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Biomedical subjects

S W Perry

Publications and source records attributed to S W Perry.

At least 55 records · Page 3Linked to original sources
PubMed1986

Determining resuscitation status: a survey of medical professionals.

Regarding the determination of resuscitation status (RS) and the writing of do-not-resuscitate orders, we compared the recent Presidential Guidelines with the attitudes and perceptions of 143 medical professionals in a major medical center. Seventy-four percent of respondents believed that RS was primarily determined by the physician. Only 1% believed the patient decides and a minority (40%) believed the patient should decide; 61% would want to decide for themselves if they were ill. Most respondents agreed that neither patients nor staff were well-informed about the individual patient's RS. When presented case vignettes requiring a decision about RS, the respondents frequently chose a RS contrary to the wishes of a competent patient. The findings of this survey point to the significant differences between the Presidential Commission's guidelines and the actual attitudes and perceived practices of clinicians.

Advisory Committees↗
PubMed1986

Psychiatric interventions for AIDS-spectrum disorders.

Although the medical and psychosocial problems posed by acquired immune deficiency syndrome (AIDS) are unique, interventions to treat AIDS-related psychiatric disorders are currently available. The depression, delirium, and denial that occur in medically hospitalized patients with AIDS respond to standard psychotherapeutic and psychopharmacological approaches. Outpatients with AIDS or AIDS-related complex benefit from clarification, abreaction, and support if the therapist accepts the regression associated with the sick role, focuses initially on somatic rather than on psychological concerns, and overcomes unwarranted fears of contagion. Patients with AIDS-related dementia are helped considerably by early diagnosis and planning, and patients with antibodies to the AIDS virus require a psycho-educational approach that includes stress inoculation and problem-solving techniques. The authors describe the above interventions as well as common countertransference responses that impede their implementation.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Reversibility of cognitive impairment in medical inpatients.

To determine outcomes of patients admitted to the hospital with global cognitive impairment and to identify factors that might predict improvement, we screened all medical ward admissions over a one-month period with Folstein's Mini-Mental State Examination. Of 115 patients, 23 (20%) scored less than 24, indicating that they were cognitively impaired. Nineteen patients survived to discharge and were followed up for three months; three additional patients died in this period. Nine (47%) of the 19 patients significantly improved their Mini-Mental State scores. Five (26%) of the 19 improved to normal. They scored better on the initial Mini-Mental State Examination and lower (less dementia) on Blessed's Dementia Rating Scale. Age, severity and stability of medical illness, presence of neurologic abnormalities, clinical course, extensiveness of medical evaluation, and psychiatric criteria for delirium did not predict improvement.

Adult↗
PubMed1984

Undermedication for pain on a burn unit.

As the consultation-liaison psychiatrist for a large burn service, the author investigated the undermedication for pain. This phenomenon could not be adequately explained by the staff's insensitivity, by mistaken ideas about analgesics, or by fears of iatrogenic addiction. For both patients and staff, the pain served to maintain self-object differentiation and to provide reassurance that the patient was alive. Developmental observations and psychoanalytic theory support this unconscious need for pain.

Analgesics, Opioid↗
PubMed1984

Rationale for the use of hypnotic agents in a general hospital.

A survey at a teaching hospital found that 46% of medical patients had prescriptions written specifically for sleep and 31% received a hypnotic agent at least once during hospitalization. Physicians for 96% of surgical patients ordered hypnotic agents and 88% received such a drug. The rationale for prescribing hypnotic agents was not well documented. Administration did not correlate with requests by patients, with previous use of hypnotic agents, or with recorded indications of sleep disturbance; however, the chance of receiving a hypnotic agent was greater if the patient was on a private instead of a ward service and if nurses were more inclined to fill as-needed prescriptions. Patients who received a hypnotic agent did not rate the quality of their sleep as being any better than those who did not, and they complained of as many awakenings during the night. Further studies are necessary to ascertain the indications and efficacy of hypnotic agents for hospitalized patients.

Adult↗
PubMed1983

Photosynthetic rate control in cotton : photorespiration.

