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Biomedical subjects

P R May

Publications and source records attributed to P R May.

At least 19 recordsLinked to original sources
PubMed1979

Woodpecker drilling behavior. An endorsement of the rotational theory of impact brain injury.

High-speed cinematograph films of a drilling woodpecker were examined by direct visual inspection and by a microdensitometer and computer-imaging technique. These showed (1) that the drilling trajectory is essentially linear, with very little, if any, rotation of the head; (2) that there is minimal movement after impact; (3) that the impact velocity is of the order of 600 to 700 cm/s; and (4) that the impact deceleration is of the order of 1,000 g. Dynamic and morphologic findings in the woodpecker may be highly relevant to the prevention of concussion and brain injury in man. Taken in the context of modern packaging technology and other animal and mathematical modelling research, they suggest that brain injury preventive systems could be greatly improved over those now in common use.

Animals↗
PubMed1979

Approaches to reliability in a clinical simulation study.

Discusses the reliability of measurements made by 48 raters who used the Problem Dysfunction Rating Scale (PDRS) under simulated routine clinical record-keeping conditions. Ten- to 15-minute videotape interviews of two simulated patients with predefined problems were shown to a multidisciplinary psychiatric hospital staff of varying educational background and clinical experience. These raters were given only brief instructions and no training in the use of the PDRS. Statistical analysis included application of the usual, traditional test and retest variation studies and used variance components and comparison to random rating models. A random contrast of rater agreement was found to index most realistically reliability in instances such as this, in which a large number of raters rate a small number of items. There was greater intrarater consistency than interrater agreement, and it was concluded that when reasonably adequate information was available the degree of dysfunction due to patients' problems could be rated on the PDRS with a useful degree of consistency by untrained raters.

Hospitals, Psychiatric↗
PubMed1979

And if that doesn't work, what next ...? A study of treatment failures in schizophrenia.

A systematic study of schizophrenic patients who did not respond satisfactorily to one of five different forms of treatment given under controlled conditions showed that almost all of them responded satisfactorily to subsequent treatment with the combination of ataraxic drugs and group psychotherapy. Whatever the original form of treatment, and despite subsequent retreatment with drugs and group psychotherapy, there was a treatment-resistant core--a few patients who either responded very slowly or who improved relatively little.

Adolescent↗
PubMed1979

The hospital and optimal chemotherapy in schizophrenia.

With some schizophrenics, response to antipsychotic drugs is best monitored in the hospital. They include dysphoric responders, those whose illness has been only minimally responsive to antipsychotic drugs, and habitual noncompliers with drug regimen. Dysphoric responses need to be acknowledged and regarded as a danger signal. Patients whose illness is only modestly sensitive to drugs are particularly in danger of psychotoxicity due to excessive dosage. Habitual noncompliers have little investment in staying well, and cannot be expected to bear even mild drug side-effects.

Antipsychotic Agents↗
PubMed1978

Therapist characteristics and the outcome of treatment in schizophrenia.

The broad task of identifying and characterizing specific components of personality and behaviours of therapists that may be differentially helpful in the treatment of schizophrenia still remains to be addressed. This report presents data systematically collected in the course of a controlled study of the outcome of five different treatment methods in schizophrenia. Therapists seem to play a significant role in determining the outcome of the treatment of schizophrenia by drugs and by psychotherapy plus drugs. The salient therapist behaviors that seem to make a difference in outcome are yet to be identified and studied. The A-B dimension as customarily defined seems of little value for this task. The findings show a distinct need to identify cognitive and affective personality characteristics of the therapist relevant to eliciting patient cooperation, and the degree of knowledge and sophistication in the use of particular methods of treatment necessary for good results.

Adult↗
PubMed1978

Subjective response as a predictor of outcome in pharmacotherapy: the consumer has a point.

Forty-two newly admitted patients with a schizophrenic illness were given a test dose of chlorpromazine, and their subjective response was graded on a euphoric-dysphoric continuum. Subjective response at 4, 24, and 48 hours after the test dose was significantly correlated with the subsequent outcome of a therapeutic course of treatment with chlorpromazine, as measured by the Brief Psychiatric Rating Scale, the Global Assessment Scale, and a write-in symptom scale. An early dysphoric response to chlorpromazine seemed to augur a poor prognosis for further treatment with the drug. These findings suggest that the subjective response to a test dose of chlorpromazine may be a useful predictor of short-term symptomatic outcome.

Chlorpromazine↗
PubMed1978

Plasma levels of chlorpromazine in schizophrenia; a critical review of the literature.

Measurment of chloropromazine and metabolite levels in the blood has not yet developed such that it can help the clinician. Apart from their chemistry, the clinical aspects of the experimentql design of most studies leave much to be desired, so that it is not possible to draw any overall conclusions about the relationship between chlorpromazine blood levels and clinical outcome from the data currently available. Measurement of response to a single test dose may prove potentially more fruitful in predicting outcome and in establishing drug and dosage choice for a given patient than simple attempts to correlate sustained dosage levels with clinical response. For chlorpromazine, indeed for any drug, it would seem wise in the first instance to focus clinically well-designed studies on the parent substance, rather than launching into more costly, but clinically unsophisticated, studies of its metabolites.

