Dementia reversal in post-shunt normal pressure hydrocephalus predicted by neuropsychological assessment.
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Aged↗
Biomedical subjects
W J Meyer
Publications and source records attributed to W J Meyer.
Anxiety: current practices in assessment and treatment of anxiety of burn patients.
Anxiety is an affective response commonly experienced by persons after emotional and physical trauma, as well as associated with aversive medical treatments. The scientific information related to the conceptualization, assessment, and treatment of anxiety is limited. In order to develop a pilot protocol for anxiety management, nursing directors at 64 burn centers were surveyed. At 89% of the centers, anxiety measures were not used. Most of the teams assess informally through observation of patient (n=21), dialogue with patient (n=12), or both observation and dialogue with patient (n=15). Assessors of anxiety range in breadth from nurse only to the entire burn team, including pastoral care representatives and family. The class of medication most frequently endorsed in treating anxiety is the benzodiazipine, most often lorazepam (Ativan). A number of non-pharmacologic techniques are used to manage anxiety, e.g., muscle relaxation, breathing, imagery. Consideration should be given to assessing anxiety systematically, so knowledge can be gleaned and applied to conceptualization of symptom presentation and application of treatment resources.
Adult↗
On changing curricula: lessons learned at two dissimilar medical schools.
Two dissimilar U.S. medical schools--the University of Pittsburgh School of Medicine and the University of Texas Medical Branch at Galveston-changed their curricula for the first two years of medical education from ones that were lecture-dominated and departmentally run to ones that are centrally governed, multi-modal, goal-oriented, and fully integrated, with mechanisms to continue curricular change into the last two years of medical education. The change at each school was in response to national education philosophy, the recommendations of the Liaison Committee for Medical Education after the most recent site visit, and faculty's and students' concerns and interests. The change process took place over a three- to four-year period at each school, involved students, faculty, and administration, and utilized task forces and retreats as communication vehicles. The barriers encountered (e.g., belief by some that the curriculum needed no change; concern over loss of departments' control) and the processes employed to overcome them and to radically change the curricula (e.g., commitment of the central administration and dean to the change, involvement of all segments of the school in the change process, appointment of department chairs on task forces, and creation of a strong curriculum committee that gave authority to faculty and students) were essentially identical. The resulting curricula were also largely similar in their main characteristics, but there were notable differences, based on the goals and concerns of the two institutions.
Curriculum↗
University of Texas Medical Branch at Galveston.
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Curriculum↗
Randomized, placebo-controlled pilot study of divalproex sodium in the treatment of acute exacerbations of chronic schizophrenia.
Experimental and clinical data suggest that GABA-ergic drugs such as valproate may have a potential role in the treatment of schizophrenia. The authors designed a 21-day prospective, double-blind, randomized, placebo-controlled pilot study of divalproex sodium as add-on treatment to haloperidol in 12 hospitalized patients with acute exacerbations of chronic schizophrenia. All patients received haloperidol 10 mg/day for 3 days and 15 mg/day for the remaining 18 days. In addition, five patients were randomly assigned to receive divalproex augmentation and seven to receive placebo. The divalproex dose was adjusted to a target serum concentration of 75 microg/mL for 2 weeks; placebo replaced divalproex during the third and last weeks to determine any carryover effect. Psychiatric rating scales were administered at baseline and on days 7, 14, and 21. Although the placebo group improved with haloperidol treatment, the divalproex group demonstrated greater improvement. On day 21, the divalproex group had greater improvement from baseline on the Clinical Global Impression Scale (p < or = 0.04), Brief Psychiatric Rating Scale (p < or = 0.13), and Schedule for Assessment of Negative Symptoms scores (p < or = 0.007). After divalproex withdrawal on day 15, a carryover effect was observed during week 3. The authors concluded that the addition of divalproex sodium to standard antipsychotic drugs may prove effective in relieving the symptoms of acute schizophrenia. Future studies may benefit from the design of this pilot study. However, it is premature to apply this augmentation strategy in the clinical setting just yet because of the small sample size and the likely heterogeneity of the disorder.
