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Biomedical subjects

R Draper

Publications and source records attributed to R Draper.

At least 19 recordsLinked to original sources
PubMed2000

An ICT solution for community mental health--putting virtuality into the vision.

The digital age has brought about revolutionary changes in the capacity and methods of managing information. There has been an evolutionary pathway leading from information technology through informatics to communication technology. The 'nineties' has been a decade of patient empowerment fuelled by Internet access and legal rights to information. Clinicians as a whole have lagged in their adoption of the new technologies. Mental health has been seen as a particularly difficult domain because of its multi-professional and multi-locational patterns of service delivery and its traditional reliance upon narrative in the absence of bio-pathologic data. The Hospitaller Order of St John of God has been facing these challenges. The authors describe an integrated information/communication technology (ICT) which can be provided on the clinician's desktop and show that the new integrated ICT affords new opportunities for addressing the needs of community-based mental health services.

Community Mental Health Services↗
PubMed1999

Finding ethical principles and practical guidelines for the controlled flow of patient data.

The application of computing to health care, and particularly to electronic patient records, offers major benefits but raises issues of confidentiality and of potential misuse. Sound access control mechanisms are therefore important, but most models focus upon informed consent by the data subject. This raises challenges in mental health care, and for other vulnerable patients including those comatose, and the severely ill and temporarily distressed. Published algorithms which are used to control record access within a controlled environment therefore have value, as a means of ensuring an open and informed, yet ethically sound, solution. The paper describes the background and issues, and gives an example of such an algorithm.

Computer Security↗
PubMed1998

The electronic patient record as a guarantor of personalised mental health care.

A provider of mental health services on multiple sites experienced major problems of availability with traditional paper records and commenced development of an electronic patient record (EPR) and clinical information system in order to provide integrated, real time patient based information. The development process, including clinical and technical considerata is described in order to draw conclusions about the ways in which EPR's can be a vehicle for change from traditional practice to the multidisciplinary, community based practise developments of recent years. The system can generate information for continuous quality improvement, service planning, and philosophies of care. The key requirements of good record systems are established and the inability of paper records to meet them. In contrast the electronic record has demonstrated ability to guarantee personalised, quality, mental health care.

Computer Systems↗
PubMed1998

Towards an ethical protocol in mental health informatics.

Application of informatics to mental health has the potential to benefit a disadvantaged yet important patient group. At the same time, difficult issues are raised with regard to data protection and ethics because many patients are not able to express informed and rational views, and this increases their vulnerability. However, developments in this field are limited, and there is little literature. Generic data protection legislation and guidance assumes that data subjects are mentally competent adults. This paper distils key ethical issues and principles in mental health informatics, and describes a process which has initiated the identification of "reasonable" practice.

Adult↗
PubMed1995

Suicide among psychiatric hospital in-patients.

We examined for risk factors for suicide among psychiatric in-patients by comparing 37 in-patients from an Ontario Provincial Psychiatric Hospital who had committed suicide with 37 age and sex matched in-patient controls. Significantly more of the suicide victims had made a previous suicide attempt (62.2 v. 35.1%), suffered from schizophrenia (75.7 v. 35.1%), were involuntary at their last admission (70.3 v. 43.2%) and lived alone (70.3 v. 43.2%). Only six patients committed suicide on the ward. Almost a third of the patients, the majority schizophrenic, committed suicide after having been in the hospital for more than a year. These results suggest that in the psychiatric hospital setting the in-patient at risk for suicide has previously exhibited suicidal behaviour, suffers from schizophrenia, was admitted involuntarily, lives alone and that the risk of suicide may remain high among long-stay schizophrenics.

Cause of Death↗
PubMed1989

Physician recruitment in Ontario Provincial Psychiatric Hospitals.

Recruitment of Physicians/Psychiatrists to staff the Ontario Provincial Psychiatric Hospitals remains an ongoing problem despite the introduction of measures such as University Affiliation and Incentive Grants. Historically there has been heavy reliance upon Foreign Medical Graduates (GOFM's) who have been denied the possibility of professional mobility and advancement because of restrictive licences. Recent changes in regulations have severely restricted the recruitment of GOFM's. During 1987, details of all physicians employed in the provincial hospitals during the preceeding five years were entered into a computerized data base. This paper presents some initial analyses which indicate that Canadian graduates have provided low levels of service, especially outside major urban centres, quite insufficient to replace the GOFM's. These findings raise urgent social and professional concerns.

Forecasting↗
PubMed1989

Developing a regional psychiatric rehabilitation service.

The development of a Regional Psychiatric Rehabilitation Service at Brockville, serving 900 thousand people in Eastern Ontario is described. Eight ward units supported the development of innovative rehabilitation programs integrated into an overall service which draws upon all prominent methods and schools. The organizational changes required to accommodate these developments and the new treatment philosophies are described. Case studies are used to illustrate the adaptation and operationalization of some of the principal methods. Their effectiveness in altering longstanding patterns of hospitalization and in moving the rehabilitation focus into the community is demonstrated.

Adult↗
PubMed1988

Medroxyprogesterone acetate therapy in early pregnancy has no apparent fetal effects.

