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Biomedical subjects

I Watt

Publications and source records attributed to I Watt.

At least 55 records · Page 3Linked to original sources
PubMed1998

Treatment of rheumatoid arthritis with recombinant human interleukin-1 receptor antagonist.

OBJECTIVE: To evaluate the efficacy and safety of interleukin-1 receptor antagonist (IL-1Ra) in patients with rheumatoid arthritis (RA). METHODS: Patients with active and severe RA (disease duration <8 years) were recruited into a 24-week, double-blind, randomized, placebo-controlled, multicenter study. Doses of nonsteroidal antiinflammatory drugs and/or oral corticosteroids (< or =10 mg prednisolone daily) remained constant throughout the study. Any disease-modifying antirheumatic drugs that were being administered were discontinued at least 6 weeks prior to enrollment. Patients were randomized to 1 of 4 treatment groups: placebo or a single, self-administered subcutaneous injection of IL-1Ra at a daily dose of 30 mg, 75 mg, or 150 mg. RESULTS: A total of 472 patients were recruited. At enrollment, the mean age, sex ratio, disease duration, and percentage of patients with rheumatoid factor and erosions were similar in the 4 treatment groups. The clinical parameters of disease activity were similar in each treatment group and were consistent with active and severe RA. At 24 weeks, of the patients who received 150 mg/day IL-1Ra, 43% met the American College of Rheumatology criteria for response (the primary efficacy measure), 44% met the Paulus criteria, and statistically significant improvements were seen in the number of swollen joints, number of tender joints, investigator's assessment of disease activity, patient's assessment of disease activity, pain score on a visual analog scale, duration of morning stiffness, Health Assessment Questionnaire score, C-reactive protein level, and erythrocyte sedimentation rate. In addition, the rate of radiologic progression in the patients receiving IL-1Ra was significantly less than in the placebo group at 24 weeks, as evidenced by the Larsen score and the erosive joint count. IL-1Ra was well tolerated and no serious adverse events were observed. An injection-site reaction was the most frequently observed adverse event, and this resulted in a 5% rate of withdrawal from the study among those receiving IL-1Ra at 150 mg/day. CONCLUSION: This study confirmed both the efficacy and the safety of IL-1Ra in a large cohort of patients with active and severe RA. IL-1Ra is the first biologic agent to demonstrate a beneficial effect on the rate of joint erosion.

Adolescent↗
PubMed1998

Evidence into practice. Prescribing selective serotonin reuptake inhibitors.

This descriptive analysis examines prescribing trends of antidepressants in English primary care, providing analysis of NHS reimbursement data for groups of antidepressants between 1989 and 1994. Prescribing trends seem unaffected by the release of information on the effectiveness and cost-effectiveness of antidepressant drugs. We found that simple distribution of the results of health technology assessments may not be sufficient to influence practice.

Depression↗
PubMed1997

Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence.

OBJECTIVE: To examine the research evidence for the health consequences of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure. DESIGN: A systematic review of published research, studies being identified by searching Medline (1966-96), Embase (1974-96), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) (1982-95); scanning citations; and consulting experts. Studies in all languages were considered which either investigated the association between obstructive sleep apnoea in adults and key health outcomes or evaluated the effectiveness of treatment of obstructive sleep apnoea with continuous positive airways pressure in adults. MAIN OUTCOME MEASURES: Mortality, systematic hypertension, cardiac arrhythmias, ischaemic heart disease, left ventricular hypertrophy, pulmonary hypertension, stroke, vehicle accidents, measures of daytime sleepiness, and quality of life. RESULTS: 54 epidemiological studies examined the association between sleep apnoea and health related outcomes. Most were poorly designed and only weak or contradictory evidence was found of an association with cardiac arrhythmias, ischaemic heart disease, cardiac failure, systemic or pulmonary hypertension, and stroke. Evidence of a link with sleepiness and road traffic accidents was stronger but inconclusive. Only one small randomised controlled trial evaluated continuous positive airways pressure. Five non-randomised controlled trials and 38 uncontrolled trials were identified. Small changes in objectively measured daytime sleepiness were consistently found, but improvements in morbidity, mortality, and quality of life indicators were not adequately assessed. CONCLUSIONS: The relevance of sleep apnoea to public health has been exaggerated. The effectiveness of continuous positive airways pressure in improving health outcomes has been poorly evaluated. There is enough evidence suggesting benefit in reducing daytime sleepiness in some patients to warrant large randomised placebo controlled trials of continuous positive airways pressure versus an effective weight reduction programme and other interventions.

