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Biomedical subjects

E Walker

Publications and source records attributed to E Walker.

At least 91 records · Page 5Linked to original sources
PubMed1995

Collaborative management to achieve treatment guidelines. Impact on depression in primary care.

OBJECTIVE: To compare the effectiveness of a multifaceted intervention in patients with depression in primary care with the effectiveness of "usual care" by the primary care physician. DESIGN: A randomized controlled trial among primary care patients with major depression or minor depression. PATIENTS: Over a 12-month period a total of 217 primary care patients who were recognized as depressed by their primary care physicians and were willing to take antidepressant medication were randomized, with 91 patients meeting criteria for major depression and 126 for minor depression. INTERVENTIONS: Intervention patients received increased intensity and frequency of visits over the first 4 to 6 weeks of treatment (visits 1 and 3 with a primary care physician, visits 2 and 4 with a psychiatrist) and continued surveillance of adherence to medication regimens during the continuation and maintenance phases of treatment. Patient education in these visits was supplemented by videotaped and written materials. MAIN OUTCOME MEASURES: Primary outcome measures included short-term (30-day) and long-term (90-day) use of antidepressant medication at guideline dosage levels, satisfaction with overall care for depression and antidepressant medication, and reduction in depressive symptoms. RESULTS: In patients with major depression, the intervention group had greater adherence than the usual care controls to adequate dosage of antidepressant medication for 90 days or more (75.5% vs 50.0%; P < .01), were more likely to rate the quality of the care they received for depression as good to excellent (93.0% vs 75.0%; P < .03), and were more likely to rate antidepressant medications as helping somewhat to helping a great deal (88.1% vs 63.3%; P < .01). Seventy-four percent of intervention patients with major depression showed 50% or more improvement on the Symptom Checklist-90 Depressive Symptom Scale compared with 43.8% of controls (P < .01), and the intervention patients also demonstrated a significantly greater decrease in depression severity over time compared with controls (P < .004). In patients with minor depression, the intervention group had significantly greater adherence than controls to adequate dosage of antidepressant medication for 90 days or more (79.7% vs 40.3%; P < .001) and more often rated antidepressant medication as helping somewhat to helping a great deal (81.8% vs 61.4%; P < .02). However, no significant differences were found between the intervention and control groups in the percentage of patients who were satisfied with the care they received for depression (94.4% vs 89.3%), in the percentage who experienced a 50% or more decrease in depressive symptoms, or in the decrease of depressive symptoms over time. CONCLUSION: A multifaceted intervention consisting of collaborative management by the primary care physician and a consulting psychiatrist, intensive patient education, and surveillance of continued refills of antidepressant medication improved adherence to antidepressant regimens in patients with major and with minor depression. It improved satisfaction with care and resulted in more favorable depressive outcomes in patients with major, but not minor, depression.

Adult↗
PubMed1995

Daily gastrointestinal symptoms in women with and without a diagnosis of IBS.

This study compared daily gastrointestinal symptoms and stool characteristics across two menstrual cycles, and recalled bowel symptoms and psychological distress in women with irritable bowel syndrome (IBS, N = 22), IBS nonpatients (IBS-NP, N = 22), and controls (N = 25). Daily reports of abdominal pain, bloating, intestinal gas, constipation, and diarrhea did not differ significantly between the IBS and IBS-NP groups but both groups reported significantly higher symptoms than the control group. Stool consistencies was significantly looser in the IBS group relative to the control group. Menstrual cycle effects on symptoms were noted in all the groups. There were no significant differences in psychological distress between women with IBS and IBS-NP, but both groups reported significantly higher global distress than the control group. The lack of difference between the IBS and IBS-NP groups in contrast to the results of others, can be understood in terms of differences in recruitment strategies.

Abdominal Pain↗
PubMed1995

Outcomes of "inadequate" antidepressant treatment.

