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Biomedical subjects

J F Mayberry

Publications and source records attributed to J F Mayberry.

At least 73 records · Page 4Linked to original sources
PubMed1997

Rectal steroids suppress bone formation in patients with colitis.

BACKGROUND: The aetiology of bone loss in inflammatory bowel disease is multifactorial, but oral corticosteroids are an important contributory factor. Rectally administered steroids are widely used in patients with distal disease, but very little is known about their effect on bone metabolism. The aim of this study was to investigate the effect of a standard course of rectal prednisolone on biochemical markers of bone turnover. METHODS: In a longitudinal study of 10 patients, biochemical markers of bone turnover were measured before, during and after treatment with prednisolone metasulphobenzoate (Predfoam, Pharmax Ltd) 20 mg twice daily for 2 weeks. Bone formation markers measured were serum osteocalcin (BGP), bone-specific alkaline phosphatase (BALP) and procollagen carboxy-terminal propeptide (PICP). Urinary deoxypyridinoline (dPyr) was measured to assess bone resorption. RESULTS: Disease activity scores improved during treatment (difference in mean Powell-Tuck score = 2.3 (+/-13.1), 95% CI: 0.11-4.48, P = 0.04). There was a significant fall in BALP (P = 0.02) during treatment, and a rapid but non-significant fall in BGP (P = 0.19). PICP (0.42), and urinary dPyr (0.30) did not change significantly during treatment. CONCLUSIONS: Following a standard 2-week course of rectal prednisolone metasulphobenzoate, we observed a significant fall in bone-specific alkaline phosphatase activity. These results suggest that bone formation is suppressed in patients with distal colitis treated with pharmacological doses of rectal steroids.

Administration, Rectal↗
PubMed1997

Increasing compliance with colorectal cancer screening: the development of effective health education.

The ability of a health education leaflet to raise awareness of the frequency of colorectal cancer and its asymptomatic nature and to increase intention to participate in screening with faecal occult blood testing (FOBT) was investigated. One hundred subjects were interviewed before and after reading the leaflet. The number of men stating bowel cancer was 'very common' increased significantly from 20 to 60% (chi 2 = 16.7, P < 0.0001) and those understanding its asymptomatic nature form 64 to 92% (chi 2 = 11.4, P < 0.001). The leaflet significantly increased the percentage of women reporting bowel cancer as 'very common' from 30 to 70% (chi 2 = 16.0, P < 0.0001) and as being asymptomatic from 58 to 94% (chi 2 = 17.8, P < 0.0001). After reading the leaflet, 55% of men who initially declined screening reversed their decision (chi 2 16.5, P < 0.0001) and 50% of female non-adherers reversed their decision (chi 2 = 17.3, P < 0.0001). Reasons most frequently given for declining colorectal cancer screening were feeling well (77% of subjects declining), concern about further tests (38%), unpleasantness of FOBT (13%) and illness (6%). This leaflet successfully educates people about colorectal cancer and increased intention to participate in screening programmes.

Aged↗
PubMed1997

Near patient testing for Helicobacter pylori: a detailed evaluation of the Cortecs Helisal Rapid Blood test.

OBJECTIVE: To evaluate the Cortecs Helisal Rapid Blood test for accuracy overall and in specific subgroups by age and ethnic origin. Additionally, to assess readability of results, including inter-observer error, with consideration also given to usability and acceptability. DESIGN: A prospective evaluation using four reference tests. SETTING: A hospital endoscopy unit. METHODS: Two hundred patients attending for endoscopy were recruited for H. pylori testing with the Helisal test, plus antral biopsies for CLO test, culture and histology and serology using a commercial enzyme-linked immunosorbent assay (ELISA). The Helisal test was carried out and results read strictly according to the manufacturer's instructions. Two or more reference tests positive were taken as a gold standard positive; all results negative as negative and any remaining cases were regarded as equivocal. Performance figures were calculated twice, treating patients with equivocal status as either positive or negative. Results were in most cases double-read, blinded, by two observers and readings subsequently compared. RESULTS: The test was considered convenient, easy to use and acceptable to symptomatic patients, but a notable proportion (10%) of results were very difficult to read. Sensitivity was acceptable (91-92% overall, 95% confidence interval (CI) 82-97%), but specificity was poor overall (56-62%, 95% CI 45-72%), and particularly in patients aged 45 years or over (44-51%) and those of South Asian origin (42-50%). CONCLUSION: The test could be appropriate for testing younger symptomatic patients. Its usefulness was, however, found to be limited by poor readability of some results and poor specificity. Reading of some results as equivocal would be appropriate.

