Assessment instruments in respiratory care.

The basis for using therapist-driven protocols effectively is an accurate assessment of the patient's respiratory status. Patients must be assessed to initiate indicated therapy and reassessed so that therapy can be modified or discontinued if no longer needed. This article addresses the role of respiratory therapists in patient assessment for the selection of appropriate and effective protocols.

Sustained facial muscle activity during REM sleep and its correlation with depression.

Recently, we proposed that the coupling of cognitive activation and diminished arousal during REM sleep may have a mood regulating effect. Conversely, increased arousal during REM sleep may be associated with mood dysregulation. In this paper, the desensitization model is described, and data are presented on the association between motor activity during REM sleep, wakefulness and severity of depression.

Depression spectrum disease with and without depression in first-degree relatives.

Family history was assessed in 211 outpatients with unipolar major depression and diagnoses were rendered according to Winokur et al. (Winokur et al. (1978) J.

Short-term effects of postural drainage with clapping vs autogenic drainage on oxygen saturation and sputum recovery in patients with cystic fibrosis.

To compare the short-term effects of postural drainage with clapping (PD) and autogenic drainage (AD) on oxygen saturation, pulmonary function, and sputum recovery, we studied ten patients with cystic fibrosis (CF) randomly treated with PD or AD on separate days. Pulse oximetry was monitored and sputum was collected during and for 1 h following each treatment. Pulmonary function was measured before and then 1, 15, and 60 min after each treatment.

Clinical characteristics of outpatients with chronic major depression.

A cross-sectional evaluation of 243 unipolar, nonpsychotic outpatients with major depression was conducted. All subjects were diagnosed by RDC with SADS-L structured interviews. Diagnoses included RDC primary/secondary, RDC endogenous/nonendogenous and Winokur's family-history subtypes.

Familial influence in unipolar depression: effects of parental cognitions and social adjustment on adult offspring.

As part of an ongoing study of risk factors for unipolar depression in adult first-degree relatives of depressed probands, we have evaluated the relationship between cognitions and social adjustment in parents and adult offspring. Asymptomatic relatives of families with at least one parent with major depression, of families with no affected parent, and of normal control families were assessed. Maternal social adjustment was associated with both negative thinking and social adjustment in adult offspring.

Childbearing in women with and without a history of affective disorder. II. Electroencephalographic sleep.

Electroencephalographic (EEG) sleep was examined longitudinally in 34 obstetrically healthy volunteers recruited early in pregnancy. All women were free of current psychiatric disorder. Fourteen women had a personal history of affective disorder, and 20 had no history of any psychiatric disorder.

Childbearing in women with and without a history of affective disorder. I. Psychiatric symptomatology.

Psychiatric symptoms and morbidity were examined prospectively in 34 obstetrically healthy volunteers recruited early in pregnancy. All women were free of current psychiatric disorder. Fourteen women had a history of affective disorder, and 20 had no lifetime history of any psychiatric disorder.

Physician-ordered respiratory care vs physician-ordered use of a respiratory therapy consult service: early experience at The Cleveland Clinic Foundation.

Background: Accumulative evidence suggests that respiratory care is frequently misallocated. We report the results of a pilot study of a delivery system aimed at correcting such misallocation.

Methods: The delivery system (Respiratory Therapy Consult Service, or RTCS) allows respiratory therapists (when requested by the case-managing physician) to determine respiratory care, with decisions guided by algorithm (ie, Consult patients).

Project Swaziland (Part 1): development of oral health services--study methodology and summary of results.

A collaboration in oral health services research between the Kingdom of Swaziland and the Republic of South Africa is reported. The aim and methodology of the project is described and a summary of the results of the descriptive study is given. The latter included the status of dental caries, periodontal disease and malocclusion of 12 year old school children, an evaluation of a community preventive programme, an assessment of the knowledge, attitudes and behaviour of school teachers towards oral health and an analysis of the output of public oral health services.

Cognitive and psychiatric correlates of functional hypothalamic amenorrhea: a controlled comparison.

Objective: To assess the association of cognitive function, emotional, and psychiatric history in women with functional hypothalamic amenorrhea compared with amenorrheic and eumenorrheic controls.

Design: Each subject was medically evaluated for origin of amenorrhea or to establish eumenorrhea. Subjects completed a structured psychiatric interview and self-report questionnaires.

Prospective assessment of electroencephalographic sleep in remitted major depression.

We studied 29 patients with major depression before treatment and then followed these patients prospectively with monthly electroencephalographic (EEG) sleep assessments after successful treatment. Most EEG sleep measures demonstrated no change from the episode throughout a prolonged period of clinical remission. When there was evidence of a change in EEG sleep measures, the effect was modest and due to only a small subset of patients.

