Search PubMed⌕ Search

Biomedical subjects

G Parker

Publications and source records attributed to G Parker.

At least 163 records · Page 9Linked to original sources
PubMed1996

Depressive psychomotor disturbance, cortisol, and dexamethasone.

We examine the dexamethasone suppression test as a biological correlate of melancholia as defined by the CORE system, a scale for rating objective signs of psychomotor disturbance. Postdexamethasone cortisol concentrations and rates of nonsuppression were higher in CORE, Newcastle, and DSM-III-R defined melancholic groups. These differences, however, were no longer significant after partialling out the combined effects of age, dexamethasone, and basal cortisol concentrations. There was a significant correlation between the CORE (but not the Newcastle) scale and 8:00 AM postdexamethasone cortisol levels, which persisted after partialling out those same three covariates. Dexamethasone concentrations themselves were lower in CORE- and Newcastle-defined melancholics, though these were no longer significant after covarying for cortisol concentrations. Dexamethasone levels were also significantly inversely correlated with CORE and Newcastle scales. A significant correlation between CORE (but not Newcastle) scores and dexamethasone levels at 4:00 PM persisted after partialling out the effects of age and cortisol. These findings indicate an intriguing relationship between the CORE system as a dimensional construct for rating psychomotor disturbance, and both postdexamethasone cortisol and dexamethasone concentrations.

Age Factors↗
PubMed1996

Comparative validity of two measures of psychomotor function in patients with severe depression.

Psychomotor function is a key construct in depressed patients and two measures have been developed for systematic rating. Parker and colleagues utilise an observer-rated scale (CORE) while the scale (DRRS) developed by Widlöcher assesses motor and ideational aspects. Association between the scales and their relative capacity to predict ECT response were investigated in a sample of 81 depressed patients. Both predicted ECT response. While the CORE scale rates a wider variety of phenomena (including non-interactiveness and agitation) and does not rely on the subject's capacity to report aspects of their cognitive function, the study supports the predictive and comparitive validity of both scales.

Adult↗
PubMed1996

Pharmacokinetics of oral mycophenolate mofetil in volunteer subjects with varying degrees of hepatic oxidative impairment.

Eighteen patients with compensated alcoholic cirrhosis participated in a single-dose pharmacokinetic study of oral mycophenolate mofetil (MMF). Participants were divided into groups of 6 patients each with mild, moderate, or severe hepatic oxidative impairment as defined by the aminopyrine breath test (APBT). Clinically, hepatic disease was of mild or moderate severity. Six healthy volunteers were included as control subjects. Plasma and urine samples were collected over 96 hours and assayed for the active metabolite mycophenolic aced (MPA) and the glucuronide conjugate, MPAG. Plasma protein binding of MPA also was determined in 6 unrelated patients with cirrhosis. Cirrhosis did not grossly affect plasma pharmacokinetics or plasma binding of MPA. Maximum plasma concentrations (C(max)) and area under the curve (AUC) of MPA and MPAG consistently decreased, increased, and then decreased as oxidative impairment declined from normal to severe. Patients with cirrhosis had comparable or greater recovery of administered drug substance in urine than controls, showing that cirrhosis did not affect the extent of MMF absorption. Urine clearance of MPAG was two times higher in the group with severe impairment than in the other groups. Creatinine clearance was similar in all groups. These results suggest progressive impairment of hepatic glucuronidation of MPA and induction of renal glucuronidation in patients with severe hepatic oxidative impairment.

Administration, Oral↗
PubMed1996

Prediction of ECT response: validation of a refined sign-based (CORE) system for defining melancholia.

BACKGROUND: The clinical validity of melancholia has been argued on the basis of its capacity to predict response to electroconvulsive therapy (ECT). We have argued that a sign-based (CORE) rating system of psychomotor disturbance can identify patients with melancholia. Therefore, the clinical validity of the CORE system was tested here in terms of its capacity to predict response to ECT. METHOD: The response of 81 patients with primary affective disorders to an individualised course of ECT was investigated. CORE scores and other clinical predictors were evaluated in terms of their capacity to predict effect size changes in symptoms and disability. RESULTS: CORE scores predicted ECT response, as did the presence of psychotic features. The combination of marked psychomotor change (high CORE scores) and psychotic features predicted the best response to ECT. CONCLUSION: This study supports the clinical validity of the CORE system for diagnosing melancholia.

Aged↗
PubMed1996

An exploration of the quality of peer review group activities within Australasia.