The purpose of this research was to determine the magnitude of photorespiration in field-grown cotton (Gossypium hirsutum L.) as a function of environmental and plant-related factors. Photorespiration rates were estimated as the difference between measured gross and net photosynthetic rates.A linear increase in photorespiration was observed as air temperature increased from 22 to 40 degrees C at saturating photon flux density. At 22 degrees C, photorespiration was less than 15 per cent of net photosynthesis and very comparable to the dark respiration rate. At 40 degrees C, photorespiration represented about 50 per cent of net photosynthesis. Gross photosynthesis had a temperature optimum of 32 to 34 degrees C. Water stress, as indicated by Psi(L), did not alter the ratio of gross photosynthesis to net photosynthesis when the confounding effects of leaf temperature differences were accounted for in the data analyses. A reduction in both gross and net photosynthesis was apparent as Psi(L) declined from -2.0 megapascals indicating direct effects of water stress on the photosynthetic process. Photorespiration expressed as a proportion of net photosynthesis increased as water stress intensified.Cotton cultivars possessing a fruit load had significantly higher gross and net photosynthetic rates and lower photorespiration rates than did photoperiod-sensitive cotton strains without a fruit load. Within the fruiting types, which were genetically very similar, only minor differences were observed in the photorespiration:net photosynthesis ratios. However, in the photoperiod-sensitive strains, considerable genetic variability existed when photorespiration was expressed as a proportion of net photosynthesis. These results suggest that the kinetics of ribulose-1,5-bisphosphate carboxylase:oxygenase may be different and, thus, the possibility of genetically reducing photorespiration exists.

Journal Article↗
PubMed1981

The disruptive patient or visitor.

A disruptive patient or visitor can be managed by a four-person team under the direction of a single leader. When the disruptive person is subdued and transported to a separate room for evaluation, a brief examination is recommended before medication. If medication is found necessary, haloperidol is the drug of choice. A patient can be treated without consent if a court has determined that the patient is incompetent to make such a decision.

Dangerous Behavior↗
PubMed1980

Use of a psychodynamic life narrative in the treatment of depression in the physically ill.

Depression, unlike grief, is a maladaptive response to the crisis of illness. This crisis has certain characteristics: (a) psychic disequilibrium with confusion and uncertainty; (b) regression with intensified transferences; and (c) a tendency to examine the trajectory of one's life. This situation makes the patient not only more vulnerable but also more responsive to intervention. These characteristic reactions of illness can be considered in designing a therapeutic maneuver to treat depression. Three cases are used for illustration. In each case a depressed patient was presented a statement that placed his physical illness in the context of his life trajectory and demonstrated the psychodynamic logic of his depression. We call this intervention a "psychodynamic life narrative." The therapeutic effect of such a narrative and the type of patient most likely to benefit from such an intervention are discussed.

Adolescent↗
PubMed1980

A resident's rotation in consultation psychiatry. A maturational experience.

The authors emphasize the importance of a consultation psychiatry experience in the maturation of the young psychiatrist by examining some of the processes operational in both community and hospital consultation work, performed by the senior author during his fourth year of residency. Such experiences can provide opportunities for developing psychiatric skills not emphasized elsewhere, including the adoption of an active therapeutic stance, the application of the psychodynamic theory to the consultation system itself, and teaching without the use of jargon. In addition the experience as consultant facilitates the transition from residency to the outside world, not only through attitudinal changes achieved by exposure to less structured settings, a change in the supervisory model, and a solidification of identity as a physician and psychiatrist, but also by providing the resident the opportunity to begin de-cathecting from the training program.

Adult↗
PubMed1980

The psychiatry internship and the development of professional identity.

Advocates of the psychiatry internship believe the experience fosters professinal maturity. The authors examined the maturing process of 10 psychiatry residents during their internship year. Changes in the interns' professional identity including expectations of self and others are described and seen as a goal of the experience. The authors outline danger signals of poor professional development and suggest interventions to help interns resolve conflicts.

Attitude of Health Personnel↗