OBJECTIVE: To examine outcomes of primary care patients receiving low levels of antidepressant treatment. DESIGN: Cohort study comparing patients receiving anti-depressant treatment within and below the recommended dosing range. SETTING: Primary care clinics of a staff-model health maintenance organization. PATIENTS: Primary care patients initiating antidepressant treatment for depression. MEASUREMENTS AND MAIN RESULTS: Of 88 patients beginning antidepressant treatment, 49 (56%) used "adequate" doses for 30 days or more. Likelihood of "adequate" pharmacotherapy was not related to patient age, gender, medical comorbidity, or baseline depression severity. All the patients showed substantial clinical improvement after four months. Compared with those using "adequate" pharmacotherapy, the patients receiving low-intensity treatment had lower likelihood of clinical response (64% vs 84%; chi-square = 4.44; df = 1; p = 0.035). At four months, however, those receiving low-intensity and those receiving higher-intensity treatment did not differ significantly in either the score on the 20-item Symptom Checklist depression scale (18.91 and 15.72, respectively; F = 1.45; df = 1.86; p = 0.23) or the proportion with persistence of major depression (10% and 4%, respectively; chi-square = 1.30; df = 1; p = 0.25). A replication sample of 157 patients (assessed only at baseline and four months) yielded similar results. CONCLUSIONS: While the patients receiving recommended levels of pharmacotherapy showed somewhat higher improvement rates, many of the patients receiving "inadequate" treatment experienced good short-term outcomes. Efforts to increase the intensity of depression treatment in primary care should focus on the subgroup of patients who fail to respond to initial treatment.

Adult↗
PubMed1995

Vascular trauma on the rise.

Trauma is the leading cause of death in people under the age of 45. Guns, drugs, and street violence contribute to this growing epidemic. As a result, there is an increased incidence of lower extremity vascular trauma. The most common cause of vascular injury is gunshot wounds. This article presents two case studies to illustrate the complex nursing management of this patient population. It is important for nurses to be aware of the physiologic and psychological treatment of these patients. A detailed nursing plan of care is also included.

Adult↗
PubMed1995

Risk factor assessment for the acquisition of fluoroquinolone-resistant isolates of Pseudomonas aeruginosa in a community-based hospital.

A case-control study was performed in a community-based nonteaching hospital to assess patient risk factors for the acquisition of fluoroquinolone-resistant isolates of Pseudomonas aeruginosa. Fifty-five patients who were hospitalized between July 1, 1993 and December 31, 1993 and who had P. aeruginosa recovered from a clinical specimen were included in the analysis. Two patient populations were designated based on the fluoroquinolone susceptibility of their P. aeruginosa isolates. Statistical evaluation using univariate analysis of demographic and clinical data from the 42 patients with quinolone-susceptible P. aeruginosa and the 13 patients with quinolone-resistant P. aeruginosa demonstrated that prior receipt of a fluoroquinolone was the only significant risk factor for the subsequent emergence of fluoroquinolone resistance among P. aeruginosa isolated from patients hospitalized in this small community-based institution (p = 0.0196). Multivariate analysis supported the finding that prior receipt of a fluoroquinolone was the major risk factor for the isolation of fluoroquinolone-resistant P. aeruginosa (p = 0.0004); isolation of this Gram-negative bacillus from sputum (p = 0.0306) and a history of recent surgery (p = 0.0058) were also significantly associated as risk factors for resistance.

Adolescent↗
PubMed1995

The role of the primary care physician in patients' adherence to antidepressant therapy.

In this study, the authors attempted to determine predictors of adherence to antidepressant therapy and to identify specific educational messages, side effects, and features of doctor-patient collaboration that influence adherence. Patients newly prescribed antidepressants for depression at a health maintenance organization were identified by using automated pharmacy data and medical records review. Patients (n = 155) were interviewed 1 and 4 months after starting antidepressant medication. Approximately 28% of patients stopped taking antidepressants during the first month of therapy, and 44% had stopped taking them by the third month of therapy. Patients who received the following five specific educational messages--1) take the medication daily; 2) antidepressants must be taken for 2 to 4 weeks for a noticeable effect; 3) continue to take medicine even if feeling better; 4) do not stop taking antidepressant without checking with the physician; and 5) specific instructions regarding what to do to resolve questions regarding antidepressants--were more likely to comply during the first month of antidepressant therapy. Asking about prior experience with antidepressants and discussions about scheduling pleasant activities also were related to early adherence. Side effects, only at severe levels, were associated with early noncompliance. Neuroticism, depression severity, and other patient characteristics did not predict adherence. Primary care physicians may be able to enhance adherence to antidepressant therapy by simple and specific educational messages easily integrated into primary care visits.

