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Biomedical subjects

David Armstrong

Publications and source records attributed to David Armstrong.

At least 37 records · Page 2Linked to original sources
PubMed2006

Does the treatment of gastroesophageal reflux disease (GERD) meet patients' needs? A survey-based study.

OBJECTIVE: Symptoms of gastroesophageal reflux disease (GERD) affect approximately 20% of people on a weekly basis. A number of different therapies are prescribed to control the disease. This survey-based study was carried out to assess patients' and physicians' perceptions of GERD and its treatment. METHODS: Randomly selected general practitioners (GPs) from five countries (USA, UK, Japan, Germany and France) took part in a faceto-face interview, using a standard questionnaire, concerning the last four GERD patients (those taking GERD medication) who had consulted them and who consented to be interviewed. Those patients were then interviewed via telephone, also using a standard questionnaire. RESULTS: Completed questionnaires were available for 927 of the 1044 patients who were identified. The mean length of time that patients suffered GERD symptoms prior to consultation was more than 1.5 years, with 52.3% of those consulting a GP stating the reason they sought medical attention was that 'symptoms were too uncomfortable to bear'. Only 36% of patients receiving prescription therapy reported that they were currently asymptomatic; 20.5% of patients were also taking at least one over-the-counter (OTC) medication. CONCLUSIONS: In the primary care setting, many patients receiving GERD therapy do not have fully controlled symptoms. It is recommended that GPs question patients routinely about persistent symptoms on therapy, and OTC use, in order that effective treatment choices are made in the management of GERD.

Attitude of Health Personnel↗
PubMed2006

An investigation of the forces used by clinicians to open spaces with coil springs.

AIMS: To determine the forces applied by coil springs used to open spaces for blocked out lateral incisors, and to compare the actual forces used with clinicans' concepts of an 'ideal' force. METHODS: Twelve postgraduate orthodontic students (7M, 5F) and 12 orthodontic tutors (9M, 3F) participated in this study. They were asked to state what they considered was an ideal orthodontic force, and then to cut appropriate lengths of stainless steel and nickel titanium open coil springs to open spaces for blocked out maxillary and mandibular permanent lateral incisors on a typodont set-up. The forces generated by the open coil springs were measured and compared to the stated ideal forces. RESULTS: The mean ideal force was 76.75 g (Range: 25-200 g). The mean applied force was 314 g (Range: 21-519 g). There were no significant differences in the forces used by the male and female postgraduates, but the male tutors used a significantly higher force than the male postgraduate students (p = 0.007) and the female tutors (p < 0.001). The female tutors used a significantly lower force than the female postgraduates (p = 0.024) and the male postgraduates (p = 0.003). Higher forces were produced by the stainless steel coil springs in both arches (Maxillary arch: p = 0.007; Mandibular arch: p < 0.005). CONCLUSIONS: The clinicians could not agree on an ideal force to open spaces for blocked out lateral incisors. There were substantial differences between the forces applied by the coil springs and the forces considered by the clinicians to be ideal. There were large differences in the forces used by the different groups of orthodontists.

Biomechanical Phenomena↗
PubMed2006

Root resorption after orthodontic treatment.

BACKGROUND: Orthodontic treatment can result in root resorption. OBJECTIVE: To determine if apical root resorption is related to the type of appliance used and/or the direction and amount of tooth movement. METHODS: The pre- and post-treatment tooth lengths of the maxillary and mandibular first molars and incisors were measured on panoramic radiographs of 114 subjects. Associations between changes in the lengths of the incisors and positional changes in the upper and lower central incisors were determined for 45 subjects with pre- and post-treatment cephalometric radiographs. RESULTS: Taking into account the gender and OPT machine seven statistically significant differences were found between the appliance groups for the lengths of teeth 31 and 41. Within the groups four teeth decreased significantly in length when the pre-adjusted appliance was used (teeth 12, 11, 21, 26) and four teeth when the Speed appliance was used (teeth 26, 31, 41, 42). Only tooth 31 was shorter when the Tip-Edge appliance was used. Lower incisors were significantly shorter post-treatment if the apices were moved close to the lingual cortex. CONCLUSIONS: When panoramic radiographs are used to assess treatment-induced changes in the lengths of the incisors, apical resorption is only one factor that should be considered. The images of lower incisors proclined during treatment may be foreshortened and/or the apices may lie outside the focal plane: both may result in 'shorter' teeth post-treatment. Because of the confounding factors panoramic radiographs may not be a reliable method of determining apical root resorption.

