblers treated before, during, and after the shutdown of video lottery in the state of South Dakota. A marked decrease in the number of inquiries and number of gamblers treated was seen during the time the machines were turned off as compared to the time periods when video lottery gambling was available. The results suggest that the accessibility and availability of video lottery machines is an important factor in the number of people being adversely impacted by gambling.

Adult↗
PubMed1996

Clinical pathway effects on treatment of the alcohol withdrawal syndrome.

We investigated whether initiating a clinical pathway, that incorporated the use of an alcohol withdrawal assessment scale, would decrease length of stay (LOS) for and/or amount of benzodiazepine prescribed during uncomplicated alcohol detoxification. We retrospectively reviewed alcohol detoxification admissions on an inpatient unit: 66 admissions before, 56 after, and 75 admissions 1-year after initiation of the pathway. Admissions were grouped into completers and non-completers. Comparison of group means before and after pathway implementation demonstrated a significant decrease in LOS for completers of the detoxification service from 7.35 to 4.77 days, and from 6.67 to 4.31 days for all admissions. Similarly, total benzodiazepine exposure decreased to a third of the mg amount given per admission prior to the pathway. There were no increases in the "irregular" discharge rate or complication rate. These findings suggest that a clinical pathway, with an incorporated withdrawal assessment scale, can decrease LOS and benzodiazepine prescribing on an alcohol detoxification unit.

Alcohol Withdrawal Delirium↗
PubMed1993

Alcoholism and drug abuse in patients with PTSD.

The combination of PTSD and substance abuse is both common and problematic. In this chapter we review the following questions: 1) What is the relationship between PTSD, Alcoholism, and Drug Abuse? 2) Can the general "dual diagnosis" literature be of help? 3) Is the phenomenology of PTSD combined with alcoholism and/or drug abuse either unique or specific? 4) Does current pathophysiologic data allow conceptualization of a neurobiological model of PTSD, alcoholism, and drug abuse? 5) Drawing on these ideas, on the limited treatment literature, and the "dual diagnosis" literature, can we develop rational assessment and treatment approaches? Available literature suggests that diagnoses can be validly applied to these patients; that the illnesses must be treated simultaneously as co-primary illnesses; that extreme psychological symptoms reduce the efficacy of alcoholism or drug abuse treatment; and that effective control of these symptoms improves treatment outcome.

Alcoholism↗
PubMed1993

Outpatient vs. inpatient treatment for the chronically mentally ill with substance use disorders.

Treatment decisions about complex patients with both substance use disorders and chronic mental illness cannot be reduced to an inpatient vs. outpatient dichotomy. Treatment progresses through a series of stages, in each of which we must make decisions about treatment settings and approaches. I discuss treatment decisions within the framework of a staged treatment model, reviewing decisions to be made during stabilization, engagement, persuasion, active (or primary) treatment, and relapse prevention (or aftercare).

Ambulatory Care↗
PubMed1989

Darwinian evolution of social behavior: implications for group psychotherapy.

Medicine typically looks to biology for guidance in examining complexity. Application of biological principles to social processes has not been easy. Still, we need not abandon biology in the study of complex social phenomena. Biologists have come to view the study of proximate form and function (revealed by disciplines such as anatomy, psychology and physiology) versus the study of how the form and function ultimately "got to be" (revealed by disciplines such as ethology and sociobiology) as distinct and complementary levels of understanding (Lorenz 1981; Mayr 1982). Though we cannot undertake in this paper explication of the value of understanding the ultimate, as well as the proximate, in studying biological phenomena, interested readers will find a comprehensive discussion in Mayr. The evolutionary principles structuring social interactions are becoming understood and hold promise as a biologically valid system for organizing and guiding the study of complex social behaviors (Essock-Vitale and Fairbanks 1979; Kofoed and MacMillan 1987). Psychological processes have evolved in varying complexities as mechanisms to enable and guide social behavior, increasing the probability that such behavior will be adaptive in a wide variety of circumstances (Trivers 1971). Dynamic and social psychologies describe the proximate internal and interactive intricacies that have resulted from this process but cannot help us understand the goals evolution has "naturally designed" (Thompson 1986) these mechanisms to achieve. The hypothesized drives or instincts underlying most psychological models, often derived from a simplistic understanding of evolutionary theory, are usually simply taken for granted in the development of these models.(ABSTRACT TRUNCATED AT 250 WORDS)

Biological Evolution↗
PubMed1989

The malpractice claims experience of physicians investigated for inappropriate prescribing.

Inappropriate prescribing of controlled substances, primarily opiates and benzodiazepines, is the most common complaint brought before the Oregon Board of Medical Examiners. We describe the malpractice claims experience of 120 physicians previously investigated by the Oregon board for inappropriate prescribing. These physicians were matched with a comparison group by age, specialty, and practice location. We found that a mean of one malpractice claim had been filed against each physician in our study, with the specialties of obstetrics and gynecology, neurosurgery, and orthopedics having the most claims. A significantly higher mean number of malpractice claims had been filed against 31 physicians disciplined by the board. Our study suggests a role for state regulatory boards in the malpractice area. We propose that such bodies do practice reviews based on the convergence of two events, a disciplinary action such as those described in this article and the filing of more than one malpractice claim against a physician. Further research is needed on inappropriate prescribing by physicians and its possible association with malpractice.

Drug Prescriptions↗
PubMed1989

Physicians investigated for inappropriate prescribing by the Oregon Board of Medical Examiners.

We retrospectively reviewed all allegations of inappropriate prescribing investigated by the Oregon Board of Medical Examiners from 1981 through 1986. Inappropriate prescription writing accounted for 51% of all investigations during this period, with controlled drugs, primarily opiates and benzodiazepines, accounting for most complaints. Of 130 physicians investigated, more than half had previous complaints; 50 were ultimately restricted or disciplined by the board. Inappropriate prescribing of controlled drugs is probably underdetected and frequently repeated. Available literature suggests that inappropriate prescribing of other drugs, especially antibiotics, is extremely common, but such problems were rarely identified by the current discovery and review processes of the Oregon board. Inappropriate prescribing will require increased attention from physician educators and licensing boards.

Adult↗