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Biomedical subjects

A House

Publications and source records attributed to A House.

At least 55 records · Page 3Linked to original sources
PubMed1999

Costs of antidepressant overdose: a preliminary study.

There is ongoing debate regarding the relative cost effectiveness of different classes of antidepressants. Although factors such as tolerability and discontinuation rates have been taken into account, there has been little consideration of the cost of overdose. In the current study we examined the cost of antidepressant overdose at four teaching hospitals over a four-week period and found that the cost of selective serotonin reuptake inhibitor overdose was less than half that of tricyclic anti-depressant overdose. The cost of overdose is often ignored and should be considered in future analyses of the cost effectiveness of different antidepressant prescribing policies in primary care.

Adult↗
PubMed1998

Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition.

OBJECTIVE: To identify and synthesise the findings from all randomised controlled trials that have examined the effectiveness of treatments of patients who have deliberately harmed themselves. DESIGN: Systematic review of randomised controlled trials of psychosocial and physical treatments. Studies categorised according to type of treatment. When there was more than one investigation in a particular category a summary odds ratio was estimated with the Mantel-Haenszel method. SETTING: Randomised trials available in electronic databases in 1996, in the Cochrane Controlled Trials Register in 1997, and from hand searching of journals to 1997. SUBJECTS: Patients who had deliberately harmed themselves shortly before entry into the trials with information on repetition of behaviour. The included trials comprised 2452 randomised participants with outcome data. MAIN OUTCOME MEASURE: Repetition of self harm. RESULTS: 20 trials reported repetition of self harm as an outcome variable, classified into 10 categories. Summary odds ratio (all for comparison with standard aftercare) indicated reduced repetition for problem solving therapy (0.73; 95% confidence interval 0.45 to 1.18) and for provision of an emergency contact card in addition to standard care (0.45; 0.19 to 1.07). The summary odds ratios were 0.83 (0.61 to 1.14) for trials of intensive aftercare plus outreach and 1.19 (0.53 to 2.67) for antidepressant treatment compared with placebo. Significantly reduced rates of further self harm were observed for depot flupenthixol versus placebo in multiple repeaters (0.09; 0.02 to 0.50) and for dialectical behaviour therapy versus standard aftercare (0.24; 0.06 to 0.93). CONCLUSION: There remains considerable uncertainty about which forms of psychosocial and physical treatments of patients who harm themselves are most effective. Further larger trials of treatments are needed.

Aftercare↗
PubMed1998

Working patterns and the quality of training of medical house officers: evaluating the effect of the 'new deal'.

The 'new deal' on junior doctors' hours of work has led to the widespread introduction of working patterns such as full shifts and partial shifts in the United Kingdom. The impact of these changes on the training of medical staff is unclear. The subjects of the current study were 36 pre-registration medical house officers working shift rotas and on-call rotas at a teaching hospital in the north of England. They were studied over a 12-month period using a self-report questionnaire seeking their views on the quality of their training experience and their satisfaction with the in-service training they received. Nursing staff, consultant and medical student opinion was also sought. Partial-shift and full-shift systems led to reduced hours of work when compared to on-call rotas (mean hours: partial shift 65.0; full shift 59.8; on-call 72.7), but they were associated with significantly lower training experience and training satisfaction scores for the house officers than were on-call systems (P < 0.01). Shift systems were unpopular among consultants and medical students but not nursing staff. Despite reducing excessive hours of work, shifts may be detrimental to the training of medical house officers. The further imposition of shift working should be suspended until such time as the impact of new working patterns on the training of medical staff has been determined.

Adult↗
PubMed1998

Psychological associations with emotionalism after stroke.

The psychological associations with emotionalism were examined, 1 month after stroke, in 448 stroke survivors who met inclusion criteria for a randomised trial of psychological treatment. One hundred and one (21.5%) patients had emotionalism. Thirty eight (38%) of those with emotionalism had a clinically significant mood disorder, compared with 64 of 347 (18%) of those without emotionalism. Emotionalism was associated with 10 other psychiatric syndromes, the presence of most of which could be accounted for by the coexistence of depression with emotionalism. In a logistic regression analysis, irritability and ideas of reference were associated with emotionalism after adjustment for the presence of depression. These psychological associations with emotionalism may be incorporated into a psychological model of emotionalism as a disorder of emotional control, and they may help in the understanding of the socially disabling effects of this common condition.

Adolescent↗
PubMed1998

Important cost differences of blood transfusions and erythropoietin between hemodialysis and peritoneal dialysis patients.

Based on our previous study [House AA, Pham B, Pagé DE. Perit Dial Int 1997; 17(Suppl 1):S74.], we compared the costs of blood transfusions and erythropoietin for 90 peritoneal-dialysis (PD) patients with those of 90 hemodialysis (HD) patients over a 1-year period. The mean monthly transfusion rate was higher in the HD group (0.47 units per month versus 0.19 per month for the PD group: P < 0.01). The maintenance erythropoietin dose was higher for HD (7370 units/week versus 5970 units/week: P < 0.01). There was an average of 507 transfusions per year in the HD group (Cdn $152,280) compared to 205 transfusions per year in the PD group (Cdn $61,500). Since HD patients required more erythropoietin than the PD patients, the cost for the 90 HD patients per year was (Cdn $460,463) compared to (Cdn $361,747) for the 90 PD patients. Combining the annual costs of both blood transfusions and erythropoietin, the 90 patients on HD cost Cdn $189,435 more than the 90 PD patients, a difference of Cdn $2105 per patient.

