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Biomedical subjects

J Doyle

Publications and source records attributed to J Doyle.

At least 91 records · Page 5Linked to original sources
PubMed1996

Patient satisfaction with time use in audiological consultations.

An analysis of how time was used in and around 60 consultations was carried out for the purpose of exploring the relationship of time use to patient satisfaction. Sixty patients across two practice settings were surveyed, immediately following their interaction with the audiologist, regarding satisfaction with the consultation. Satisfaction was measured via: (1) a four-point scale, which yielded a satisfaction rating; and (2) a check list of satisfaction with 11 aspects of the consultation, which yielded a satisfaction score. Satisfaction ratings and scores were correlated significantly (rs = 0.76 corrected for ties, P = 0.0001). The majority of patients were either 'very satisfied' (63%) or 'satisfied' (31.6%) with the consultation experience. Temporal pictures of the consultations of 'very satisfied', 'satisfied' and 'dissatisfied' patients were clearly different. For the present sample it appeared that patient satisfaction ensued when the total consultation time was equal to or exceeded 0.6 of the sum of total consultation time and the time spent waiting at the clinic immediately prior to the consultation. Regression analyses showed that of the temporal variables studied, total consultation time (TCT) and the amount of time waiting immediately pre consultation (WT) contributed most to the variation in patient satisfaction ratings and scores. Forty-two per cent of the variance in satisfaction ratings and 36% of the variance in satisfaction scores could be explained by TCT/(WT + TCT).

Adult↗
PubMed1996

The persisting communicative difficulties of 'remediated' language-impaired children.

This study addresses the effiacy of dismissal criteria used by speech and language pathologists by investigating communicative functioning in children declared 'remediated'. A battery of measures comprising the Language Assessment and Remediation Procedure (LARSP); the Behavioural inventory of Speech Act Performances (BISAP); the BISAP Addendum and the Devereux School Behaviour Rating Scale (DESB) was conducted on five children with language impairment who had been declared 'remediated'. Findings for certain 'remediated' subjects revealed persisting problems. The results suggest that decisions about dismissal from therapy may, in some cases, be premature and point to the need for a broad-based perspective concerning remediation dismissal decisions. An additional study on larger populations and the use of designs which investigate long term outcomes would further inform clinical decision-making concerning dismissal from therapy.

Child↗
PubMed1996

Mismatch between aspects of hearing impairment and hearing disability/handicap in adult/elderly Cantonese speakers: some hypotheses concerning cultural and linguistic influences.

This paper addresses the observation that some Cantonese-speaking adults do not perceive a hearing problem even when hearing screening identifies hearing loss. A sample of 49 Cantonese speakers was surveyed about their self-perceptions of hearing prior to a 25 dB HTL pure-tone screening test. All 49 persons failed the screening test, yet 34 (69.4%) reported that they had no problems hearing during conversations. Persons who admitted hearing difficulties tended to have mean hearing levels in excess of 45 dB HTL. A number of hypotheses concerning cultural and linguistic influences are proposed as explanations for the apparent lack of significance of auditory sensitivity loss for some Cantonese speakers. Ways in which these hypotheses might be tested are suggested.

Aged↗
PubMed1995

Co-amplification of MYCN and a DEAD box gene (DDX1) in primary neuroblastoma.