Adolescent↗
PubMed2005

Gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is increasingly common worldwide; symptoms differ between individuals and endoscopically visible injury is present in only about 50% of cases. Although GERD is a disorder of gastrointestinal motility and structure, the most effective therapy is based on the use of acid antisecretory drugs. Proton pump inhibitors (PPIs), the most effective class of acid suppression agents to date, have revolutionised the management of GERD. However, PPIs do have some shortcomings and recent developments include documentation of increased healing rates with more prolonged acid suppression, more prolonged acid suppression with a new PPI (tenatoprazole) and more rapid onset of acid suppression with a new class of drugs, the reversible, potassium-competitive acid blockers. Studies with motility agents, such as the 5-HT(4) partial agonist tegaserod and the GABA(B) agonist baclofen, indicate that motility is important in the pathogenesis of GERD but, for several reasons, it will be a challenge to develop new classes of drug that outperform current PPIs with respect to efficacy, broad applicability and safety.

Animals↗
PubMed2005

Social determinants of diagnostic labels in depression.

The role of diagnostic labels in medicine is usually that of labelling an illness as a means of communication. Control over labelling processes in medicine is ordinarily imposed via medical schools, textbooks, education or by diagnostic manuals. Diagnostic labels often change following new discoveries in underlying pathology such as 'consumption' being relabelled as 'TB' or 'cancer'. Sub-types of broad diagnostic labels also often emerge from such discoveries e.g. 'lung cancer' or 'throat cancer'. In mental health, underlying pathology is the subject of ongoing debate spanning ideas including the brain as a faulty organ, faulty genetics and environmental problems. With controversy over pathology comes controversy over labels and the idea that labels may be used not just for communication, but as devices of social and professional control, arising out of a social process. This study explores the codification of the diagnostic label 'depression' which emerged in the twentieth-century and has proliferated with numerous sub-types over the last 40 years. The aim is to examine its social determinants and context. Medline is used as a data source for professional label usage. A range of depression sub-type labels in professional use was identified. This exercise revealed many official and 'unofficial' terms in professional use. Citation rate plots by year were then generated for these depression sub-type labels. The rise and fall of different labels are examined in relation to social determinants and context, including publication of diagnostic manuals DSM and ICD, power shifts in psychiatry, the discovery of psychiatric drugs and the shift from inpatient to community care. Exploring the changing use of official and unofficial labels over time in this way provides a novel historical perspective on the concept of depression in the late twentieth-century.

Bibliometrics↗
PubMed2005

The impact of illness in patients with moderate to severe gastro-esophageal reflux disease.

BACKGROUND: Gastro-esophageal reflux disease (GERD) is a common disease. It impairs health related quality of life (HRQL). However, the impact on utility scores and work productivity in patients with moderate to severe GERD is not well known. METHODS: We analyzed data from 217 patients with moderate to severe GERD (mean age 50, SD 13.7) across 17 Canadian centers. Patients completed three utility instruments--the standard gamble (SG), the feeling thermometer (FT), and the Health Utilities Index 3 (HUI 3)--and several HRQL instruments, including Quality of Life in Reflux and Dyspepsia (QOLRAD) and the Medical Outcomes Short Form-36 (SF-36). All patients received a proton pump inhibitor, esomeprazole 40 mg daily, for four to six weeks. RESULTS: The mean scores on a scale from 0 (dead) to 1 (full health) obtained for the FT, SG, and HUI 3 were 0.67 (95% CI, 0.64 to 0.70), 0.76 (95% CI, 0.75 to 0.80), and 0.80 (95% CI, 0.77 to 0.82) respectively. The mean scores on the SF-36 were lower than the previously reported Canadian and US general population mean scores and work productivity was impaired. CONCLUSION: GERD has significant impact on utility scores, HRQL, and work productivity in patients with moderate to severe disease. Furthermore, the FT and HUI 3 provide more valid measurements of HRQL in GERD than the SG. After treatment with esomeprazole, patients showed improved HRQL.

