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Biomedical subjects

G A Baker

Publications and source records attributed to G A Baker.

At least 73 records · Page 4Linked to original sources
PubMed1996

The development, reliability and validity of a disease specific quality of life model for adults with growth hormone deficiency.

OBJECTIVE: Adults with GH deficiency frequently complain of lack of energy, fatigue, social isolation and problems with sexual relationships resulting in a low perceived quality of life. Previous studies of quality of life (QOL) in GH deficient adults have involved small numbers of patients and used measures not specifically designed for this patient population. We have devised a health related QOL model specifically designed for use in adults with GH deficiency and to assess the impact of future GH replacement therapy. DESIGN: Six measurements were chosen for inclusion in the model. Two were adapted for use after clinical interviews with 12 adult GH deficient patients: the Impact and the Life Fulfilment scales. The others were the Nottingham Health Profile, the Hospital Anxiety and Depression Scale, the Self-Esteem Scale and the Mental Fatigue Questionnaire. The reliability of the 6 measures was assessed by 2 methods: test re-test correlation and internal consistency (Cronbach's alpha). The validity of the Impact and Life Fulfilment scales was assessed by correlation with the other 4 scales. PATIENTS: Questionnaires were completed by 32 adults with hypothalamic pituitary disorders and GH deficiency (11 male, mean age 35.1 years), with a stimulated maximum serum GH response less than 10 mU/l (mean 2.96). Two had previously received GH injections in childhood. The questionnaires were also completed by 32 age and sex matched control subjects. RESULTS: The 6 scales had test re-test correlations of 0.70-0.92 indicating reliability over time. The Impact and Life Fulfilment Scales and the Mental Fatigue Questionnaire had Cronbach's alpha scores of greater than 0.6 indicating their potential for use in clinical trials. The Impact and Life Fulfilment scales correlated significantly with many physical and psychological domains from the other 4 scales indicating these were valid in the assessment of health related QOL in GH deficient adults. Compared to the controls the patients with GH deficiency were significantly psychosocially disadvantaged in terms of depression, self-esteem, mental fatigue and life fulfilment. CONCLUSION: The results of the reliability and validity studies indicate that this health related quality of life model for use with adults with GH deficiency is a potentially valid and reliable tool that could be used to assess the effect of GH treatment.

Activities of Daily Living↗
PubMed1996

The clinical course of epilepsy and its psychosocial correlates: findings from a U.K. Community study.

As part of a large community-based study, we retrospectively examined the clinical course of epilepsy in an unselected population of people who had a recent history of seizures or were receiving antiepileptic drugs (AEDs). Clinical information was collected from medial records, and information about psychosocial functioning was obtained by means of postal questionnaires sent to identified subjects. The response rate to the postal questionnaire was 71%. There were some deficiencies in the recording of clinical data, which is not unusual since data were taken from records held by primary physicians rather than from hospital clinics. Nevertheless, findings regarding the clinical course of epilepsy corresponded to those of earlier studies. Fifty-seven percent of the sample had had at least a 2-year seizure-free period and 46% of subjects were currently in a remission of at least 2-year duration. There was a clear relationship between current seizure frequency and levels of anxiety and depression, perceived impact of epilepsy, perceived stigma, and marital and employment status. The relationship of seizure frequency and other clinical variables to psychosocial function was explored by multivariate analysis techniques. The amount of variation in scores on the various measures of function accounted for by the clinical variables was small. The most important predictor was current seizure activity, which was the first variable to enter the regression analyses for six of the eight measures of psychosocial function considered. Age at epilepsy onset also emerged as a significant predictor for depression, stigma, and marital status. In individuals with epilepsy in remission, there was little evidence that psychosocial functioning was associated with length of remission, a finding which may in part reflect the nature of this study population. The results indicate that there are several more important predictors of psychopathology and social dysfunction in epilepsy and suggest several implications for treatment interventions.

Adult↗
PubMed1996

Patients' experiences of and satisfaction with care for their epilepsy.

PURPOSE: To determine condition-specific satisfaction with care, we studied patients' experience of general practitioner (primary physician) and hospital clinic care for their epilepsy and their views about the provision of information concerning the management of their condition. METHODS: A postal questionnaire was sent to an unselected, community-based population of patients with epilepsy. In addition to clinical and demographic details and previously validated scales of psychosocial well-being, the instrument contained a series of questions about patients' experiences and views of the care they received for epilepsy from both general practice and the hospital services. RESULTS: Doctors' interpersonal skills were the most influential factors affecting both patient satisfaction overall and the likelihood that doctors might discuss with patients certain clinical and social issues surrounding the management of the patient's condition. A sizable proportion of patients reported that they received insufficient information about epilepsy, both from hospital doctors and general practitioners. CONCLUSIONS: Patients with epilepsy place great importance on having a doctor who is approachable, communicative, and knowledgeable and on receiving adequate information about their condition. Clinicians may need to be made more aware of the importance of accessibility and sensitivity to the nonclinical needs of their patients. Such easily implemented changes in the delivery of care would improve services in the United Kingdom for people with epilepsy.