DEAD box proteins are putative RNA helicases that have been implicated in cellular processes involving alteration of RNA secondary structure, such as translation initiation and splicing. These proteins share eight conserved amino acid motifs, including Asp(D)-Glu-(E)-Ala(A)-Asp(D) which is part of a more extended motif. Recently, we have shown that the novel DDX1 gene containing a DEAD box motif maps to the same chromosome band as MYCN at 2p24 and is co-amplified with MYCN in retinoblastoma cell lines. Here, we show that the DDX1 gene is co-amplified with the MYCN gene in 2 of three neuroblastoma cell lines and that DDX1 RNA levels correlate with DDX1 gene copy number. Since amplification of MYCN is an indicator of poor prognosis in neuroblastoma, it was of interest to determine whether co-amplification with DDX1 occurred in clinical samples of neuroblastoma and whether such a finding carried any additional prognostic significance. We determined the gene copy number of DDX1 in 32 neuroblastoma patient samples (representative of all stages): 13 were MYCN amplified and 19 had normal copy numbers of the MYCN gene. Of the 13 neuroblastomas that were MYCN amplified, seven were also DDX1 amplified. Of the 19 that were not MYCN amplified, none were DDX1 amplified. This is the first example of a gene that is co-amplified with MYCN at a high frequency in neuroblastoma. While there was a trend towards a worse clinical outcome with co-amplification, the numbers were too small to reach significance.

Child↗
PubMed1995

Prostate cancer screening in a large corporation population.

The Polaroid Medical Department conducted a prostate cancer screening program of all male employees over the age of 49 years. The screening consisted of a World Health Organization (WHO) questionnaire, a digital rectal examination (DRE) by an occupational medicine doctor, and a serum prostate-specific antigen (PSA) study. There were 2241 eligible employees (males between 50 and 65 years of age). 1219 (54%) took part in the screening. Thirty-seven PSAs above the 3.9 level were found (3%) and were further evaluated with ultrasound and/or biopsy. Twelve previously unknown cancers of the prostate (1%) were discovered. The cost of the entire program to the Polaroid Medical Department, including ultrasound and biopsy studies, was $72,130 ($6,012 per cancer detected). Of the 12 cancers, two were discovered by abnormal DRE alone, eight by an elevated PSA alone, and two by both an abnormal DRE and elevated PSA. There appeared to be no correlation between the WHO symptom score and the detection of prostate cancer. Our final conclusion was that a corporate medical department screening for cancer of the prostate is both effective and cost efficient.

Aged↗
PubMed1995

Anaphylactoid reactions in children receiving high-dose intravenous cyclosporine for reversal of tumor resistance: the causative role of improper dissolution of Cremophor EL.

PURPOSE: An unusually high incidence of anaphylactoid reactions was observed during a phase I/II trial of high-dose intravenous cyclosporine (CsA) therapy to attenuate tumor multidrug resistance (MDR). Five of 21 children experienced severe anaphylactoid reactions shortly after initiation of the first or second CsA infusion. We hypothesized that improper dissolution of the vehicle Cremophor EL may have been a cause for these anaphylactoid reactions. METHODS: All nurses who had administered intravenous CsA were interviewed regarding their technique of preparing the infusion and the occurrence of an anaphylactoid reaction. The responses were statistically analyzed. The effect of various mixing techniques on the distribution of Cremophor EL in the infusion was experimentally evaluated. Different mixing techniques were used to assess their effect on the distribution of Cremophor EL in the solution. RESULTS: Analysis of the preparation techniques of the CsA infusion showed significant correlation between suboptimal mixing of CsA by nurses and the occurrence of anaphylactoid reactions (P = .02). Experimental simulation showed that suboptimal mixing results in an uneven distribution of Cremophor EL, which subsequently sinks to the bottom of the vial. CONCLUSION: Improper mixing of high-dose CsA infusions causes nonsolubilized Cremophor EL to sink to the outflow area of the bottle. An initial bolus infusion of highly concentrated Cremophor EL may produce an anaphylactoid-like response. This mechanism of toxicity is important to recognize, because it is easily preventable by proper preparation of the infusion, thus reducing the incidence of potentially life-threatening anaphylactoid reactions.

Adolescent↗
PubMed1995

Choosing talkers for the BKB/A Speechreading Test: a procedure with observations on talker age and gender.