Adult↗
PubMed2005

Electron attachment in ice-HCl clusters: an ab initio study.

Experimental work has shown that small amounts of HCl strongly enhance electron capture in ice films. The purpose of the present study was to investigate the effect of adsorbed HCl on the interaction of electrons with small clusters of water. Studies were made with clusters of 6 and 12 water molecules with various geometries both with and without one HCl attached. A number of distinct HCl coordination motifs were examined. All of the neutral structures with HCl exhibited zero thresholds for electron attachment and formed dipole bound anionic states (DBS). The relaxation processes for these "initial DBS" depended on the number of H(2)O (n) and on the number and type of H-bonds to the HCl (x). The initial DBS of systems with only O-H...Cl H-binding underwent dissociative electron attachment (DEA), forming H atoms. Relaxation for systems with ClH...OH(2) bonds was more complex. For the two layer n = 12 systems with x = 2 or 3 the HCl proton moved to the nearest oxygen to form H(3)O(+). Then rearrangement of the proton network occurred, and the Cl(-) became solvated by three HO-H...Cl(-) bonds. The presence of Cl(-) and H(3)O(+) increases the dipole moment and the electron binding energy (EBE) of the network. Further stabilization is achieved by decay into deeper DBS electron traps and/or by reaction of the excess electron with H(3)O(+) to form H(*) atoms. The HCl(H(2)O)(6) clusters with a single Cl-H...OH(2) bond behaved differently. They increased their stability by becoming more linear. This raised the dipole moment and the EBE therefore increased, reducing the total energy. None of these species showed any signs of increasing the number of H-bonds to Cl. The implication of these observations for the interpretation of the results of the experiments with 0.2 monolayer of HCl on 5 monolayer of H(2)O at 20 K, and on the possible role of cosmic ray-induced ionization in polar stratospheric clouds in ozone depletion is discussed.

Anions↗
PubMed2005

Potential impact of the HIPAA privacy rule on data collection in a registry of patients with acute coronary syndrome.

BACKGROUND: Implementation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule has the potential to affect data collection in outcomes research. METHODS: To examine the extent to which data collection may be affected by the HIPAA Privacy Rule, we used a quasi-experimental pretest-posttest study design to assess participation rates with informed consent in 2 cohorts of patients eligible for the University of Michigan Acute Coronary Syndrome registry. The pre-HIPAA period included telephone interviews conducted at 6 months that sought verbal informed consent from patients. In the post-HIPAA period, informed consent forms were mailed to ask for permission to call to conduct a telephone interview. The primary outcome measure was the percentage of patients who provided consent. Incremental costs associated with the post-HIPAA period were also assessed. RESULTS: The pre-HIPAA period included 1221 consecutive patients with acute coronary syndrome, and the post-HIPAA period included 967 patients. Consent for follow-up declined from 96.4% in the pre-HIPAA period to 34.0% in the post-HIPAA period (P<.01). In general, patients who returned written consent forms during the post-HIPAA period were older, were more likely to be married, and had lower mortality rates at 6 months. Incremental costs for complying with the HIPAA Privacy Rule were $8704.50 for the first year and $4558.50 annually thereafter. CONCLUSIONS: The HIPAA Privacy Rule significantly decreases the number of patients available for outcomes research and introduces selection bias in data collection for patient registries.

Acute Disease↗
PubMed2005

Determination of ReQuest-based symptom thresholds to define symptom relief in GERD clinical studies.

BACKGROUND/AIMS: The growing importance of symptom assessment is evident from the numerous clinical studies on gastroesophageal reflux disease (GERD) assessing treatment-induced symptom relief. However, to date, the a priori selection of criteria defining symptom relief has been arbitrary. The present study was designed to prospectively identify GERD symptom thresholds for the broad spectrum of GERD-related symptoms assessed by the validated reflux questionnaire (ReQuest) and its subscales, ReQuest-GI (gastrointestinal symptoms) and ReQuest-WSO (general well-being, sleep disturbances, other complaints), in individuals without evidence of GERD. METHODS: In this 4-day evaluation in Germany, 385 individuals without evidence of GERD were included. On the first day, participants completed the ReQuest, the Gastrointestinal Symptom Rating Scale, and the Psychological General Well-Being scale. On the other days, participants filled in the ReQuest only. GERD symptom thresholds were calculated for ReQuest and its subscales, based on the respective 90th percentiles. RESULTS: GERD symptom thresholds were 3.37 for ReQuest, 0.95 for ReQuest-GI, and 2.46 for ReQuest-WSO. CONCLUSION: Even individuals without evidence of GERD may experience some mild symptoms that are commonly ascribed to GERD. GERD symptom thresholds derived in this study can be used to define the global symptom relief in patients with GERD.

