PubMed Health⌕ Search

Biomedical subjects

P R Silverman

Publications and source records attributed to P R Silverman.

At least 19 recordsLinked to original sources
PubMed2000

Research, clinical practice, and the human experience: putting the pieces together.

The work of the clinician and that of the researcher are presented as representing 2 cultures that cannot exist without each other. A third culture is described to reflect the common human experience of death and grief that invariably informs the work of both clinicians and researchers. At different times in our lives we can be both the subjects and the objects of the work in which we are involved. The author's experience as co-principal investigator with the Massachusetts General Hospital/Harvard Child Bereavement Study and the application of qualitative research is used to exemplify these ideas and demonstrate how the cultures can be integrated.

Bereavement↗
PubMed1998

Children's construction of a deceased parent: the surviving parent's contribution.

Constructing a connection to the deceased is helpful to children in adjusting to the death of a parent. Using interview data from a subset of a larger study of childhood bereavement, this paper describes ways in which parents help children, ages 10-12, build this connection, provides case examples contrasting parental attitudes and behavior that are helpful and those that are not helpful to the child, and offers implications for clinical practice.

Adaptation, Psychological↗
PubMed1997

Observations about cancer and implications for cancer control in Delaware.

Cancer is a provocative disease, made more so in Delaware because of our high cancer mortality rates. Information made available to the public is often insufficient to form a balanced perspective about the causes of cancer and appropriate interventions. Four observations are offered to guide communication and to consider in the development of cancer-related public health programs. These are: (1) focusing on our cancer mortality rank obscures important information; (2) four sites are responsible for most of the cancer in Delaware; (3) cancer intervention are based on common sense; and (4) there are limitations to what can be done to control cancer.

Delaware↗
PubMed1994

Reunions between adoptees and birth parents: the adoptive parents' view.

This article looks at the reactions of adoptive parents to reunions between their adopted children and the children's birth parents. The focus is on how adoptive parents feel the reunion affects the family's integrity. Three types of family responses are identified: (1) closed, (2) divided, and (3) open. Acceptance of the differences between families created by adoption of children and those created by childbirth was a factor in the families' openness. Closed families saw no difference, and reunion suggested to the adults that they had failed as parents. Parents in open families understood the difference in families, saw the children as separate, and felt no threat to their competence as parents. Families' need for boundaries is examined, and the way the concept of family is constructed is discussed. Implications for the practice of adoption are considered.

Adolescent↗
PubMed1992

Children's reactions in the early months after the death of a parent.

The reactions of a nonclinical group of 125 dependent children aged 6-17 years were examined within four months of the death of a parent. Focus was on normative behavior in the domains of the children's reactions to the death itself, their affective experience, their efforts at remaining connected to the deceased, their social network and support system, and changes in their families resulting from the death.

Adaptation, Psychological↗
PubMed1992

Detachment revisited: the child's reconstruction of a dead parent.

During the year following a parent's death, children in a community-based sample were found to have developed an inner construction of the dead parent. This continued, though altered, relationship appeared to facilitate their coping with the loss and with accompanying changes in their lives. Implications for understanding the bereavement process and for interventions focusing on detachment are discussed.

Adaptation, Psychological↗
PubMed1992

Can myocardial contrast echo determine coronary flow reserve?

