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Biomedical subjects

R M Rosser

Publications and source records attributed to R M Rosser.

15 recordsLinked to original sources
PubMed1995

The Kings Cross fire: psychological reactions.

The psychological reactions of 50 survivors of the King's Cross fire, which hit London's underground railway system on the 18th day of November 1987, are described. Results are presented for the Impact of Event scale, the General Health Questionnaire (28-item version), the Eysenck Personality Questionnaire and a King's Cross Event Schedule. These are investigated in relation to (a) validity measures, (b) relationships between exposure and personality, and (c) spontaneous de-briefing. Two thirds of the sample had significant levels of psychological distress (meeting the "caseness" criterion on the GHQ). Both personality (neuroticism and L-scale) and degree of trauma exposure were related to subsequent reaction. Spontaneous debriefing was associated with subjective benefit. Transportation disasters present particular problems in relation to research and service delivery.

Adaptation, Psychological↗
PubMed1993

Impact of diagnosis on utilities assigned to states of illness.

This paper addresses some of the fundamental issues surrounding the measurement of quality of life in relation to health care and highlights the need for continuous and careful review. Healthy volunteers were used to study the effect of diagnosis on the utilities placed on three dimensions of health-related quality of life encompassing 17 states of disability, distress, and discomfort including pain. The standard gamble (SG) was used to elicit values for appropriate levels of each dimension for selected diagnostic conditions. It was shown that clinical diagnosis affects the utilities that people assign to different states of ill-health. Mental conditions were consistently assigned lower utilities with subjects attributing their decisions to the social unacceptability and intractability associated with these conditions. These findings suggest that the comprehensiveness of the descriptive system for health indicators and profiles is important and should be kept under review. Furthermore, these data have implications for the role of the Quality Adjusted Life Years (QALY) estimates which assume that utility is uniform across various conditions. Finally, the study may have implications for mental health services if other population samples were to accord such high priority to the relief of mental conditions.

Diagnosis↗
PubMed1990

Psychiatric morbidity among Punjabi medical patients in England measured by General Health Questionnaire.

The 28-item GHQ was administered to 282 Punjabi and white British patients visiting two Health Centres in Bedford. We discovered that ethnicity is not significantly correlated with GHQ 'caseness', but that differences exist in somatic and depressive symptomatology. The discussion relates these findings to debates about the psychiatric morbidity of Asian immigrants and somatization.

Adult↗
PubMed1987

Five-year follow up of patients treated with inpatient psychotherapy at the Cassel Hospital for Nervous Diseases.

Twenty-eight patients who were admitted consecutively to a single-adult unit of the Cassel Hospital in 1977/8 were followed up 5 years after discharge. Those who were found to have improved at the end of treatment remained well 5 years later. These could be distinguished by their combination of neurotic psychopathology, considerable depression, superior intelligence, and lack of a chronic outpatient history. Patients who had improved 5 years after discharge did not show these characteristics, but had all spent at least 9 weeks on the waiting list and had the capacity to form close and helpful relationships. Patients who were judged to have improved were less dependent on the Health Service and their economic productivity was improved, often as a consequence of returning to education or training. Those who did not improve clinically continued to be admitted to hospital and tended to become less economically productive.

Adult↗
PubMed1983

The Charing Cross-Cassel Focal Psychotherapy Research Project: method of content analysis.

A method of content analysis has been designed for application in brief focal psychotherapy with physically ill patients. The method is being used to study the process of therapy with patients with chronic obstructive airways disease. This paper discusses its reliability and validity in this context and suggests that it may illuminate the relevance of environmental factors to the development of the transference.

Humans↗
PubMed1980

Diazepam in the treatment of dyspnoea in the 'Pink Puffer' syndrome.

Diazepam, in moderate doses, has been used in a placebo controlled, single blind study to treat dyspnoea in four patients severely disabled from chronic airflow obstruction. The subjects had the 'pink puffer syndrome', usually associated with emphysema and were not hypercapnoeic nor severely hypoxic at rest. With diazepam, they experienced a striking reduction in dyspnoea, and an improvement in effort tolerance; in addition the slope of the ventilation/CO2 response curve was reduced. There were no changes in resting blood gases. Psychiatric examination at the end of the study did not reveal prominent anxiety, although three patients were depressed. The use of diazepam to treat dyspnoea in this syndrome is safe in the absence of any acute infection

Aged↗
PubMed1976

The reliability and application of clinical judgment in evaluating the use of hospital beds.

A technique is described which circumvents the difficulty in obtaining reliable judgments by clinicians on cases of inappropriate use of hospital beds. By application of the Delphi method of measuring group expert opinion, convergence was achieved in the estimate, by four physicians, of the total number of bed days wasted on a medical ward during a period of two weeks. Cases of possible misutilization were identified by the author and a second study was designed to measure the effect on the physicans' behavior of her presence on the ward (Hawthorne effect). It is suggested that review of cases of misutilization by the Delphi method could be used in the continuing education of physicians.

Education, Medical, Continuing↗
PubMed1976

16. Recent studies using a global approach to measuring illness.

Global measures of illness are designed to measure the performance of a health service as a whole and the contribution of its various components. Such measures convert data about the outcome of medical care into information for use in planning at all administrative levels including the highest levels of government. This is achieved by means of a classification of states of illness applicable to all patients, whatever their diagnosis and symptoms, and of a scale which places valuations as perceived by society on the defined states. The valuations of changes in the states of individuals during treatment or over a period of time can then be summed for heterogeneous populations. By adjusting the valuations of future changes for time preferences it may be possible to take into account prognosis, and by placing a valuation on death, mortality and morbidity data can be combined. The properties appropriate to the classification and scale are defined and problems encountered in their derivation are discussed. Examples are presented of the application of one global measure to a group of medical specialists and to population data for the United Kingdom.

Classification↗
PubMed1974

Blood levels and management of lithium treatment.

The limited value of plasma measurements in the management of treatment with lithium is discussed in the light of the mechanisms of its therapeutic actions and toxic effects.The plasma level of lithium usually rises twofold or threefold in the three to five hours after ingestion of each dose of delayed-release tablets and then gradually falls. The precise shape and height of the lithium curve depend on gastric emptying, which can be slowed with propantheline or speeded with metoclopramide. Depressed or demented patients may be irregular in taking their tablets and variable in food intake. Both the time of the blood test and this behaviour must be considered before changing the prescribed dose of lithium salt because of a laboratory result. A lithium tolerance curve may be a safer guide to treatment than single measures.Mild intermittent thirst is a common early side effect, and severe persistent thirst with polyuria is an uncommon later effect of daily intakes of at least 1,500 mg lithium carbonate. This diabetes insipidus is reversible, non-progressive, unrelated to plasma level, and distinct in attack from lithium-induced hypothyroidism, which may occur at low dosage but is also usually of late onset and reversible or treatable with thyroxine while lithium is continued. Obesity is another occasional effect of large doses. These side effects and the antimanic and prophylactic effects may have different mechanisms.

Administration, Oral↗