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Biomedical subjects

W A James

Publications and source records attributed to W A James.

16 recordsLinked to original sources
PubMed2000

Completed suicides and emergency psychiatric evaluations: the Louisville experience.

Suicide is one of the most serious outcomes of psychiatric illness, and the most extreme intervention (involuntary hospitalization) can be exercised if this event is likely. Despite this, the rate of suicide has remained fairly consistent at 1.1-1.4%. In an ongoing effort of identifying factors that can predict subsequent suicides, we retrospectively examined the records of individuals who completed suicides in Jefferson County, January 1997 through September 1998, and who were evaluated at the Emergency Psychiatric Service (EPS) at University of Louisville Hospital. Fifteen of the 132 (11.4%) subjects who completed suicide were evaluated at some point in time at EPS. Only 8 (6.1%) were seen within 60 days of the fatal event. This represents less than 0.1% of the total 9,469 patients seen at the EPS during this time period. No specific factors could be identified that predicted imminent suicide. Given the inaccuracy in being able to predict suicide, clinicians need to continue to be vigilant when assessing acutely distressed substance abusing or psychiatric patients.

Adult↗
PubMed1993

AIDS and the family: implications for counselling.

The presence of HIV spectrum illness stimulates a powerful emotional reaction from a patient's family and friends. Grief and shock over the infection, and its implications are frequent observations. Sadness, anxiety, helplessness and anger are also common. Health care staff should address these responses in order to strengthen coping skills and maximize interpersonal comfort. Stigmatization and isolation are major stressors. Bereavement is complicated by fear, shame, dependency and hopelessness. Therefore, a task in counselling is to maintain the integrity and supportiveness of the patient's social unit by encouraging open communications between those involved and by educating about AIDS. Information should be provided on HIV transmission, self-protection, and illness progression as well as the safety of causal contacts and the practices of 'safer sex'. The significant others should retain outside interests and be encouraged to seek help for patients from supportive social agencies. Instillation of hope lends benefit to patient, family and friends. Kind, non-judgmental counselling and good quality medical care should be made available, especially since HIV-related disorders are increasingly becoming a chronic disease. Advocacy for the significant others translates into better adjustment and it enhances the patient's medical prognosis.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Clomipramine for obsessive-compulsive disorder: prescribing guidelines.

Clomipramine is a newly marketed tricyclic antidepressant drug prescribed for obsessive-compulsive disorder (OCD). It selectively blocks neuronal uptake of serotonin. Clomipramine has been prescribed in Europe and Canada for 20 years in management of depression. Studies have now shown clomipramine to be effective in treating OCD. Dry mouth, visual disturbances, constipation, sexual dysfunction, somnolence, tremors, and dizziness are among the commonly reported side effects. Like other tricyclics, clomipramine exhibits a potential for cardiotoxicity, especially by impairing conduction and/or orthostasis. It also has the effect of lowering seizure threshold. Overdose risk is considerable. Careful medical supervision and adherence to prescribing guidelines are presumed to reduce medication risk factors. The outstanding benefit of this drug is its proved efficacy in the management of obsessive-compulsive disorder, as the first pharmacotherapy approved for this previously rather treatment-resistant condition.

Clomipramine↗
PubMed1991

Bupropion: overview and prescribing guidelines in depression.

Bupropion is a new antidepressant medicine that is chemically distinct from previous agents. Clinical studies have shown it to be as effective as the standard antidepressant drugs currently used in the treatment of major depression. It is useful in patients resistant to other agents as well as in patients with atypical depression. Bupropion is 10 to 100 times less likely to induce cardiac conduction problems than the tricyclic drugs, and orthostatic hypotension is rare. Minimal anticholinergic effects account for its being generally well tolerated. The most common side effect is dry mouth. An epileptogenic potential is prominently reported. Because it may lower the convulsive threshold, bupropion is not recommended for individuals who may be predisposed to seizures. In people without an increased ictal risk factor, and when dosage is maintained at 450 mg/day or less in a divided schedule, the seizure rate is comparable to that of other antidepressant drugs.

