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Biomedical subjects

P Fox

Publications and source records attributed to P Fox.

At least 19 recordsLinked to original sources
PubMed1992

Implications for expressed emotion therapy within a family therapeutic context.

Expressed emotion instruments measure variant levels of criticism, blaming, and anger within families of mentally ill people. Some theorists believe that high levels of expressed emotion predispose schizophrenic patients for relapse. However, recent trends in family therapy indicate that high expressed emotion may naturally result from caring for an ill family member. Families may therefore often feel unfairly blamed by practitioners for causing mental illness. The author examines the usefulness of integrating expressed emotion measures into family therapy from three theoretical perspectives: the transactional perspective, the coping and adaptation perspective, and the systems perspective. Each of these perspectives provides a framework for incorporating expressed emotion measures into the broader context of research on and treatment of schizophrenia. The author postulates that appropriate controls designed to reduce pent-up emotion in families must accompany expressed emotion interventions in family therapy. Appropriate controls might include exercise, meditation, spiritual focus, or membership in a support group.

Adaptation, Psychological↗
PubMed1991

A randomized clinical trial of scatter photocoagulation of proliferative sickle cell retinopathy.

A randomized prospective clinical trial of argon laser scatter photocoagulation therapy for proliferative sickle cell retinopathy was performed on 116 patients (174 eyes) in Kingston, Jamaica. Ninety-nine eyes were treated with scatter photocoagulation and 75 eyes served as controls. The average length of follow-up was 42 months for the control eyes and 47 months for the treated eyes. Prolonged loss of visual acuity was statistically significantly reduced in the treated eyes. The incidence of vitreous hemorrhage was also significantly reduced in the treated eyes after controlling for the previously defined risk factors of vitreous hemorrhage and extent of proliferative sickle cell retinopathy at entry into the study. There were no complications associated with argon laser scatter photocoagulation. Scatter photocoagulation of proliferative sickle cell retinopathy is currently the most effective and safe way to treat patients with sea fan neovascularization.

Adult↗
PubMed1989

From senility to Alzheimer's disease: the rise of the Alzheimer's disease movement.

Alzheimer's disease, once a rarely applied medical diagnosis, is now considered to be the fourth or fifth leading cause of death in the United States. Several interrelated factors account for the disease's ascendancy as the preferred category to characterize specific types of neuropsychiatric problems associated with aging. These include a shift in the disease's conceptualization, the emergence of an institutional structure facilitating increased awareness of the disease, and the growth of a constituency advocating greater spending for and expansion of research on the disorder. A biological phenomenon was transformed into a social issue when persons took concerted action to promote Alzheimer's disease as a major social and health problem affecting the elderly.

Aged↗
PubMed1988

The contribution of a non-invasive test to clinical care. The impact of echocardiography on diagnosis, management and patient anxiety.

We prospectively studied the impact of echocardiography on a cardiologist's diagnosis and management plan and on patient anxiety for 300 consecutive referrals. There was an impact on diagnosis in 90% of patients. Most common was confirmation of diagnosis usually with the addition of information pertinent to management (81%); change of disease category or resolution of diagnostic doubt was uncommon (9%). The consultant cardiologist believed the heart to be normal in 48 patients who did not have any associated disease; none had any echocardiographic abnormality. The cardiologist reported increased diagnostic confidence in 74% of all patients but management changed in only 9%. One-third of all patients reported reduced anxiety when this was an important clinical issue but in less than half of them did the cardiologist consider that echocardiographic information was essential for reassurance. Anxiety was increased in 6%, and in 12% the anxiety response was inconsistent with the test result. The clinical contribution of the test report was most obvious for those patients (30%) in whom this data was required for (a) a decision concerning specific diagnostic or technical intervention (b) a change of management plan which implied obvious or likely health benefit (c) reassurance which was a clinically important issue. The magnitude of this contribution was related to the study indication. The value of echocardiography is obvious when assessing patients for invasive intervention or when proper treatment or adequate reassurance are impeded by diagnostic doubt. However, for many current indications, we need better definition of factors which predict a clinically useful result. In particular, when the aim is to rule-out disease, our results suggest that an expert cardiological opinion would often be more appropriate than an echocardiogram.

Adult↗
PubMed1986

Prospective payment for psychiatry--feasibility and impact.

Although 15 diagnosis-related groups (DRGs) have been proposed for psychiatric hospital patients, psychiatric hospitals are currently exempt from the DRG prospective payment system. We investigated the ability of the psychiatric DRGs to predict the hospital length of stay and costs by retrospectively analyzing the charts of 8816 randomly selected patients from 32 psychiatric hospitals throughout the United States. In addition, we developed other grouping systems to see whether they would have been better predictors of length of stay. We found that grouping the patients in the 15 psychiatric DRGs reduced the total variance in length of stay by only 3.9 percent. Furthermore, our best alternative grouping--based on major diagnostic categories, whether the patient was transferred from another facility, age, and psychiatric complications and comorbidities--reduced the variance by only 7.8 percent. We conclude that DRGs do not adequately predict length of stay or costs in psychiatric hospitals. We identified factors other than diagnosis that predicted the length of stay better, but all the models we tested would create large financial "winners" and "losers" and thus introduce inappropriate incentives into the care of patients in psychiatric hospitals.

Costs and Cost Analysis↗
PubMed1986

Gd-DTPA contrast enhancement and tissue differentiation in MR imaging of experimental breast carcinoma.