OBJECTIVE: To describe a two-phase study of the structure of Australasian psychiatrist peer review groups. METHOD (Phase one): Initially, information was sought from chairs/coordinators of psychiatrist peer review groups regarding the nature and organisation of their group. RESULTS (Phase one): One hundred and three questionnaires were returned describing a number of models of peer review. Three principal models were identified: a teaching hospital model, a private practice model, and a private institution model. METHOD (Phase two): The second-phase questionnaire sought information on the quality of the review, using six proposed standards developed by the Quality Assurance Committee of the Royal Australian and New Zealand College of Psychiatrists. RESULTS (Phase two): Many groups indicated that four of the proposed standards (those relating to documentation, having clear goals, reviewing actual clinical cases, and rigorous protection of confidentiality) were either already being followed or would be relatively easy to implement. The remaining two proposed standards (including structure, process and outcome dimensions of health care in the case discussion, and the use of explicit criteria) presented more difficulty. CONCLUSION: The application of such standards to peer review group meetings should assist groups to provide a forum for presentation and evaluation of clinical work where participants know they will be challenged in an environment which is both supportive and educational.

Attitude of Health Personnel↗
PubMed1996

If the referral fits: bridging the gap between patient and referrer requirements in a tertiary referral unit.

OBJECTIVE: We examined the reasons for which doctors refer and patients request referral to our tertiary Mood Disorders Unit (MDU), focussing on congruence and 'fit', and the potential for more efficient use of referral resources. METHOD: A postal survey of patients (n = 265 or 83% responders) and referrers (n = 156 or 94% responders) sought views regarding referral and service components. Ratings from 156 matched referrer-patient dyads were compared. RESULTS: Overall, referrers and patients were satisfied with the MDU. There was disparity between what referrers sought and what patients thought were the reasons for referral, and different perceptions of the value of interventions and the amount of improvement. Congruent matched referrer-patient judgements of patient outcome were more likely to correspond with objective clinician ratings than discordant ratings. Satisfaction with MDU contact or intervention was not necessarily linked to improvement; better management of chronic depression was also valued. Referrer and patient responses to open-ended questions highlighted beneficial ingredients of referral. CONCLUSIONS: There was considerable lack of fit between referrers' and patients' experience of the referral. Better communication between referrer and patients can clarify the purpose of referral and possibly lead to increased compliance with medical regimens.

Adolescent↗
PubMed1996

To whom do you refer? A referrer satisfaction study.

OBJECTIVE: To report the development of a referrer satisfaction measure. METHOD: Urban and rural general practitioners, physicians, neurologists, as well as obstetricians and gynaecologists rated 36 items in terms of their judged importance to the respondent's satisfaction with a psychiatric service. Responses of the whole sample and component practitioner sub-groups were ranked. RESULTS: We established a high level of agreement across the several subgroups suggesting that we had identified general rather than idiosyncratic variables contributing to referrer satisfaction. Referrers prioritised as most important the immediacy of initial appointment, the psychiatrist reporting at the beginning and end of any treatment course, and ready verbal communication between the referrer and the psychiatrist. Items accorded low priority were the psychiatrist's billing arrangements, the psychiatrist being 'perfect' (in either having a high 'cure' rate or making a definitive diagnosis initially), or the psychiatrist taking complete responsibility for difficult patients. A principal components analysis identified four factors underpinning the item set, and we again established that scores on these factors were not influenced by the particular referrer sub-group. CONCLUSIONS: Such findings suggest that only minor modifications would need to be made to the item set in developing a referrer satisfaction measure for quality assurance activities.

Family Practice↗
PubMed1996

The development of a patient satisfaction measure for psychiatric outpatients.

OBJECTIVE: To describe the first stage of development of a patient satisfaction form designed for psychiatric outpatients. METHOD: An initial 62-item questionnaire was completed by 172 patients, who were asked to assess the importance of a number of practice and practitioner features in contributing to their satisfaction. RESULTS: Mean scores prioritized the psychiatrist respecting the rights of the patient; appointment and billing arrangements were of intermediate importance, while amenity issues were rated as unimportant. When rankings across the several practices were examined, very high levels of agreement were demonstrated, supporting the likely validity of the overall rankings. Four underlying domains were identified by factor analysis, the principal one being defined by respect for confidentiality, by support and adequate communication. The three remaining factors were contributed to more by practice (e.g. billing arrangements, amenities) than by practitioner features. CONCLUSION: We consider how a refined and modified version of the measure might be developed for use by both individual practitioners and group practices, as well as being used as a formal QA component activity.

Australia↗
PubMed1996

Descriptors of depression: the importance of agreed definitions.

OBJECTIVE: We suggest that some descriptors and criteria of depressive features lack clarity or are overinclusive, with definitional limitations and vagaries in rating options, leading to variable ratings of similar items across differing measures as well as cloudy interpretation of positive ratings. METHOD: We illustrate these limitations by reference to two items: 'guilt' and 'distinct quality of mood'. RESULTS: We note problems emerging from confounded and imprecise definitions. CONCLUSIONS: We emphasise the need for definitions of depressive descriptors possessing greater specificity.