Acute Disease↗
Imipramine treatment in pediatric burn patients with symptoms of acute stress disorder: a pilot study.
OBJECTIVE: Pediatric burn patients often exhibit acute stress disorder (ASD) symptoms. Information on psychopharmacological treatment of ASD symptoms in children is scarce. This pilot study used a prospective, randomized, double-blind design to test whether thermally injured children suffering ASD symptoms benefit from imipramine. METHOD: Twenty-five children, aged 2 to 19 years, received either imipramine or chloral hydrate for 7 days. A structured interview (clinically useful, but validity and reliability not yet established) was used to assess the presence and frequency of ASD symptoms both before treatment and 3 times during the treatment period. RESULTS: Eleven females and 14 males participated, with a mean total burn surface area of 45% (SD = 23%) and mean age of 8 years (SD = 6). Imipramine was more effective than chloral hydrate in treating ASD symptoms (chi 2 [1, N = 25] = 5.24, p < .02). Five of 13 were positive responders to chloral hydrate (38%). Ten of 12 were positive responders to low-dose imipramine (83%). CONCLUSIONS: This pilot study suggests a place for cautious initial use of imipramine to reduce ASD symptoms in burned children. Care must be taken to minimize cardiovascular risks in an off-label application of imipramine in children, especially those receiving additional medications.
Acute Disease↗
Critical review of GABA-ergic drugs in the treatment of schizophrenia.
GABA-ergic medications may have a potential role in the treatment of schizophrenia. Laboratory evidence has generally supported the ability of gamma-aminobutyric acid (GABA) to reduce dopaminergic activity and has suggested that GABA may be effective in combating hypofrontality by acting on mesoprefrontocortical tracts in patients resistant to treatment with antipsychotic drugs. Although the results of clinical trials of several GABA-ergic compounds have been inconclusive because of methodologic limitations and drug toxicity, benzodiazepines and valproate seem to be associated with favorable treatment outcomes, especially when combined with typical antipsychotic agents. This study concludes that further investigation of the use of GABA in schizophrenia is likely to improve the understanding of the psychopathology of this illness and to expand our treatment alternatives. Also provided are suggestions to enhance the design of future studies, improve the potential for favorable treatment outcomes, and assist in predicting patients' responses to GABA-ergic medications.
Anti-Anxiety Agents↗
Relationship between parental emotional states, family environment and the behavioural adjustment of pediatric burn survivors.
The purpose of this study was to examine the relationship between psychosocial adjustment of the burned child and characteristics of the child's family. It hypothesized that parents who perceived their children without major behavioural problems would possess supportive family values and would, themselves, be better adjusted psychologically than those parents who perceived their children as possessing multiple behavioural problems. A stratified random sampling technique was used to select 35 (29 boys, 6 girls) paediatric burn survivors, ages 9 to 18, 1-5 years post-burn, with burn sizes ranging from 3 to 92% burn. Subjects' parents were administered the Child Behaviour Checklist (CBCL), the Family Environment Scale (FES), the Impact of Events Scale (IES), and the Beck Depression Inventory (BDI). The subjects were divided into two groups on the basis of the total problem CBCL scores. i.e. troubled (T > or = 60) or untroubled (T<60). One-way ANOVA tests revealed no significant differences between the two groups in the way parents reacted to trauma (IES) and parental depression (BDI). Significant differences (p<0.01) were revealed between the two groups on FES subscales. The parents of the untroubled group scored higher on 'Cohesion' and 'Organization' and lower on 'Conflict'. These parents also scored higher (p< or =0.05) on 'Achievement Orientation'. The results indicate that work with the family to promote cohesion. to decrease conflict, to enhance stability and to promote expectation of positive achievement must he a part of the rehabilitation of the burned child.
