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Biomedical subjects

A Mann

Publications and source records attributed to A Mann.

At least 91 records · Page 5Linked to original sources
PubMed1998

Predictive value of response to treatment of T-lymphocyte subpopulations in idiopathic pulmonary fibrosis.

T-cell types are important in maintaining immune homeostasis in the lung and their imbalance may be associated with several diseases. We examined the relationship between bronchoalveolar lavage (BAL) T-cell subset profiles and the clinical course of 46 patients with idiopathic pulmonary fibrosis (IPF). A flow cytometry cell sorter (FACS) was used to analyse the T-cell subsets. Pulmonary function tests (PFT) were performed at baseline and 6-12 months later. Patients were divided into two groups according to their CD4/CD8 ratio: CD4/CD8 >1 (group 1, n=21); and CD4/CD8 <1 (group 2, n=25). A lower percentage of lymphocytes, a higher percentage of CD8/S6F1 cells (cytotoxic T-lymphocytes) and a higher percentage of neutrophils were found in the BAL in group 2 compared to group 1 (11+/-7.5% versus 19+/-13.2%; p=0.024 and 29.8+/-17.6% versus 13.3+/-6.9%; p=0.068, respectively for lymphocytes and cytotoxic T-lymphocytes; and 8+/-11% versus 29+/-27%; p=0.003 for neutrophils). Inversely, in the peripheral blood, the distribution of CD8/S6F1 cells was lower in group 1 than in group 2 (8.3+/-6.9% versus 33.4+/-16.5%; p=0.0048). The patients were followed over a period of 1 yr in order to test whether those findings could determine efficacy of therapy. The baseline transfer factor of the lung for carbon monoxide (TL,CO) capacity in group 1 and group 2 was 59+/-22% and 51+/-21%, respectively (p=0.29), but only in group 1 was the TL,CO capacity improved significantly in response to steroids treatment after 6-12 months. IPF patients with a higher percentage of lymphocytes, a lower percentage of neutrophils, CD4/CD8 >1 and a low percentage of CD8/S6F1 may have a more benign course of disease. These parameters may identify an early stage of reversible disease responsive to therapy. We conclude that these measurements may be a useful tool in monitoring response to treatment in patients with idiopathic pulmonary fibrosis.

Bronchoalveolar Lavage Fluid↗
PubMed1998

A continuing postoperative complication: nausea and vomiting--who is affected, why, and what are the contributing factors? A review.

Outpatient surgery has become increasingly popular. Technical advances in both surgery and anesthesia have made the practice of ambulatory surgery safe and attractive. However, vomiting remains one of the most common postoperative complications. The valid patient complaint of postoperative nausea and vomiting has been shown to significantly delay discharge from the recovery area after ambulatory surgery. This article reviews the numerous factors that have been identified as fostering the postoperative complication of nausea and vomiting.

Ambulatory Surgical Procedures↗
PubMed1998

Effect of time on liver clearance of technetium-99m-tetrofosmin in patients with acute chest pain: when should imaging begin?

OBJECTIVE: Due to stable myocardial retention and technetium imaging characteristics, 99mTc-tetrofosmin has been considered potentially useful for acute chest pain imaging. Tetrofosmin also has favorable biokinetics with reported rapid liver clearance, 5 min poststress and 30-45 min post-rest injection. Since comparable data are not available, the effect of time on liver clearance was evaluated in patients with acute chest pain. METHODS: One hundred six patients received an intravenous injection of 25-30 mCi 99mTc-tetrofosmin to evaluate acute chest pain. SPECT imaging was performed 15-120 min after injection of the tracer. Patient images were grouped according to the time of acquisition after acute injection: 15-30 min, 31-45 min, 46-60 min, 61-90 min and > 90 min. Quantitative analysis was performed of a similar anterior projection for each patient consisting of 6 X 6-pixel region of interest over the myocardium and adjacent liver. Average counts per pixel were determined and a heart/liver (H/Li) ratio was calculated. RESULTS: The mean H/Li ratio was < 1.0 for patient images acquired 15-45 min after injection, and > 1.0 for patient images acquired after 45 min. The difference was statistically significant (p < 0.05). CONCLUSION: Quantitative analysis suggests that the optimal imaging time should be at least 45 min after the injection of 99mTc-tetrofosmin to allow adequate liver clearance before image acquisition of acute chest pain syndromes.

Aged↗
PubMed1998

Fasting and nonfasting iodine-123-idophenylpentadecanoic acid myocardial SPECT imaging in coronary artery disease.

