Biomedical subjects

Raymond M Costello

Publications and source records attributed to Raymond M Costello.

6 recordsLinked to original sources

PubMed2006

Long-term mortality from alcoholism: a descriptive analysis.

OBJECTIVE: Short-term alcoholism mortality studies are limited in their ramifications for long-term, comprehensive treatment program planning. Therefore, this study was pursued for more than 33 years to answer questions such as how, when, and why alcoholics die after discharge from an intermediate care component of a comprehensive community-based treatment program. METHOD: A cohort of 500 alcoholics admitted in five groups of 100 in the years 1963, 1964, 1967, 1970, and 1972 to an intermediate care unit of a community-based, comprehensive treatment program was tracked for 33-42 years to document deaths. Case-fatality rate (CFR) and cause-specific mortality rate were computed and correlated with follow-up lag and ethnicity. RESULTS: Four hundred and forty nine subjects died within 39 years, with 50% of the deaths occurring by Year 11. Average annual CFR was .057. Cause-specific mortality varied over time and with ethnicity. Deaths attributable to lifestyle causes (i.e., suicide, homicide, accidents, and AIDS) occurred disproportionately in the earlier years of the follow-up, claiming the youngest and ethnic minority (black and Hispanic) persons disproportionately to white. Whites tended to live longer, but all three racial/ethnic groups died of lifestyle causes at young ages, early in the follow-up series, and at relatively older ages from cancer and diseases of the lung late in the follow-up series. CONCLUSIONS: Comprehensive treatment programs must prepare for lifestyle crises soon after discharge from intermediate care and for organ diseases later. Ethnicity is a significant predictor of early death in alcoholic cohorts and must be considered in comprehensive treatment program planning.

Adult↗

PubMed2005

Item difficulty scaling for WAIS-III picture arrangement.

Only one study regarding the sequencing of items of the WAIS-III Picture Arrangement subtest was located in a search of published literature. That study of 50 alcohol abusers failed to demonstrate that the items are sequenced in the perfect order of difficulty as suggested by the test publisher. The current study was accomplished to replicate or refute the prior study and to extend findings into related matters. Two laboratories provided four archival samples of 100 cases. Only five items appear properly placed, with one (OPENS) especially misplaced. A new sequence is recommended so that clinicians can administer the test more efficiently and examine errors from a process approach to evaluation. Difficult items were not passed as often as expected by Hispanic respondents. This finding was considered an artifact related to archival convenience sampling and may not be representative as a general finding regarding Hispanic performance until experimental sampling techniques or proper statistical controls can be applied. Statistically controlling for IQ, through analysis of covariance, eliminated ethnicity effects on total score for the PA subtest.

Adult↗

PubMed2003

Minimal model to document psychometric change after standard anterior temporal lobectomy for intractable seizure disorder.

Neuropsychological assessment of persons with epilepsy is recommended whenever neurosurgery is considered as an alternative therapy for seizure disorders refractory to ordinary medical management. Although psychological assessment is common in centers specialized in the care of epilepsy patients, standardized protocols are not common. This study addresses the question of the optimal minimal test battery necessary to differentiate groups of right-handed patients with refractory, complex partial seizure disorder who receive either right or left anterior temporal lobectomy or no surgery. No variable differentiated the groups before surgery. Only Logical Memory-Immediate of the Wechsler Memory Scale differentiated the groups following surgery. This finding is consistent with the literature.

Adolescent↗

PubMed1990

P-A-I-N reviews.

Explore the source record for details and available documents.

Algorithms↗

PubMed1987

P-A-I-N: a four-cluster MMPI typology for chronic pain.

A 4-cluster empirically derived MMPI typology for chronic pain sufferers has been demonstrated by combining the results of 10 investigative teams. These MMPI 'types' have been labeled P-A-I-N and appear to have important clinical and demographic correlates. Type P is the most 'psychopathological' looking as nearly all scales are usually elevated. Type P patients are extreme in their claims of physical illness, psychological distress and social maladaptation. Demographic correlates include poor education, high rates of unemployment, and limited household income. Type A is defined by a 'conversion V' on the 'neurotic' triad scales. It has no unique correlates. Type I has elevations on all of the neurotic triad scales and on no others. Type I patients appear to be the most physically infirm with multiple surgeries and hospitalizations. They may not improve physical status with treatment, but appear to benefit psychologically. Type N profiles are 'normal' in that no scale, except perhaps scale K, is often elevated. Type N patients are moderate in their claims of ill health, often are better educated and employed, and appear to respond well to treatment. Classification rules have been proposed to allow patient-typing without a computer. Use of these rules should allow programmatic research into treatment/type interactions even in the ordinary clinical setting. The typology appears well enough established to allow for prospective studies to test theoretical hypotheses drawn from the literature base.

Chronic Disease↗

PubMedDate not supplied

Self-assessment of cultural and linguistic competence in an ambulatory health system.

The University Health System (UHS) leaders organized a comprehensive planning process of its ambulatory care system. As part of this planning process, UHS assessed the cultural and linguistic competence of its outpatient environment. This assessment was conducted within the context of standards outlined in the U.S. Department of Health & Human Services (2001) Standards for Cultural and Linguistically Appropriate Services, using a multimethod approach. This multimethod approach included (1) a review of the organizational profile, (2) a review of organizational documents, (3) a review of policies and procedures, (4) clinic site visits, (5) a staff survey, (6) patient and provider focus groups, and (7) interviews with key stakeholders in the community. Generally, the UHS was found to have several strengths that enable it to continue meeting the medical needs of its target populations. To develop greater capacity in the areas of cultural and linguistic competencies, the UHS should continue to promote respect for diversity by focusing on attitudes; beliefs; behaviors; practices; and communication patterns associated with race, ethnicity, religion, socioeconomic status, historical and social context, physical or mental ability, age, gender, sexual orientation, generational status, and acculturation level. Recommendations for achieving a more culturally competent healthcare organization are provided.

Academic Medical Centers↗