Depressive Disorder↗
PubMed1996

Defining the personality disorders: description of an Australian database.

OBJECTIVE: We seek to improve the definition and classification of the personality disorders (PDs) and derive a large database for addressing this objective. METHOD: The paper describes the rationale for the development of a large set of descriptors of the PDs (including all DSM-IV and ICD-10 descriptors, but enriched by an additional 109 items), the design of parallel self-report (SR) and corroborative witness (CW) measures, sample recruitment (of 863 patients with a priori evidence of personality disorder or disturbance) and preliminary descriptive data. RESULTS: Analyses (particularly those comparing ratings on molar PD descriptions with putative PD dimensions) argue for acceptable reliability of the data set, while both the size of the sample and the representation of all PD dimensions of interest argue for the adequacy of the database. CONCLUSIONS: We consider in some detail current limitations to the definition and classification of the PDs, and foreshadow the analytic techniques that will be used to address the key objectives of allowing the PDs to be modelled more clearly and, ideally, measured with greater precision and validity.

Adult↗
PubMed1996

General practitioners and occupational health services.

BACKGROUND: Occupational physicians and general practitioners often appear to differ in their attitudes to the provision of health screening, health promotion and vaccination in the workplace. AIM: This study aimed to explore the attitudes of occupational physicians and general practitioners to particular aspects of workplace health services. METHOD: Anonymous piloted postal questionnaires were sent to 400 UK general practitioners and 300 occupational physicians. RESULTS: Questionnaires were returned by 260 general practitioners (65%) and 223 occupational physicians (74%). There are differences between the specialties in attitude to specific health screening and vaccination at work, and to the role of occupational health services in helping the disabled, but greater agreement on the usefulness of workplace health promotion. CONCLUSION: General practitioners may misunderstand the role, responsibilities and priorities of occupational health services. Further educational work needs to be done to overcome communication difficulties between the specialties.

Attitude of Health Personnel↗
PubMed1996

Occupational medicine and training for general practice.

The inclusion of occupational health topics in vocational training for general practice is limited-principally by course overload, and by a lack of local contact between occupational physicians and general practitioners (GPs). There is a need for the Royal College of General Practitioners and the Faculty of Occupational Medicine to review communication and training opportunities between the specialties.

Education, Medical, Continuing↗
PubMed1995

Epstein-Barr virus efficiently immortalizes human B cells without neutralizing the function of p53.

Epstein-Barr virus (EBV) efficiently converts resting human B cells into actively cycling, immortal, lymphoblastoid cell lines (LCLs). Here we show that LCLs expressing the full complement of latent viral genes are very sensitive to DNA-damaging agents such as cisplatin. The response includes a rapid accumulation of the tumour suppressor protein p53 and induction of the cellular genes mdm2 and WAF1/p21. Although the levels of Bcl2 protein and Bax mRNA appear unaltered by the activation of p53, within 24 h the majority of cells undergo apoptosis. Over-expression of wild-type p53 in an LCL also resulted in apoptosis; this was preceded by the dephosphorylation of the retinoblastoma gene product, pRb. Primary resting B cells showed no response to cisplatin and even after drug treatment, p53 remained undetectable. However, after infection with EBV, p53 gene expression was induced to a similar level to that found in mitogen-activated B cells. When the physiologically activated primary B cells were exposed to cisplatin, although p53 accumulated as in LCLs, the outcome was growth-arrest rather than gross cell death. We conclude that, in contrast to the transformation of fibroblasts by adenovirus, SV40 or HPV, when B cells become activated and immortalized by EBV they are sensitized to the p53-mediated damage response. When the resulting LCLs are treated with genotoxic agents such as cisplatin, they are unable to arrest like normal cells because they are driven to proliferate by EBV and consequently undergo apoptosis.

Apoptosis↗
PubMed1995

Low parental care as a risk factor to lifetime depression in a community sample.

A number of studies have reported links between experiencing low parental care and subsequent depressive experience. As the majority have involved patient samples, links may reflect anomalous parenting disposing to help-seeking behaviour (and patient status) rather than directly to depression. We, therefore, report a community study, so redressing any such artefact emerging from a patient sample and, additionally, quantify the relevance of low parental care to depression in comparison to several other risk factors (i.e., age, gender, educational level, socioeconomic status and marital status). Subjects were drawn from the ECA study and comprised those assessed at the 1-year follow-up interview undertaken at the New Haven site, with parental care being assessed by a key item from the Parental Bonding Instrument (PBI). Those reaching criteria for a lifetime episode of major depressive disorder were significantly more likely to report low care from both parents as well as to be female, divorced or separated, and younger. Low parental care (along with age and mental status but not female sex) appeared pathoplastic in being linked with an increased chance of psychopathology in general, rather than demonstrating specificity to major depressive disorder.

Adult↗