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Biomedical subjects

P R Yarnold

Publications and source records attributed to P R Yarnold.

At least 19 recordsLinked to original sources
PubMed1992

Diagnostic and demographic correlates of substance abuse in schizophrenia and major affective disorder.

The relationship between history of specific types of substance abuse (alcohol, stimulants, cannabis, hallucinogens, narcotics) and demographic and diagnostic variables was evaluated in a large (n = 263) sample of schizophrenic, schizoaffective, major depression and bipolar disorder patients. Prevalence rates were also compared with rates observed in a previous study (1983-1986) conducted using the same methods. Demographic characteristics (gender, age, race, educational level) were strong predictors of type of substance abuse. Patients with a history of cocaine abuse had fewer prior hospitalizations, suggesting that less impaired psychiatric patients may be more prone to illicit substance abuse. Diagnoses were not related to most types of substance abuse, although there was a trend for bipolar patients to have a history of alcohol abuse. The results demonstrate the importance of matching groups on demographic characteristics when exploring diagnostic differences in preference to abuse specific types of substances.

Adolescent↗
PubMed1991

Outcome of prophylactic therapy for idiopathic anaphylaxis.

OBJECTIVE: To determine the efficacy of a prophylactic regimen (prednisone, H1 blockade, and sympathomimetic amine therapy) in patients with idiopathic anaphylaxis. DESIGN: Clinical trial before and after treatment. SETTING: Referral-based allergy clinic at a major medical center. PATIENTS: Fifty-three patients with a history compatible with idiopathic anaphylaxis for at least 6 months before presentation to the allergy service and with subsequent management by the service for at least 6 months. INTERVENTIONS: Patients with frequent life-threatening symptoms were treated with a prophylactic regimen. Patients with infrequent episodes of idiopathic anaphylaxis were only treated acutely for each episode of anaphylaxis. MEASUREMENTS AND MAIN RESULTS: The results favored prophylactic treatment with prednisone for patients who were classified as generalized-frequent in the clinical outcome measures of frequency (per patient per year) of episodes (mean before treatment, 7.31 +/- 6.46; after treatment, 3.61 +/- 4.73; P less than 0.02) and emergency room visits (mean before treatment, 1.94 +/- 3.42; after treatment, 0.21 +/- 0.44; P less than 0.005) and for patients classified as angioedema-frequent in the frequency of episodes (mean before treatment, 14.93 +/- 15.89; after treatment, 2.58 +/- 2.18; P less than 0.003) and emergency room visits (mean before treatment, 0.76 +/- 1.01; after treatment, 0.07 +/- 0.11; P less than 0.025). No statistically significant difference was found for patients classified as generalized-infrequent in the frequency of episodes (mean before treatment, 2.01 +/- 1.30; after treatment, 1.36 +/- 1.79) or of the emergency room visits (mean before treatment, 0.56 +/- 0.71; after treatment, 0.32 +/- 0.75) or for patients classified as angioedema-infrequent in the frequency of episodes (mean before treatment, 1.94 +/- 1.55; after treatment, 2.03 +/- 2.16) or of emergency room visits (mean before treatment, 0.27 +/- 0.44; after treatment, 0.37 +/- 0.59). CONCLUSIONS: Prophylactic treatment with prednisone and H1 antihistamines with or without sympathomimetic amines improves clinical outcome in patients who are classified as idiopathic anaphylaxis-angioedema frequent and idiopathic anaphylaxis-generalized frequent.

Adolescent↗
PubMed1991

The factor structure and cross-sectional distributional properties of the Beth Israel/UCLA Functional Status Questionnaire.

The functional status of ambulatory patients is an important correlate of their emotional and physical well-being and is subject to influence by the delivery of health care. First, the present study obtains a profile on the FSQ for a large sample of young, healthy adults (N = 508 college undergraduates), for use as an "empirical standard" against which to evaluate the effect of disease or injury on an individual's functional status. Second, cross-sectional analyses contrast distributional features of responses to the FSQ between (a) the present younger, healthy sample and (b) a previously published, older ambulatory patient sample. These analyses suggest that the FSQ has acceptable discriminant validity for intergroup comparisons. Finally, confirmatory structural analyses suggest that the theoretical six-factor model hypothesized to underlie responses to the FSQ has a modest, yet acceptable, goodness of fit to actual data.

