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Biomedical subjects

G Beaumont

Publications and source records attributed to G Beaumont.

At least 19 recordsLinked to original sources
PubMed2004

[In utero transfer for preterm labor: experience of a regional perinatal hotline providing a 24-hour on call service].

OBJECTIVE: Preterm labor is one of the major causes of concern for level I and II obstetricians. The purpose of this study was to determine the incidence of in utero transfer performed for preterm labor. We also aimed to evaluate the algorithm we used in case of call for preterm labor. This algorithm allowed us to study the rate of endovaginal sonography use prior to in utero transfer, to calculate its predictive value and to evaluate the risk of delivery during transfer. PATIENTS AND METHOD: We conducted an 8-months prospective study of all calls for preterm labor received at a regional call center in France (EU). All obstetrical data were entered in a computerized anonymous database. Three months after the first call midwives collected data from the receiving hospital. RESULTS: Calls for preterm labor account for 40% of calls for in utero transfer. Two hundred and sixty-five calls have been received for preterm labor; among them 50 cases were associated with a preterm rupture of membrane, a maternal or fetal pathology and 14 cases were lost for follow-up. Those 64 cases were excluded leaving 201 cases for analysis. Twenty-eight had a cervix dilated 4 cm, or more, while 173 had a cervix dilated less than 4 cm. Fifty percent of woman that had a cervical dilatation of 4 cm or more delivered more than 4 h after the call. Among the 173 patients that had a cervix dilated less than 4 cm, 71% had not delivered 7 days after the hotline call and 26% had an endovaginal ultrasonography performed before the transfer. None of the women that had a cervical length longer than 27 mm delivered in the 7 following days. None of the 176 women that were transferred delivered during the transfer. DISCUSSION AND CONCLUSION: In utero transfer for preterm labor is the leading cause of in utero transfer. Endovaginal ultrasonography prior to transfer should be performed in order to avoid unnecessary transfer. Women who have a preterm labor with a cervical dilatation of 4 cm or more are not an absolute contra-indication to in utero transfer. In those cases the transfer indication should be discussed on a case-to-case basis including the actual term and the distance between hospitals.

Female↗
PubMed2000

Antipsychotics--the future of schizophrenia treatment.

Schizophrenia is a debilitating mental disorder affecting up to five in every thousand people. Although specialist psychiatrists are initially responsible for treating patients suffering from acute schizophrenia, the current structure of mental healthcare in the U.K. puts the onus for the delivery of maintenance therapy of discharged patients on to the general practitioner. It is crucial, therefore, that the general practitioner is aware of all available therapies for the effective, long-term, community-based treatment of patients with schizophrenia. The so-called typical antipsychotics effectively treat the positive but not the negative symptoms of schizophrenia, and up to 40% of patients are nonresponders. These antipsychotics, however, are associated with high levels of extrapyramidal side-effects (EPS), which are the main cause of patient non-compliance and their subsequent relapse and hospital readmission. Clozapine, the first atypical antipsychotic, may cause severe agranulocytosis and patients must undergo regular haematological monitoring, which is both costly and a factor unlikely to foster patient compliance. In contrast, newly developed atypical antipsychotics, such as olanzapine and quetiapine, are not only efficacious in treating the symptoms of schizophrenia, but also give rise to fewer EPS and are generally better tolerated than clozapine. In particular, olanzapine and quetiapine are not associated with severe agranulocytosis. Atypical antipsychotics, therefore, have the potential to enhance patient compliance and thus ease the general practitioner's problems of providing long-term and effective treatment for patients with schizophrenia.

Antipsychotic Agents↗
PubMed1995

[Routine use of electronic portal imaging. Positioning verification in 922 successive pelvic fields].

Treatment reproducibility is a major criterion of quality assurance in radiation therapy. During each course, the same dose should be delivered in the same volume of irradiation. Today, portal imaging devices can be used routinely to check and correct patient positioning before much of the daily irradiation has been delivered. In this study we used the Portal Vision Varian (PVV) system during pelvic irradiation in 16 patients. This device can automatically acquire portal images in the first seconds of each course. Observed discrepancies are directly classified by the radiation oncologist according to their type (cranio-caudal, lateral, antero-posterior) and severity (correction of patient positioning is necessary or not). In case of error, patient positioning is corrected before the end of irradiation. Of the 922 portals analysed with PVV, 901 could be analysed (97%). Two hundred and ninety-nine positioning discrepancies were observed (33%) with 59 of them leading to correction (6%). Most of the time, these errors concerned antero-posterior portals. Finally, each patient had an average of 18 to 19 discrepancies which were mainly of no importance for treatment quality. Nevertheless, real errors leading to correction were observed in 14 patients (88%) with an average of four per patient. In some patients many errors occurred, while in others only a few. These shifts were not related to patient weight and thickness but probably a portal dimension. In summary, we think that during pelvic irradiation a portal imaging device should be used daily to improve treatment quality. This system can help the radiation oncologist to discover many positioning errors (an average of four) in the majority of patients (88%) and to correct them before the end of irradiation.

