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Biomedical subjects

G Dunn

Publications and source records attributed to G Dunn.

At least 91 records · Page 5Linked to original sources
PubMed1994

Statistical methods for measuring outcomes.

This issue of the journal concerns promotion of the routine use of outcome measures in clinical practice; the purpose of this particular article, however, is to warn care providers to think very very carefully before routinely using such measures. Just what are the benefits of their use? What are the outcome measures intended to demonstrate? In order to try to convince the reader that there might be real difficulties in the interpretation of the results, the main body of the paper concentrates on the difficulties in the interpretation of data from a structured research project that has been specifically designed to evaluate an innovation in mental health care provision. The difficulties of interpreting haphazardly collected data as part of routine clinical or administrative practice will be far greater. One of the main purposes of an evaluative exercise is comparison: which approach to service provision is the better? If care providers really want to be involved in mental health service evaluation then their time would be much better spent in taking part in a large multicentre trial.

Controlled Clinical Trials as Topic↗
PubMed1994

Cognitive behavioural therapy for drug-resistant psychosis.

A small controlled trial of cognitive behaviour therapy for drug-resistant psychosis is reported. The study was designed as a pilot study for a future larger and longer randomized controlled trial. The therapy was offered to patients with a diagnosis of schizophrenia or schizo-affective psychosis who presented unremitting positive symptoms. An average of 16 sessions were delivered over a six-month period. The results of this pilot study are promising. Rates of engagement in therapy were high. The treatment group also improved significantly on a number of key symptom measures when compared with the controls. These were reductions in delusional conviction, general symptomatology and depression scores. Future studies should offer therapy over a longer period, targeting social as well as symptom change, and considering factors which will enhance maintenance of improvement.

Activities of Daily Living↗
PubMed1994

Tiapride in the prevention of relapse in recently detoxified alcoholics.

BACKGROUND: The aim was to investigate the effect of tiapride (100 mg three times a day for at least one month) on outcome following detoxification. METHOD: The setting was a tertiary referral centre. The study design was randomised, double-blind, and placebo-controlled. One hundred routinely admitted alcohol-dependent patients were entered, and 54 completed the trial. Outcome was assessed by considering drinking status at three months and six months follow-up, and by comparing psychological status at intake and follow-up using the Crown-Crisp Experiential index, the Litman Self-esteem scale and a Satisfaction with Life Situations scale. We also compared performance over the six months before admission with the three and six months of follow-up on measures of health, social and drinking variables. RESULTS: Tiapride proved better (usually at statistically highly significant levels) than placebo at promoting: abstinence, self-esteem, and satisfaction with life situations; and at reducing: alcohol consumption, use of health service resources, and levels of neuroticism. CONCLUSIONS: Tiapride merits serious consideration in the longer-term treatment of alcoholic patients.

Alcohol Drinking↗
PubMed1994

Food service trends in NSW hospitals, 1986-1993.

In 1993 a survey of the food service departments in 159 hospitals in New South Wales was carried out using a mailed questionnaire, and the results were compared with those of a similar survey in 1986. The results reveal that over the past seven years there has been a significant increase in the proportion of hospitals using cook-chill systems, from 5 per cent in 1986 to 18 per cent in 1993. Hospitals with cook-chill systems do not appear to be operating more efficiently than those with conventional catering systems: in cook-chill hospitals the mean food service staffing ratio was 7.1 beds/full-time equivalent (FTE) compared to 7.8 beds/FTE in hospitals with cook-serve systems. Most hospitals in New South Wales still use traditional hot food delivery to the wards, and more of these are now using effective heat maintenance systems for patient meals. The proportion of special diet meals has increased over the past seven years to 17.1 per cent in public hospitals. The percentage of food service departments with an unqualified person in charge fell from 47 per cent in 1986 to 22 per cent in 1993. Meal times remain largely unchanged, with more than 90 per cent of hospitals still serving the evening meal before 5.30pm.

Food Handling↗
PubMed1993

Statistics and the nature of depression.

A critical examination is made of the role that statistical methods have played in the understanding of depression. The development of instruments for measuring depression is illustrated by reference to the Beck Depression Inventory and the Hamilton Rating Scale. The controversy over the existence of one or two types of depression is examined from the perspective of the statistical tools used. Some of the problems in studies of the heritability of depression are outlined. The development of clinical trials of depression is examined, with particular reference to ECT and maintenance therapy, and the role of meta-analysis is discussed.

Data Interpretation, Statistical↗
PubMed1993

Influences upon attendance at out-patient facilities--the contribution of linear-logistic modelling.