UNLABELLED: Iodine-123-labeled idophenylpentadecanoic acid (IPPA) metabolic imaging has been shown to be clinically useful for the identification of myocardial viability in patients with coronary artery disease and left ventricular dysfunction. Imaging is usually performed under fasting conditions since nonfasting conditions may affect myocardial uptake of 123I-IPPA. The purpose of this study was to examine the impact of dietary condition on 123I-IPPA metabolic imaging. METHODS: Forty patients with stable coronary artery disease underwent, in randomized order and on separate days, 123I-IPPA SPECT myocardial imaging under fasting and nonfasting conditions. Patients were injected with 123I-IPPA (4-5 mCi) at rest with imaging performed at 4 (initial) and 30 (delay) min. For each image (initial and delay images), 10 segments were analyzed by three experienced observers without knowledge of patient identity or dietary condition using a 5-point grading system (O = no uptake to 4 = normal uptake). A summed global score was obtained for each image by adding the scores for all 10 segments. Image quality was assessed using a 3-point grading system. RESULTS: Visual agreement for normal and abnormal segments between fasting and nonfasting conditions was 82% (kappa = 0.63). There were no significant differences in the summed global scores for both conditions. Image quality was equivalent for both conditions in 65% of cases and superior under the nonfasting condition in 25% of cases. CONCLUSION: Image quality as well as the presence, location and severity of defects are similar under fasting and nonfasting conditions with 123I-IPPA. Therefore, fasting is not necessary before 123I-IPPA SPECT imaging for the assessment of myocardial viability.

Adult↗
PubMed1998

Evaluation of technetium-99m red blood cell labeling efficiency in adults receiving chemotherapy and the clinical impact on pediatric oncology patients.

OBJECTIVE: Technetium-99m-labeled RBCs are used to evaluate ventricular function and are the preferred method for monitoring the cardiac function of patients receiving chemotherapy. Optimal imaging quality is critical for monitoring small but important changes in ventricular function. The labeling efficiency of three products from two manufacturers and images from 30 patients (21 men, 9 women; age 60.3 +/- 11.9 yr) referred for clinical radionuclide ventriculograms before chemotherapy were evaluated to determine the best labeling technique. METHODS: Patients received RBCs labeled in one of three ways. Two pyrophosphate methods used a modified in vitro method and the manufacturer's instructions were used for the in vitro method. Imaging was performed and, upon completion (42.1 +/- 9.6 min), blood samples were drawn, separated and counted to determine labeling efficiency. RESULTS: The labeling efficiencies were: (a) 88.1% +/- 4.2% and (b) 88.4% +/- 4.8% for the two modified in vitro methods; and (c) 95.3% +/- 1.7% for the in vitro method. The difference between the methods was statistically significant (p = 0.019). Twenty pediatric oncology patients (6.4 +/- 5.2 yr) received in vitro labeled RBCs through their Hickman catheters. All 20 pediatric studies were of high quality. CONCLUSION: In vitro labeling demonstrated a higher labeling efficiency than the modified in vitro methods. In vitro labeling also yielded high-quality images when the labeled RBCs were injected through existing chronic in-dwelling catheters.

Aged↗
PubMed1997

An adolescent female Neandertal mandible from Montgaudier Cave, Charente, France.

In 1974, an incomplete human mandible was discovered in the site of Montgaudier Cave, along the Tardoire (Charente), France. The mandible was found in association with stone tools and animal bones in geological deposits referable to the very end of the Middle Pleistocene or the beginning of the Upper Pleistocene. The mandible preserves much of the anterior part of the body and three permanent teeth: left lateral incisor, canine and first molar. Estimates based on tooth eruption of modern humans, as well as occlusal wear and root development, suggest an age at death of between 12.5 and 14.5 years. Morphologically, the fossil possesses features, such as a lack of a chin and multiple mental foramina, which have been observed on immature Neandertal mandibular specimens from Europe. Comparison with these immature European Neandertals indicates that the jaw and teeth of the Montgaudier mandible are small for its chronological age, suggesting it was that of a female.

Adolescent↗
PubMed1997

Concurrent validity of a telephone-administered version of the Gospel Oak instrument (including the SHORT-CARE).

OBJECTIVE: The aim of the study was to establish the concurrent validity of a telephone-administered version of the survey measures utilized in the Gospel Oak studies, the core of which was the SHORT-CARE. DESIGN: Comparisons were made between data obtained by administering the interview in its conventional, face-to-face form with those generated by conducting it by telephone. SETTING: A UK teaching hospital. PATIENTS: Elderly subjects of both sexes, recruited from geriatric and psychogeriatric day hospitals. MEASURES: The Depression Diagnostic Scale, Dementia Diagnostic Scale and Organic Brain Syndrome scale (all taken from the SHORT-CARE) and the London Handicap Scale. RESULTS: For depressive symptomatology, cognitive impairment, subjective memory impairment and handicap, intraclass correlations were 0.86, 0.89, 0.83 and 0.70, respectively. The kappa coefficient for agreement on case-level diagnosis of pervasive depression was 0.79. CONCLUSIONS: These results indicate that the instrument is broadly reliable when administered by telephone.

