Search PubMed⌕ Search

Biomedical subjects

A Farmer

Publications and source records attributed to A Farmer.

At least 73 records · Page 4Linked to original sources
PubMed1996

Screening for psychiatric morbidity in subjects presenting with chronic fatigue syndrome.

BACKGROUND: There is a need for a valid self-rating questionnaire to screen for psychiatric morbidity in patients with chronic fatigue syndrome (CFS). This study had the aim of assessing the utility and validity of two commonly used measures. METHOD: Scores obtained on the General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) were compared with various diagnostic and severity ratings obtained via a validating clinical interview, the Schedules for the Clinical Assessment of Neuropsychiatry (SCAN) in 95 consecutively referred subjects at a medical out-patient clinic who fulfilled standard criteria for CFS, and 48 healthy controls. Outcome measures were validating coefficients and receiver operating characteristics (ROC) for different thresholds and scoring on GHQ and BDI and index of definition (ID) as measured by SCAN; and Pearson and point by serial correlation coefficients for different diagnostic groups derived via SCAN and defined according to ICD-10 and DSM-III-R. RESULTS: GHQ and BDI perform poorly as screeners of psychiatric morbidity in CFS subjects when compared with various SCAN derived ratings although results for controls are comparable with other studies. CONCLUSIONS: Neither the GHQ nor BDI alone can be recommended as screeners for psychiatric morbidity in CFS subjects.

Fatigue Syndrome, Chronic↗
PubMed1995

Using interactive videos in general practice to inform patients about treatment choices: a pilot study.

Our objective was to assess the acceptability of using an interactive video system in a general practice setting to inform patients about treatment choices. A descriptive cohort study was carried out in eight general practices in Oxfordshire. Fifty-four patients with mild hypertension and 29 with benign prostatic hypertrophy were studied. Patients' views of the video, treatment preference, level of involvement in treatment decision and satisfaction with decision-making process and GPs' views of the effect of the video on subsequent consultations were measured. Both patients and GPs reported favourable impressions of the interactive video system: 71% of patients said it definitely helped with their treatment decision; GPs said they found the video helpful in 82% of cases. The results of this pilot study were sufficiently encouraging to indicate the need for a randomized controlled trial to evaluate the impact of the video on the doctor-patient relationship, on subsequent treatment decisions and on health outcomes and patients' well-being.

Aged↗
PubMed1995

Neuraesthenia revisited: ICD-10 and DSM-III-R psychiatric syndromes in chronic fatigue patients and comparison subjects.

BACKGROUND: Different definitions of chronic fatigue syndrome (CFS) have different psychiatric exclusion criteria and this affects the type and frequency of associated psychiatric morbidity found. The operational criteria for neuraesthenia in ICD-10 vary in this and other respects from the Centers for Disease Control and Prevention (CDC) criteria for CFS. Neuraesthenia and associated psychiatric morbidity in CDC-defined CFS are evaluated. METHOD: CFS subjects and controls were interviewed with the Schedule for the Clinical Assessment of Neuropsychiatry (SCAN). The computerised scoring program for SCAN (CATEGO5) facilitates the assignment of operational definitions according to DSM-III-R and ICD-10. Subjects were re-interviewed with SCAN an average of 11 months later. No specific treatments or interventions were given during this period. RESULTS: The majority of subjects fulfilled ICD-10 operational criteria for neuraesthenia and had two and a half times the rate of psychiatric morbidity as the healthy comparison group according to the CATEGO5 Index of Definition (ID). Approximately 80% of subjects fulfilled both DSM-III-R and ICD-10 criteria for sleep disorders. There was a significant fall in the number of subjects fulfilling criteria for depression and anxiety disorders and a significant increase in the number of subjects with no diagnosis for DSM-III-R criteria over time. There were no significant changes over time for any diagnosis according to ICD-10 criteria or for overall levels of psychopathology as reflected in CATEGO5 ID levels. CONCLUSIONS: The ICD-10 'neuraesthenia' definition identifies almost all subjects with CDC-defined CFS. Fifty percent of CFS subjects also had depressive or anxiety disorders, some categories of which remit spontaneously over time.

Adult↗
PubMed1995

An unusual case of central pontine myelinolysis.