Adolescent↗
PubMed1996

Validation of the Wechsler Memory Scale-Revised in a sample of people with intractable temporal lobe epilepsy.

PURPOSE: The Wechsler Memory Scale-Revised (WMS-R) is used routinely for presurgical assessment of memory for patients considering elective resection of the temporal lobe and/or hippocampus for the relief of intractable temporal lobe epilepsy (TLE). We investigated the validity of the WMS-R in a population of people with TLE. METHODS: The sample consisted of 138 patients with a diagnosis of TLE in which the epileptogenic focus was clearly and exclusively lateralized to either the right or left hemisphere. They underwent a complete neuropsychological examination as a routine part of their investigation for epilepsy surgery. Psychometric scores included in this study were: Wechsler Adult Intelligence Scale-Revised (WAIS-R) I.Q. scores, National Adult Reading Test Revised (NART-R) predicted-I.Q. scores, and WMS-R Memory Index and subtest scores. RESULTS: Multiple univariate analyses were performed. The group with left temporal focus had significantly lower Verbal Memory Index, Logical memory (both immediate and delayed), and Digit Span scores. Visual/Verbal discrepancy scores incorrectly identified most patients with right temporal focus. Analyses of a total group of people with epilepsy (i.e., mixed temporal, frontal, occipital and unknown foci) as compared with the normative sample indicated that the patient group scored significantly lower across all memory index scores and most memory subtests. CONCLUSIONS: Our results confirm that the WMS-R is capable of lateralizing to left hemispheric impairment but is more problematic in the assessment of right hemispheric impairment. The Visual/Verbal Memory Index discrepancy has questionable validity. People with epilepsy performed less well on the WMS-R than did the normative sample. The need for reliable and valid nonverbal tests of memory is therefore warranted.

Adult↗
PubMed1995

Advances in methods for assessing the impact of epilepsy and antiepileptic drug therapy on patients' health-related quality of life.

We studied 31 previously validated and newly developed generic and epilepsy-specific scales to evaluate their usefulness for assessing the impact of epilepsy and anti-epileptic drug (AED) therapy on health-related quality of life (HRQOL). Included were the MOS SF-36 Health Survey, additional measures of mental health, cognition, epilepsy-specific perception of control, behavioural problems, distress, worries and experiences, the Liverpool Epilepsy Impact and Seizure Severity scales, and a patient-completed symptom checklist. Questionnaires were completed twice by 136 patients on AED therapy in a multicentre study in the UK. Validity was assessed in relation to disease severity, defined as time since last seizure, and to patient-reported symptoms. Statistical analyses to estimate the contribution of HRQOL information of each scale relative to that of others were conducted. The 171-item questionnaire could be completed by out-patients with epilepsy with good data quality. With few exceptions, generic and epilepsy-specific measures satisfied psychometric tests of hypothesized item groupings and scale score reliability (internal consistency and test-retest reliability) and differentiated well between groups of patients differing in time since last seizure and in symptom impact, regardless of time since last seizure. However, scales differed widely in their validity in discriminating between groups of patients known to differ clinically. The SF-36 Role Physical scale best discriminated among groups differing in disease severity. The epilepsy-specific Mastery, Impact, Experience, Worry, Distress, and Agitation scales were among the 10 best measures in discriminating among groups differing in disease severity. Generic measures, especially measures of social and role functioning and mental health, were best at differentiating groups of patients differing in symptom impact. Recommendations are offered for concepts and specific scales most likely to be useful in future studies of the HRQOL burden of epilepsy and the HRQOL benefits of AED therapy.

Adolescent↗
PubMed1995

Non-epileptic attack disorders in children and adolescents: a single case study.

Previous research into non-epileptic attack disorder (NEAD) has focused on the individual. We report a teenager with non-epileptic seizures which highlights the importance of the family in the development and maintenance of such attacks. The authors propose that in children and adolescents the focus of therapeutic intervention should be the individual within the context of the family.

Adolescent↗
PubMed1995

Health-related quality-of-life issues: optimizing patient outcomes.