Adult↗
PubMed1997

The relation of hand skin-fold thickness to bone mineral density in patients with Crohn's disease.

OBJECTIVES: In healthy postmenopausal women, the association of skin-fold thickness (SFT) with bone mineral density (BMD) is well described, and a low SFT is a useful predictor of osteoporosis. In this study the association between hand SFT and BMD in patients with Crohn's disease was assessed; and the potential for hand SFT as a screening test for osteoporosis evaluated. DESIGN/METHODS: In a cross-sectional study, BMD was measured at the hip and lumbar spine by dual energy x-ray absorptiometry (DEXA). SFT was measured on the dorsum of the right hand using Holtain Tanner Whitehouse calipers. One hundred and seventeen patients (48 male) with Crohn's disease and 50 (25 male) controls were studied. RESULTS: There was a significant correlation between hand SFT and BMD (expressed as t scores) at all four measured sites (lumbar spine r = 0.41, P < 0.0001, 95% CI 0.25-0.55, Ward's triangle r = 0.38, P < 0.0001, 95% CI 0.21-0.53, trochanter r = 0.33, P < 0.0001, 95% CI 0.16-0.48, femoral neck r = 0.38, P < 0.0001, 95% CI 0.21-0.53). On stepwise regression analysis, the association remained significant after correcting for age, weight, menstrual status and current steroid use (P < 0.05). Hand SFT was significantly lower in patients with Crohn's disease than controls (difference in means 0.51 mm, 95% CI 0.3-0.72, P < 0.0001). Mean hand SFT was significantly lower in patients with osteoporosis compared to patients with normal BMD (difference in means 0.74 mm, 95% CI 0.33-1.15, P < 0.001), as was that of osteopenic patients compared to patients with normal BMD (difference in means 0.28 mm, 95% CI 0.01-0.55, P < 0.05). In the diagnosis of osteoporosis, the sensitivity of hand SFT ranged from 29% to 93%, with specificities of 54% to 95%. CONCLUSIONS: Hand SFT is independently associated with BMD in Crohn's disease and is lower than in age-matched healthy subjects. Hand SFT in combination with other easily measurable confounding variables might be useful in screening for osteoporosis in patients with Crohn's disease.

Adult↗
PubMed1997

The effect on compliance of a health education leaflet in colorectal cancer screening in general practice in central England.

OBJECTIVE: To raise compliance in a general practice based colorectal cancer screening programme by the use of a simple health educational leaflet. DESIGN: A randomised controlled trial of the leaflet's effect on completion of faecal occult blood tests. The leaflet explained the high frequency of colorectal cancer, the principles of screening, and addressed reasons for non-compliance. SETTING: The British town of Market Harborough where most of the population are registered with a single practice. PARTICIPANTS: These comprised 1571 residents aged 61 to 70 years registered with the practice. Residents were invited to receive a free faecal occult blood test in a colorectal cancer screening programme. Half the population were randomly assigned to receive the educational leaflet about screening. RESULTS: Compliance in test and control groups, positive rate of stool testing, and pathology detected were measured. Compliance was higher in men who received the leaflet in those aged 61 to 65 years (36% v 27%, chi2 = 4.0, p < 0.05) and in men aged 66 to 70 years (39% v 23%, chi2 = 9.7, p < 0.01). In women, use of the leaflet did not affect compliance in those aged either 61 to 65 years (38% v 36%, chi2 = 0.1, NS) or 66 to 70 years (31% v 31%, chi2 = 0.0, NS). The positive rate of stool testing in patients observing the required dietary restrictions was 1.6%. A significant lesion was detected in 1.4% of people tested (2 carcinomas and 5 patients with adenomatous polyps). CONCLUSIONS: Health education leaflets addressing reasons for non-compliance significantly increased compliance in men and should be used in screening programmes. Reasons for the lack of success of the leaflet in women should be investigated and other interventions for raising compliance should be developed.

Aged↗
PubMed1997

The views of medical students and junior doctors on pre-graduate clinical teaching.

A total of 277 third and fourth year medical students and 304 house officers and senior house officers were asked to prioritise the content and methods of clinical teaching. Response rates were poor, but similar to that in market surveys. Bedside teaching and medical clerking were considered the most valuable methods of teaching and training in practical procedures such as venepunctures and urinary catheterisation was seen as valuable. The design of new curricula in medical education will need to accommodate the views of its clients.

Attitude of Health Personnel↗
PubMed1996

Epidemiology of inflammatory bowel disease in different ethnic and religious groups: limitations and aetiological clues.