Activities of Daily Living↗
PubMed1991

Transesophageal stress echocardiography: detection of coronary artery disease in patients with normal resting left ventricular contractility.

A new nonexercise test to detect significant coronary disease was prospectively evaluated in 36 patients with chest pain syndrome and normal left ventricular contractility. Transesophageal atrial pacing was used to provoke ischemia during monitoring of left ventricular contractility by transesophageal echocardiography. A 12-lead ECG was recorded. A TSE was abnormal if new segmental wall motion abnormalities developed. On the basis of the TSE results, patients were separated into normal (group 1, n = 16) and abnormal response (group 2, n = 20). Arteriography revealed significant disease in 21 patients, 19 from group 2 and two from group 1. Sensitivity and specificity of TSE were 90% and 93%, respectively, and those for pacing ECG were 43% and 100%, respectively. In addition, TSE accurately predicted the coronary artery perfusion bed involved. In 10 patients, Wenckebach AV block developed during pacing and resolved immediately by the administration of atropine sulfate. No serious complications were seen. Thus TSE is a highly sensitive and specific novel technique to detect significant coronary disease in patients with chest pain syndrome and normal resting left ventricular contractility.

Aged↗
PubMed1991

Statistical analysis for single-case designs. Evaluating outcome of imaginal exposure treatment of chronic PTSD.

A recently developed statistical method for single-case subject designs based on classical test theory was used to examine the efficacy of imaginal exposure treatment for posttraumatic stress disorder (PTSD) in four Vietnam veterans. The method was sensitive to intraindividual changes across different outcome measures even when relatively few data points were available. Two veterans clearly improved from exposure and maintained their gains at 3- and 15-month follow-ups. One veteran improved marginally, whereas one veteran's symptoms worsened. Changes in heart rate monitored over the first two imaginal exposures indicated that veterans with greater heart-rate habituation responded better to exposure than did veterans with less or no habituation. The results suggest that the statistical method illustrated here has some advantages over other methods (e.g., visual inspection, time-series analysis) for examining clinical interventions in single-case designs.

Adult↗
PubMed1990

Prevalence of substance abuse in schizophrenia: demographic and clinical correlates.

Methodological issues involved in assessing the prevalence of substance abuse in schizophrenia are discussed, and previous research in this area is comprehensively reviewed. Many studies suffer from methodological shortcomings, including the lack of diagnostic rigor, adequate sample sizes, and simultaneous assessment of different types of substance abuse (e.g., stimulants, sedatives). In general, the evidence suggests that the prevalence of substance abuse in schizophrenia is comparable to that in the general population, with the possible exceptions of stimulant and hallucinogen abuse, which may be greater in patients with schizophrenia. Data are presented on the association of substance abuse with demographics, diagnosis, history of illness, and symptoms in 149 recently hospitalized DSM-III-R schizophrenic, schizophreniform, and schizoaffective disorder patients. Demographic characteristics were strong predictors of substance abuse, with gender, age, race, and socioeconomic status being most important. Stimulant abusers tended to have their first hospitalization at an earlier age and were more often diagnosed as having schizophrenia, but did not differ in their symptoms from nonabusers. A history of cannabis abuse was related to fewer symptoms and previous hospitalizations, suggesting that more socially competent patients were prone to cannabis use. The findings show that environmental factors may be important determinants of substance abuse among schizophrenic-spectrum patients and that clinical differences related to abuse vary with different types of drugs.

Adolescent↗
PubMed1989

Meta-analyses of the reliability of Type A behaviour measures.

The accuracy of assessments of Type A behaviour made using different methods is the focus of active debate. Presented here are preliminary meta-analyses regarding: (a) internal consistency, test-retest and parallel forms reliabilities of the most frequently used questionnaire (Jenkins Activity Survey); (b) inter-rater and test-retest reliabilities of the most prospectively valid method (Friedman Structured Interview); and (c) correlations and percentage classification agreement between these measures. The findings generally suggest highly statistically significant yet moderate effect strengths for these various psychometric properties.

Coronary Disease↗
PubMed1989

An autopsy-based study of diagnostic errors in geriatric and nongeriatric adult patients.

