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Biomedical subjects

M Blumenfield

Publications and source records attributed to M Blumenfield.

At least 19 recordsLinked to original sources
PubMed1993

The effects of renal and hepatic disease on the pharmacokinetics, renal tolerance, and risk-benefit profile of fluoxetine.

Renal and hepatic diseases have a significant impact on the plasma concentration profiles and the dose requirements for almost all drugs. This paper reviews the effect of these diseases and their associated physiological derangements on the pharmacokinetics of fluoxetine and norfluoxetine. Metabolic studies of fluoxetine in man show that more than 70% of the radiolabelled compound is excreted in the urine. Most of the urinary radiolabelled products are metabolites and not the parent compound nor its active metabolite, norfluoxetine. Cirrhosis of the liver significantly reduces the clearance of fluoxetine and norfluoxetine, but mild, moderate, or severe renal dysfunction does not affect fluoxetine or norfluoxetine pharmacokinetics. Daily administration of fluoxetine, 20 mg, for more than 2 months to renally impaired, depressed patients (who require haemodialysis) produces steady-state fluoxetine and norfluoxetine plasma concentrations that are comparable to the concentrations in depressed patients with normal renal function. Renal function is not an important determinant of the steady-state concentrations of fluoxetine or norfluoxetine, though the concentrations may be higher in patients with significantly impaired liver function.

Adult↗
PubMed1990

Noncompliance in hospitalized patients with AIDS.

Compliance with treatment is an important concern in the management of patients with a wide array of medical disorders. A chart review of 20 hospitalized AIDS patients at one medical center was done to determine the degree of noncompliance in this extremely ill population. Ninety percent of AIDS patients declined some procedure or treatment, leading to a mean refusal rate of 19.7 refusals per 100 hospital days. Compared to a control population of male leukemics, the mean rate of refusal per hospital day among AIDS patients was over four times greater (p less than 0.05, Student's t-test, two-tailed). Reasons for noncompliance among hospitalized AIDS patients deserve further study.

AIDS Serodiagnosis↗
PubMed1987

Identification of psychologic impairment in patients with mild-moderate thermal injury: small burn, big problem.

Sixty-eight patients hospitalized at a tertiary care burn center for more than 1 week, aged 18-32 years, with a mild or moderate burn, adequate social and economic support, and the absence of preexisting psychopathology, substance abuse, or medical illness were studied. From this group 16 patients were identified who had been unable to resume social or occupational functioning even after several months and were impaired by psychologic symptoms related to the burn. Utilizing a psycho-social data base of 250 items, these "Small Burn, Big Problem" (SBBP) patients were compared to those who did not have this problem (control). There were no differences between the two groups with respect to age, sex, race, hospital length of stay, agent of injury, circumstances of the accident, extent of burn, or amount of disfigurement. The SBBP patients did develop significantly more sleep disturbances, which continued into the posthospitalization period. There were significant differences in the use of the defense mechanisms of regression and displacement, the extent of experiencing the injury as a narcisistic injury and in the indication of sexual dysfunction in the SBBP patients as compared to the control group. There were no differences in the amount of psychiatric treatment performed while the patients were in the hospital, although 68% of the SBBP group were referred for psychiatric treatment upon discharge as compared to 14% of the control group. Two case vignettes are presented to demonstrate some of the psychodynamics involved.

Adolescent↗
PubMed1987

Survey of attitudes of nurses working with AIDS patients.

This article reports the results of a ten-question anonymous survey given to nurses at Westchester County Medical Center in July 1983 and January 1984 concerning attitudes about caring for AIDS patients. Two-thirds of the responding nurses reported that they had friends or family express concern about associating with hospital personnel who have contact with AIDS patients. Other questions showed that between one fourth and one half of nurses have a fear of caring for homosexual men and male prisoners because of their awareness about AIDS. One half of the nurses believe that AIDS can be transmitted to hospital personnel because of contact with patients despite precautions. The fear of caring for patients with AIDS as compared to caring for patients with hepatitis, a more contagious but less serious disease than AIDS, was highest in the intensive care unit staff. Eighty-five percent of the health care personnel responding believed that pregnant nurses should not care for AIDS patients and one half of the nurses responding indicated that they would ask for a transfer if they had to care for AIDS patients on a regular basis. The implication of these findings for future treatment programs, medical and nursing education and psychologic support for staff are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Recognizing the role of bereavement and reactive depression in modern psychiatry.

In the modern world the recognition, understanding and treatment of bereavement in recent widows, widowers, those who experienced severe medical and surgical trauma, and victims of disasters is essential for all physicians, rescue workers such as the International Red Cross, and the community in general. This paper reviews the consequences of personal encounters with catastrophic events, as well as methods of immediate and long-term management. Similarly, the dynamic manifestations and treatment of psychologic dissonance in the family of victims, the community, and survivors are addressed. Of special interest are the problems of rescue workers, witnesses and reporters involved in disasters.

Adjustment Disorders↗
PubMed1983

Patients' fantasies about physical illness.

All patients with physical illness have an underlying fantasy concerning why they became sick. This fantasy can be elicited by the consulting psychiatrist and the treating physician. The meaning of the fantasy is consistent with the psychodynamic theory of human behavior. Also, once the fantasy is understood, it can be applied in the patient's therapy.

Adult↗
PubMed1979

Current attitudes of medical students and house staff toward terminal illness.

A survey questionnaire about attitudes toward terminal illness was administered to all medical students, interns, and all medical, surgical, and psychiatric residents at the Downstate Medical Center. The majority of students and new physicians surveyed reported that patients with terminal illness should be told their diagnosis--a reversal of attitudes as compared with those revealed by studies done before 1970. Most of the respondents also expressed the view that they would want to be told of their own fatal illness. The attitudes at different levels in medical school, internship, and residency did not differ significantly despite the differences in formal education and clinical experience of the respondents. Implications of these findings are discussed with particular emphasis on the need to teach an individualized approach to the dying patient.

Attitude of Health Personnel↗
PubMed1978

Psychological factors involved in request for elective abortion.

In order to understand the increasing numbers of women who are requesting a repeat elective abortion, 13 First Abortion and 13 Repeat Abortion patients were interviewed. There were no significant differences between the two groups. It was found that the failure of contraception was not because the women did not have access to adequate contraception. There was evidence of underlying psychological conflicts, sometimes in one and even both sexual partners. In 9 of the 26 patients there was material clearly suggesting that the women had an underlying conflictual wish to become pregnant. The data also suggests that many of the male partners had a strong wish to father a child. All of these situations suggest the need for adequate counselling.

Abortion Applicants↗