Adaptation, Psychological↗
Acetaminophen in the management of background pain in children post-burn.
This retrospective review evaluated the pain management of 395 acutely burned pediatric patients who were treated by a pain management protocol emphasizing acetaminophen as the initial medication to control background pain. Pain was assessed by using standardized instruments based on observations by patients, nurses, and parents. Morphine was added when scheduled acetaminophen (10-15 mg/kg/4 hr) did not control background pain. Fifty percent of the children received only acetaminophen to control background pain. Younger children and children with the smallest burns, regardless of age, were likely to be managed with acetaminophen alone. Most peak serum concentrations of acetaminophen were less than 10 micrograms/mL. When needed, children also received medication for painful procedures, anxiety, and posttraumatic stress symptoms. These additional medications were not more frequently given to children receiving only acetaminophen for background pain. These data suggest that acetaminophen is a safe, useful medication for the control of post-burn background pain in some children.
Acetaminophen↗
Comorbidity of gender dysphoria and other major psychiatric diagnoses.
Previous studies suggest that many transsexuals evidence an Axis I diagnosis according to the DSM-IV classification (e.g., psychoses, major affective disorder). The current study examined retrospectively the comorbidity between gender dysphoria and major psychopathology, evaluating the charts of 435 gender dysphoric individuals (318 male and 117 female). All had undergone an extensive evaluation, addressing such areas as hormonal/surgical treatment, and histories of substance abuse, mental illness, genital mutilation, and suicide attempts. In addition, a subgroup of 137 individuals completed the MMPI. Findings revealed over two thirds were undergoing hormone reassignment, suggesting a commitment to the real-life cross-gender process. One quarter had had problems with substance abuse prior to entering treatment, but less than 10% evidenced problems associated with mental illness, genital mutilation, or suicide attempts. Those completing the MMPI (93 female and 44 male) demonstrated profiles that were notably free of psychopathology (e.g., Axis I or Axis II criteria). The one scale where significant differences were observed was the Mf scale, and this held true only for the male-to-female group. Psychological profiles as measured by the MMPI were more "normal" in the desired sex than the anatomic sex. Results support the view that transsexualism is usually an isolated diagnosis and not part of any general psychopathological disorder.
Adult↗
Policy development for the control of sex-offending behavior.
Sexual violence is among the foremost problems that our society faces today. Addressing this problem will require more direct public education, effective and accessible resources for victims, punishment for offenders, and treatment of offenders to prevent recidivism. Although the 74th Texas legislative session began a concentrated approach to addressing this problem, further legislation is needed to provide a cost-effective method to increase public safety from sexual violence over the long term.
Child, Preschool↗
The Jarisch-Herxheimer reaction in pregnancy: a nursing perspective.
The Jarisch-Herxheimer reaction is a systemic event that can occur after the first dose of penicillin administration during treatment of syphilis. This article presents a case report of the Jarisch-Herxheimer reaction in a woman who was treated for syphilis at 27 weeks gestation. The proposed pathophysiology of the reaction is described, and complications of this reaction during pregnancy are reviewed. Recommendations for the nursing care of women treated for syphilis are provided.
Adolescent↗
Early gestational glucose screening and gestational diabetes.
