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Biomedical subjects

G Wilkinson

Publications and source records attributed to G Wilkinson.

At least 37 records · Page 2Linked to original sources
PubMed1999

Health of the Nation Outcome Scales: a case study in general psychiatry.

BACKGROUND: Health of the Nation Outcome Scales (HoNOS) were incorporated in a data set recording the routine clinical activities of a mental health team in Liverpool. AIMS: To evaluate the use of HoNOS in general adult psychiatry. METHOD: All consecutive patients who came in contact with the mental health team were administered HoNOS by the consultant psychiatrist. A cohort (n = 204) of patients was identified over a period of 8 months. All patients (n = 156) who had a repeat HoNOS after an interval of 6 months were included in the study. RESULTS: There was an overall reduction in HoNOS scores after an interval of 6 months, more so among patients with psychotic and affective disorders. Patients scoring on other disorders showed no change on HoNOS. The measured change in clinical state based on the Clinical Global Impression scale was broadly consistent with HoNOS scores. CONCLUSIONS: It was feasible to administer HoNOS during routine assessments, but HoNOS data were of limited value in care-planning in day-to-day clinical practice. The widespread adoption of HoNOS for use in routine clinical practice would be premature.

Adolescent↗
PubMed1998

Characteristics of the healthy worker effect: a comparison of male and female occupational cohorts.

The healthy worker effect (HWE) poses a serious methodological problem to investigators of occupational cohorts in that it may mask mortality excesses that result from occupational exposures. This problem is further complicated by the fact that the strength of the HWE generally varies according to sociodemographic, employment, and time-related factors. While the HWE has been well documented among numerous cohorts of male workers, little is known about its expression among female occupational workers. Follow-up mortality data on 44,154 employees from the Hanford nuclear facility for the period of 1944-1986 were examined using standardized mortality ratio (SMR) analysis to assess whether modifiers of the HWE were expressed differently in females than in males. Results of this analysis show that while the HWE was modified by race, age at hire, occupational class, and length of follow-up in both male and female cohorts, different patterns of modification emerged across the two subgroups. Learning about how gender differentiates expression of the HWE will help investigators more precisely assess the confounding effect of the HWE in studies of working cohorts. Therefore, this study's findings are relevant for designing and interpreting future occupational cohort studies.

Adult↗
PubMed1998

Outcomes of Depression International Network (ODIN). Background, methods and field trials. ODIN Group.

BACKGROUND: ODIN aims (a) to provide data on the prevalence, risk factors and outcome of depressive disorders in rural and urban settings within the European Union (EU) based on an epidemiological sampling frame; and (b) to assess the impact of two psychological interventions on the outcome of depression and on service utilisation and costs. METHOD: Five centres across the EU are participating in ODIN. The centres are linked electronically and members meet regularly for training and strategic reviews. Urban and rural areas have been identified in each centre. The sampling frame is of adults aged 18-64, identified via primary care databases or electoral registers. Potential cases of depressive disorders are identified using the Beck Depression Inventory SCAN II and other validated measures are used to assign caseness against DSM-IV and ICD-10 criteria; assess comorbidity, disability, genetic/familial susceptibility, psychosocial stressors, personality traits and cognitive factors; and utilisation of local health care services. A randomised controlled trial of individual problem-solving treatment and a group educational programme is undertaken for respondents identified as cases of depressive disorder individuals are followed-up at six and 12 months. RESULTS AND CONCLUSIONS: ODIN has already stimulated the development of an effective international research partnership.

Adult↗
PubMed1998

Peer review and editorial decision-making.

INTRODUCTION: This paper describes and analyses the editor's decision-making process at the British Journal of Psychiatry (BJP), and investigates the association between reviewers' assessments and editorial decisions. METHOD: Four hundred consecutive manuscripts submitted over a six-month period to the BJP were examined prospectively for assessors' comments and editorial decisions on acceptance or rejection. Interrater reliability of assessments was calculated and a logistic regression analysis investigated the effect of the rank allocated by assessors and the comprehensiveness of the assessments on the editor's decision. RESULTS: The editor sent 248/400 (62%) manuscripts to assessors for peer review. Kappa for reliability of assessors rankings was 0.1 indicating poor interrater reliability. Assessors agreed best on whether to reject a paper. A ranking of five (indicating rejection) had the greatest association with editor's rejection (P < 0.001, odds ratio 0.079), and the mean ranking of assessments was also significantly associated with editorial acceptance or rejection (P = 0.004, odds ratio 0.24). CONCLUSION: Assessors and editors tend to agree on what is clearly not acceptable for publication but there is less agreement on what is suitable.

Decision Making↗
PubMed1998

An evaluation of practice nurses working with general practitioners to treat people with depression.