Adult↗
PubMed2005

The influence of demographic factors and health-related quality of life on treatment satisfaction in patients with gastroesophageal reflux disease treated with esomeprazole.

BACKGROUND: The correlation between treatment satisfaction and demographic characteristics, symptoms, or health-related quality of life (HRQL) in patients with gastroesophageal reflux disease (GERD) is unknown. The objective of this study was to assess correlates of treatment satisfaction in patients with GERD receiving a proton pump inhibitor, esomeprazole. METHODS: Adult GERD patients (n = 217) completed demography, symptom, HRQL, and treatment satisfaction questionnaires at baseline and/or after treatment with esomeprazole 40 mg once daily for 4 weeks. We used multiple linear regressions with treatment satisfaction as the dependent variable and demographic characteristics, baseline symptoms, baseline HRQL, and change scores in HRQL as independent variables. RESULTS: Among the demographic variables only Caucasian ethnicity was positively associated with treatment satisfaction. Greater vitality assessed by the Quality of Life in Reflux and Dyspepsia (QOLRAD) and worse heartburn assessed by a four-symptom scale at baseline, were associated with greater treatment satisfaction. The greater the improvement on the QOLRAD vitality (change score), the more likely the patient is to be satisfied with the treatment. CONCLUSIONS: Ethnicity, baseline vitality, baseline heartburn severity, and change in QOLRAD vitality correlate with treatment satisfaction in patients with GERD.

Adult↗
PubMed2005

Efficacy of topical metronidazole (10 percent) in the treatment of anorectal Crohn's disease.

PURPOSE: The aim of this study was to investigate the efficacy of 10 percent topical metronidazole in the treatment of symptomatic anorectal Crohn's disease. METHODS: Patients with symptomatic anorectal Crohn's disease were studied in a prospective, nonblinded, nonrandomized study to evaluate the efficacy of topical 10 percent metronidazole. Perianal Crohn's Disease Activity Index and each component (pain, discharge, induration, sexual dysfunction, and type of pathology) were recorded before treatment and at four weeks. Visual analog pain score (0-10) was recorded before treatment and at weekly intervals for up to four weeks. RESULTS: Fourteen patients were studied prospectively for four weeks. Mean Perianal Crohn's Disease Activity Index decreased from 8.8 +/- 0.9 before treatment to 4.1 +/- 0.7 after four weeks' treatment (P < 0.0001). Visual analog pain scores decreased from 5.4 +/- 0.7 before treatment to 2.4 +/- 0.5 at one week (P < 0.001) and to 1.0 +/- 0.4 after four weeks' treatment (P < 0.0001). Of the Perianal Crohn's Disease Activity Index components, significant decreases were noted in pain and discharge (P < 0.0001) and induration (P < 0.001). CONCLUSION: For patients with perianal Crohn's disease, topical 10 percent metronidazole decreases the Perianal Crohn's Disease Activity Index and anorectal pain.

Administration, Topical↗
PubMed2005

A comparison of GPs and nurses in their approach to psychological disturbance in primary care consultations.

It has frequently been reported that GPs fail to diagnose many of the psychological problems that present to them. It also appears that practice nurses working in primary care also show similar diagnostic 'failings'. This study extends these observations by reporting the psychiatric diagnostic practices of GPs and nurses working in the same settings of six general practices. After each consultation the health professional involved assessed the degree of psychological morbidity and the amount of time they had spent attending to this problem. The health professionals' assessment was compared with the score from a General Health Questionnaire completed by the patient. Analysis of 1646 consultations revealed that GPs saw patients with more psychological problems than nurses. Nurses, however, spent significantly more time dealing with their psychological workload than their GP colleagues, after allowing for the fact that they saw fewer patients in this category. This observation raises the question of whether this use of scarce time resource in the consultation is appropriate.

Family Practice↗