Adult↗
PubMed1995

The relationship between cognitive functions and behavioral deviance in children at risk for psychopathology.

Previous studies have generally found that children at risk for psychopathology (i.e. children characterized by risk factors such as parental psychopathology and maltreatment) display more deviant behavior and cognitive dysfunctions than children not at risk. The present study examined the relationship between behavioral deviance and cognition in children characterized by a variety of risk factors (parental schizophrenia, parental psychiatric disorders other than schizophrenia, parental maltreatment). The results indicated that the effects of parental schizophrenia could be distinguished from the more generalized effects of maltreatment and that cognitive deficits were associated with schizoid behavior in children at risk for schizophrenia. These findings suggest that cognitive ability may serve as a moderator of vulnerability to maladjustment in children at risk for schizophrenia.

Adolescent↗
PubMed1995

Immunoreactivity of canine transitional cell carcinoma of the urinary bladder with monoclonal antibodies to tumor-associated glycoprotein 72.

Tumor-associated glycoprotein 72 (TAG-72) is a large, high molecular weight, mucinlike antigen that is expressed in a wide variety of human carcinomas. Three different TAG-72 monoclonal antibodies (MAbs), designated B72.3, CC49, and CC83, were applied to the following archived samples from the dog: 1) 51 transitional cell carcinomas of the urinary bladder, 2) 15 hyperplastic/inflamed urinary bladders, and 3) eight normal urinary bladders. Immunoreactivity was detected with an avidin-biotin complex immunoperoxidase method. Fifty-three percent (27/51) of transitional cell carcinomas were positive (> or = 5% staining) for MAb B72.3. MAb B72.3 staining of these transitional cell carcinomas did not statistically correlate with any of the examined features of malignancy, including histologic grade, clinical stage, DNA ploidy, or presence of vascular/lymphatic invasion. In regard to the staining of transitional cell carcinoma by the other two TAG-72 antibodies, 53% (27/51) of the samples were positive for MAb CC83 and 63% (32/51) were positive for MAb CC49. The finding that similar populations of neoplastic urothelial cells in serial sections from the same neoplasm stained with all three TAG-72 antibodies supports the hypothesis that an antigen similar to TAG-72 was expressed in canine transitional cell carcinoma. None of the normal urinary bladders nor any of the hyperplastic/inflamed urinary bladders stained with any of the three TAG-72 antibodies tested. The results of these studies demonstrated that the staining of canine transitional cell carcinoma with all three TAG-72 antibodies was specific for neoplastic urothelial cells and that an antigen similar to TAG-72 was expressed.

Animals↗
PubMed1995

Primary care physician use of cognitive behavioral techniques with depressed patients.

BACKGROUND: Although researchers are paying more attention to the treatment of depression in the primary care setting, little is known about the nature of psychotherapeutic interactions that occur between primary care physicians and their patients in the context of a visit for depression. In recent years, brief cognitive behavioral therapy has been demonstrated to be efficacious, and the public has become more familiar with these techniques through media exposure and self-help books. METHODS: Depressed primary care patients were surveyed regarding the extent to which cognitive behavioral (CB) techniques were suggested during the primary care visit in which antidepressant medication was initially prescribed. One hundred fifty-five patients completed responses to phone surveys 1 month and 4 months after the visit. Patients were also surveyed regarding the recommendation of counseling by the primary care physician. RESULTS: The majority of patients (61%) reported that their physician advised them to identify activities they were already doing that helped them feel better. Physician recommendations regarding planning pleasurable activities, problem solving, challenging depressive thoughts, and planning activities that boost confidence were reported by 22% to 40% of study patients. Older patients reported fewer interactions about CB strategies. Primary care physicians' suggestion of CB strategies was associated with both patient use of CB strategies in the months following the visit and better adherence to recommended medication therapy during the first month of treatment. CONCLUSIONS: Many patients seem to recognize the occurrence of psychotherapeutic interactions during visits to their primary care physician in which an antidepressant medication was prescribed, and patients' recognition of these interactions is associated with increased adherence to the recommended course of antidepressant prescriptions.

Adaptation, Psychological↗
PubMed1994

The predictors of persistence of depression in primary care.