A procedure is described for choosing talkers for the BKB/A (BKB/Australian version) Speechreading Test. The main aims were: to select several talkers from a pool of potential talkers, to avoid adventitiously choosing a markedly atypical single talker; to assess speechreading as a general skill rather than as talker-specific; and to select talkers who were acceptable to speechreaders, relatively easy to speechread, and comparable in their speechreadability. Because of the number of variables involved and the demanding nature of the task for speechreaders, a three-stage selection procedure was adopted. In the resulting BKB/A 21-sentence list Speechreading Test, four of the 16 sentences in a list are each spoken by four talkers, chosen as follows. In Stage 1, 16 talkers (four of each age/gender set: older men, older women, younger men, younger women) were selected from an original pool of 40 (10 of each set), via rankings made by eight hearing-impaired judges with speechreading experience. In Stage 2, the final four talkers (one of each set) were selected from the 16 via the speechreading scores of further hearing-impaired subjects with speechreading experience. In Stage 3, the order of talker appearance within lists (in random order versus over blocks of four consecutive sentences) was determined. This three-stage approach to talker selection identified differences between talker candidates within sets, except for younger men, and suggested that, overall, younger women were the easiest to speechread. The discussion addresses the merits and disadvantages of this approach to talker selection, and suggests some reasons for the documented differences in speechreadability among talkers of different age and gender.

Cross-Over Studies↗
PubMed1995

Cytogenetic and molecular studies of Down syndrome individuals with leukemia.

There is an increased risk of leukemia in Down syndrome (DS) patients, with estimates ranging from 14 to 30 times the incidence rate observed for chromosomally normal children. Furthermore, one type of leukemia, called "transient leukemia" (TL), occurs almost exclusively in DS infants. The basis of the association between DS and leukemia is unknown, but we and others have hypothesized that it may be influenced by the mechanism of origin of the extra chromosome. Therefore, we initiated a cytogenetic and molecular study of nondisjunction in leukemia DS individuals. To date, we have obtained blood and/or tissue samples from 55 individuals consisting of 17 cases with TL, 7 cases of acute nonlymphocytic leukemia subtype M7 (ANLL-M7, or acute megakaryoblastic leukemia, postulated to be related to TL), and 31 cases of other forms of leukemia. Analysis of these cases suggests differences between DS children with TL and those with other types of leukemia or DS individuals with no history of leukemia. Specifically, the TL and ANLL-M7 cases have a highly significant increase in the frequency of "atypical" constitutional karyotypes (i.e., mosaic trisomies, rings, and/or isochromosomes) and are almost always male. Additionally, genetic mapping studies suggest an increase in the frequency of disomic homozygosity, especially in proximal 21q, in DS individuals with TL and ANLL-M7.

Adolescent↗
PubMed1995

Economic and quality of life outcomes: the four-step pharmacoeconomic research model.

Increasingly, economic data are being considered in formulary decisions. In oncology, pharmacoeconomic evaluations are essential to help decision makers weigh the associated costs and outcomes of competing chemotherapeutic interventions. In this article, we present a four-step pharmacoeconomic research model that can be customized for specific provider or payer systems. The model encompasses problem identification, clinical management analysis, three pharmacoeconomic analyses (cost consequence, expected cost, and cost effectiveness), and a sensitivity analysis--the rank order stability analysis (ROSA)--to validate the findings.

Antineoplastic Agents↗
PubMed1994

Concurrent RhGM-CSF does not offset myelosuppression from intensive chemotherapy: randomized placebo-controlled study in childhood acute lymphoblastic leukemia.