OBJECTIVE: The aim was to evaluate the applicability of myocardial contrast echocardiography in the measurement of coronary flow reserve. METHODS: Eleven anaesthetised open chest pigs were studied, in which coronary atherosclerosis had been induced by abrasion of the left anterior descending coronary artery at one month, followed by an atherogenic diet for eight months. Coronary flow reserve was determined by electromagnetic flow measurement and contrast echocardiography before and after partial occlusion of the left anterior descending coronary artery, using papaverine as a coronary vasodilator. Coronary blood flow was reduced by tightening a clamp placed around the coronary artery. Systemic haemodynamics and myocardial wall thickness (epicardial ultrasound 5 MHz transducer) were recorded simultaneously. Echocardiograms were recorded on VHS tape and analysed by digitised videodensitometry off line for construction of the time v videointensity curve (time-intensity curves). From these curves washout time (T50), area under the curve, peak contrast intensity, and time to peak intensity were calculated. RESULTS: Following papaverine, coronary blood flow increased significantly from 47 (SD 23) ml.min-1 at baseline to 88(39) ml.min-1 (p less than 0.05). During the stenosis, flow decreased to 19(16) ml.min-1 (p less than 0.01), and increased to 38(29) ml.min-1 (p less than 0.05 v stenosis) after administration of papaverine. Correlations between coronary blood flow and indices calculated from the quantitative videodensitometric analysis were poor, varying between r = 0.03 for area at control flow to r = 0.62 for T50 during stenosis. The same was true for coronary flow reserve: r = 0.09 for peak to r = 0.75 (p less than 0.05) for time to peak without the stenosis. CONCLUSIONS: Current limitations in injection, imaging, and analysis techniques cause variability in data from time-intensity curves, which precludes accurate quantification of coronary flow (reserve) by myocardial contrast echocardiography.

Animals↗
PubMed1991

A multistate outbreak of Norwalk virus gastroenteritis associated with consumption of commercial ice.

Between 19 and 27 September 1987, a cluster of outbreaks of gastrointestinal illness occurred among persons who had attended a museum fund-raiser in Wilmington, Delaware and an intercollegiate football game in Philadelphia. A survey of four groups attending these events showed that 31% (191/614) became ill. Altogether, those who consumed ice were 12 times more likely to experience either vomiting or diarrhea than those who did not (attack rate, 55% vs. 4%, P less than .001). Ice consumed at the events was traced to a manufacturer in southeastern Pennsylvania whose wells had been contaminated when flooded by a nearby creek after a torrential rainfall on 8 September. Of 19 affected persons tested within 1 week of exposure, 13 (68%) had at least a fourfold rise in antibody titer to the Norwalk virus. This report, the first to document an association of contaminated commercial ice with Norwalk gastroenteritis should prompt reassessment of government regulation of the production and distribution of ice.

Antibodies, Viral↗
PubMed1991

Reunions between adoptees and birth parents: the adoptees' experience.

One hundred fourteen adult adoptees who had reunions with their birth parents responded to a mail questionnaire about these reunions. Some had been found by their birth parent, and others had searched for this parent. Those who searched were stimulated to do so by a life-cycle transition, by a need to get background information, and by a need to complete their sense of identity. For most of these adoptees, their self-esteem improved and their relationship with their adoptive parents was strengthened as a result of the reunion. These respondents advocate open adoption and better preparation for the adoptive family about adoptees' need to connect with their birth families.

Adolescent↗
PubMed1990

Safety and efficacy of a new transpulmonary ultrasound contrast agent: initial multicenter clinical results.

Myocardial contrast echocardiography has been found to be a safe and useful technique for evaluating relative changes in myocardial perfusion and delineating areas at risk. Although earlier contrast agents required direct delivery into the coronary arteries or aortic root, a new echocardiographic contrast agent, sonicated albumin microspheres (Albunex), has been found to cross the pulmonary circulation in experimental models. To determine the safety and preliminary efficacy of intravenous injections of Albunex in humans, 71 patients at three independent medical institutions underwent two-dimensional echocardiographic examination before, during and after the administration of three intravenous doses of Albunex, ranging from 0.01 to 0.12 ml/kg body weight. All patients provided a complete history and underwent physical and neurologic examination and laboratory and electrocardiographic evaluation before the injections; all evaluations (except for the history) were repeated at 2 h and 3 days after the injections of Albunex. The efficacy of the injections was qualitatively assessed by two independent blinded observers using a grading system of 0 to +3, with 0 indicating an absence of contrast effect and +3 indicating full opacification of the cavities examined. All injections were well tolerated and no serious side effects were noted in any of the patients. Irrespective of dose group, a cavity opacification greater than or equal to +2 was seen in the right ventricle in 212 (88%) of 240 injections and in the left ventricle in 151 (63%) of 240 injections as judged by the independent observers. The degree of ventricular cavity opacification appeared to be dose and concentration related.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

An outbreak of tuberculosis in rural Delaware.

