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Biomedical subjects

B Duncan

Publications and source records attributed to B Duncan.

At least 19 recordsLinked to original sources
PubMed2004

Parental perceptions of the therapeutic effect from osteopathic manipulation or acupuncture in children with spastic cerebral palsy.

Fifty children were involved in a randomized, controlled trial to evaluate the effectiveness of either osteopathic manipulation or acupuncture as a 6-month therapeutic adjunct for children with spastic cerebral palsy. Exit interviews were used to obtain parental perceptions and form the basis of this report. Only 2 of 17 parents reported positive gains while their child was in a wait-list control period but all 17 reported gains while in the treatment phase of the study. Ninety-six percent (48 of 50) of the parents reported some improvement while their child was receiving treatments but the gains varied from child to child. The most frequent gains were seen in improvement in the use of arms or legs (61% and 68%) and more restful sleep (39% and 68%) in the osteopathic and the acupuncture groups, respectively. Improvement in mood and improved bowel function were also very common benefits noted by the parents in both groups.

Acupuncture Therapy↗
PubMed2001

Qualitative analysis of psychosocial impact of diagnosis of Chlamydia trachomatis: implications for screening.

OBJECTIVES: To investigate the psychosocial impact for women of a diagnosis of Chlamydia trachomatis and discuss the implications for the proposed UK chlamydia screening programme. DESIGN: Qualitative study with semistructured interviews. Interview transcripts analysed to identify recurrent themes. PARTICIPANTS: Seventeen women with a current or recent diagnosis of chlamydia. SETTING: A family planning clinic and a genitourinary medicine clinic in Glasgow. RESULTS: Three themes were identified: perceptions of stigma associated with sexually transmitted infection, uncertainty about reproductive health after diagnosis, and anxieties regarding partner's reaction to diagnosis. Most women had not previously perceived sexually transmitted infections as personally relevant; this was a function of stereotypical beliefs about who was "at risk" of sexually transmitted infection. These beliefs were pervasive and negatively affected reactions to diagnosis and produced anxiety about disclosure of the condition to others (particularly sexual partners) and future reproductive morbidity. This anxiety, given the uncertain natural history of chlamydia, may prove difficult to dispel. CONCLUSIONS: There are three primary areas of concern for women after a diagnosis of chlamydia which need to be examined in the proposed screening programme. Information provided should normalise and destigmatise chlamydial infection and positively promote genitourinary medicine services. Support services should be available because notification of partner can cause anxiety. Uncertainty about future reproductive morbidity may be inevitable; staff providing screening will require guidance in providing advice under such conditions.

Adult↗
PubMed2001

A pilot study of donepezil for memory problems in epilepsy.

We performed a pilot 3-month, open-label study of 5-10 mg donepezil, an anticholinesterase inhibitor, as treatment for memory problems in people with epilepsy. The Buschke Selective Reminding Test was administered at baseline and after 3 months of donepezil. In 18 completing patients, the total number of words recalled across learning trials was greater on donepezil (P = 0.4). No change was noted in attention, visual sequencing, mental flexibility, psychomotor speed, or reported quality-of-life scores. Mean 3-month seizure frequency at baseline was 2.70 ± 4.60, and during treatment, 3.06 ± 4.52 (P = 0.19, not significant). Two patients experienced increased tonic-clonic seizures. Side effects included diarrhea, stomach cramps, insomnia, depression, and blurred vision. Cholinergic medication is worthy of investigation as treatment for memory problems in people with epilepsy, but attention must be paid to possible exacerbation of seizures.

Journal Article↗
PubMed2001

Treatment of chronic hypertension with intravenous enalaprilat and transdermal clonidine.

We report an 11-year-old boy with hypertension and chronic intestinal pseudo-obstruction, which renders him totally dependent on parenteral nutrition and prevents the use of oral medications. Here we report the feasibility of utilizing chronic i.v. enalaprilat and transdermal clonidine on a chronic basis to control hypertension. Over the last 10 months, the patient's hypertension has been well controlled by 1.25 mg i.v. enalaprilat every 8 h and a 0.2-mg clonidine patch every 6 days, with no apparent side-effects. There are no reports of i.v. enalaprilat usage exceeding 3 weeks' duration. Therefore we believe that it is possible to effect reasonable management of chronic hypertension with the use of chronic i.v. enalaprilat and transdermal clonidine therapy.