Humans↗
PubMed1993

A randomized, double-blind, multi-centre, parallel-group study comparing the tolerability and efficacy of moclobemide and dothiepin hydrochloride in depressed patients in general practice.

A randomized, double-blind, multi-centre, parallel-group study compared the tolerability and efficacy of 450 mg of moclobemide and 75-150 mg of dothiepin in the management of depressed patients in general practice. Patients who fulfilled the DSM-III-R criteria for major depressive disorder and who scored 13 or more on the Hamilton Depression Rating Scale were admitted. The trial lasted six weeks. The dose of moclobemide was 150 mg three times daily and that of dothiepin was 75 mg daily for the first two weeks and 150 mg thereafter. Assessments were made at baseline and after one, three and six weeks using the HDRS, the Zung SRS and the CGI. Adverse events and vital signs were monitored at each visit, and laboratory screening tests performed at the beginning and end of the study. Sixty-four general practitioners from four centres recruited 345 patients: 175 received dothiepin and 170 moclobemide; 265 completed six weeks of treatment. Thirty-eight dothiepin-treated patients (22%) and 42 who received moclobemide (25%) dropped out, most commonly because they experienced adverse events. More patients on dothiepin (24) than on moclobemide (16) dropped out for this reason; the incidence of adverse events was 10% higher in the dothiepin-treated group and of "side effects" more than 10% higher, the latter difference being statistically significant. Both treatments resulted in significant improvement; this was greater in the dothiepin-treated group and the difference was statistically significant, although clinically small.

Adolescent↗
PubMed1992

The SmithKline Beecham 'quality of life' scale: a validation and reliability study in patients with affective disorder.

The rationale for the development of Repertory-Grid based quality of life assessment (QOL) is described. The emergent scale, the SmithKline Beecham Quality of Life Scale (SBQOL) utilizes 23 predetermined constructs and three fixed elements: self now, ideal self and sick self. Inclusion of the latter two elements provides a personal frame of reference for the individual and recognizes the highly idiosyncratic and subjective nature of the experience which constitutes quality of life. A study of the validity and reliability of the SBQOL was conducted in 129 patients presenting to their GP with either major depression or generalized anxiety disorder, as defined by DSM III R. Patients were treated at the discretion of their GP and followed over a period of 12 weeks with assessments of treatment efficacy being performed at 6 weeks and 12 weeks in parallel with administration of the SBQOL. The results from co-administration of standard efficacy measures such as the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Scale (HAMA) with the SBQOL, provided good evidence of construct validity. Evidence in support of the concurrent validity of the SBQOL was provided by co-administration of the Sickness Impact Profile and General Health Questionnaire (external criteria) with the SBQOL scale. Test-retest reliability and internal consistency were high. No obvious advantage was conferred by the use of principal components analysis from the Flexigrid software package in contrast to a simple arithmetical procedure for computing interelement distances. It is concluded that the SBQOL provides a valid, reliable and practicable approach to the assessment of quality of life in patients with affective disorder.

Adolescent↗
PubMed1992

Patients at risk of suicide and overdose.

Suicide is a complex and confusing subject. Although social factors may be important a clear relationship has been established between suicide and some medical conditions, notably depression, schizophrenia and alcohol dependence. Primary care physicians are in the "front line" as far as the recognition of suicidal risk is concerned. There is good evidence that many individuals who commit suicide have had recent contact with medical services. Those who have attempted suicide are at a much greater risk of subsequently completing the act than the general population. Poisoning by solids or liquids is a common method of committing suicide. Prescribed medication is often used. Antidepressants vary considerably in their toxicity in overdosage. Newer compounds, including moclobemide appear to be safer than older ones. There is some evidence that suicide rates can be influenced by changing the availability of lethal substances and methods. It is suggested the prescription of toxic antidepressants should be restricted or avoided in patients in whom the risk of suicide is high.

Adult↗
PubMed1990

Mequitazine in the treatment of hayfever.