Accidents, Traffic↗
PubMed1997

Basic differential diagnosis of arthritis.

This article outlines an approach to basic plain-film diagnosis and differential diagnosis of the arthritides. It advocates the use of an analysis of which part of the joint is involved, and works through a logical sequence to reach a final diagnosis. It recommends the concept of dividing up the arthritides into those in which the radiological effects predominantly affect synovium, cartilage or the enthesis.

Arthritis↗
PubMed1997

Tumors around implants.

In 1989, A. G. Apley recommended cautious surveillance of malignant tumors that developed in association with orthopaedic implants. This retrospective review of the Bristol Bone Tumour Register between 1980 and 1992 reports on 240 malignant soft tissue sarcomas. Eighteen developed in the thigh region of patients more than 50 years old, and 4 of these developed in the soft tissues around a hip arthroplasty.

Aged↗
PubMed1997

Promoting clinically effective practice: general practitioners' awareness of sources of research evidence.

BACKGROUND: Practitioners are being encouraged to base their clinical practice on research evidence. In order to do this, they must be aware of and use the sources of evidence. METHODS: A questionnaire survey was undertaken to establish GPs' awareness of research evidence in their clinical practice and, in fundholding practices, its influence on purchasing plans. Questionnaires were sent to 360 lead fundholders in North Thames Region and 440 of a random sample of the remaining general practitioners in the region for comparison. RESULTS: Questionnaires were returned by 62% of lead fundholders and 63% of GPs in the random sample. There was limited use of the electronic sources of clinical effectiveness. There was greater reported awareness of published sources of research evidence and fundholding GPs were significantly more likely to have referred to publications summarizing research evidence. CONCLUSIONS: GPs seem to make more use of published clinical effectiveness sources than the electronic databases. Consequently, they need educational and technical support if they are to make full use of the available sources of research evidence available in other media.

Contract Services↗
PubMed1997

Promoting clinical effective practice. Attitudes of fundholding general practitioners to the role of commissioning.

Aims to evaluate the acceptability of commissioning to improve clinical effectiveness in secondary care and explore the conditions under which fundholders would be willing to use commissioning in this way. Describes how fundholders in two contrasting districts in North Thames Region were interviewed in 1995-1996. Respondents were selected from a list of all fundholders in the district with few fundholding practices and from lists of fundholders holding contracts with specified hospitals in the district with many fundholders. Interviews were analysed using the constant comparison method of content analysis. All fundholders in the districts were eligible. The sample represented a broad range of fundholders, containing all fundholding waves and large and small practices. Managers and general practitioners from multifunds outside the districts were also interviewed to assess whether they faced different issues from single practice fundholders. Many respondents felt unable to use commissioning to improve clinically effectiveness despite their awareness of the policy. Reasons identified included the problem of agreeing complex commissioning arrangements to reflect clinical issues, and an unwillingness to use fundholding to challenge hospital practice. Respondents from early wave fundholding practices and those with training in critically appraising research literature expressed more readiness to review research evidence, but only a few early wave fundholders said they would consider evidence-based commissioning. Concludes that steps should be taken to educate fundholders in clinical effectiveness and provide appropriate information to them. Also, they must be persuaded that clinical effectiveness is not a politically-driven policy or they will resist it.

Attitude of Health Personnel↗
PubMed1997

Quantitative magnetic resonance imaging of the knee: a method of measuring response to intra-articular treatments.

OBJECTIVES: To investigate the potential of quantitative magnetic resonance imaging (MRI) to differentiate between therapeutically induced changes in inflammation and synovial proliferation in rheumatoid arthritis (RA) of the knee. METHODS: MRI of the knee was performed on patients with RA before and one week after injection with corticosteroid (triamcinolone acetonide, TA group, n = 9) and before, four, and 12 weeks after injection with yttrium-90 plus TA (TA+Y group, n = 7). MRI scans were analysed by subjective visual grading by a trained observer and by computer aided quantitation for three features: synovial fluid volume, synovial pannus volume, and synovial enhancement after intravenous contrast agent. RESULTS: All TA subjects improved clinically at one week but the effects of TA+Y were more variable. TA significantly reduced synovial enhancement and effusion volume, whereas TA+Y at 12 weeks tended to increase synovial enhancement and decrease pannus volume. Quantitative MRI values agreed well with subjective assessment of scans. Comparison of calculated change on MRI scan before and immediately after aspiration with actual volume aspirated showed high correlation (r = 0.96). CONCLUSIONS: Quantitative MRI correlates with subjective visual assessment and, at least for synovial fluid, is accurate. MRI can differentiate actions of two therapeutic modalities on various pathological processes and is sensitive enough to detect change after one week. With the additional advantage of lack of observer bias, it will probably become a useful tool in the development and assessment of existing and novel treatments.

