Biomedical subjects
Publications and source records attributed to W H Reid.
Psychiatrists, clinical psychologists, and family practitioners very rarely receive serious injuries from assaults by their outpatients or former patients. The rate of significant assault is comparable to that for nonpatient assault (e.g., mugging). No relationship between clinical experience and being an assault victim could be established.
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Throughout history burn wounds have been treated by covering with dressings of many different materials. The successful application of a burn dressing remains an objective for biomaterial development. This paper examines how the burn wound differs from other skin injuries, the requirements of the ideal burn wound dressing, and reviews the type of dressings available. The dressings in common use in the treatment of burns are compared with the 'ideal' dressing, in so far as it can be defined.
A silicone gel (Dow Corning X7-9119) has been successfully used in the management of hypertrophic scars. The gel softens and reduces scars in a shorter time period than pressure therapy. Relevant properties of the material and its mode of action have been investigated. The mode of action is unknown, but it is not due to pressure, temperature, oxygen tension or occlusion.
Definition, understanding, and treatment of antisocial personality disorder continue to present difficulties, but there have been several encouraging developments. Recently published data on antisocial syndromes from several different disciplines have been strikingly consistent and have raised hopes for an integrated understanding of the disorder. In addition, many of the sources of antisocial symptoms have been identified, and certain highly structured therapeutic programs have been effective in modifying antisocial behavior. The paper reviews the latest issues related to diagnosis, symptom presentation, and treatment, as well as pathologic, sociologic, and epidemiologic aspects of the disorder.
Nightly ingestion of diazepam, 10mg, alleviated some or all symptoms of intractable sleepwalking in several otherwise healthy adults. Some other patients did not respond as well. The results of this double-blind, crossover study suggest that diazepam is effective for the treatment of adult sleepwalking in some individuals. Data from this study are consistent with uncontrolled case reports of such treatment. Serious side effects or tolerance to the medication did not develop in any of the subjects studied. Other benzodiazepines, which may be more or less effective, remain unstudied. Psychiatric and social histories of these adult sleepwalkers are consistent with earlier work by the authors, which indicates little evidence for an association between uncomplicated sleepwalking and serious psychopathology.
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The use of a Q-switched pulsed Ruby laser was studied in removing tattoos. The results were very satisfactory, but there are several major disadvantages which at present would probably preclude the use of this therapy on a routine basis.
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The purpose of the study was to investigate the role of flexible bronchoscopy in the management of patients admitted to a busy Regional burns unit, with particular reference to possible smoke inhalation injury. The basic procedure employed was that used in routine bronchoscopy for the diagnosis of bronchial carcinoma, with modification of the premedication required in view of the shorter duration of the technique and the lack of a requirement for bronchial biopsy. We have found the procedure easy to perform, well tolerated by the patients and not associated with any complications. It provides additional information not otherwise available, which can influence the subsequent management of the patient. An experienced bronchoscopist and additional personnel skilled in resuscitation techniques are required. It should be performed in patients with clear evidence of smoke inhalation injury and in particular with facial burns in order to visualise the extent of airway injury, remove debris and give some indication of the likelihood of subsequent complications such as acute upper airways obstruction.
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Pathological affect--impairment of facial expressiveness and demeanor--is a common manifestation of the schizophrenic process. In this study, empirically defined and statistically independent concepts of affectual range, mobility, appropriateness, and communicability were rated by 30 professionals and paraprofessionals from special videotapes of 22 chronic schizophrenics. Reliability of the ratings, measured by correlations among and across parameters and rater types, averaged r = .70, notably better than that of the same raters using traditional subjective clinical judgment (r = .54). There was little disagreement among psychiatrists, psychology interns, junior medical students, or social workers/nurses, nor were any of those groups significantly more reliable than the average for all raters. Significant trends toward low reliability of the appropriateness parameter are pointed out and possible clinical relevance is discussed.
Loss of vision is a social and psychologic handicap as well as a physical one. The patient's initial reactions to blindness may include self-pity, feelings of hopelessness and recrimination, and even suicidal ideation. The ophthalmologist should encourage expression of these feelings. Severe or lasting emotional problems are often associated with previous psychologic problems, previous eye disease, coexisting physical handicaps, middle age, low income, poor education, humility and shyness. Acceptance of one's visual loss is crucial to good adjustment. The ophthalmologist should be understanding and supportive but should help the patient avoid false hope. Every ophthalmologist should be able to provide blind patients with information about local agencies that offer social support and rehabilitation services.
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Blood carboxyhaemoglobin and cyanide concentrations were measured in 53 fire survivors, 36 of whom had clinical evidence of smoke inhalation. Carboxyhaemoglobin and cyanide levels were raised only in patients with smoke inhalation. Blood carboxyhaemoglobin measurement can be used to confirm the diagnosis of severe smoke inhalation in cases in which the clinical data are inconclusive, provided that the time of sampling after exposure is taken into account. A nomogram has been constructed for this purpose. There is no quick method of measuring blood cyanide levels, but the close relation between cyanide and carboxyhaemoglobin levels suggests that carboxyhaemoglobin concentrations, which can be rapidly and easily measured, could be used to identify those who might benefit from treatment with cyanide antidotes.
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