OBJECTIVE: The purpose of this study was to determine the benefit of early glucose screening prior to 24 weeks' gestation in detecting gestational diabetes. STUDY DESIGN: A retrospective analysis of 329 patients who received both early and complete prenatal care at the University of Illinois was performed. A 50-g, 1-hour glucose screen was performed at the first prenatal visit. An abnormal glucose screen, defined as blood sugar > 135 mg/dL, was followed by a 100-g, 3-hour glucose tolerance test. Gestational diabetes was defined as the presence of two or more abnormal values on the three-hour test. This protocol was repeated again at 28 weeks in all patients except those diagnosed as diabetic by having abnormal early three-hour tests. Data collected included maternal age, race, gravidity, presence of risk factors, pregnancy weight gain at glucose testing and delivery, neonatal birth weight and trauma. Data were analyzed using analysis of variance and chi 2 testing, with P < .05 considered significant. RESULTS: Gestational diabetes was diagnosed in 20 (6.1%) of the study patients. Eight (40%) of the gestational diabetics in the study population were detected with the early screening protocol. Factors associated with early detection of glucose intolerance included maternal age > 30 years (P < .001), black race (P < .001) and the presence of risk factors (P < .0001). Poor pregnancy weight gain was associated with the late development of glucose intolerance (P < .001). Gestational diabetes was subsequently diagnosed in 16% (6/38) of those patients who had, on early testing, an elevated one-hour glucose screen and negative three-hour glucose tolerance test when testing was repeated in the third trimester. CONCLUSION: Early gestational glucose screening may be beneficial in detecting gestational diabetes in patients over 30 years old who are black or who have risk factors for diabetes. Consideration should be given to repeat glucose testing in the early third trimester in patients with false positive early one-hour screening tests.
Adult↗
Catalase activity as a predictor of amniotic fluid culture results in preterm labor or premature rupture of membranes.
OBJECTIVE: To evaluate catalase activity as a rapid predictor of microbial invasion of amniotic fluid (AF). METHODS: The study population consisted of 74 patients before 36 weeks' gestation with preterm labor or premature rupture of membranes (PROM). Subjects were excluded if there was evidence of clinical chorioamnionitis or fetal distress at admission. Amniocentesis was done within 24 hours of admission, and the AF was cultured for aerobic and anaerobic bacteria and for Mycoplasma species. All AF samples were Gram stained, and slides were examined by microbiology technologists. Amniotic fluid catalase activity was measured immediately after amniocentesis using a commercially available kit. The sensitivity of the Gram stain and catalase activity were compared using McNemar exact test. RESULTS: Amniotic fluid cultures were positive in 12 of 37 (32%) patients presenting with preterm labor and in 21 of 37 (56%) patients with PROM. Catalase activity was significantly more sensitive than Gram stain in detecting positive AF cultures in cases of PROM (P < .001) and preterm labor (P < .04). CONCLUSION: Catalase activity is a simple, rapid test that is useful in identifying subclinical intra-amniotic infection in patients with preterm labor or PROM.
Amniotic Fluid↗
A placebo-controlled evaluation of the effects of buspirone on smoking cessation: differences between high- and low-anxiety smokers.
One hundred one smokers were divided into high and low trait anxiety groups on the basis of a normalized score on the Profile of Mood States Anxiety/Tension Scale and were randomly assigned to receive buspirone or placebo in a double-blind fashion. After a 1-week baseline, smokers were exposed to an 8-week drug and behavioral intervention involving buspirone or placebo (up to 60 mg/day) with concurrent group cognitive behavioral intervention. All smokers were to quit smoking on the target date, set at 4 weeks after the program began. Medication was provided for an additional 4 weeks after group treatment ended. The results showed that buspirone had a beneficial effect on smoking abstinence but only among smokers who were already relatively high in anxiety and only for as long as the drug was available. Moreover, when provided to smokers who were relatively low in anxiety, the drug appeared to interfere with abstinence, although these effects also reversed when the drug was withdrawn. These effects were associated with an attenuation of the expected rise in anxiety before the quit date and its actual reversal thereafter, but only in the buspirone high-anxiety group. One-month abstinence averaged 88, 61, 60, and 89% for the buspirone high-anxiety, placebo high-anxiety, buspirone low-anxiety, and placebo low-anxiety groups, respectively. By 12 months, abstinence for the buspirone and placebo high- and low-anxiety groups fell to 12, 23, 41, and 36%, respectively. No differences were observed for measures of self-efficacy, symptoms of withdrawal, medication side effects, or compliance.