Gadolinium-DTPA (Gd-DTPA) enhancement of magnetic resonance (MR) imaging was tested for diagnostic utility in evaluating carcinoma. Human breast carcinoma implanted in ten nude mice was studied before and after injection of Gd-DTPA at two different doses (0.2 and 0.5 mmol/kg body weight). Before injection, all tumors appeared homogeneous in intensity on spin-echo images; after injection, it was possible to distinguish areas of strong enhancement from areas of weak enhancement. Histologic correlations showed that the strongly enhanced areas corresponded to richly vascularized connective tissue and apparently viable tumoral tissues, while the weakly enhanced areas corresponded to nonvascularized necrotic tissue. The results indicate that intravenously administered paramagnetic agents such as Gd-DTPA may improve the specificity and diagnostic accuracy of MR imaging by permitting better differentiation of tumor elements.

Adult↗
PubMed1986

The application of positron emission tomography to the study of panic disorder.

Positron emission tomography was used to study eight patients with panic disorder who were vulnerable to lactate-induced panic, eight patients with panic disorder who were not vulnerable to lactate-induced panic, and 25 normal control subjects. Patients who were vulnerable to lactate-induced panic had several abnormalities in the resting, nonpanic state: an abnormal hemispheric asymmetry of parahippocampal blood flow, blood volume, and oxygen metabolism; abnormally high whole brain metabolism; and abnormal susceptibility to episodic hyperventilation. A hypothetical model for the neurobiology of panic disorder, involving the abnormal parahippocampal region and its afferent and efferent connections, is proposed.

Adult↗
PubMed1986

The effect of SMS 201-995, a long-acting somatostatin analogue, on anterior pituitary function in healthy male volunteers.

The endocrine effect of SMS 201-995, an octapeptide analogue of somatostatin, was assessed during a combined anterior pituitary function test. There was no effect on the extent of hypoglycaemia after intravenous insulin infusion or on the subsequent rate of recovery of plasma glucose. SMS 201-995 administration, however, resulted in a profound and selective suppression of the GH response to hypoglycaemia without affecting the ACTH or cortisol responses. There was also a marked reduction of TSH release in response to intravenous TRH; the prolactin response was unimpaired. The LH response to LHRH was blunted and the FSH response unaffected. SMS 201-995 does not significantly impair the counterregulatory mechanisms in response to hypoglycaemia, and, in particular, the hypothalamic-pituitary-adrenal axis remains intact.

Adrenocorticotropic Hormone↗
PubMed1979

LSD's effect on neuron populations in visual cortex gauged by transient responses of extracellular potassium evoked by optical stimuli.

The effects of systemic LSD (10--25 micrograms/kg) on visually evoked [K+]o responses from the striate cortex have been investigated in cats. Elevation of [K+]o was dependent on the orientation, and direction of stimulus movement and showed ocular dominance. LSD most commonly produced a depression of [K+]o transients and a deterioration in their directional selectivity. These observations suggest that the effect of LSD is to produce a net depression in visually evoked neuronal firing.

Animals↗
PubMed1979

Assessment of the antihypertensive effect of atenolol with 24 h ambulatory monitoring of blood pressure.

1. Twenty-four hour intra-arterial blood pressure measurements and electrocardiograms were obtained from 12 subjects with untreated essential hypertension. 2. The patients kept records of their activity, paying particular attention to times of retiring to bed, and times of waking in the morning. 3. All subjects were treated with a single daily dose of atenolol (50 to 200 mg) for between 2 and 9 months, and then underwent a second 24 h blood pressure study. 4. Arterial blood pressure was lowered significantly throughout the 24 h period with a single daily dose of atenolol.

Adult↗
PubMed1978

The effect of mental arithmetic on blood pressure variability and baroreflex sensitivity in man.

1. Baroreflex sensitivity was tested in three normal, three borderline and one hypertensive subject before and during mental arithmetic, the prolongation of pulse interval caused by a provoked rise in blood pressure being used as a measure of baroreflex sensitivity. 2. Baroreflex sensitivity was significantly decreased during mental arithmetic. 3. During mental arithmetic the arterial pressure fluctuated markedly. 4. These findings suggest that in man, as well as animals, the defence of alerting reaction depresses baroreflex control and thus contributes to the rise in blood pressure seen at this time.

Blood Pressure↗
PubMed1978

A comparison of the biological and biochemical properties of 1-(4-amino-2-methylpyrimidin-5-yl)methyl-3-(2-chloroethyl)-3-nitrosourea and 2-[3-(2-chloroethyl)-3-nitrosoureido]-D-glucopyranose.

1-4-Amino-2-methylpyrimidin-5-yl)methyl-3-(2-chloroethyl)-3-nitrosourea (ACNU) is a water-soluble nitrosourea that has produced delayed hematological toxicity in man during Phase 1 clinical trials. ACNU has in vitro alkylating activy 40% less than that of 2-[3-(2-chloroethyl)-3-nitrosoureido]-D-glucopyranose (chlorozotocin) but shares the property of negligible carbamoylating activity with the latter compounds. ACNU is highly active against murine L1210 leukemia. However, the maximum therapeutic dose, 30 mg/kg (a dose lethal to 10% of the animals), produced a 64% reduction in peripheral WBC and an 85% decrease in circulating neutrophils in normal mice. This was correlated with a 76% inhibition of normal mouse bone marrow DNA synthesis within 24 hr after treatment, followed by full recovery within 48 hr after treatment, followed by full recovery within 48 hr. In contrast, DNA synthesis in L1210 cells was suppressed to less than 10% of control for a minimum of 72 hr. While ACNU, a pyrimidine analog, possesses many of the chemical properties of chlorozotocin, it does not share with the latter compound its reduced myelotoxicity at therapeutic doses. The glucose carrier of the chlorozotocin molecule appears to impart the selective sparing of normal bone marrow.

Animals↗