BACKGROUND: The diagnosis and treatment of depression constitutes a significant component of a general practitioner's workload. A pilot study has suggested that the practice nurse may have an important contribution to make in the care of patients with depression. AIM: To evaluate an extended role for practice nurses in improving the outcome of depression through two specially-designed interviews running in parallel. METHOD: Two naturalistic, random allocation studies took place concurrently over four months. Study 1 evaluated the effectiveness of standardized psychiatric assessment by a practice nurse and feedback of information to the general practitioner (GP). Study 2 evaluated the above assessment and feedback combined with nurse-assisted follow-up care. Twenty general practices participating in the Medical Research Council General Practice Research Framework took part in the study. Subjects included general practice attenders identified as depressed by their GP. The main outcome measures were a change in Beck Depression Inventory (BDI) scores and in the proportion of patients fulfilling DSM-III criteria for major depression. RESULTS: A total of 577 patients were recruited; 516 [89% (95% CI = 86-92%)] were rated as depressed on the BDI and 474 [82% (95% CI = 79-85%)] met criteria for DSM-III major depression. Altogether, 524 (91%) patients completed follow-up at four months. All groups of patients showed improvement, but no difference in the rate of improvement was shown for the nurse intervention groups. BDI mean scores fell from 18.54 (95% CI = 17.53-20.06) to 11.53 (95% CI = 10.02-13.04) in Study 1, and from 21.01 (95% = CI 20.26-21.86) to 10.62 (95% CI = 9.73-11.51) in Study 2. The proportion of patients fulfilling criteria for DSM-III major depression in Study 1 fell from 80% (95% CI = 73-87%) to 30% (95% CI = 22-38%), and in Study 2 from 80% (95% CI = 76-84%) to 27% (95% CI = 23-31%). Prescription rates of antidepressant medication were higher than expected, ranging between 63% and 76% in the two studies. CONCLUSION: There was an increase in the rate of antidepressant prescription, but no additional benefit could be adduced for patients who received a nurse intervention.

Adolescent↗
PubMed1997

Induction of cytotoxic T-cell response against hepatitis C virus structural antigens using a defective recombinant adenovirus.

A replication-defective recombinant adenovirus (RAd), RAdCMV-CE1, containing core and E1 genes of hepatitis C virus (HCV) was constructed. RAdCMV-CE1 was able to express core and E1 proteins both in mice and human cells. Immunization of BALB/c mice with RAdCMV-CE1 induced a specific cytotoxic T-cell response against the two HCV proteins. This response was characterized using a panel of 60 synthetic 14- or 15-mer overlapping peptides (10 amino-acid overlap) spanning the entire sequence of these proteins. Five main epitopes were found in the core protein, four of which had been previously described either in mice or humans. One single novel epitope was found in E1. Fine mapping of this E1 determinant, showed that octamer GHRMAWDM is the minimal epitope recognized by cytotoxic T lymphocytes (CTL). The cytotoxic T-cell response was H-2d restricted, lasted for at least 100 days, and was mediated by T cells with the classic CD4-CD8+ phenotype. This work demonstrates that replication-defective recombinant adenoviruses can efficiently express HCV proteins and are able to induce an in vivo cytotoxic T-cell response against a diversity of epitopes from HCV antigens. These vectors should be taken into consideration in the design of vaccines and also as a means to stimulate specific T-cell responses in chronic HCV carriers.

Amino Acid Sequence↗
PubMed1997

Lunar cycle and consultations for anxiety and depression in general practice.

The influence of the moon on patient consultations for anxiety or depression in general practice was assessed through a retrospective survey based on general practice medical records and on lunar records detailing the dates and times of different phases of the moon. Seven-hundred-eighty-two patients continuously registered in a general practice in Beckenham, South London, between 1971 and 1988 were included in analyses. No statistically significant lunar effect was found by setting the expected surge in consultations one to three days after the full moon and the period of the sine-wave curve to 30 days. Similarly, no statistically significant lunar effect was found, when the period of the sine-wave curve was allowed to vary in order to best fit the data. The moon had little influence on when individuals consulted their general practitioner with anxiety or depression.

Adolescent↗
PubMed1997

Impact factors of psychiatric journals.

BACKGROUND: We examined citation data for the British Journal of Psychiatry (BJP) and four other general psychiatry journals to assess their impact on the scientific community. METHOD: Data on three measures of citations (total number of citations, impact factor and ranking by impact factor) were obtained from Journal Citation Reports for 1985-1994. Rank correlations from year to year were calculated. RESULTS: The BJP currently ranks sixth of all psychiatry journals when journals are ranked by impact factor. The journal's impact factor fell between 1985 and 1990 and this was followed by a rise in impact factor after 1991. The BJP did not rank in the top 10 psychiatry journals between 1991 and 1993. Archives of General Psychiatry is cited more frequently than any other psychiatry journal, with the American Journal of Psychiatry usually ranking second. Psychopharmacology journals are replacing more general journals in the top rankings. Rankings of most journals have become less stable in recent years. CONCLUSIONS: The BJP would have to change the nature and number of papers published to improve its impact factor. There are a number of limitations to citation data and such data are only one of several factors useful in evaluating the importance of a journal's contribution to scientific and clinical communities.

