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Biomedical subjects

R G Harper

Publications and source records attributed to R G Harper.

At least 19 recordsLinked to original sources
PubMed1992

Psychotherapy: past training and current practice.

Our 1988 survey of Texas psychiatrists indicates that hospital work is more common, and long-term psychotherapy less common than it had been in the 1982 APA survey. Almost 85% reported long-term psychotherapy experience as residents. Thirty-nine percent reported multiple patients treated for approximately 2 years. Use of audio techniques by resident and teacher in the post-1970-trained group predicted current long-term therapy activity as did an experience of personal therapy and seeing a patient at least twice weekly in training. Concurrent drug use is widely reported for long-term psychotherapy patients and to a lesser degree in psychoanalysis. Our data suggest a shift to increased hospital work and decreased long-term psychotherapy.

Attitude of Health Personnel↗
PubMed1992

Comparison of two cognitive screening measures for efficacy in differentiating dementia from depression in a geriatric inpatient population.

The Folstein Mini-Mental State Examination (MMSE) and dementia screening measures developed by Benton (temporal orientation, oral word association, and visual reconstruction tasks) were compared for diagnostic efficacy with geriatric inpatients manifesting depression without dementia or mild or moderate dementias complicated by depression. Both instruments showed generally acceptable differentiation between dementia and depression-only cases overall. The MMSE was less sensitive in identifying mild and moderate multi-infarct dementias but showed better specificity than the Benton measures. The degree and type of dementia and the associated risk of classification error were found to be important factors in the choice of screening instruments.

Aged↗
PubMed1991

Noncardiac chest pain in patients with heart disease.

This is a retrospective study of cardiac patients with noncardiac chest pain referred for evaluation of esophageal motility. Sixty-eight patients with heart disease were compared with 210 patients without heart disease according to findings from symptom questionnaires and a psychologic test (Brief Symptom Inventory). More than 70% of each group qualified for an anxiety or depressive diagnosis on the symptom questionnaire. These diagnoses were supported by significant elevations of scores on the anxiety and depression scales of the Brief Symptom Inventory. Male gender and a diagnosis of panic disorder occurred significantly more often in the patients with heart disease. "Stress" was cited as the cause of illness in about half the sample, but this led to less than satisfactory rates of psychiatric evaluation or pharmacotherapy. This is of particular concern for the cardiac patients because of the known adverse effect of anxiety and depression in those with heart disease.

Adolescent↗
PubMed1991

Observations on the postpartum shivering phenomenon.

Fifty healthy, nonmedicated, laboring women who had normal spontaneous vaginal deliveries were studied to determine the incidence, time of onset, severity, duration, temperature patterns and relationship of various perinatal factors to the postpartum shivering phenomenon. Axillary temperature was recorded on admission, before delivery, at delivery and every 15 minutes postpartum for 75 minutes. The degree and duration of shivering were quantified visually. The environmental temperature was recorded. Of the 50 women, 22 (44%) commenced shivering during delivery or up to 30 minutes postpartum. Shiverers and nonshiverers exhibited a reduction in the mean axillary temperature during labor, with a rise post-partum (P less than .002). The median axillary temperature of the shiverers at all time points was higher than that of the nonshiverers and was statistically significant 30 (P less than .01), 45 (P less than .003), 60 (P less than .004) and 75 minutes (P less than .001) after delivery. The shiverers tended to raise their postdelivery temperature somewhat later than did the nonshiverers. The temperature pattern of both shiverers and nonshiverers fell during labor, and the temperature pattern of the shiverers differed from that of the nonshiverers postpartum. The mean delivery room temperature for shiverers was lower than for nonshiverers (P less than .009), as was the mean recovery room temperature (P less than .03). Environmental temperature may play a heretofore unsuspected role in the postpartum shivering phenomenon.

Adult↗
PubMed1991

Blood pressure values in 500- to 750-gram birthweight infants in the first week of life.

The means and standard deviations for systolic, mean, and diastolic blood pressure were noted in the first week after delivery for 12 hemodynamically stable infants by a retrospective chart review. Blood pressure taken by means of an umbilical artery transducer or an oscillometer were not statistically different. All blood pressure values increased during the first week after birth. A trend was noted toward increasing blood pressure with increasing gestational age for the first week after birth. We conclude that the range of blood pressure in 500- to 750-g birthweight infants is extremely wide and that it may be necessary to use other clinical criteria in conjunction with blood pressure to determine which infants require intervention for hypotension.

Blood Pressure↗
PubMed1990

Psychometric assessment of depression in an elderly general medical population. Over- or underassessment?