Adult↗
PubMed1997

Systematic review of the effectiveness of laxatives in the elderly.

OBJECTIVES: To determine the effectiveness and cost of laxatives in the prevention and treatment of constipation in the elderly. HOW THE RESEARCH WAS CONDUCTED: Randomised controlled trials (RCTs) of treatment or prevention of constipation were included in the review. INTERVENTIONS: The four classes of laxatives, bulk, osmotic, stimulant laxatives and faecal softeners, were covered by the review. The main laxatives included in the trials were bran, psyllium, prucara, cascara, dioctyl sodium, lactulose, and lactitol. PARTICIPANTS: Elderly people suffering from chronic functional constipation. A trial was eligible for inclusion if all participants were aged 55 years or older and being treated for chronic constipation. The trials reviewed did not provide further subcategorisation by aetiology. MAIN OUTCOMES: Number of bowel movements per week; symptom improvement; stool consistency; abdominal pain. DATA SOURCES: The recent systematic review by Tramonte and colleagues was used as a source of trials (J Gen Intern Med 1997;12:15-24). In addition, the following databases were searched: Embase, Psychlit, Medline, the Cochrane library, the nursing database CINAHL, International Pharmaceutical Abstracts, and the alternative therapies database, AMED. Authors and manufacturers were also asked for information. Studies in any language were eligible for inclusion. Decisions on the relevance of primary studies were made independently by two reviewers. Economic information was searched for in Current Contents/Clinical Medicine, Medline, and the NHS Economic Evaluation Database (NEED). VALIDITY ASSESSMENT: The quality of primary studies was summarised on a 6-item scale. This covered reporting of inclusion and exclusion criteria, randomisation method, standardised assessmment of adverse effects, double-blind design, description of withdrawals, and statistical analysis. The assessment of validity of included studies was carried out independently by two reviewers. Data were extracted from studies independently by two reviewers. Authors were contacted for more information where necessary to obtain unpublished information. CLINICAL TRIALS INCLUDED: Ten trials comparing single agents with placebo were identified, with a total of 367 patients were identified, with a total of 367 patients who had a mean age of about 74 years. Two of these presented no information on the numbers of men and women (54%) in the remaining eight trials. The majority of patients were in an institutional setting, such as a nursing home or hospital. Ten trials compared one laxative agent with another. The mean age of participants in these trials was estimated at 77 years. Only one trial examined patients in an outpatient setting; the other trials were carried out in nursing homes or hospitals. (ABSTRACT TRUNCATED)

Adult↗
PubMed1996

Informed choice for users of health services: views on ultrasonography leaflets of women in early pregnancy, midwives, and ultrasonographers.

With the aim of promoting the informed choice of pregnant women, staff and pregnant women at two urban hospitals were offered leaflets summarising the best available evidence about the effectiveness of routine ultrasonography in early pregnancy. Ultrasonographers doubted the credibility of the evidence and were concerned that the leaflets would raise women's anxiety, reduce uptake of scans, disrupt hospital organisation, and reinforce media messages about the poor safety record of ultrasonography. Midwives thought that the leaflets would inform women, help them to talk about their care with health professionals, and help them to get better care. Women were shocked at some of the contents but thought that it was appropriate to include both advantages and disadvantages of routine scanning in the leaflet. This case study highlights the resistance of some health professionals to evidence based health care; underlying conflicts with the principle of professional autonomy; concern that informed choice may create anxiety; and professional and organisational barriers to allowing informed choice.

Attitude of Health Personnel↗
PubMed1996

[MR imaging in seronegative spondyloarthritis].