One hundred sixty-two consecutive adult autopsies (87 of subjects over age 65 years and 75 of subjects aged 23 to 64 years) performed at a university hospital were studied retrospectively by six internists to determine (1) if diagnostic errors were quantitatively or qualitatively different between the two age groups; (2) if the underlying causes of error (divided into nine categories) were different or age related in any way between the two groups; and (3) any aspects of care that related age to clinical outcome. We found the frequency of major clinical/autopsy discrepancies to be similar to those in previous studies (35%), but in only 7% of cases were these likely to have affected therapy/outcome. Ther was no difference in the frequency of major discrepancies between age groups. There were significantly more "unexpected" minor discrepancies in the older patients, probably related to the multiplicity and complexity of their problems, but these would have affected therapy/outcome in only 1 (3%) of 37 cases. The most common causes of 136 clinical "errors" in 151 autopsies were, in order of frequency: a diagnostic "blind spot," a conscious decision not to pursue a clinical finding (not a real "error"), failure to account for a symptom or sign, atypical presentations, and inadequate follow-up of abnormal laboratory findings. There were no differences between the geriatric and adult groups in terms of frequency or cause of the errors. We conclude that (1) there is no difference in the diagnostic accuracy regarding cause of death between geriatric and nongeriatric patients in the acute hospital environment, and (2) closer attention to basic knowledge and clinical skills and a special focus on judgment and reasoning skills, utilizing autopsy findings among other things, will lead to even further improvement in clinical care at all ages.

Adult↗
PubMed1988

Clinical use of the olecranon-manubrium percussion sign in shoulder trauma.

We conducted a study to assess the efficacy of the use of osteophony in the evaluation of shoulder trauma. Evaluation of the shoulder includes the physical examination and often a radiographic series. We studied the usefulness of the olecranon-manubrium percussion (OMP) test, a physical diagnostic procedure performed in shoulder trauma. The bell of the stethoscope is placed over the manubrium, both elbows are flexed at 90 degrees, and the olecranon is percussed. In the normal examination with no disruption of bony conduction, both sides should produce a crisp equal sound. In the event of a dislocation or fracture with disruption of bony conduction, the affected side should be duller in pitch and intensity. We evaluated the utilization of the OMP test to assess its accuracy when used as a screening test for radiographs in conjunction with the physical examination and radiographic examination. Ninety-six patients were prospectively evaluated by the OMP test and also received radiographs. In those patients who had radiographic abnormalities, 40 of 47 (85.1%) had an abnormal OMP sign. In those patients without radiographic abnormalities, none had an abnormal OMP sign. In assessing anterior shoulder dislocations, 11 of 13 (84.6%) had an abnormal OMP sign (P less than .02). After relocation, 100% had a normal OMP sign. Of those with clavicular fractures, nine of nine (100%) had abnormal OMP signs (P less than .005). Of those with a fracture of the humerus, 16 of 20 (80%) revealed an abnormal OMP test (P less than .01). The test was not significant in assessing acromio-clavicular joint abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergencies↗
PubMed1988

Statistical properties of the maintained discharge of chemically isolated ganglion cells in goldfish retina.

Action potentials were recorded from isolated goldfish retinae maintained in a superfusate of Ringer's solution. Responses to flashes of light and maintained discharges were obtained from 84 cells. The properties of these cells were compared to those in two other goldfish preparations: the isolated retina maintained in a flow of moist oxygen and the self-respiring fish. Maintained discharges of cells in the superfused retinae tended to have lower mean firing rates, higher variability, and weaker high-pass properties than had been observed in the previous preparations. These properties seemed insensitive to the particular formulae used to superfuse the retinae. Cobalt, which disables synapses, dramatically reduced maintained firing and eliminated photic responses. Cells that did fire in the presence of cobalt generally had low variabilities before cobalt was added; their firing in cobalt was considerably more variable than the baseline. Nevertheless, cobalt did not seem to change the temporal dependency (high-pass properties) of the maintained discharges. The cholinergic agonist carbachol had an excitatory effect upon 71% of the cells tested. Bursty or oscillatory firing in cobalt was rendered more regular by the addition of carbachol. With the exception of the mean firing rate, none of the statistical properties of the maintained discharge differed in cobalt plus carbachol from those in normal Ringer's solution. There was a tendency for the statistical properties of the maintained discharge after the treatment to approach those of the previously reported preparations; the treatment was at least partially responsible for the drift in properties. The results are discussed in terms of the possible sources of variability in the ganglion cell's discharge, with particular reference to the high-pass filter that appears to act upon it.