Concordance between habitual sleep times and laboratory recording schedules.

The validity of laboratory-based studies of sleep depends, in part, upon good concordance between habitual sleep schedule and laboratory recording schedule. Without good concordance, error variance due to the circadian misplacement of sleep and to different amounts of time in bed is probable. In an assessment of scheduling concordance in 1,762 research patient nights over two time intervals, we observed good concordance (< 30-minute discrepancy) in 71.

Personality traits as predictors of good diabetic control.

To identify personality characteristics that might contribute to overall good control of type I diabetes mellitus, we used a biological correlate of control, glycosylated hemoglobin A1c values, as a means of selecting patients. Patients with evidence of good control (HbA1c less than 7.5%) were compared with patients with evidence of poor control (HbA1c greater than 10.

Electroencephalographic sleep abnormalities in depressed children: a hypothesis.

Although most studies on sleep in child and adolescent depression have indicated that sleep is relatively unaffected, abnormalities have been found. We hypothesized that discrepancies occur because family history of depression and sleep abnormalities in a parent have not been taken into account. In a group of parents and offspring with a family history of depression, 57% of parents had evidence of abnormal sleep.

Digital period analysis of sleep EEG in depression.

The period-analyzed sleep electroencephalogram (EEG) was compared in a group of 9 depressed outpatients and 9 age-matched normal controls. Both groups showed rhythms in beta, delta, and theta activity with an approximately 90-min period. The phase and coherence between fast and slow frequency EEG measures, however, differed significantly in the two groups.

[A gastric multiple neuroendocrine tumor. A case report].

A 24-year-old woman underwent an upper digestive hemorrhage. Endoscopy revealed a triple, elevated, submucosal lesion. One of them was ulcerated.

Does learned resourcefulness predict response to cognitive therapy in depressed outpatients?

Thirty-seven unipolar, nonpsychotic, outpatients with major depression were treated with cognitive therapy in an ongoing study designed to identify which depressions respond to cognitive therapy. Pretreatment levels of learned resourcefulness, assessed by Rosenbaum's (1980) Self Control Schedule (SCS), were used to predict response to cognitive therapy (according to the 17-item Hamilton Rating Scale for Depression and the 21-item Beck Depression Inventory). Pretreatment SCS scores did not predict response to cognitive therapy according to either measure.

The relationship between the medial branch of the lumbar posterior ramus and the mamillo-accessory ligament.

Gross dissection anatomical studies have investigated the course of the human lumbar posterior primary ramus and its branches. This nerve has frequently been associated with low back pain; however, the cross-sectional area of the space beneath the mamillo-accessory ligament, which is occupied by the medial branch of the posterior primary ramus, has not been clearly defined. The purpose of this study is to use a histological procedure to identify the cross-sectional area of the space beneath the mamillo-accessory ligament which is occupied by the medial branch of the posterior primary ramus as it passes en route to the zygapophyseal joint capsules.

A cross-sectional study of the effects of depression on REM latency.

In a cross-sectional design to address the effects of the course of depression on rapid-eye-movement (REM) latency, we have matched patients in their first-episode with (1) age-matched patients with recurrent depression, (2) onset-matched patients with recurrent depression, and (3) age-matched normal control subjects. Patients were also matched for sex and treatment site (inpatient or outpatient). No differences were found in REM latency for the three depressed groups, and all had lower REM latency than normals.

Risk factors in unipolar depression: II. Relation between proband REM latency and cognitions of relatives.

In an ongoing study of risk factors for depression in first-degree relatives of unipolar depressed probands, we have assessed cognitive variables (beliefs, attributional style, and moment-to-moment thinking) in relatives of reduced REM (rapid eye movement) latency unipolar probands, nonreduced REM latency unipolar probands, and normal control probands. Relatives of reduced REM latency probands had more negative cognitions; the effect of REM latency of the proband was independent of the effect of a personal history of depression in the relative. It appears that both biological and psychological factors can be identified as predictors for lifetime rates of depression and may be useful in identifying high-risk individuals.

Age-adjusted threshold values for reduced REM latency in unipolar depression using ROC analysis.

To determine an age-adjusted, clinically meaningful depressive diathesis, we have implemented Receiver Operator Characteristic (ROC) analysis for mean rapid eye movement (REM) latency in patients with unipolar depression. Depressed patients were compared with age-matched normal control subjects. Sensitivity and specificity estimates were calculated for selected threshold values on the ROC curves as well as for the Research Diagnostic Criteria endogenous/nonendogenous subtype.