Bibliometrics↗
PubMed1996

P2 purinoceptor-stimulated conversion of arginine to citrulline in bovine endothelial cells is reduced by inhibition of protein kinase C.

Bovine aortic endothelial cells contain two coexisting receptors for extracellular ATP, named the P2Y and P2U purinoceptors. Previous studies have shown that these receptors are linked to phospholipase C in a manner that is modulated in part by protein kinase C (PKC). In this study, we investigate the influence of PKC in the regulation of endothelial nitric oxide synthase (NOS) by these two purinoceptors. Activation of either P2Y or P2U purinoceptors by either 2-methylthio-ATP or UTP, respectively, stimulated the formation of [3H]-citrulline in [3H]-arginine-labelled cells in a concentration-dependent manner. This stimulation was sensitive to inhibition by NG-nitro-L-arginine. Ten minutes of pretreatment with the PKC activator tetradecanoyl phorbol acetate (TPA) failed to affect NOS activity, either alone or when stimulated with 2-methylthio-ATP or UTP. However, under these conditions TPA caused almost complete translocation of PKC-alpha from the cytosol to the membrane. Ten minutes of pretreatment with the PKC inhibitor Ro 31-8220 significantly inhibited the agonist-induced stimulation of NOS. These results show that both P2Y and P2U purinoceptors stimulate endothelial NOS in a manner that is dependent on PKC activity.

Animals↗
PubMed1995

Review of liver trauma management in Tasmania: an analysis of risk factors for mortality and morbidity.

A review of liver trauma treated by the major trauma care facilities of Tasmania in the 5 year period between 1989 and 1993 is presented. The aim of this retrospective review was to provide an audit of the management of liver trauma in the island of Tasmania and to analyse the risk factors contributing to mortality and major morbidity. Thirty-seven patients were treated with a median Injury Severity Score (ISS) of 14 (range 9-34). The overall mortality rate of this series was 5.8%. Age, mechanism of injury (blunt or penetrating), delay prior to hospital presentation and modality of treatment (operative or non-operative) were not significant risk factors for mortality and morbidity; however, transfusion requirement of over 10 units of blood (P < 0.005), ISS score of over 20 (P < 0.0005), haemodynamic instability at presentation (P < 0.05) and a Hepatic Injury Score (HIS) grade of 3 or more (P < 0.05) were statistically significant risk factors.

Abdominal Injuries↗
PubMed1995

Efficacy of drug treatment in obsessive-compulsive disorder. A meta-analytic review.

BACKGROUND: A review of the efficacy of antidepressant drug treatment in patients with obsessive-compulsive disorder (OCD), using a meta-analytic approach. METHOD: Randomised double-blind clinical trials of antidepressant drugs, carried out among patients with OCD and published in peer-reviewed journals between 1975 and May 1994, were selected together with three studies currently in press. Forty-seven trials were located by searching the Medline and Excerpta Medica-Psychiatry data bases, scanning psychiatric and psychopharmacological journals, consulting recent published reviews and bibliographies, contacting pharmaceutical companies and through cross-references. Hedges' g was computed in pooled data at the conclusion of treatment under double-blind conditions or at the latest reported point of time during this treatment period. For each trial, effect sizes were computed for all available outcome measures of the following dependent variables: obsessive-compulsive symptoms considered together; obsessions; compulsions; depression; anxiety; global clinical improvement; psychosocial adjustment; and physical symptoms. RESULTS: Clomipramine was superior to placebo in reducing both obsessive-compulsive symptoms considered together (g = 1.31; 95% CI = 1.15 to 1.47) as well as obsessions (g = 0.89, 95% CI = 0.36 to 1.42) and compulsions (g = 0.79; 95% CI = 0.34 to 1.24) taken separately. Also, selective serotonin re-uptake inhibitors (SSRIs) as a class were superior to placebo, weighted mean g being respectively 0.47 (95% CI = 0.33 to 0.61), 0.54 (95% CI = 0.34 to 0.74) and 0.52 (95% CI = 0.34 to 0.70) for obsessive-compulsive symptoms considered together, and obsessions and compulsions taken separately. Although on Y-BOCS the increase in improvement rate over placebo was 61.3%, 28.5%, 28.2% and 21.6% for clomipramine, fluoxetine, fluvoxamine, and sertraline respectively, the trials testing clomipramine against fluoxetine and fluvoxamine showed similar therapeutic efficacy between these drugs. Finally, both clomipramine and fluvoxamine proved superior to antidepressant drugs with no selective serotonergic properties. CONCLUSION: Antidepressant drugs are effective in the short-term treatment of patients suffering from OCD; although the increase in improvement rate over placebo was greater for clomipramine than for SSRIs, direct comparison between these drugs showed that they had similar therapeutic efficacy on obsessive-compulsive symptoms; clomipramine and fluvoxamine had greater therapeutic efficacy than antidepressant drugs with no selective serotonergic properties; concomitant high levels of depression at the outset did not seem necessary for clomipramine and for SSRIs to improve obsessive-compulsive symptoms.

1-Naphthylamine↗