Action Potentials↗
PubMed1988

Control theory and type A behaviour.

As a test of 'control theory', 75 Type A/B undergraduates completed a multidimensional health locus-of-control measure. Type A behaviour correlated significantly with beliefs regarding personal control over health, but not with beliefs regarding chance or powerful others. These findings suggest Type As' desire for control is multidimensional.

Female↗
PubMed1988

A note on measurement issues in type A research: let's not throw out the baby with the bath water.

It has been suggested that researchers rely exclusively on the structured interview (SI) to assess Type A behavior instead of using objective self-report measures, because the SI is the only prospectively validated instrument currently available. This article considers the costs and benefits of relying solely on the SI to measure Type A behavior. Although using only the SI would assure that researchers measure, in a relatively unobtrusive fashion, actual Type A behaviors known to be predictive of heart disease, it would dramatically increase research costs, impede longitudinal studies of changes in Type A behavior, reduce the validity of statistical conclusions, restrict the convergent and discriminant validity of the Type A construct, and ultimately inhibit our ability to improve accuracy in predicting heart disease. A set of recommendations is proposed for improving the quality of measurement in Type A research.

Humans↗
PubMed1988

Comparative performance information in the dean's letter.

Comparative medical school performance information, including the presence of a summative "dean's code" statement, was identified by selective content analysis of 310 dean's letters. There was a significant increase in the report of comparative information over the ten year study period, and correlation with residency in-training evaluations showed that this information may be useful to housestaff selection committees.

Clinical Competence↗
PubMed1987

Comparing the long and short forms of the student version of the Jenkins Activity Survey.

The 44-item (long-form) student Jenkins Activity Survey (SJAS), used in locating subjects on the Type A/B continuum, requires an average of 8 min more to complete than the short form (containing only the 21 scored items). This study was conducted to determine whether the long and short forms provide comparable score distributions and factor structures for independent random samples of undergraduates (N = 1248). Analyses revealed that the short form provides factors that are more independent than those of the long form, provides comparable factor structures for A's and B's, and provides comparable distributions of SJAS scores.

Factor Analysis, Statistical↗
PubMed1987

Dimensions of social insecurity and their relation to coronary-prone behaviour in college undergraduates.

Research suggests that Type A behaviour and 'social insecurity' (SI) may represent independent additive task factors for coronary disease. Research examining SI and Type A behaviour, however, has not rigorously evaluated the structure of the SI scale. The present study examined the structure of a previously used eight-item SI scale, and its relation to a questionnaire measure of Type A (the student Jenkins Activity Survey), for a sample of 504 undergraduates. Exploratory and confirmatory factor analyses of responses to the SI items revealed a three-factor solution was most appropriate for Type As, and a two-factor solution for Type Bs. For both As and Bs, the first factor reflected insecurity regarding one's own capabilities and worth (self-specific insecurity), and the second factor reflected insecurity specific to a group or social context (group-specific insecurity). A third factor emerging only for Type As reflected insecurity regarding others' capabilities (other-directed insecurity). Semipartial correlations revealed Type A total score was marginally negatively related to group-specific insecurity and marginally positively related to other-directed insecurity, corroborating previous angiographic and prospective medical research. The hard-driving/competitive subscale was significantly negatively related to self-specific insecurity, supporting evidence regarding Type A and interpersonal dominance, competitiveness, and aggression.

Adolescent↗
PubMed1987

Type A behaviour and time urgency: perception of time adjectives.

Relations between time perception and Type A behaviour were investigated. Extreme Type A (n = 26) and B (n = 28) male college undergraduates rated the appropriateness of 158 adjectives as descriptors of time. Adjectives were independently rated using seven-point Likert 'speed' and 'energy' scales. Analyses showed that Type As rate adjectives low in speed and energy as less descriptive of time than Type Bs and vice versa.

Humans↗