In twenty-five patients with a clinical diagnosis of suspected sacroiliitis conventional radiography, CT and MRI were performed. In ten patients no abnormalities were demonstrated. In thirteen cases CT and MRI revealed sacroiliitis. In two patients with normal plain films and CT para- and intraarticular changes of signal intensity suggested suspicious sacroiliitis. MRI can be considered as an important imaging modality for early diagnosis of sacroiliitis. In eighteen patients with a firm diagnosis of ankylosing spondylitis and plain films of the thoracolumbar junction suggesting destructive Romanus and Anderson inflammatory lesions MRI was done. Two distinct groups of inflammatory changes were found. In ten patients MRI findings compatible with active inflammatory enthesitis were revealed at the disco-vertebral junction. In eight cases focal and linear changes of signal intensity within the intervertebral disks suggested an active inflammation. Using MRI the spectrum of inflammatory changes in sero-negative spondylitis can be presented. In sixteen patients with definite clinical diagnosis (psoriatic arthritis--thirteen cases and Reiter's syndrome--three cases) plain films and MRI of small hand joints were performed. The patients fell into two distinct groups. In the first MRI findings could not be differentiated from those seen in rheumatoid arthritis. In nine cases the distribution and extent of soft tissue findings were different, similar to changes seen in enthesitis. Therefore, on the basis of MRI findings in small peripheral joints easier differential diagnosis between sero-negative spondyloarthritides and rheumatoid arthritis is possible. In five patients with a diagnosis of Reiter's syndrome having clinical signs of enthesitis plain films and MRI of calcaneus were done. MRI revealed findings compatible with active inflammation which resembled those seen at the attachment of the annulus fibrosus and collateral ligaments of the small hand joints.

Adult↗
PubMed1996

[Arthritis: imaging and therapy. Past, present and future].

Osteoarthritis (OA) and rheumatoid arthritis (RA) are chronic diseases in which pathological anatomy changes very slowly. Whilst clinical and laboratory measures can be used to evaluate therapeutic response, assessment of disease progression requires imaging. Conventional radiography has performed well in RA but is too insensitive in OA. Never have imaging techniques been discussed which focus on the sites of fundamental pathological change in cartilage and synovia. Such techniques would provide potential end-points for measuring disease progression and the efficacy of therapeutic intervention. Many are non-invasive but are still at a developmental stage. Expense and complexity currently restricts their use to research. However, improving imaging hardware and information technology provide an exciting future for radiologists involved in joint imaging. Clinical trials involving techniques described here are just around the corner.

Arthritis, Rheumatoid↗
PubMed1996

The value of MR imaging in the diagnosis of the os trigonum syndrome.

OBJECTIVE: The objective of this study was to evaluate the value of magnetic resonance (MR) imaging in the diagnosis of the os trigonum syndrome. DESIGN: Sagittal and coronal spin echo MR sequences of the ankle were acquired along with sagittal images in both dorsiflexion and plantar flexion. PATIENTS: Three consecutive patients presenting with posterior triangle pain were assessed. RESULTS AND CONCLUSIONS: MR imaging delineated the anatomical site of the abnormality and demonstrated coexisting pathology in all patients. Flexion/extension MR images yielded additional information regarding the mobility of the os trigonum in one patient. MR imaging is the technique of choice for investigating the os trigonum syndrome.

Adult↗
PubMed1996

Advantages of an increased dose of MRI contrast agent for enhancing inflammatory synovium.

MRI intravenous contrast enhancement of inflammatory synovium has been studied at two different doses to determine to what extent enhancement is dose dependent. 19 patients with clinically active rheumatoid arthritis involving a knee were scanned twice, one week apart, using 0.1 mmol/kg of gadoteridol (ProHance) on the first occasion and 0.3 mmol/kg on the second. Static pre-and post-contrast images together with dynamic images immediately following injection were obtained on a 1.0T scanner. On subjective assessment, 84% of patients showed improved enhancement. 47% showed more enhancing tissue, a clearer delineation of enhancing tissue or both. Objectively, enhancement was increased significantly at the higher dose, as judged by the percentage increase in mean signal intensity within regions of interest plotted over the suprapatellar pouch (1723% v. 1005% enhancement P < 0.05). In practical terms the better visualization of enhancing tissue achieved with higher doses is likely to reduce margins of error in attempts at quantification from MRI scans, particularly of synovial volume, but emphasizes also the need for care and consistency to be exercised in calculating the exact dose of contrast medium to be administered.

Adult↗
PubMed1996

Prognostic value of contrast enhanced Gd-DTPA MRI for development of bone erosive changes in rheumatoid arthritis.

Conventional radiograms have been used to quantitate the progression of rheumatoid arthritis, mainly through the assessment of bone erosions, but this approach has many limitations. It has been suggested that an advantage of contrast-enhanced Gd-DTPA MRI over radiography may be its prognostic value due to its ability to show the natural history of active destructive to inactive fibrous pannus. The aim of this study was to evaluate the possible prognostic value of MRI for future development of bone erosive changes in small hand joints in patients with RA. The results of the study confirm that in joints in which inflammatory active pannus is shown by contrast-enhanced MRI, progression of bone-destructive changes can be expected.

Arthritis, Rheumatoid↗