A total of 35 patients diagnosed with tuberculosis in 1976-1984 were identified as part of a sustained outbreak involving five communities located in southern Delaware. The index case, a 25-year-old black female with sputum smear-positive, cavitary pulmonary tuberculosis, was a sexual partner of three other persons with cavitary pulmonary tuberculosis and a close contact of 10 other persons with tuberculosis. The median age of the 35 patients was 23 years (range 15 months to 77 years), and 13 (37%) were less than 15 years of age. Sixteen patients (46%) were male, and 34 (97%) were black. Pulmonary parenchymal disease was noted in 18 cases (51%), including nine (26%) with cavitary lesions; 11 (31%) had lymphatic disease (hilar and/or mediastinal); five (14%) had pleural disease; and one (3%) had a normal chest radiograph. Infection prevalence (per 100 tested) was 44.7 for close contacts of cases and 18.3 for other than close contacts, and disease prevalence (per 100 tested) was 8.9 and 1.4 for those two groups, respectively. This outbreak highlights several points: Outbreaks of tuberculosis may go undetected for several years; aggressive and complete surveillance and containment efforts are needed to control tuberculosis; and tuberculosis in children and minorities is still a problem in the United States.

Adolescent↗
PubMed1989

Contrast echocardiography: effects of microbubbles on coronary blood flow and left ventricular hemodynamics.

Contrast echocardiography is currently being used to define and quantitate myocardial perfusion at the time of cardiac catheterization. Limited and conflicting data exist regarding the physiologic effects of microbubble-containing contrast agents. In the present study, coronary blood flow measured using an electromagnetic flow meter, blood pressure, and heart rate responses were studied in six dogs. An ECG-gated power injector was used to deliver 7 to 9 ml of sonicated and nonsonicated solutions (saline, Renografin-76, dextrose 50% and 70%, and sorbitol 70%) through an intra-aortic catheter placed above the aortic cusps. Paired injections of sonicated and nonsonicated agents were compared to determine whether the presence of microbubbles affected the physiologic response to these agents. Simultaneous recordings of two-dimensional cross-sectional images of the left ventricle were obtained. Data are expressed as percentage of change from preinjection control values. Within 10 seconds of an injection, decreases in coronary blood flow occurred in a range from -1 to -10% compared with preinjection control values. Coronary blood flow increased between 10 and 25 seconds postinjection within a range from +11 to +29%. Systemic blood pressures rose during injections and then declined below control values within 10 seconds. The magnitude of the decline in systolic blood pressure ranged from -5. to -18%. Diastolic blood pressure declined in a range from -13 to -33%. Within 20-30 seconds postinjection, systemic blood pressure rose above control values. The magnitude of the systolic and diastolic blood pressure rise ranged from +4 to +11%.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Sensitivity and specificity of clinical case definitions for pertussis.

We evaluated the diagnostic performance of 15 clinical case definitions for pertussis in 233 patients who developed acute respiratory illness during community outbreaks in Wisconsin and Delaware. Using results from culture (Regan-Lowe media) and serology (Ig-class-specific ELISA) as diagnostic standards, cough for greater than or equal to 14 days was both sensitive (84 per cent-92 per cent) and specific (63 percent-90 per cent) in identifying patients with pertussis. This definition may be useful in monitoring pertussis outbreaks and for investigating contacts of culture-positive cases.

Adolescent↗
PubMed1987

The impact of parental death on college-age women.

This is a small sample study of the impact of a parent's death on college-age women. These women report that the death matures them, often putting them out of step with their peers. How they cope is related to the surviving parent's ability to respond to their needs as children. Regardless of the age at the time of the death, they felt unsure about how safe the world was for them, and they needed reassurance that they could count on the surviving parent to take care of them. As they mature, they need to discover what kind of person their deceased parent was and to find a place for the deceased in their adult identity.

Adult↗