The research on attendance at out-patient psychiatric facilities has produced conflicting evidence that provides little guidance for the practitioner. It is suggested that inadequate data exploration could explain some of the discrepant findings. Analyses of multi-way tables using linear-logistic models were undertaken to demonstrate patterns of association that cannot be revealed through the use of simple chi-square tests on two-way contingency tables. The variables chosen for these analyses were those that have produced conflicting findings in the literature on children's attendance at child guidance facilities.

Adolescent↗
PubMed1993

Shedding of virulent poliovirus revertants during immunization with oral poliovirus vaccine after prior immunization with inactivated polio vaccine.

Fecal shedding of virulent revertant polioviruses was examined in isolates from infants previously immunized with > or = 1 dose of orally administered live attenuated polio vaccine (OPV) alone, enhanced-potency inactivated polio vaccine (EIPV) alone, or a combination of both. After administration of OPV alone, vaccine poliovirus serotypes were recovered in feces within 1 week and for as long as 31-60 days in 30%-80% of subjects after 1 or 2 doses and in 30%-50% after immunization with > or = 3 doses. No revertant poliovirus shedding was observed after OPV challenge in subjects immunized previously with > or = 3 doses of OPV. However, fecal shedding of revertant poliovirus after OPV challenge was observed in 50%-100% of subjects previously immunized with > or = 3 doses of the EIPV. These findings suggest that prior immunization with EIPV does not prevent fecal shedding of revertant polioviruses after subsequent reexposure to OPV.

Feces↗
PubMed1993

Characterization and primary structure of a human immunodeficiency virus type 1 (HIV-1) neutralization domain as presented by a poliovirus type 1/HIV-1 chimera.

The poliovirus/human immunodeficiency virus (HIV) chimera S1/env/3 presents the sequence DRPEGIEEEGGERDRDRS, a known glycoprotein gp41 neutralizing domain (residues 735 to 752) of HIV IIIB in an antigenic site of the Sabin type 1 strain of poliovirus. Of 10 monoclonal antibodies raised against the sequence as presented in S1/env/3, eight were shown to neutralize HIV IIIB in vitro whereas all 10 neutralized S1/env/3, suggesting that the presentation of the sequence is comparable between HIV and the poliovirus/HIV chimera. The monoclonal antibodies were characterized by the selection of escape mutants from S1/env/3 and by Pepscan analysis. The two methods gave similar results, identifying two epitopes involving amino acids corresponding to residues 740 to 743, and to residues 745 to 750 of gp41. Mutations selected in the chimera with S1/env/3-specific MAbs are identical or similar to changes occurring in vivo in natural isolates of HIV-1. This finding suggests that the epitope may be significant in the neutralization of HIV in vivo.

Amino Acid Sequence↗
PubMed1993

Psychological testing on schoolchildren before and after pollution of drinking water in North Cornwall.

The tap water supply in Camelford, North Cornwall and environs was contaminated by aluminium and other metals in 1988. Richmond tests were routinely given before and after the pollution and here scores are compared between 39 children from schools in the contaminated area and 64 children from Cornish schools outside the polluted area. The study was retrospective and it was not possible to determine whether or how much polluted water individuals had consumed. No differences were found between groups either before or after the pollution accident nor was there any evidence for any sub-group of the polluted group which had been affected. The limits of conclusions which can be drawn from data available are discussed.

Alum Compounds↗
PubMed1993

Acting on delusions. II: The phenomenological correlates of acting on delusions.

The aim of the study was to identify the phenomenological characteristics of those delusions which are associated with action. The sample consisted of 79 patients admitted to a general psychiatric ward, each of whom described at least one delusional belief. The variables studied included the phenomenology of the delusions, and behaviour. Two behavioural ratings were used, one derived from the subjects' own description of their behaviour and the other from information provided by informants. There was no association between delusional phenomenology and acting on a delusion when the subjects' behaviour was described by informants. When action was described by the subjects themselves, acting was associated with: being aware of evidence which supported the belief and with having actively sought out such evidence; a tendency to reduce the conviction with which a belief was held when that belief was challenged; and with feeling sad, frightened or anxious as a consequence of the delusion.

Acting Out↗
PubMed1992

Cognitive deficit and the prediction of rehabilitation success in a chronic psychiatric group.

This paper describes the second stage (years 4, 5 and 6) of a prospective follow-up of a sample of chronic patients which was designed to investigate the in service use. It also tested the relative predictive power of variables which included demographic, symptomatic and behavioural factors as well as a novel reaction time variable which reflects response processing time. During the six years of the study 91% of the patients in the sample changed either the degree of their day and/or night care. Many moved to more independence but, a number did also become more dependent on psychiatric services. There were no differences in outcome between a schizophrenic group and patients with other diagnoses. These results suggest a level of flexibility in outcome even in a severely disabled chronic group. The main predictor of future service use at each stage of the follow-up for the whole group was chronicity at entry to the study. But, when the group was divided into schizophrenic patients and 'others', the response processing measure was a significant predictor of service use in the schizophrenic group and accounted for between 17% and 30% of the variance. For the 'other' diagnostic group, the age of the patient seemed to be the major determinant of care. The reaction time variable seems to be an extra class correlate of a strict diagnosis of schizophrenia. It may also be a stable or episodic vulnerability factor, but as well as these promising hypotheses, which have yet to be justified, this measure does seem to have pragmatic value in predicting outcome in a rehabilitation network.

