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Biomedical subjects

R B Hyman

Publications and source records attributed to R B Hyman.

At least 19 recordsLinked to original sources
PubMed1996

Characteristics of suicidality among adolescents.

The identification of high-risk adolescent suicide attempters in a population of depressed and suicidal adolescents is of crucial importance. This retrospective study examined characteristics of suicidality (recent and lifetime, active and passive) and psychopathology (depression, aggression, impulsivity, stressful life events, SCL-90 dimensions) among four groups of depressed adolescent outpatients: (1) suicide attempters who required medical treatment (n = 84), (2) suicide attempters who did not require medical treatment (n = 57), (3) suicidal ideators who had never made a suicide attempt (n = 40), and (4) nonsuicidal patients (n = 44). Results indicate that the nonsuicidal group could be differentiated from the three suicidal groups on the basis of suicidality and psychopathology, and that the three suicidal groups could be differentiated from one another on the basis of suicidality but not psychopathology. These findings are discussed in terms of the usefulness of certain self-report measures of suicidality for identifying suicidal adolescents and for differentiating among them. Furthermore, the findings suggest that psychopathological factors do not determine which suicidal adolescents make a medically dangerous suicide attempt and which do not.

Adolescent↗
PubMed1995

Five factor model of schizophrenia: replication across samples.

In order to examine the effect of neuroleptic medication on the factor structure of schizophrenic symptomatology, 517 DSM-III-R schizophrenic in-patients enrolled in a multicenter phase II drug study were evaluated on their pre-existing neuroleptic at screening on the Positive and Negative Syndrome Scale (PANSS) and after a one-week drug-free period. Separate principal components analyses of the PANSS were done at each time point. PANSS total and component scores were assessed for differences utilizing paired t-tests. Both factor analyses confirmed the five factor model (negative, positive, cognitive, excitement and depression components) explaining 51.7 and 56.2% of the variances at each time point. After medication wash-out psychopathology significantly worsened as measured by total PANSS score and by each of the components. The overall worsening of component scores appeared global and uniform, as evidenced by the fact that at washout, the proportion of individual component scores to total psychopathology remained constant for most components. The lack of change of most components in proportion to the psychopathology total is evidence for the stability of these individual psychopathological dimensions of patients while on and off neuroleptics. The results further support the validity of the five-factor model of schizophrenic psychopathology as measured by the PANSS.

Adult↗
PubMed1995

Smoking, dietary, and breast and cervical cancer screening knowledge and screening practices of employees in an urban medical center.

This paper reports results of a survey of 500 health care workers in a private New York City Hospital that assessed knowledge and behaviors in the areas of smoking and cancer, diet and cancer, and breast and cervical cancer screening. Given the small number of knowledge items, the results indicated good knowledge concerning diet and cancer, smoking and cancer, and mammography and Pap test guidelines. Conformity with American Cancer Society guidelines for Pap testing was comparable to national figures, but with women over 50 as likely to obtain Pap smears as younger women. Conformity with mammography guidelines was excellent, although compliance with breast self-examination recommendations was low (25.4%). Of female employees over age 50, 87.4% had ever had mammography and 77.6% reported yearly mammography. Only 19% of the respondents admitted to current smoking. Although methodologic differences made comparison of knowledge of diet and cancer with the work of others difficult, knowledge of the risks of smoking was comparable to levels found in other studies.

Adult↗
PubMed1995

Reassessment of circadian profile of blood pressure and heart rate in diabetic patients with autonomic neuropathy.

Previous studies have shown that the normal circadian blood pressure fall is absent in patients with diabetic autonomic neuropathy, while the reported rise in blood pressure during the night in the same patients is controversial. This study analyzed the circadian profile in 19 diabetic patients with established autonomic neuropathy. Twenty-four hour ambulatory systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate were recorded every 20 minutes during the day and every 60 minutes at night in 29 patients, 19 with diabetic autonomic neuropathy and 10 nondiabetic hypertensive patients as controls. Twelve diabetic patients with autonomic neuropathy with unknown hypertension were found to have hypertension based on 24 hour ambulatory blood pressure monitoring. Repeated measured analysis of variance (ANOVA) and trend analysis indicated that the linear systolic blood pressure increased from night to morning to afternoon while mean arterial pressure and diastolic blood pressure increased from night to morning but decreased from morning to afternoon. In practice, the early morning rise in systolic blood pressure in diabetic neuropathy is not different from that in normal or hypertensive patients and requires appropriate treatment. The absence of the nocturnal rise in the blood pressure revealed a subgroup of patients with diabetic neuropathy which demonstrated no fatal cardiovascular or renal events over 18 to 24 months of follow-up.

Aged↗
PubMed1994

Variable light-dose effect on photodynamic therapy for laryngeal papillomas.