To determine whether recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) can offset the myelosuppressive effects of intensive chemotherapy, we carried out a double-blind placebo-controlled trial in which 40 patients with acute lymphoblastic leukemia (ALL) were randomized into two groups of 20 each. One group received rhGM-CSF (5.5 micrograms/kg SC) coadministered with chemotherapy and the other, placebo coadministered with chemotherapy from day 5 to day 11 and from day 19 to day 25 of the 28-day intensification phase of our institutional high-risk protocol for childhood ALL. The results indicate that, at the dose and schedule used, rhGM-CSF did not prevent neutropenia or shorten the number of days required to complete this phase of therapy. In addition, the treated and placebo groups showed no significant difference in absolute neutrophil counts, number of days with neutropenia, number of days with fever, number of days spent in hospital, or number of days on antibiotics during the 28-day study period. There was also no difference between the two groups in the number, type, or severity of infectious episodes. Two of 20 patients in the treatment group have relapsed, whereas none of the patients in the placebo group has yet relapsed (follow-up: 3-37 months), but these events were not statistically significant. We conclude that treatment with rhGM-CSF at the dose and schedule employed is not clinically beneficial.

Adolescent↗
PubMed1994

Letters of recommendation for surgical residencies: what they say and what they mean.

Screening of applicants and selection of interns for surgical residency programs continue to rely heavily on letters of recommendation from surgical faculty. To define important aspects of letters useful for screening and selection, letters written on behalf of housestaff with known performance and those of new applicants were circulated to a sample of 120 academic surgeons. Eighty letters, written on behalf of 42 students, were divided into 10 groups of 8; each group was sent to 12 individuals. Half of the letters were "open" (full letter-head and signature), and half were "text only" (i.e., no identification). Candidate names were omitted. Each faculty reviewer was asked to rank the candidate represented by each letter, for their program, on a scale of 1 to 5, and indicate key negative or positive phrases on individual letters. Reviewers were also asked to indicate the importance they generally ascribe in evaluating such letters to the school of origin, academic rank of the letter writer, personalization (of letter to reader), formal vs informal reference to the candidate, and mention of interest in specialty training. A response rate of 60% was obtained. Faculty reviewers stated explicitly that school of origin, personalization of the letter, and the academic rank of the writer are important factors influencing their ranking of candidate letters. The scores they gave to "open" and "text only" letters, however, do not differ significantly (P > 0.05). Letters were scored similarly, indicating that school of origin or writer may not be as critical as implied or believed.(ABSTRACT TRUNCATED AT 250 WORDS)

Correspondence as Topic↗
PubMed1994

Soft tissue and visceral sarcomas in Irish patients. Interim analysis of data obtained by the Dublin Soft Tissue Tumour Panel.

The Dublin Soft Tissue Sarcoma Panel was established in 1989 with a view to achieving a unified approach to diagnosis and management of soft tissue and visceral sarcomas. This interim report presents data on 265 prospectively-evaluated patients and on a separate retrospective series of 126 patients. The patients in the prospective series were treated by 93 different surgical and medical specialists. Tumours presented in all anatomic sites and ranged in size from 0.2 to 60 cm. Leiomyosarcoma was the commonest tumour type. Eighty-nine tumours were inoperable at clinical presentation. There was a consensus panel diagnosis in over 90%, non-neoplastic reactive lesions and primitive round cell tumours being the most difficult cases diagnostically. Management, including onward referral for chemotherapy or radiation therapy, was inconsistent. The 2-year survival figures were: 43% (1989-91) and 37% (1980-88). These findings should provide a basis for the evaluation of coherent treatment strategies for Irish sarcoma patients.

Adolescent↗
PubMed1994

Myelodysplasia and acute megakaryoblastic leukemia in Down's syndrome.

In this report we describe the clinical and hematologic features of 23 cases of myelodysplasia (MDS) or acute megakaryoblastic leukemia (AMKL) occurring in Down's syndrome. MDS was characterized by thrombocytopenia, abnormal megakaryocytopoiesis, megakaryoblasts (< 30%) in the marrow and abnormal karyotype, the most common of which was trisomy 8, found in 7/15 patients with MDS. Three of five patients achieved a complete remission with low dose cytosine arabinoside, vincristine and retinyl palmitate. The high cure rate and the distinctive features of the leukemic process in these cases suggest that this type of MDS and AMKL are unique to patients with Down's syndrome.