Adult↗
Effect of amniotic fluid volume on ultrasonic fetal weight estimation.
We evaluated the relationship between the amniotic fluid index and the accuracy of fetal weight estimation using ultrasonography. Six hundred and sixty-four patients, between 20 and 42 weeks' gestational age, who were delivered within 1 week of a sonographic examination were studied. Five formulas for estimating fetal weight also were studied. Systematic and random errors in predicting birth weight were analyzed relative to birth weight and amniotic fluid index. The accuracy of sonographic fetal weight estimation was independent of amniotic fluid index across all gestational ages and birth weights. Each of the five formulas had similar error percentages, and no significant differences were detected. Predicted fetal weight was significantly underestimated with each of the formulas studied, a finding that was also independent of birth weight and amniotic fluid index. We conclude that ultrasonography can be used reliably to estimate fetal weight in patients with altered amniotic fluid volumes.
Amniotic Fluid↗
Stimulatory effects of immunoreactive growth hormone on proliferation of a human lymphocyte cell line.
Previous studies have indicated the secretion of a growth hormone-like molecule by the lymphocyte T-cell line, H9. We examined the autocrine growth-promoting effects of this T-cell derived factor. H9 conditioned medium stimulates proliferation of H9 cells themselves in a dose-dependent fashion. This growth stimulating effect could be blocked by anti-human growth hormone antiserum, but could not be simulated by addition of growth hormone only or interleukin 2 only, or a combination of both. Dexamethasone inhibited H9 growth in low nutrient culture conditions and seemed to somewhat offset the growth promoting effect of the hGH-like molecule. However, the exact role played by dexamethasone in H9 cell growth and death, as well as the exact mechanism by which the hGH-like molecule exerted its growth-promoting action, remain to be elucidated.
Cell Line↗
Codominant mixtures of viruses in reference strains of influenza virus due to host cell variation.
Influenza viruses grown in chicken eggs may comprise mixtures of variants, creating problems in establishing international reference strains and in preparing high growth reassortants. We therefore analyzed representative reference strains of H3N2 viruses from 1987 to 1989 by direct sequencing of HA1. Three of seven reference strains had different nucleotides at the same position in nucleotide gels, indicating the presence of codominant mixtures. These nucleotide duplications occurred at residues previously shown to code for amino acids associated with egg adaptation (156, 186, and 193 of HA1). Cloning of these viruses in chicken eggs permitted separation of the mixtures, and the majority of these cloned viruses could be distinguished with monoclonal antibodies. The remaining four reference strains were homogeneous and contained one of the two amino acids usually found at these residues in HA1 (e.g., 145 Glu or Lys, 186 Ser or Ile). Analysis of epidemic H3N2 isolates, for which mammalian cell and egg isolates are available for sequence analysis from the same patient, confirmed that multiple nucleotide changes can occur at residues associated with egg adaptation. When reference or epidemic strains containing codominant mixtures were passaged in eggs one to five times, one of the codominant strains usually became dominant. Similar results were obtained with Madin Darby Canine kidney (MDCK) cells, although the dominant virus usually differed from that in eggs. Attempts to reselect an influenza virus possessing sequence changes in HA1 characteristic of mammalian cells or the original human isolate (i.e., 156 Glu, 158 Glu, 186 Ser) by multiple passages in MDCK cells were not successful, but evidence was obtained that MDCK cells can provide a selective growth advantage. Thus, variants that are dominant in eggs are not necessarily dominant in MDCK cells. To preserve the original genotype of viruses used as reference strains, we recommend the following procedure: (i) cloning in chicken eggs of the candidate virus at a very early passage, (ii) selection and analysis of multiple clones with the same ferret polyclonal and/or monoclonal antibodies used in the initial screening, and (iii) selection of the isolate whose hemagglutinin molecule most closely resembles the clinical isolate.
Animals↗