Aged↗
PubMed1997

Etic and emic criteria for non-psychotic mental disorder: a study of the CISR and care provider assessment in Harare.

The paper describes the relationships between the Revised Clinical Interview Schedule (CISR) and the assessment of psychiatric status by primary care providers in Harare. Primary care clinic (PHC) and traditional medical practitioner (TMP) clinic attenders (n = 302) were interviewed with the Shona Symptom Questionnaire, the CISR and the Explanatory Model Interview. The PHC nurses and TMP were interviewed to elicit diagnostic formulation using the WHO Health Staff Rating codes. "Etic" cases were those who scored 12 or more on the CISR and "emic" cases were those whom the care provider had assessed as having a mental disorder. In all, 52% of subjects were classified as etic cases and 59% as emic cases. Overall agreement between the two criteria was 55%. Three-quarters of care provider "false-positives" were accounted for by a failure to take into account the varying reasons for consultation, such as social or spiritual problems. Most of the "false-negative" groups were symptomatic subjects, though with fewer symptoms than those who were "definite cases". One etic concept-phobia-was not considered as a mental disorder and appeared to lack concept validity in this setting.

Adult↗
PubMed1997

Do socio-economic risk factors predict the incidence and maintenance of psychiatric disorder in primary care?

In a prospective cohort study of consecutive primary care attenders in south London, the estimated prevalence of non-psychotic psychiatric disorder was 45.6%, using the Revised Clinical Interview Schedule (CIS-R). The estimated 12-month incidence rate was 15.7%. Extremely high stability was found in CIS-R scores over 12 months (r = 0.65) and 68.8% of cases at baseline were also cases 12 months later. A clear difference emerged in the types of risk factor which were associated with the incidence and maintenance of disorder in the study population: while socio-economic variables, especially low household income and not having a partner were associated with a worse outcome among prevalent cases at baseline, such variables were only weakly associated with the incidence of psychiatric disorder after adjusting for potential confounders. The latter, notably family psychiatric history and the severity of psychiatric symptoms at baseline were independently associated with the incidence of psychiatric disorder after adjusting for other risk factors, including measures of previous psychiatric disorder.

Adolescent↗
PubMed1997

The Shona Symptom Questionnaire: the development of an indigenous measure of common mental disorders in Harare.

The objective of this study was to develop an indigenous measure of common mental disorders (CMD) in the Shona language in Zimbabwe. Ethnographic and qualitative studies elicited idioms of distress of mental disorder leading to the preliminary Shona Symptom Questionnaire (SSQ), and items from the Self-Report Questionnaire (SRQ) were added to it. The 56-item Preliminary Shona Symptom Questionnaire (PSSQ) was administered to 302 randomly selected primary care attenders, of whom 100 were classified as cases on the basis of agreement between care provider assessment and a psychiatric interview. Discriminant analysis identified 14 items that were the strongest predictors of mental disorder. The 14-item SSQ has a high level of internal consistency (Cronbach's alpha = 0.85). The items are a mixture of emic and etic phenomena. The total score correlates strongly with patients' self-assessment of the emotional nature of their illness. Satisfactory specificity and sensitivity occurred at a cut-off point of 7/8. The SSQ is the first indigenous measure of mental disorder developed in sub-Saharan Africa to have included idioms or distress of primary care attenders and involved patients consulting traditional medical practitioners. It promises to be a useful instrument for epidemiological and clinical research. The methodology used is an innovative way of combining etic and emic methods in the evaluation of CMD.

Adolescent↗
PubMed1997

Strategies for the prevention of psychiatric disorder in primary care in south London.

STUDY OBJECTIVE: To compare the potential impact of high risk and population based approaches to the prevention of psychiatric disorder, using a representative sample of general practice attenders as the target population. DESIGN: This was a prospective cohort study. SETTING: A health centre in south London. PARTICIPANTS: Three hundred and seven consecutive attenders aged 16-65, recruited at randomly selected general practice surgeries. MAIN RESULTS: A linear association was found between the number of different types of socioeconomic adversity reported at recruitment (T1) and the prevalence of psychiatric disorder one year later (T2). The population attributable fraction (PAF) for socioeconomic adversity at T1 was 37.4%. In theory, social interventions for high risk individuals at T1 would reduce the prevalence of psychiatric disorder at T2 by 9% at most, compared with a reduction of 18% if just one item of socioeconomic adversity were eliminated among those with any socioeconomic risk factors. CONCLUSIONS: Social interventions targeted at individuals at highest risk of the most common mental disorders are likely to be extremely limited in their capacity to reduce the prevalence of these conditions. A population based risk reduction strategy, modified according to individual risk, represents a potentially feasible and effective alternative.