Central pontine myelinolysis (CPM) is a rare complication of alcoholism. There have been recent reports that hyponatremia and its rapid correction are of aetiological significance in the development of CPM. We describe the case of a 47-year-old alcoholic who developed CPM and subsequently recovered. Alcoholic and psychiatric patients are at risk for CPM and clinicians need to have a high index of suspicion to diagnose this condition.

Alcoholism↗
PubMed1994

The strength of the genetic effect. Is there room for an environmental influence in the aetiology of schizophrenia?

The evidence for a genetic contribution to schizophrenia is compelling. However, the pattern of inheritance is complex and it is usually assumed that environmental factors also have a role that will eventually be identified. We argue that this is not necessarily the case. While a hypothesis combining genetic diathesis with environmental stress cannot be disproved, it is also possible that 'non-genetic' factors consist entirely of stochastic events affecting gene expression or structure.

Diseases in Twins↗
PubMed1994

Within-patient correlation between the antihypertensive effects of atenolol, lisinopril and nifedipine.

OBJECTIVE: To investigate whether there are definable subgroups of patients with essential hypertension who respond specifically to particular antihypertensive drugs. DESIGN: Randomized cross-over comparison of the antihypertensive effect of 50 mg atenolol per day, 10 mg lisinopril per day and 20 mg nifedipine retard twice a day. Ambulatory blood pressure monitoring was used to assess the blood pressure level both for recruitment and at the end of each treatment period. The treatment periods lasted 4 weeks and were preceded by 4 weeks of placebo. PATIENTS: Seventy-two untreated hypertensive patients with a mean age of 52 (SD 8.4) years were recruited from six general practices and from the hospital outpatient clinic. Sixty-eight patients completed the trial. MAIN OUTCOME MEASURES: To assess the within-patient correlations among the blood pressure responses to each drug and explore the possible role of simple characteristics, such as the initial blood pressure, plasma renin concentration and age, in identifying the responders to a particular drug. RESULTS: Systolic/diastolic blood pressure fell significantly with each agent (P < 0.001): atenolol reduced it by 16.3 +/- 13.3/9.9 +/- 8.8, lisinopril by 14.8 +/- 15.0/9.4 +/- 9.1 and nifedipine by 11.6 +/- 12.3/6.7 +/- 8.3 mmHg. There was a low degree of correlation between the changes in blood pressure with the three drugs in individual patients. With each drug there was a small percentage (8.9-14.7%) of non-responders. The initial level of systolic blood pressure was weakly correlated with the antihypertensive effect of nifedipine (r = 0.47, P < 0.001) and plasma renin concentration was related to the effect of atenolol (r = 0.32, P < 0.01). Age did not predict the blood pressure response to any agent. CONCLUSIONS: The low level of the correlation between the blood pressure changes with the three drugs suggests that different mechanisms may be involved in the aetiology of essential hypertension. Plasma renin concentration and the initial level of systolic blood pressure contribute only weakly to the identification of responders to the three drugs.

Adolescent↗
PubMed1993

Medical practice guidelines: lessons from the United States.

Clinical guidelines, or protocols, have been devised by many different groups, often with differing aims. Some aim to reduce variations in care by using guidelines, while others seek to improve outcomes. Guidelines have long been used in the United States to try to control the behaviour of the medical profession--and the cost of health care. The "effectiveness initiative," run by the Agency for Health Care Policy and Research spawned much activity among other groups, including the American Medical Association and the American College of Physicians. The experience of the Americans in analysing data to gauge effectiveness and then in disseminating good practice may help British moves in this direction. In particular, it is often hard to get guidelines adopted in practice; doctors have to be exposed to the same message in different forms. Also guidelines must not be unrealistic: those devised by senior doctors away from the realities of day to day practice are likely to fail.

Education, Medical↗
PubMed1993

A SCAN-SADS comparison study of psychotic subjects and their first-degree relatives.

Two diagnostic interviews, the Schedule for Affective Disorders and Schizophrenia (lifetime version) (SADS-LA) and the Schedule for the Clinical Assessment of Neuropsychiatry (SCAN) were compared for main diagnoses and for their acceptibility to psychotic subjects and their psychiatrically well relatives. Broad agreement for DSM-III, DSM-III-R and draft ICD-10 diagnoses was good, although there were areas of disagreement between the two interviews which are discussed.