Quality of life has emerged as an important health care outcome for patients with chronic illnesses requiring long-term therapy. Disease-specific quality-of-life instruments have been developed as outcome measures for several chronic diseases, and the number of studies that have used quality of life as an outcome measure has increased dramatically in the past 10 years. Quality-of-life measures have not been widely applied in epilepsy, however. Because seizure severity is an important measure of quality of life, seizure severity scales that quantify seizure severity in the evaluation of medical and surgical treatments of epilepsy have been developed for use in clinical trials. The development of a health-related quality-of-life model for epilepsy, including previously validated scales, and its application to the assessment of treatment effects in a clinical trial are described.

Anticonvulsants↗
PubMed1994

Stress in midwifery: a comparison of midwives and nurses using the Work Environment Scale.

Previous research into midwifery has identified a number of potential sources of stress without attempting to understand the variables that might contribute to it. The study sample was drawn from a population of registered nurses and midwives and compares the work environment of 29 midwives with 180 nurses, using the Work Environment Scale Questionnaire. Significant differences were found between midwives and nurses for involvement, supervisor support, autonomy, work pressure and clarity of roles. These results have the potential for forming the basis of future research.

Analysis of Variance↗
PubMed1994

Epilepsy, pseudoseizures and perceived family characteristics: a controlled study.

Previous research in the area of pseudoseizures has focused upon their phenomenology and the characteristics of the individual with pseudoseizures. This study set out to examine the role of pseudoseizure behaviour in fulfilling a function within the family context. Pseudoseizure patients, patients with epilepsy and healthy controls completed questionnaires measuring the following variables--anxiety and depression, locus of control, self-esteem, family characteristics and perceived seizure severity. People with pseudoseizures perceived their families as displaying less commitment and support to each other (family Cohesion scale) and less emphasis on ethical issues and values (family Moral-religious scale) than both the epilepsy and the control groups. People with pseudoseizures reported levels of family interest in political, social and recreational activities (family Intellectual-cultural scale) similar to people with epilepsy, both these group scores being lower than the control group. The two patient groups also reported higher depression scores than controls, yet only the epilepsy group had lower self-esteem than the controls. These initial findings support a role of family involvement in therapy for people with pseudoseizures and may lead to a better understanding of the aetiology of pseudoseizures, as well as clarifying characteristics which may well aid the differentiation of pseudoseizures from epilepsy.

Adolescent↗
PubMed1994

Towards a comprehensive neuropsychological service in the United Kingdom for adult patients being considered for epilepsy surgery.

We report the findings of two one-day meetings concerned with the current practice of clinical neuropsychologists involved in epilepsy surgery in Britain. Nine centres participated in the survey, the aim of which was to examine the strengths and current weaknesses in the services provided nationally and move toward further development. Each centre was asked to provide information via a questionnaire on three definitive areas: patient and family expectations and psychological health; neuropsychological protocol pre- and post-surgery; the intra-carotid sodium amytal protocol. Results of the survey revealed diverse practices across the three areas. Implications and recommendations for a uniformed approach have been made and a standard approach to assessing outcome is being further investigated by the epilepsy surgery group. However, the authors argue that a review of the whole of neuropsychological services for epilepsy and surgery is required.

Brain↗
PubMed1993

The initial development of a health-related quality of life model as an outcome measure in epilepsy.

Patients with refractory epilepsy, despite no fixed physical deficit, are often socially and psychologically handicapped. Currently available outcome measures for epilepsy do not adequately address these manifestations or their influence on well-being and quality of life. A patient-based health-related quality of life (HRQL) model for epilepsy including physical, social and psychological domains was constructed. It contains previously validated measures of anxiety, depression, happiness, overall mood, self-esteem, mastery, social satisfaction and general health and a specifically designed seizure severity scale with patient- and carer-based components. The psychometric properties of this model were evaluated in the context of the trial of a potential new antiepileptic drug. All the scales, except the Social Problems Questionnaire, have acceptable internal consistency (alpha 0.69-0.85) in this patient population. Construct validity is indicated by the ability of the scales to differentiate between groups of patients predicted to have different levels of psychosocial function. Treatment effects were detected by the patient (P = 0.017) and carers (P = 0.035) subscales of the seizure severity scale, the happiness (P = 0.003) and the mastery (P = 0.003) scales. Despite obvious deficiencies preliminary analyses are encouraging. This model provides a framework for investigating the complex interaction between the physical, social and psychological manifestations of epilepsy. The model has potential as an outcome measure for use in longitudinal studies and as a measure of disability for use in cross-sectional studies designed to compare quality of life in different populations of people with epilepsy.

Activities of Daily Living↗
PubMed1993

Detecting the faking of amnesia: performance differences between simulators and patients with memory impairment.