Administration, Cutaneous↗
PubMed2001

Cost-effectiveness of a trial of labor after previous cesarean.

OBJECTIVE: To determine the cost-effective method of delivery, from society's perspective, in patients who have had a previous cesarean. METHODS: We completed an incremental cost-effectiveness analysis of a trial of labor relative to cesarean using a computerized model for a hypothetical 30-year old parturient. The model incorporated data from peer-reviewed studies, actual hospital costs, and utilities to quantify health-related quality of life. A threshold of $50,000 per quality-adjusted life-years was used to define cost-effective. RESULTS: The model was most sensitive to the probability of successful vaginal delivery. If the probability of successful vaginal birth after cesarean (VBAC) was less than 0.65, elective repeat cesarean was both less costly and more effective than a trial of labor. Between 0.65 and 0.74, elective repeat cesarean was cost-effective (the cost-effectiveness ratio was less than $50,000 per quality-adjusted life-years), because, although it cost more than VBAC, it was offset by improved outcomes. Between 0.74 and 0.76, trial of labor was cost-effective. If the probability of successful vaginal delivery exceeded 0.76, trial of labor became less costly and more effective. Costs associated with a moderately morbid neonatal outcome, as well as the probabilities of infant morbidity occurring, heavily impacted our results. CONCLUSION: The cost-effectiveness of VBAC depends on the likelihood of successful trial of labor. Our modeling suggests that a trial of labor is cost-effective if the probability of successful vaginal delivery is greater than 0.74. Improved algorithms are needed to more precisely estimate the likelihood that a patient with a previous cesarean will have a successful vaginal delivery.

Adult↗
PubMed2001

"That sort of place...where filthy men go...": a qualitative study of women's perceptions of genitourinary medicine services.

BACKGROUND: A stigma is a pejorative social label. Stigmatisation is a process by which individuals are made to experience isolation and reduced opportunities in life. Some diseases are particularly associated with stigmatising attitudes; this applies particularly to sexually transmitted infections. Although several studies report the effects of stigma, no study to date has attempted to investigate its nature, which is a prerequisite to designing health interventions. METHODS: This qualitative, exploratory study investigated the experience of stigma among young women recently diagnosed with an STI and considered the implications of these experiences in terms of maximising access to GUM clinics. RESULTS: Three themes were identified from interviews undertaken with women recruited in family planning and genitourinary medicine (GUM) clinics: the perception of STIs as a condition of "others," the threatening nature of the GUM clinic, and the evolution of the experience of stigma within the GUM clinic. CONCLUSION: More open discussion and education about sexual health services and STIs should take place at a general population level; awareness of sexual health services should be raised in inclusive ways, which are seen as relevant to the needs of a wide range of individuals; medical, nursing, and counselling staff in GUM clinics should be supported in their efforts to reduce the experience of stigma. Finally, future interventions designed to improve access to sexual health services should formally assess their impact on stigma.

Adolescent↗
PubMed2000

Can children with spastic cerebral palsy use self-hypnosis to reduce muscle tone? a preliminary study.

A few scattered reports suggest self-hypnosis may be helpful in reducing muscle tone in children with spastic cerebral palsy (CP). These reports are largely anecdotal and offer little objective evidence. This study used the Biocomp 2000 biofeedback electomyogram device to measure the degree of muscle tension in two muscle groups before, during, and after hypnosis in four children with spastic quadriplegic CP. Three of the four children were able to show a very significant decrease in muscle tension while under "trance" and were able to use self-relaxation techniques when confronted with stressful situations. Two of the children also had athetoid or involuntary movements and each was able to better control those movements with the aid of hypnosis. All four children demonstrated improved functional abilities.

Journal Article↗
PubMed2000

The Night Vision Threshold Test (NVTT): a simple instrument for testing dark adaptation in young children.