A total of 247 consecutively evaluated geriatric medical patients was administered a battery of neuropsychological and psychological tests as part of their diagnostic workup for unexplained deterioration in their functioning. Depression was assessed with a short form of the MMPI, the Brief Symptom Inventory, and the Geriatric Depression Scale. By Research Diagnostic Criteria, most suffered from major (59%) or minor (21%) depressions; some degree of cognitive impairment was seen in 80% of the patients, defining a population of "vulnerable" geriatric patients typical of referrals to a general medical hospital setting. Using both conventional score cutoff criteria and discriminant analyses, false-negative rates up to 53% for major depression and 100% for minor depression were found. Psychometric misrecognition of depression was not related to degree of dementia or education but on some measures was positively associated with verbal intelligence level and patient age. Contrary to previous suggestions that psychometric measures overestimate depression in the elderly, these findings suggest that there may be a subgroup of elderly in which treatable affective distress is not appreciated.

Aged↗
PubMed1990

Chest pain and anxiety disorder.

Chest pain is a common clinical expression of coronary artery disease. Less well known is that chest pain is far more frequently a somatic expression of inner stress. This study reports on data gathered from all patients with completely normal angiograms studied in the Catheterization Laboratory of The Methodist Hospital in the years 1984 and 1985. Questionnaires were sent to 570 patients, and there were 371 replies. Of those who replied, 26% qualified for a diagnosis of "generalized anxiety disorder" only, while an additional 43% qualified for a diagnosis of "panic attacks" or "panic disorder." Stress was frequently diagnosed, but seldom treated. This article includes suggestions about identification of these disorders and their treatment.

Anxiety Disorders↗
PubMed1989

Nursery privileges of the private attending pediatrician in the care of critically sick neonates in New York state.

To determine the role of the private attending pediatrician in caring for newborns who require intensive, intermediate, or continuing care in New York state, a request was sent to New York state institutions to select the statement best describing private attending pediatrician privileges. Privileges were graded from 1 to 6 with category 1 allowing the private attending pediatrician to care for all newborns and category 6 not allowing the private attending pediatrician to care for any newborns. Nurseries were classified (per New York State Department of Health) as regional, nonregional intensive care, intermediate care, and continuing care centers. A total of 97% (88/90) of institutions responded, representing 2,040 private attending pediatricians. In 95% (79/83) of the New York state institutions with staff private attending pediatricians, the pediatricians' privileges were limited. In 18% (15/83), the private attending pediatrician does not supervise any newborns receiving special care, whereas in an additional 77%, pediatricians' privileges have been limited. Despite this, the majority of institutions encourage the private attending pediatrician to continue communication with the family. Limited hospital privileges coupled with continued family communication may be the future trend for private attending pediatricians in the hospital setting.

Communication↗
PubMed1988

Angina as a symptom of psychiatric illness.

We retrospectively studied all patients who had normal coronary angiograms at The Methodist Hospital during the year 1984 (8% of all angiograms). Patients were surveyed eight to 18 months after angiography. Of the 216 patients (83% of total sample), 130 were female and 86 male. Sixty-three percent of the women and 50% of the men satisfied the criteria for generalized anxiety disorder, and 20% satisfied the criteria for panic attacks. On the Brief Symptom Inventory (BSI) Somatization Scale, 64% had scores above the average reported for psychiatric outpatients. Eighty-one percent received only reassurance about the absence of heart disease, and 25% received continuing nitrate therapy in the absence of heart disease. A majority of these patients remain untreated functional "cardiac neurotics" with untreated anxiety symptoms. We make suggestions regarding a clinical profile to identify these patients and appropriate measures to avoid prolonged disability.

Adult↗
PubMed1986

Patterns of bilirubin staining in nonhemolytic kernicterus.

Patterns of bilirubin staining were studied in nine infants with kernicterus related to nonhemolytic hyperbilirubinemia, all weighing less than 1200 g, and nine matched controls. Three staining patterns were disclosed: a localized pattern in the central nervous system of kernicteric infants, with only the thalamus staining significantly often; staining, in extraneural tissues (adrenal, myocardial, renal, and colonic mucosa) only in kernicteric infants, despite similar bilirubin levels in both groups; and yellow staining of the alveolar hyaline membranes as a function of survival duration in both groups. Bilirubin staining of tissue is apparently a generalized phenomenon, most recognized in the central nervous system as kernicterus. Failure to maintain the impermeability of the cell membrane coupled with regional differences in blood flow would best explain bilirubin distribution. In contrast, the degree of bilirubin staining of alveolar hyaline membranes is time related in kernicteric and control infants.

Bilirubin↗