A single-blind, multicentre, comparative clinical trial was performed in 59 hayfever sufferers to compare the efficacy of mequitazine 5 mg bd and terfenadine 60 mg bd over a period of 14 days. Clinical assessments of nasal and ocular symptoms were made on admission to the trial and after seven and 14 days treatment by both physicians and patients. Critical flicker fusion threshold was measured at each assessment. A global assessment of efficacy was determined by both the doctor and patient at the end of treatment. Patients also completed a daily diary card. Thirty patients on mequitazine and 22 on terfenadine completed the trial. There were seven dropouts (five on terfenadine and two on mequitazine). Both treatments were equally effective in reducing the severity of symptoms over the 14 days of treatment. The overall assessment at the end of treatment showed no important significant differences between the two drugs. According to the physicians, 60 per cent of the mequitazine-treated patients and 63 per cent of the terfenadine-treated patients had an excellent or good response. Patients assessed their response as excellent or good in 56 and 62 per cent of cases respectively. Neither drug significantly impaired performance.

Adolescent↗
PubMed1990

A multi-centre open study in general practice to evaluate the efficacy and acceptability of zopiclone 7.5 mg nocte in patients requiring the prescription of an hypnotic.

This was an open study of the efficacy and acceptability of zopiclone 7.5 mg nocte as a somnifacient. The study population comprised 108 insomniac patients (70 female, 38 male) aged 22-74 years who received zopiclone 7.5 mg for 7 consecutive nights. Based on subjective sleep assessments, zopiclone reduced the patients' difficulty in falling asleep, increased the number of hours slept and decreased the number of nocturnal awakenings (p less than 0.001). The majority of patients reported sleeping well or very well. The quality of sleep improved (p less than 0.0001), and the incidence of waking earlier than desired decreased (p less than 0.001), with respect to baseline, after receiving zopiclone. Physicians rated efficacy as good or very good in the majority of patients. Zopiclone was efficacious both in patients who had not previously received hypnotic therapy (n = 37) and in patients who transferred directly to zopiclone from a benzodiazepine hypnotic (n = 26). Whilst receiving zopiclone, patients reported feeling better in the morning than they did prior to treatment (p less than 0.004); 78% expressing satisfaction with zopiclone as an hypnotic. Physicians reported zopiclone treatment to be without side-effects in the majority of patients. In conclusion, zopiclone appears to be an effective and well-tolerated hypnotic that may play a role in the treatment of insomnia in the general population.

Adult↗
PubMed1990

The management of anxiety in general practice.

This paper attempts to summarize a personal approach to the management of anxiety and to some of the problems that have been recently encountered in respect of public attitudes to benzodiazepines. In the management of anxiety 'psychological' approaches should be sought where possible. There are, however, occasions, both in connection with normal and abnormal anxiety, when drug therapy is appropriate or where perhaps a combination of 'psychological' and pharmacological methods represents the most expedient course of action. Prescribers need an 'armamentarium' of drugs, since no one type of anxiolytic meets all our needs. The paper suggests limited use of benzodiazepine, beta blockers, low dose neuroleptics, some newer anxiolytic agents and certain specific drugs. The general practitioner needs to tailor his choice to the needs and attributes of particular patients.

Anxiety Disorders↗
PubMed1989

The toxicity of antidepressants.

Considerable attention has been paid, both by regulatory authorities and clinicians, to the side-effects of antidepressants, but despite the known high suicide risk in depression, toxicity in overdosage has been largely ignored. On the basis of the evidence currently available, 'older' antidepressants appear to be more toxic than 'newer' agents. A case can be made for limiting the use of some of the older tricyclic antidepressants, especially in patients who remain in the community, when continuous supervision is lacking, in favour of newer, safer drugs.

Antidepressive Agents↗
PubMed1989

Suicide and antidepressant overdosage in general practice.

Depression is a very common condition, and most depressed patients in many countries are treated by their General Practitioners. It is a frequent cause of suicide - one of the major causes of death in young adults - and is the disorder most commonly associated with deliberate self-poisoning, a large percentage of suicides being due to poisoning with drugs that are only available on prescription. Self-poisoning with older tricyclic antidepressants (TCAs) poses major clinical management problems, since the majority of patients who overdose with these agents do not reach hospital alive. Though there is no convincing evidence that any one antidepressant is more effective than others or more rapid in onset of therapeutic action, antidepressants do differ substantially in their side-effect profiles and in their toxicity in overdosage, those introduced before 1970 being relatively more toxic. Since suicide rates have been reduced by limiting the availability of toxic substances such as barbiturates and harmful domestic gas, restricting the use of older antidepressant in favour of newer, safer compounds for depressed patients being treated in general practice would also seem to be advisable.

Antidepressive Agents↗