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Biomedical subjects

P Wasek

Publications and source records attributed to P Wasek.

3 recordsLinked to original sources

Use of antithrombotic drugs in the treatment of acute ischemic stroke: a survey of neurologists in practice in the United States.

In an attempt to determine the opinions and practices of neurologists regarding the use of antithrombotic drugs in the treatment of acute ischemic stroke, we conducted a survey of 349 randomly selected neurologists from throughout the United States. Responses were received from 247 (71%), and 219 identified themselves as primary or consulting physicians for patients with acute ischemic stroke. During the previous 12 months, these 219 physicians estimated that they had seen a total of 14,636 patients within 24 hours of acute ischemic stroke, and 22% of these patients were treated with heparin. The most frequently reported indications were prevention of recurrent cerebral embolism (82% of physicians) and progressing stroke (70%). Despite the frequent use of heparin, only 6.4% of neurologists felt that it has been shown to be effective, and 16.4% felt that it has been shown to be of no value. The primary concern about the use of heparin was lack of proven efficacy in 48% and safety concerns in 41%. Results of a future trial testing the efficacy of antithrombotic drugs would be useful for most neurologists in their management of patients with acute or progressing ischemic stroke.

Acute Disease↗

Adjustment disorders in adolescents and adults.

The face and descriptive validity of the diagnosis of adjustment disorders is examined in a sample of 402 adolescents and adults who received a DSM-II diagnosis of "transient situational disturbance" over a four-year period. The study suggests that the redefinition of the disorder in DSM-II should have substantially better face and descriptive validity. This redefinition recognizes that both the stressors that precipitate the disorder and the disorder itself may often by quite chronic, and that the stressor need not be overwhelming. Among adolescents in this study, 59% of the stressors had been present for a year of more, while among the adults, 36% of the stressors had been present for a year or more. A classification that subtypes adjustment disorders in terms of predominant symptomatology appears to have potential clinical utility. In this study, adolescents tended to have many behavioral symptoms and adults many depressive symptoms.

Adjustment Disorders↗

Diagnostic instability and depression.

Blind raters applied research criteria to the charts of patients whose discharge diagnosis changed through several hospital admissions from depression to schizophrenia and to the charts of matched control patients. Fewer diagnostically unstable patients than control patients satisfied research criteria for depression despite matching discharge diagnoses. The use of operational criteria, then, can be expected to reduce diagnostic instability in depression and thus improve prognostic accuracy. Some patients satisfied the research criteria for depression when they were initially admitted and for schizophrenia at their final admission. This suggests that diagnostic error may not account for all cases of major diagnostic instability.

Adult↗