Medroxyprogesterone acetate (MPA; Provera) was given orally to 449 women from the 5th to 7th week of pregnancy until at least the 18th week. Data are recorded from two treatment groups (recurrent abortion and threatened abortion) and are compared to a matched series. A total of 1,016 pregnancies are included in the study, and all patients were recruited from a subfertile population conceiving from a range of infertility treatments. Early pregnancy wastage was high throughout the groups and was significantly elevated (43%; P less than .001) in those women who had vaginal bleeding in early pregnancy. The study focuses on the question of potential teratogenicity of progestagens administered in the first trimester. There were 15/366 (4.1%) infants with congenital abnormalities in the MPA-treated group and 15/428 in the untreated group (3.5%). The difference was not significant, and MPA is considered to have no embryopathic risk, nor is it likely to retain an abnormal fetus that might otherwise abort. It appears that MPA is a safe drug to use in pregnancy although the question of efficacy has not been addressed in this report. Considering other recent negative epidemiologic studies with regard to teratogenicity, we add to the conclusion that MPA cannot be demonstrated to have a measurable teratogenic risk and certainly does not present a risk for congenital heart disease and limb reduction defects.

Abnormalities, Drug-Induced↗
PubMed1987

Pregnancies following pronuclear stage tubal transfer.

Pronuclear stage tubal transfer (PROST) is a technique that involves in vitro fertilization (IVF) of oocytes, followed by the transfer of pronuclear oocytes into the fallopian tubes. It has been developed for its prognostic value of confirming fertilization in couples with oligospermia or asthenospermia and enabling fertilization in cases with antispermatozoal antibodies (ASAB). PROST has provided useful diagnostic information in the management of couples who have failed to conceive in other treatment programs and has particular advantages over IVF for those receiving fresh donated oocytes for ovarian failure. Fourteen pregnancies resulted from 52 transfers, providing a pregnancy rate of 27% per transfer. The pregnancy rates were higher than a matched IVF series in the male factor and female ASAB groups and reached statistical significance for the ovum donation group. It is anticipated that both pregnancy rates and fetal wastage will be improved over conventional IVF and embryo transfer for the described infertility groups.

Antibodies↗
PubMed1985

Agonist and antagonist effects of 3-PPP enantiomers on functional dopamine autoreceptors and postsynaptic dopamine receptors in vitro.

In contrast to racemic 3-PPP (3-(3-hydroxyphenyl)-N-n-propylpiperidine), (+)-3-PPP appeared to inhibit the electrically evoked release of both [3H]dopamine (DA) and [14C]acetylcholine (ACh) from superfused rat neostriatal slices, although it was considerably less potent in this respect that the DA receptor agonists apomorphine, TL-99 (6,7-dihydroxy-N,N-dimethyl-2-aminotetralin) and LY 141865. At concentrations higher than 1 microM both of the 3-PPP enantiomers increased the spontaneous efflux of 3H but not that of 14C. (+)3-PPP also inhibited the cholera toxin-stimulated release of immunoreactive alpha-MSH from dispersed intermediate lobe cells of the rat pituitary gland. The inhibitory effects of (+)3-PPP on both transmitter and alpha-MSH release were antagonized by the selective D-2 receptor antagonist (-)-sulpiride. Neither [3H]DA nor [14C]ACh release were inhibited by (-)3-PPP but, in contrast, the release-inhibiting effect of the selective D-2 receptor agonist LY 141865 as well as that of (+)3-PPP were antagonized by (-)3-PPP, although less effectively than by (-)sulpiride. The inhibitory effect of LY 141865 on alpha-MSH release from intermediate lobe cells was also antagonized by (-)3-PPP. The data indicate that (+)3-PPP is a weak agonist and (-)3-PPP a weak antagonist at D-2 receptors and that neither of the 3-PPP enantiomers interacts selectively with DA autoreceptors mediating presynaptic modulation of striatal DA release.

Acetylcholine↗
PubMed1982

Parasuicide. A review of treatment interventions.

From review of studies of treatment intervention in parasuicide it is concluded that: (1) Suicide prevention centres do not lower the incidence of suicide. (2) Retrospective follow-up studies of patients self-selected for treatment or no treatment find that patients who attend for treatment have a lower repeat rate of parasuicide. This may have nothing to do with treatment. (3) Intensive domicillary follow-up for 3-6 months after inpatient treatment in a specialised unit for parasuicide is no better at preventing further parasuicides than conventional follow-up in outpatient department or via the GP. (4) A multidisciplinary outreach programme was effective in one study but not three others. (5) Behaviour therapy was no better than insight oriented psychotherapies when administered intensely over 10 days for inpatients with a previous history of overdose. (6) Medication in the form of depot flupenthixol, 20 mg every 4 weeks was significantly better than placebo for chronic repeaters (3 or more attempts) but Mianserin 30 mg/d was not. (7) There was no relationship between improved symptoms, improved social circumstances or the repeat rate for parasuicide. In a controlled trial conducted by the authors in parasuicides, Mianserin 60 mg/d reduced depressive symptoms significantly more rapidly than Nomifensine or placebo but there was no difference by 6 weeks and the risk of repeat was not affected.

Adolescent↗
PubMed1981

The value of radiography in perinatal deaths.

A prospective study of 100 consecutive stillbirths/perinatal deaths was performed by routine radiography and subsequent autopsy. The object of the study was to correlate the clinical and the autopsy causes of death with any abnormal radiographic findings. A prime objective was to study the incidence of major skeletal abnormalities in the series and to ascertain if routine radiography could be used to detect abnormalities that might require genetic counselling. No skeletal abnormalities or dysplasias were detected that did not have obvious external stigmata. The use of routine radiography on undeformed stillbirths is not recommended.

Autopsy↗