Adolescent↗
PubMed1997

Common mental disorders in primary care in Harare, Zimbabwe: associations and risk factors.

BACKGROUND: This study aimed to investigate the associations for common mental disorders (CMD) among primary care attenders in Harare. METHOD: This was an unmatched case-control study of attenders at primary health clinics, general practitioner surgeries and traditional medical practitioner clinics; 199 cases with CMD as identified by an indigenously developed case-finding questionnaire, and 197 controls (non-cases), were interviewed using measures of sociodemographic data, disability, care-giver diagnoses and treatment, explanatory models, life events and alcohol use. RESULTS: CMD was associated with female gender (P = 0.04) and older age (P = 0.02). After adjustment for age, gender and site of recruitment, CMD was significantly associated with chronicity of illness; number of presenting complaints; beliefs in "thinking too much" and witchcraft as a causal model; economic impoverishment; infertility; recent unemployment; an unhappy childhood for females; disability; and consultations with traditional medical practitioners and religious priests. CONCLUSIONS: Mental disorders are associated with female gender, disability, economic deprivation, and indigenous labels of distress states.

Age Factors↗
PubMed1997

Mental health care training priorities in general practice.

BACKGROUND: Mental health problems constitute a large part of general practitioners' (GPs') work, for which they may have received little training beyond their undergraduate education. They continue to find themselves criticized in the literature over inadequate recognition and management of these problems. While there is concern about the effectiveness of continuing medical education (CME), educational needs assessment can improve the outcome of CME programmes. AIM: To assess GPs' perceived educational needs regarding mental health problems. METHODS: A questionnaire was developed, piloted and posted to GPs (n = 380) in the Lambeth, Southwark and Lewisham Family Health Services Authority (FHSA) area in south-east Thames. In addition to demographic data, the questionnaire asked practitioners to select from a list of 26 mental health topics those in which they would like further training, their preferred educational formats and timetabling, and willingness to attend for training. Two postal reminders were sent to non-respondents. Data were analysed using SPSS. RESULTS: Altogether, 62% (237/380) of the GPs responded. The range for the number of topics selected was from zero to 26 and the mode was 5. Most frequently selected topics were psychiatric emergencies, somatization, counselling skills, 'heartsink' patients, psychosexual problems and stress management, each of which was chosen by at least 40%. Small group work alone, and allied to a lecture, was rated as the most useful educational format. In all, 74% (175/237) indicated that they would be interested in attending a half-day training course. CONCLUSION: These results suggest that GPs working in the inner city recognize the importance of improving their skills in the care of mental health problems, and indicate which topics are regarded as the most important and suitable for educational interventions. A needs-led approach to continuing medical education of this kind will help to plan CME programmes relevant to GPs' needs.

Adult↗
PubMed1996

Long-term outcome of patients with neurotic illness in general practice.

OBJECTIVE: To determine the 11 year outcome of neurotic disorder in general practice. DESIGN: Cohort study over 11 years. SETTING: Two general practices in Warwickshire England. SUBJECTS: 100 patients selected to be representative of those identified nationally by general practitioners as having neurotic disorders. MAIN OUTCOME MEASURES: Mortality, morbidity, and use of health services. RESULTS: At 11 years 87 subjects were traced. The 11 year standardised mortality ratio was 173 (95% confidence interval 164 to 200). 47 were cases on the general health questionnaire, 32 had a relapsing or chronic psychiatric course, and 49 a relapsing or chronic physical course. Treatment for psychiatric illness was mainly drugs. The mean number of consultations per year was 10.8 (median 8.7). A persistent psychiatric diagnosis at one year follow up was associated with high attendance ( > 12 visits a year for 11 years) at follow up after age, sex, and physical illness were adjusted for. Severity of psychiatric illness (general health questionnaire score) at outset predicted general health questionnaire score at 11 year follow up, course of psychiatric illness, and high consultation rate. CONCLUSION: These data support the view that a neurotic illness can become chronic and is associated with raised mortality from all causes and high use of services. Such patients need effective intervention, particularly those with a more severe illness who do not recover within one year.

Aged↗