Adolescent↗
PubMed1994

Tumor necrosis factor-alpha (TNF-alpha), interferon-gamma, and interleukin-6 but not TNF-beta induce differentiation of neuroblastoma cells: the role of nitric oxide.

Tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), and interleukin-6 (IL-6), but not TNF-beta, can induce the in vitro differentiation of the neuroblastoma cell line N103 in a dose-dependent manner. Differentiation of N103 was accompanied by the arrest of cell growth and neurite formation. The induction of neuroblastoma cell differentiation by TNF-alpha and IFN-gamma can be specifically inhibited by a nitric oxide (NO) synthase inhibitor, L-NG-monomethylarginine. In contrast, the differentiation of N103 cells by IL-6 was not affected by L-NG-monomethylarginine. These results indicate that TNF-alpha and IFN-gamma, but not IL-6, induce the differentiation of neuroblastoma cells via NO. This is confirmed by the finding that the culture supernatants of N103 cells induced by TNF-alpha and IFN-gamma, but not that by IL-6, contained high levels of NO2-, the production of which was inhibited by L-NG-monomethylarginine. Furthermore, the differentiation of N103 cells can be induced directly in a dose-dependent manner by the addition of nitroprusside, a generator of NO, into the culture medium. These data therefore indicate that NO may be an important mediator in the induction of neuronal cell differentiation by certain cytokines such as TNF-alpha and IFN-gamma and that neuronal cells, in addition to the macrophage-like brain cells, can be induced by immunological stimuli to produce large quantities of NO.

Amino Acid Oxidoreductases↗
PubMed1994

Initial consultations in hearing aid clinics in Australia.

Fifty initial consultations in government hearing aid clinics were audiotape recorded and analyzed to study the behavior of audiologists and clients in the initial stages of hearing aid rehabilitation. Consultations averaged 34 minutes and showed a four-stage clinical routine in which clients appeared largely passive. Hearing aid fitting was initiated in 48 (96%) consultations. The consultations of individual audiologists differed significantly in total time, proportion of consultation time in which talk occurred, proportion of consultation time in which talk occurred, proportion of consultation time devoted to hearing assessment, and the number of clients' direct requests for information. Individual audiologists appeared to have one of two general patterns in hearing aid prescription. The study indicates a need for the further study of audiologist behavior and the relationship of that behavior to hearing aid rehabilitation outcomes such as client satisfaction and degree of hearing aid use.

Adult↗
PubMed1994

Idiopathic thrombocytopenia and neutropenia in childhood.

PURPOSE: Between 1975 and 1990, 13 patients seen at The Hospital for Sick Children, Toronto, Ontario, were noted to have concurrent idiopathic thrombocytopenia and neutropenia (ITN; platelet count < 150 x 10(9)/L; absolute neutrophil count < 1.5 x 10(9)/L). These patients all had normal marrow function and no evidence of systemic disease. PATIENTS AND METHODS: A detailed chart review was performed to define the clinical and laboratory features of these patients. RESULTS: Although this was a heterogeneous group of patients, they shared several common characteristics. The disease followed a chronic course with thrombocytopenia or neutropenia or both that persisted or recurred over the entire period of follow-up in all patients (18 months to 15 years). The disease was associated with splenomegaly in eight patients and lymphadenopathy in nine patients. Boys were affected more frequently than were girls (ratio 11:2). Thrombocytopenia improved temporarily during treatment with corticosteroids, i.v. immunoglobulin G, RhoGAM, and a variety of immunosuppressive agents; however, neutropenia tended to be much more resistant to these therapies. Splenectomy was ineffective in two children in whom the procedure was performed. Platelet of and neutrophil antibodies or both were detected in five of six patients who were tested, suggesting an autoimmune cause for the cytopenias. CONCLUSIONS: These findings suggest that ITN in childhood is distinct from immune thrombocytopenic purpura, particularly in terms of its chronicity and poor response to therapy.

Adolescent↗