Adolescent↗
PubMed1978

Test dose response in schizophrenia: chlorpromazine blood and saliva levels.

A gas chromatographic/mass spectrometric method for measuring chlorpromazine using 2H6--labeled chlorpromazine as an internal standard has the potential for considerable precision and specificity. Results are reported of chlorpromazine levels in plasma and saliva after administration of a single test dose to 13 schizophrenic patients in a tightly designed experiment. There was a clear and substantive relationship between blood and saliva levels of chlorpromazine, both following a typical decay curve. Saliva and plasma levels were strongly associated for a particular patient, and there was even a strong consistency in saliva-plasma ratios between patients, with an overall statistically significant correlation between plasma and saliva levels for all measurement on all 13 patients. In general, it seems that saliva sampling has great potential as a simple noninvasive technique for investigation of chlorpromazine and other antipsychotic drugs in psychotic patients. Nevertheless, for the moment, it should be regarded as strictly experimental and not suitable for immediate clinical application.

Adult↗
PubMed1978

Drug and family therapy in the aftercare of acute schizophrenics.

After a brief inpatient hospitalization, 104 acute, young schizophrenics, stratified by premorbid adjustment, were randomly assigned to one of four aftercare conditions for a six-week controlled trial. Conditions involved one of two dose levels of fluphenazine enanthate (1 ml or 0.25 ml) and presence or absence of crisis-oriented family therapy. Relapses during the six-week period and at six-month follow-up were least in patients who received both high-dose and family therapy (0%) and greatest (48%) in the low-dose-no therapy group. Brief Psychiatric Rating Scale symptom ratings disclosed a significant family therapy effect at six weeks that was sustained at six months only for therapy patients originally receiving the high drug dose. Numerous interactions were found between premorbid adjustment status and response to the two treatment conditions.

Acute Disease↗
PubMed1978

The role of operations research and systems analysis in holding down the costs of hospitals and clinics.

In the past, medical care facilities have concentrated primarily on professional clinical evaluation. With the cost of treatment rising rapidly, it is becoming increasingly important to critically review and analyze our delivery systems so that scarce resources can be used optimally. In this paper the applications of operations research (O.R.) and systems analysis techniques that have been employed successfully in private industry are explored to find ways to improve clinical operations and hold costs down.

Costs and Cost Analysis↗
PubMed1977

Mixed motives in the kitchen--current recipes for improving quality of care.

Program evaluation is a new field vested with high and often unrealistic and conflicting expectations from many quarters. Instead of being clear and realistic, evaluators have tended to react blindly to the various demands, compounding the confusion by engaging in unproved, even potentially counterproductive, efforts. A more constructive type of evaluation is needed--a cooperative enterprise in which information is obtained as a service for a client, with his full and meaningful participation in designing the evaluation and in the interpretation and implementation of the results.

Community Mental Health Services↗
PubMed1977

For better or for worse? Outcome variance with psychotherapy and other treatments for schizophrenia.

It has been suggested that psychotherapy makes some persons better and some worse, and that this might account for the findings of some studies that there was no significant difference between the mean improvement scores of psychotherapy and control groups. The results of a controlled study indicate, however, that psychotherapy alone did not significantly increase outcome variance in schizophrenia by comparison to a control group. In fact, there was a nonsignificant tendency to decreased variability. Ataraxic drugs alone, psychotherapy plus ataraxic drugs, and ECT had significant variance-reducing effects. There is no convincing evidence, either in the literature or from the findings of this study, that a greater outcome variability results from psychotherapy than that resulting from hospitalization and nursing care (control). Our findings support the view that by comparison with a control group, a treatment for schizophrenia reduces outcome variance in proportion to its efficacy on the particular criterion under study.

Electroconvulsive Therapy↗
PubMed1977

Improving patient care through measurement: goal importance and achievement scaling.

Sophisticated treatment record keeping requires something more than a focus on problems. An emphasis on positive aspects of treatment, i.e., on goals may be more appropriate for certain patients or for certain types of treatment or at specific stages of an illness. Unfortunately, currently available methods of quantifying goal importance and achievement are not entirely satisfactory for general everday use. GIA is proposed as a simple procedure for quantifying judgments of the importance of a treatment goal, of the extent to which that goal is achieved and of determining the social value of what treatment has accomplished. GIA ratings have considerable potential for improving patient care through measurement.

Humans↗
PubMed1976

Woodpeckers and head injury.

The woodpecker is an experiment in Nature, a model for the investigation of mechanisms of basic importance for head injury and its prevention. A preliminary anatomical study of the woodpecker's head suggests that it may be fruitful to explore impact protective systems which are radically different from those in common use.

Animals↗
PubMed1976

Schizophrenia--a follow-up study of results of treatment. I. Design and other problems.

This is the first of a series of articles on a follow-up study of the results of treatment of schizophrenia, studied over a period of two to five years after first admission and first release. The study compares the follow-up outcome of five different treatment methods given to first-admission male and female schizophrenic patients in the hospital. The design of the study is used as a basis for description and discussion of the practical, ethical, and statistical problems involved. A distinction is made between follow-up and continued treatment design, and it is concluded that both pose massive problems in execution, analysis, presentation, and interpretation.

Female↗