Adolescent↗
PubMed1993

Self-administered faecal occult blood tests do not increase compliance with screening for colorectal cancer: results of a randomized controlled trial.

In the UK, compliance with conventional faecal occult blood (FOB) tests such as Haemoccult is about 50% in the general population. It has been postulated that characteristics of the performance of conventional tests, in particular the need for dextrous gathering and manipulation of faeces, delay in receiving results, and the recommended dietary restrictions, may all diminish compliance. New FOB tests have been developed, popularly termed 'magic toilet paper' tests, which not only minimize faecal manipulation but are also self-reported. Compliance rates with two self-administered faecal occult blood tests (Early Detector and Coloscreen Self-Test) were compared with Haemoccult in a randomized trial involving 1,842 subjects aged 40-74 years. Use of self-administered FOB tests did not increase compliance significantly, with rates of 52.1% for Early Detector, 50.6% for Coloscreen and 49.1% for Haemoccult. Moreover, dietary restriction did not reduce compliance significantly (restricted 49.3%, unrestricted 51.8%). A wide variation (from 1.3% to 21.4%) in positivity rates was observed which was dependent on which of the three tests was used and whether dietary restrictions were applied. Since the physical aspects of test performance do not appear to determine an individual's decision to be screened, self-administered tests will not overcome the problem of poor compliance with FOB screening.

Adult↗
PubMed1992

Recent changes in the surgical management of T1/2 breast cancer in England.

Following the results of a study undertaken in 1985, a second survey was undertaken to examine whether there had been any changes in England in the surgical management of patients with a T1/2/NOMO breast cancer. The major findings were that: (i) there was a significant increase in the number of surgeons who would undertake breast conservation surgery; (ii) there was a significant increase in the number of surgeons who would discuss breast reconstruction where mastectomy was the preferred form of treatment; (iii) that significantly more surgeons would offer the patient a choice of surgery when there was more than one surgical option; and (iv) that significantly more surgeons had access to a breast specialist nurse and/or a cancer counsellor. These changes are consistent with the recommendations of the 1986 King's Fund Consensus' Conference for breast cancer treatment.

Adult↗
PubMed1991

The effect of self-administered faecal occult blood tests on compliance with screening for colorectal cancer: results of a survey of those invited.

To determine the relative importance of health beliefs and the characteristics of different methods of faecal occult blood screening in predicting acceptance of the test a self completed questionnaire was offered to 590 patients registered with a practice in an Oxfordshire market town. The patients were an age-sex stratified random sample of those who had been offered screening as part of a trial in which one of three different faecal occult blood screening tests, two of which were self-reported, had been offered. The overall adjusted response rate was 70.1%. Those who complied with the test had more positive attitudes to the implications of a positive test, to treatment and to the value of screening in general. The experience of a close relative or friend with bowel cancer was associated with an increased likelihood of compliance [odds ratio = 15.2 (9.4-24.3)]. Three were marked differences between the tests in the proportions of patients finding them 'messy' or 'disgusting' (Haemoccult 72.0%, Coloscreen 48.0%, Early Detector 55.4% chi 2 Haemoccult vs. self-reported = 5.05 P less than 0.05), and the odds of finding the procedure disgusting were significantly higher among patients who did not complete the test [odds ratio 6.9 (3.1-15.5)].

Attitude to Health↗
PubMed1991

Schizophrenia, bipolar disorder and depression. A discriminant analysis, using 'lifetime' psychopathology ratings.

Discriminant and canonical variate analyses were performed using 302 patients, on whom ratings of lifetime psychopathology and course of illness has been made. DSM-III diagnoses were used to form the criterion groups. Bipolar disorder emerged as a distinct grouping, but there are reasons for dissatisfaction with its definition. The remaining patients formed a 'schizodepressive continuum', but this also had a tendency to bimodality. It is possible that the distinction between schizophrenia and depression was obscured by inadequacies in the data and the inclusion of excessive numbers of patients with schizoaffective depression in this study.

Adolescent↗