Antidepressive Agents↗
PubMed1983

Carbon dioxide laser trabeculostomy for the treatment of neovascular glaucoma.

During the past 24 months, 23 cases of advanced neovascular glaucoma, unresponsive to medical therapy, have been treated by a trabeculostomy procedure using a carbon dioxide laser. This procedure entails surgical entry into the anterior chamber from beneath either a conjunctival or scleral flap in such a way as to completely cauterize any neovascular tissue in the corneoscleral angle and to permit adequate drainage of the aqueous in fluid from the anterior chamber to the periocular space. The average intraocular pressure prior to carbon dioxide laser trabeculostomy was 54 mmHg and these pressures were lowered below 18 mmHg in over 70% of the cases followed for longer than six months postlaser therapy. Treatment was considered a failure in 16% of the cases where the intraocular pressure was not lowered substantially. Fourteen percent of the treated eyes sustained a pressure decrease to within the 26-35 mmHg range. Carbon dioxide laser trabeculostomy provides a new method of lowering the intraocular pressure in severe cases of neovascular glaucoma without the hazard of intraocular hemorrhage common with other filtration procedures or the ciliary destruction present with the cyclocautery operations. The indications, surgical technique, and complications will be discussed.

Diabetic Retinopathy↗
PubMed1976

Argon laser photomydriasis.

Argon laser photomydriasis was used to enlarge 20 miotic pupils in 18 open-angle glaucoma patients, with beneficial visual results in patients properly selected before treatment. During eight months of observation, significant complications such as persistent iritis and lens changes did not occur. An increase in intraocular pressure occasionally occurred shortly after treatment, but chronic exacerbation of underlying glaucoma was not observed. Argon laser iris photocoagulation in rabbit eyes showed localized atrophy of the iris sphincter and stroma within the treatment zones. Discrete, anterior lens opacities occurred only at high-power levels, and these appeared to be nonprogressive during the eight-week observation period.

Animals↗
PubMed1975

A disposable vitreous cutter-aspirator with electronic vacuum control.

A sophisticated instrument system for performing vitreous surgery includes a disposable surgical tool, with all connecting tubing incorporated in a sterile template that is easy to assemble prior to surgery. The instrument console and foot switches provide all necessary surgical options, with a maximum degree of safety, for precise vitreous suction and infusion control with the disposable vitreophage or other available vitreous cutters.

Disposable Equipment↗
PubMedDate not supplied

Challenges posed by non-random missing quality of life data in an advanced-stage colorectal cancer clinical trial.

Effects of variations in agent, dose, and route of treatment administration on patient reported quality of life (QOL) were examined for 279 patients enrolled on a seven-arm randomized clinical trial (S8905) of 5-FU and its modulation for advanced colorectal cancer. Patients completed QOL questionnaires at randomization and weeks 6, 11, and 21 post-randomization with five QOL endpoints considered primary: three treatment-specific symptoms (stomatitis, diarrhea, and hand/foot sensitivity); physical functioning; and emotional functioning. Patient compliance with the QOL assessment schedule was good, supporting the feasibility of including QOL measures in cooperative group trials. However, death and deteriorating health produced substantial missing data. Cross-sectional analyses indicated that the seven therapeutic arms did not differ in their impact on QOL. Unfortunately, longitudinal analyses of the QOL data were inappropriate given non-random missing data. Graphical presentation of non-random missing data identified the seriousness of this problem and its effect on potential conclusions about QOL during treatment. This problem appears to be particularly challenging in the context of advanced-stage disease. Failure to recognize the presence of non-random missing data can lead to serious overestimates of patient QOL over time.

Adult↗
PubMedDate not supplied

Argon laser photocoagulation of iris abnormalities.

Argon laser photocoagulation of various iris abnormalities has been performed successfully. The destruction of iris cysts, the obliteration of blood vessels in iridocyclitic membranes prior to surgical discission, the correction of updrawn and deformed pupils, the mydriasis of pupils in patients debilitated by the miosis of antiglaucoma medication, and the production of iridotomies have been accomplished and are described along with the indications, photocoagulation techniques, results, and complications attendant to these particular procedures.

Adolescent↗