OBJECTIVE: We investigated photodynamic therapy (PDT) as an alternative treatment modality for recurrent respiratory papillomatosis. To optimize the effect of PDT, the light dose in this study was increased from 50 to 80 J/cm2. The clinical effect of these two light doses will be discussed and compared. DESIGN: Each patient's response was based on the growth rate of their papilloma before and after PDT. Disease response following 50 J/cm2 was compared with that after 80 J/cm2. The two study groups were also compared with a control group. SETTING: Each patient received the dihematoporphyrin ether as an outpatient and underwent direct laryngoscopy and PDT at our institution. PATIENTS: Twenty-eight patients (16 male and 12 female) with moderate to severe laryngeal disease and an age range of 18 months to 80 years were treated with a light dose of 80 J/cm2, 11 of those had been previously treated with 50 J/cm2. Seven patients had undergone photoactivation to the trachea. INTERVENTION: Twenty-four hours prior to photoactivation, patients received 2.5 mg/kg of dihematoporphyrin ether intravenously. Photodynamic therapy was given using an argon pump dye laser system. MAIN OUTCOME MEASURE: Reduction in disease severity greater than that achieved with 50 J/cm2. RESULTS: For patients treated initially with 80 J/cm2, the mean rate of papilloma growth decreased by approximately 50%, the same response seen with 50 J/cm2 of treatment. No additional benefit was found for those patients initially activated at 50 J/cm2 and then re-treated at 80 J/cm2. CONCLUSION: Although PDT has a beneficial effect on laryngeal papilloma growth rate, no significant change in response was obtained by increasing the light dose from 50 to 80 J/cm2.

Adolescent↗
PubMed1994

Health Belief Model variables as predictors of screening mammography utilization.

Despite its efficacy, screening mammography is not widely utilized due to various factors. The Health Belief Model (HBM) has previously been used as one conceptualization of relevant patient attitudes. No psychometrically validated measure of these variables has previously been utilized, however, nor have prospective studies of women all of whom have been referred by their physicians for mammography been reported. The research reported here addressed both of those issues. A psychometrically validated measure of the HBM variables, perceived susceptibility, barriers, and benefits, was used, along with age, education, ethnicity, and family breast cancer history to predict mammography utilization in a prospective study of hospital employees. Being white, perceiving fewer benefits of and barriers to mammography, and having a family history of breast cancer were predictive of noncompliance. The avoidant behavior of employees with a family history of breast cancer must be addressed in attempts to increase mammography utilization. In addition, results of the study imply the need for full discussion with women referred for mammography of all issues related to its use, both its benefits and possible barriers.

Adaptation, Psychological↗
PubMed1994

Assessing positive and negative symptoms in children and adolescents.

OBJECTIVE: The purpose of this study was to test the reliability and validity of a new assessment instrument for positive and negative symptoms in severely disturbed children and adolescents (Kiddie-PANSS). METHOD: The Positive and Negative Syndrome Scale for adult schizophrenia was modified through successive field trials on the basis of developmental characteristics of children and adolescents. The scale was then given to 34 inpatients (19 children, mean age = 9.35 years, and 15 adolescents, mean age = 14.33 years) with DSM-III-R diagnoses of schizophrenia, psychosis not otherwise specified, schizoaffective, affective, conduct, personality, and developmental disorders determined independently by child psychiatrists. All patients with schizophrenia were placed in the schizophrenic group, and all others were placed in a general inpatient group. The Kiddie-PANSS ratings were given by three trained child psychiatrists after a 30-35-minute structured interview. The Achenbach Child Behavior Checklist, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms were also administered in order to determine criterion-related association. RESULTS: Intraclass correlation coefficients revealed that all subscales and total psychopathology were reliably assessed among raters. The Kiddie-PANSS and Scale for the Assessment of Positive Symptoms/Scale for the Assessment of Negative Symptoms correlated with one another, indicating criterion-related association. Differences on measures of positive, negative, and general psychopathology, as measured by the Kiddie-PANSS, between the patients with schizophrenia and the general inpatient group were highly significant. CONCLUSIONS: The Kiddie-PANSS shows good interrater reliability and criterion-related validity. In a cohort of inpatient children and adolescents the scale successfully differentiated schizophrenic patients from nonschizophrenic patients.

Adolescent↗
PubMed1993

Evaluation of an intervention for staff in a long-term care facility using a retrospective pretest design.

It has been previously established that human service workers often suffer from emotional exhaustion, which has been conceptualized by Maslach and Jackson as burnout. Burnout may be a particularly great risk in workers providing long-term geriatric care. The current study evaluated the effects of a series of three 3-hour sessions designed to address team building, communication skills, self-esteem, and stress management on a random sample of 51 of the 188 long-term care staff who participated. Using a retrospective pretest design, a statistically significant improvement from "then" to "today" was found for the three components of burnout: Depersonalization, Emotional Exhaustion, and Personal Accomplishment. Responses to an open-ended question about workshop effects corroborated the quantitative data, and effects noted were highly related to the defined objectives of the workshops.

Adult↗
PubMed1992

Construction of the Hyman-Baker Mammography Questionnaire, a measure of health belief model variables.