Anemia↗
PubMed1998

Improving 'new deal' shifts for junior house officers.

Since the 'new deal' was introduced, new working patterns such as shift systems have become increasingly common. The current study examines how these shifts might be improved. The results suggest that organizational changes such as increased numbers of ward clerks and support workers can minimize the negative impact of shift systems. However, shifts remain unpopular among junior staff and the authors conclude that new working initiatives must be properly evaluated before their widespread implementation.

Education, Medical, Graduate↗
PubMed1998

A survey of job satisfaction, sources of stress and psychological symptoms among general practitioners in Leeds.

BACKGROUND: The past seven years have seen rapid changes in general practice in the United Kingdom (UK), commencing with the 1990 contract. During the same period, concern about the health and morale of general practitioners (GPs) has increased and a recruitment crisis has developed. AIM: To determine levels of psychological symptoms, job satisfaction, and subjective ill health in GPs and their relationship to practice characteristics, and to compare levels of job satisfaction since the introduction of the 1990 GP contract with those found before 1990. METHOD: Postal questionnaire survey of all GP principals on the Leeds Health Authority list. The main outcome measures included quantitative measures of practice characteristics, job satisfaction, mental health (General Health Questionnaire), and general physical health. Qualitative statements about work conditions, job satisfaction, and mental health were collected. RESULTS: A total of 285/406 GPs (70%) returned the questionnaires. One hundred and forty-eight (52%) scored 3 or more on the General Health Questionnaire (GHQ-12), which indicates a high level of psychological symptoms. One hundred and sixty GPs (56%) felt that work had affected their recent physical health. Significant associations were found between GHQ-12 scores, total job satisfaction scores, and GPs' perceptions that work had affected their physical health. Problems with physical and mental health were associated with several aspects of workload, including list size, number of sessions worked per week, amount of time spent on call, and use of deputizing services. In the qualitative part of the survey, GPs reported overwork and excessive hours, paperwork and administration, recent National Health Service (NHS) changes, and the 1990 GP contract as the most stressful aspects of their work. CONCLUSIONS: Fifty-two per cent of GPs in Leeds who responded showed high levels of psychological symptoms. Job satisfaction was lower than in a national survey conducted in 1987, and GPs expressed the least satisfaction with their hours, recognition for their work, and rates of pay. Nearly 60% felt that their physical health had been affected by their work. These results point to a need to improve working conditions in primary care and for further research to determine the effect of any such changes.

Adult↗
PubMed1997

Motivation and glycemic control in diabetes mellitus.

Although adherence to treatment regimes is clinically important in diabetes mellitus, the best way to improve it is unclear. As a precursor to evaluating the place of a brief intervention (motivational interviewing) in the treatment of diabetes, this study investigated the relation between motivation and glycemic control in 361 diabetic out-patients. Outcome measures were the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) and HbA1C level--a measure of glycemic control. The majority of patients (86.7%) could be allocated to a single motivational stage, indicating that this concept is applicable in the study of diabetes. There were significant associations between HbA1C level and motivational stage, but not in the direction predicted. That is, patients at an earlier motivational stage had lower HbA1C levels than those at later stages. The results suggest that feedback of HbA1C level may partly determine the patient's motivation to control their diabetes, although the effect is quite weak.

Adolescent↗
PubMed1997

p53 alterations are associated with improved prognosis in distal colonic carcinomas.

Alterations of the p53 gene and the p53 protein are common in a wide spectrum of human malignancies. In several tumor types, p53 gene mutation and/or p53 protein overexpression correlate with a more clinically aggressive phenotype as judged by worse patient survival. This has not been clearly demonstrated to be the case in colorectal cancer. Herein, we report results of the prognostic significance of p53 protein accumulation and gene mutation in a large series of colorectal cancers (n = 541) with long patient follow-up (mean, 87 months). The large majority of patients (95%) received no postoperative systemic adjuvant therapy. The incidence of p53 accumulation detected by immunohistochemistry with the monoclonal antibody DO-7 was 30%, whereas the incidence of p53 gene mutation in exons 5-8 detected using PCR-single strand conformation polymorphism was 36%. Accumulation of p53 protein was associated with improved patient survival independent of tumor stage or grade (hazard ratio, 0.66; 95% confidence interval, 0.47-0.93; P = 0.017). A marked difference was observed depending on the location of the tumor: tumors originating in the distal colon showed a strong association between the presence of p53 accumulation and improved patient survival (P = 0.003), but this was not the case for those located in the proximal colon. Dukes' stage C tumors, but not stage B, also showed an association between p53 accumulation and better outcome (P = 0.013). Mutation of the p53 gene was associated with a trend toward improved survival, particularly in the distal tumors. Our results demonstrate that in some tumor types, the presence of p53 abnormalities can correlate with better prognosis.

Aged↗