It is estimated that 41 per cent of the population aged under 5 in the developing world has an inadequate vitamin A dietary intake resulting in increased morbidity and mortality. Half a million children go blind each year as a result of vitamin A deficiency. Thirteen and a half million have night blindness, the first sign of vitamin A deficiency. Unfortunately, there is no simple, sensitive and inexpensive means to identify the child who has marginal levels of vitamin A and thus institute means to prevent their development of severe deficiency. A low cost, simple, easy-to-use instrument designed to detect a young child's ability to adapt to darkness was tested in children admitted to the Mwanamugimu Nutrition Unit at Makerere Medical School in Kampala, Uganda. Despite the severe degree of malnutrition found in these children, Night Vision Threshold Test results and serum retinol levels were related (r = 0.41, p < 0.05). Further efficacy trials for this instrument are planned at community sites in Nepal.

Adaptation, Ocular↗
PubMed2000

A new, simple, inexpensive means of testing functional vitamin A status: the night vision threshold test (NVTT). A preliminary field-test report.

Vitamin A deficiency is the leading cause of preventable childhood blindness in developing countries. Each year, an estimated 13.5 million children world-wide are unable to adapt to the dark and half a million children progress to complete blindness annually from lack of vitamin A. Most of the currently available methods for assessing vitamin A status are expensive, require sophisticated instrumentation and are not efficacious in field conditions. A simple, inexpensive method was developed to identify children with defective dark-adaptability, thereby providing a reflection of marginal vitamin A stores. The purpose of this preliminary study was to test the field-efficacy of the Night Vision Threshold Tester (NVTT). Thirty-nine middle-school children with a mean age of 13.5 +/- 1.37 years were initially tested for their ability to adapt to the dark using the

Child↗
PubMed2000

The impact of a structured programme of asthma care in general practice.

The impact of a new GP programme of asthma care was examined using: a) a retrospective pre- and post-casenote survey of 400 asthma patients, comparing patients in practices using the health board programme (HBP) and other programmes (OP); and b) a patient satisfaction questionnaire, completed by 532 people on asthma clinic lists in HBP and OP practices. Outcomes assessed were health service use, perceived change in symptoms and asthma self-management. The casenote survey indicated improved health service use by patients in HBP practices, with fewer patient-initiated (p < 0.05), emergency (p < 0.05) and other chest-related attendances (p < 0.01) and increased clinic attendance (p < 0.05) post intervention. OP practices also showed reduced patient-initiated (p < 0.01) and increased asthma clinic use (p < 0.01). Increased use of management plans (p < 0.01) and peak flow diaries (p < 0.01) was noted post intervention for HBP practices. Responders to the questionnaire survey perceived that clinic attendance improved asthma symptoms, including severity and control, sleep disturbance and early morning wheeze. People in HBP practices were more likely than those in OP practices to possess a peak flow meter, a diary and a personal management plan (all p < 0.01 or above) but were not more likely to use a peak flow diary. Notwithstanding methodological difficulties in the selection of practices, both studies showed trends towards improvement in health service use and asthma self-management. The HBP was associated with greater improvement in self-management processes and outcomes, and greater patient satisfaction with asthma care.

Adolescent↗
PubMed1999

International child health electives for pediatric residents.

BACKGROUND: International child health (ICH) electives can strengthen the skills and shape the values of pediatric residents. Much can be learned from the literature on ICH electives during medical school. Yet there is little published information regarding ICH electives during residency, nor do educational guidelines for such electives exist. OBJECTIVES: To describe existing ICH electives among pediatric residency programs and to develop guidelines for ICH electives during residency training. PARTICIPANTS AND METHODS: A survey of 248 pediatric residency programs in the United States, Canada, and Puerto Rico was conducted in November 1995. Consensus guidelines were developed by the executive committee of the American Academy of Pediatrics (AAP) Section on International Child Health. Consensus was achieved via full agreement among the 11 committee members. RESULTS: Survey response rate was 65%. International child health electives were offered by 25% of respondents. Most had no formal educational structure. An additional 42% of respondents indicated interest in ICH electives and requested more information. The AAP consensus guidelines for ICH electives focus on 4 principles: prerequisites, preceptorship, preparation, and evaluation. The guidelines are based on a conceptual framework that emphasizes reciprocity and continuity. CONCLUSIONS: While only 25% of pediatric residency programs currently offer ICH electives, many more express an interest in doing so. Educational structure for such electives is important and lacking. The AAP consensus guidelines provide a template for meaningful ICH experiences during pediatric residency. These guidelines may be applicable to other specialties as well.

Education, Medical, Graduate↗