Despite its considerable promise as a screening tool, mammography has thus far not been as widely used as seems warranted. One conceptualization of patient-related factors or motivation useful in previous research on use of services is the Health Belief Model, which postulates that health behavior can be predicted by people's perceptions of the seriousness of the disease, their susceptibility to the disease, and their perceptions of the benefits of and barriers to the health behavior. Yet no psychometrically sound measure of these variables as related to mammography was found in a search of the literature. This study reports the construction and preliminary validation of such an instrument. Factor analysis, moderate or zero correlation of the subscales, and a higher mean score on the Barriers subscale for women referred for mammography as compared to those actually presenting for mammography support the validity of the questionnaire. Although reliability coefficients for Benefits were low, those for Susceptibility and Barriers were adequate. The questionnaire appears to be a promising measure awaiting further validation.

Aged↗
PubMed1992

Variability in consultation rates and practitioner level of diagnostic certainty.

BACKGROUND: This study was designed to determine the variability in the consultation practices of family physicians and family nurse practitioners in an urban group practice, and to examine the relation between the referring practitioner's diagnostic certainty at the time of the consultation request, the specificity of the request to the consultant, and the frequency with which the practitioner ordered consultations in that specialty. METHODS: This study examined consultations requested by six family physicians and two family nurse practitioners that were directed to nine medical and surgical specialties in connection with 35,218 family practice visits made over a 19-month period in an urban family practice. Requests for consultation were scored based on the level of certainty of the referring practitioner's diagnosis at the time of consultation and the specificity of the consultation request. RESULTS: There was nearly a fivefold variation in the overall specialty consultation rates among providers, with even greater variation in each individual specialty area studied. Referral rate correlated positively with certainty of diagnosis (r = .40). There was no consistent relation between request specificity and referral rate. CONCLUSIONS: Consultation rates vary widely, even among family physicians and nurse practitioners within the same practice. The rate at which a practitioner orders consultations in a specialty area increases in relation to the practitioner's certainty of the diagnosis at the time the consultation was requested. Diagnostic certainty is discussed as a possible indicator of a referring practitioner's knowledge in a specialty area, implying that the greater a practitioner's knowledge in a specialty area, the more he or she consults with specialists in the field. Financial incentives that attempt to decrease specialty consultation should be reexamined in light of these findings.

Diagnosis↗
PubMed1990

Physician reported incentives and disincentives for referring patients to hospice.

Previous research has affirmed the key role of the physician in the decision to use hospice. Yet at least 1/4 of the physicians who have the opportunity to discuss hospice with a terminally ill patient never do so, and those that do so are selective. The present study used a qualitative approach to investigate the factors considered by the physician when deciding to discuss hospice with a patient. Participants were 17 practicing physicians who had referred patients to the one certified hospice in the geographic area of the study. Data were gathered by means of semi-structured interviews, which were audiotaped and transcribed for thematic analysis. The final categorization of data divided themes along two dimensions: a content dimension and a second dimension called incentives and disincentives. It is proposed that the physician's proactive stance toward disclosure of the terminal diagnosis and perception of hospice as an opportunity for death with dignity create a culture within which the work that is necessary to make the other factors favorable toward use of hospice is accomplished.

Adult↗
PubMed1987

Nursing management of postoperative pain: use of relaxation techniques with female cholecystectomy patients.

The purpose of this study was to assess the effectiveness of two different relaxation techniques in the management of postoperative pain. The sample consisted of 40 women between the ages of 21 and 65 years who were undergoing elective cholecystectomy. Using an experimental design, participants were randomly assigned to four groups: an experimental group who received a taped recording of a rhythmic breathing exercise (RB); an experimental group who received a taped recording of Benson's Relaxation Technique (BRT); an attention-distraction control group (CA) who received a taped recording of a history of the hospital; and a standard control (CB) group who had only the routine perioperative care which all groups received. Data were collected on postoperative sensation and distress at five time points during the first 72 postoperative hours, number of doses of analgesic medication during the same time period, and number of postoperative hospital days. Data were analysed using multivariate and univariate analyses of variance. The BRT group was significantly different from the CA group on a combined sensation and distress factor (P = 0.011). No significant differences were found among groups for doses of analgesics (P = 0.068) or postoperative hospital days (P = 0.56).

Adult↗
PubMed1980

Evaluating continuing education: a focus on the client.

This article presents the evaluation methodology used in an NIMH funded continuing education project for mental health professionals. The 96 participants who completed the course in three distinct cycles came both as work teams from agencies and as individuals and had potential impact on 1700 staff and 6913 clients. Forty-eight quantifiable and two qualitative dependent measures were used to assess participants' perceptions of the course, knowledge and attitudes, clinical behaviors as reflected in work environment and ward atmosphere, and impact on client status. A controlled experimental design with pretest, posttest, and follow-up data collection points was planned. Problems encountered and evaluation findings suggest the need for different types of evaluation strategies.

Attitude of Health Personnel↗