164 patients in primary care who were recognized as depressed by their physicians and started on antidepressants were interviewed at 1 and 4 months after initiation of treatment. Ten factors hypothesized to be related to persistence of depressive symptoms were entered into a multivariate analysis to determine predictors of persistence of affective symptoms. Patients with minor depression were significantly older, more likely to be married or cohabitating, more likely to have serious medical illness, and had significantly less comorbid panic disorder, recurrent depression and lower neuroticism scores compared to patients with major depression. Approximately half of the patients in this primary care sample with major depression and one-third of those with minor depression were still distressed at 4 months, although few met criteria for major depression. Severity of depression and high neuroticism scores were the best predictors of persistent depressive symptoms.

Adolescent↗
PubMed1994

Virulence of coagulase-deficient mutants of Staphylococcus aureus in experimental endocarditis.

A sensitive rat endocarditis model which employed relatively small inocula (< or = 10(4) cfu) was used to examine the role of coagulase in the pathogenesis of infection. Rats with indwelling, intracardiac catheters were challenged intravenously with three strains of Staphylococcus aureus. The virulence of a coagulase-positive parental strain DU5808 was compared in terms of its ID50 for resected vegetations and catheters to that of two coagulase-negative mutant strains (DU5809 and DU5814) which had undergone site-specific mutagenesis. Confidence intervals of infection rates were calculated and comparisons were performed of weights of infected vegetations, bacterial concentrations in vegetations and early mortality rates. From these virulence parameters, it was concluded that there were no differences in virulence among the three strains. The results from this investigation support the previous findings in mouse models of subcutaneous infection and mastitis, which indicated that coagulase production by S. aureus does not appear to function as a virulence factor. Together, these data refute the longheld belief that coagulase is important in the pathogenesis of infection and indicate that other markers of virulence must be operative in diseases caused by the enduring pathogen S. aureus.

Analysis of Variance↗
PubMed1994

Cytopathology in the post mortem room.

AIM: To demonstrate the role of cytopathology in examining tumours found at post mortem examination. METHODS: Tumour deposits were found in 25 hospital necropsies. Cytological diagnosis made at the time of necropsy was compared with subsequent paraffin wax embedded histological sections. RESULTS: In 19 out of 20 cases with no previous histological diagnosis, cytology at the time of necropsy provided rapid and accurate assessment of tumour type. Subsequent histological examination of formalin fixed material merely refined the diagnosis in some cases. In the remaining five cases in which tumour type was known, cytological examination of deposits found at necropsy provided extra information that was useful for compiling a provisional report. CONCLUSIONS: Rapid cytological examination of tumours found during post mortem examinations provides accurate relevant information which can be used to produce a more comprehensive provisional necropsy report. The technique has advantages over frozen section histology and can provide useful cytological experience for histopathology trainees.

Adenocarcinoma↗
PubMed1994

Flow cytometric DNA ploidy analysis in canine transitional cell carcinoma of urinary bladders.

Flow cytometric analysis of DNA ploidy was performed on 51 formalin-fixed, paraffin-embedded samples of canine transitional cell carcinoma of the urinary bladder. The DNA ploidy data obtained were compared to several clinicopathologic features. In addition, the DNA ploidy of 15 hyperplastic/inflamed and 8 normal canine urinary bladders was measured. Forty-three of the 51 neoplastic samples had interpretable DNA histograms. DNA aneuploidy was found in 34/43 (79%) of the transitional cell carcinoma samples. Of the 34 aneuploid neoplasms, 16 (47%) were hyperdiploid, 17 (50%) were tetraploid, and 1 (3%) was hypertetraploid. No significant correlation was found between the presence of DNA aneuploidy and the growth pattern, histologic grade, clinical stage, or individual morphologic features of this neoplasm. Additionally, the DNA ploidy was not related to the sex, age, or survival time of dogs with transitional cell carcinoma. All of the normal and all but one of the hyperplastic/inflamed urinary bladders were diploid. The results from this study demonstrated that DNA ploidy can be measured from paraffin-embedded canine samples by flow cytometry, a majority of the canine transitional cell carcinomas were aneuploid, and a significant correlation did not exist between the DNA ploidy and specific clinicopathologic features of this neoplasm.

Animals↗