Activities of Daily Living↗
PubMed1992

Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers.

Many of the standardized interviews currently used in psychiatry require the interviewer to use expert psychiatric judgements in deciding upon the presence or absence of psychopathology. However, when case definitions are standardized it is customary for clinical judgements to be replaced with rules. The Clinical Interview Schedule was therefore revised, in order to increase standardization, and to make it suitable for use by 'lay' interviewers in assessing minor psychiatric disorder in community, general hospital, occupational and primary care research. Two reliability studies of the revised Clinical Interview Schedule (CIS-R) were conducted in primary health care clinics in London and Santiago, Chile. Both studies compared psychiatrically trained interviewer(s) with lay interviewer(s). Estimates of the reliability of the CIS-R compared favourably with the results of studies of other standardized interviews. In addition, the lay interviewers were as reliable as the psychiatrists and did not show any bias in their use of the CIS-R. Confirmatory factor analysis models were also used to estimate the reliabilities of the CIS-R and self-administered questionnaires and indicated that traditional measures of reliability are probably overestimates.

Adult↗
PubMed1992

Design and analysis of reliability studies.

This review covers the design and analysis of essentially two types of reliability study: method comparison studies and generalizability (including inter-rater reliability) experiments. Likelihood-based methods of inference (confirmatory factor analysis and REML estimation of variance components, for example) are advocated, partly because of their ease of use but, primarily as a stimulus to the use of more ambitious designs for the investigation of the quality of measurements. The more sophisticated approaches are not intended to replace the simpler traditional methods, however, but are expected to be used to supplement them.

Analysis of Variance↗
PubMed1992

Application of monoclonal antibody panels in the virological and epidemiological review of poliomyelitis in Poland, 1981-1990.

Monoclonal antibody panels developed to differentiate vaccine-derived and wild-type strains of polio-viruses were applied to isolates from cases of paralytic poliomyelitis, non-paralytic poliomyelitis, and healthy excreters of poliovirus from Poland. All isolates from poliomyelitis cases were shown to be vaccine-derived, as were most other strains. However, two strains associated with meningitis had wild-type antigenic phenotypes and, as shown by partial genomic sequencing, wild-type genotypes. Correlation of laboratory and epidemiological data suggested that residual cases of paralytic poliomyelitis in Poland between 1981 and 1990 were vaccine-related. Study of the non-paralytic cases, however, helped identify the circulation of endemic wild-type viruses in a well-vaccinated community.

Adult↗
PubMed1991

The 5' noncoding region of the type 2 poliovirus vaccine strain contains determinants of attenuation and temperature sensitivity.

Intratypic recombinants of P2/Sabin and P2/117, a neurovirulent vaccine revertant, have been generated in vitro using infectious cDNA clones and used to demonstrate that strong determinants of the attenuation and temperature-sensitive phenotypes of P2/Sabin reside in the 5' 492 nucleotides. In this region of the genome the viruses differ only at nucleotides 437 and 481. The ts phenotype associated with the 5' noncoding region is expressed at different temperatures in different cell lines, suggesting an involvement of cellular factors which may be species specific. Suppression of both the ts and attenuation phenotypes correlates with an A-G mutation at nucleotide 481, although other changes are also involved.

Animals↗
PubMed1991

Antigenic structure of chimeras of type 1 and type 3 polioviruses involving antigenic sites 2, 3 and 4.

Chimeric polioviruses have been made in which regions of the type 1 Sabin strain corresponding to antigenic sites 2, 3 and 4 have been replaced by the corresponding regions of the type 3 Sabin strain. Manipulation of one site or a component of it generally did not affect the reactions of the others, suggesting that they form independent structural features. The extent to which the inserted site expressed the antigenic properties of type 3 could be assessed by reaction with polyclonal or monoclonal antibodies, or by immunogenicity. Site 2 could be expressed on infectious virus and site 3 on heated non-infectious virus (C antigen), but not on the native virion. The results are consistent with the view that sites consisting of a continuous sequence of amino acids may be presented on chimeras, whereas more complex sites, such as site 4 or site 3 of the native virion, are transferred less readily from type 3 to type 1.

Amino Acid Sequence↗