This study attempted to establish criteria for distinguishing patients with genuine memory problems from those who are attempting to simulate amnesia. The performance of simulators and genuine amnesics was compared under distraction conditions in which subjects had to count backwards between presentation and recall, and under no-distraction conditions in which the retention interval was unfilled. Genuine amnesics performed significantly worse than controls under distraction conditions, but did not perform significantly worse than controls under no-distraction conditions. However, those attempting to fake amnesia performed significantly worse than controls under no-distraction as well as under distraction conditions. They also exaggerated the memory deficit overall relative to genuine amnesics. It is suggested that these two criteria might be used successfully in clinical settings to assist in the detection of simulators.

Adult↗
PubMed1992

The Work Environment Scale: a comparison of British and North American nurses.

Previous research into stress in nursing has identified different sources of stress for different specialties without specifying the source of that stress or providing comprehensive understanding of the variables that might contribute to it. This study examines the work environment of 209 nursing staff using the Work Environment Scale. Significant differences were found between a UK sample and the original American norms. Further research highlighted significant interactional effects between demographic variables and the subscales of the WES, and these may form the basis for future research.

Analysis of Variance↗
PubMed1991

Seizure frequency, patient-perceived seizure severity and the psychosocial consequences of intractable epilepsy.

It is generally recognised that the assessment of treatment effects in epilepsy using seizure frequency as the only outcome measure may lack sensitivity. A patient-based seizure severity scale has been developed and initial results confirm its reliability and validity. As part of the further development of this scale it is important to explore the relationship between seizure severity, seizure frequency and the psychosocial consequences of intractable epilepsy. One hundred patients with medically refractory partial seizures completed a quality of life questionnaire including measures of physical (seizure severity and frequency), social and psychological well-being (anxiety, depression, self-esteem, locus of control and happiness). Multivariate analysis demonstrated that individual psychological variables were best predicted by other psychological variables. However, when these were removed from analysis, seizure severity was the most significant predictor of self-esteem (P = 0.005), locus of control P = 0.039) and anxiety (P = 0.048). Seizure frequency did not contribute significantly to the variance of any of the psychological factors. These results highlight the importance of considering seizure severity when assessing treatment effects in epilepsy and provide further evidence for the construct validity of a novel patient-based seizure severity scale.

Activities of Daily Living↗
PubMed1991

The development of a seizure severity scale as an outcome measure in epilepsy.

In controlled trials of antiepileptic drugs (AEDs) seizure frequency is often the only variable considered. With little prospect of improving assessment of AEDs, using seizure counts as the only end-point, there is a need for the development of new outcome measures. Clinical experience indicates that seizure severity is equally important to the patient and, by preventing seizure spread, AEDs can influence seizure severity without necessarily reducing seizure frequency. A scale capable of measuring seizure severity and change of severity attributable to treatment could be a useful additional outcome measure. Such a scale should exhibit the basic properties of validity and reliability. An easily administrable 16-point scale, containing 2 subscales--perception of control and ictal/post-ictal effects--has been developed. This scale has been tested on a patient population (n = 159) representative of that seen in trials of novel AEDs. Using standardised statistical methods, the scale has been shown to be both reliable and valid.

Adolescent↗
PubMed1991

Reality monitoring and psychotic hallucinations.

Hallucinating psychiatric patients, patients with delusions but without a history of hallucinations and normal controls were compared on a reality-monitoring task in which they were first required to generate answers to easy or difficult clues and to listen to low-probability or high-probability paired associates. After an interval of one week, the subjects were presented with a list in which their answers to the clues were mixed with the associates and with words not previously presented, and they were required to identify the source of each item (self-generated, presented by the experimenter or new). The psychiatric patients were generally less accurate in identifying the source of the items in comparison with the normal controls. However, hallucinators more often misattributed high cognitive effort self-generated items (answers to difficult clues) to the experimenter than either the psychiatric or the normal controls. The results are interpreted as consistent with the hypothesis that hallucinations are self-generated events misattributed to an external source.

Adult↗
PubMed1984

Quality of life in treated head and neck cancer patients: a preliminary report.

A psychological study of 48 elderly men after treatment for buccopharyngeal cancers was carried out to see whether treatment type (surgery alone, irradiation alone or salvage surgery after failed radiotherapy) was associated with differences in quality of life. Eight measures were used, covering functional disability, appearance, pain, depression, psychological well being and life satisfaction. Functional disability was lower and performance status high in those treated by irradiation alone. There was greater dissatisfaction with appearance in patients treated by surgery. Levels of depression were high in all groups. There were no significant differences between treatment groups however for depression, present pain, psychological well being or life satisfaction.

Affect↗