We present a review of epidemiological studies of inflammatory bowel disease and abdominal tuberculosis in various migrant communities in the United Kingdom. The differences between various South Asian groups such as Gujaratis, Bangladeshis and Punjabis are discussed in the context of age standardisation of incidence data and various dietary and social activities.

Asia↗
PubMed1996

Life insurance and inflammatory bowel disease: is there discrimination against patients?

The aims of this study were to compare and contrast the attitude of major insurance companies to patients with inflammatory bowel disease (IBD) and to a Consultant Gastroenterologist (JFM) requesting guidelines for patients with IBD. The experience of patients in Leicester with insurance companies was also investigated. A standard letter requesting information regarding the likelihood of loading on life assurance in connection with a mortgage was sent to 50 major insurance companies from a typical patient. A similar letter was constructed from a consultant gastroenterologist (JFM) to the same 50 insurance companies requesting simple guidelines for patients with IBD when applying for various types of insurance. A questionnaire investigating the experience of patients with IBD when applying for insurance was also sent to 100 patients with IBD selected at random from the Leicestershire data base of patients with Crohn's disease and ulcerative colitis, 39 insurance companies responded to the request for information by a typical patient, (response rate = 78%). 24 were split between those who thought the patient would be accepted at normal rates (n = 7) and those who would request an increased premium (n = 17). Only 27 companies replied to the letter by a consultant gastroenterologist requesting general guidelines, (response rate = 54%). There were only 17 overlapping replies to the two letters. Of these 17 overlapping replies, five companies (30%) informed the patient to expect increased premiums whilst advising the consultant a similar patient could expect normal rates. Six companies conferred (35%), telling both the patient and the consultant to expect normal rates. Either one or both of the remaining six companies (35%) felt unable to comment without either specific details of the patient or a medical examination. 69% of patients responded to the questionnaire. Over half (54%) had applied for an insurance policy. More than a third of patients had required either a medical examination (36%) or a report from their GP (41%) before being accepted for a policy. 39% of patients had received an additional loading on their policies because of IBD including two patients who had been turned down altogether. In conclusion patients with IBD are clearly discriminated against by insurance companies. Life tables should be amended to take account of the low mortality recognised in recent years. Patients should be aware of the difficulties that currently exist.

Adult↗
PubMed1996

Blood donor centres can effectively publicise cancer screening.

The ability of the blood transfusion service to promote cancer screening using the uptake of colorectal cancer screening offered to blood donors as a model was measured. Blood donors were sent an explanation of colorectal cancer screening with their appointment time to give blood. Free faecal occult blood tests (Haemoccult) were offered by a doctor to donors who attended the Leicester Blood Donor Centre. 556 registered blood donors (309 men, 247 women) aged 51 to 65 years were invited to donate blood over a three month period. Of the subjects who arrived to donate and accepted screening. 63% completed a faecal occult blood test with similar compliance in men and women (66% vs. 59%, chi 2 = 1.0, ns). Compliance was higher in older donors aged 61 to 65 years than those aged 51 to 60 years in both men (90% vs. 60%, chi 2 = 7.0, P < 0.01) and women (87% vs. 51%, chi 2 = 6.2, P < 0.02). The proportion of the total target population screened, which included those donors invited to give blood but who did not attend was 21%. This approach successfully targeted donors who attended to give blood, although only a small proportion of the total target population was screened. Blood donor centres could display cancer screening and health promotion literature and encourage doctors supervising sessions to provide further information and advice to donors.

Aged↗
PubMed1996

Cancer surveillance in ulcerative colitis: a survey of patients' knowledge.

BACKGROUND AND STUDY AIMS: The present study aimed to investigate the level of knowledge concerning colorectal carcinoma and its screening and treatment in a group of patients with long-standing and extensive ulcerative colitis. PATIENTS AND METHODS: A postal questionnaire was sent to 61 patients with long-standing and extensive ulcerative colitis. They were asked about their risk of carcinoma, about the existence of screening facilities, and about the treatment of colorectal carcinoma. RESULTS: Forty-three completed questionnaires were returned. Eighty-six per cent of patients were aware of the increased risk of carcinoma. Only 44% knew that it was possible to screen for colorectal carcinoma. Forty-seven per cent of patients were unaware that carcinoma detected at screening would require surgical removal. CONCLUSION: Large numbers of patients are unaware of the existence of screening facilities for colorectal cancer, and are ignorant of the treatment of the disease. Increased public information is required to improve compliance with screening programmes, and to enable patients to take part in decisions about their management.

Colitis, Ulcerative↗
PubMed1996

Sigmoidoscopy and rectal biopsy: a survey of current UK practice.

OBJECTIVE: To establish the pattern of practice of sigmoidoscopy and rectal biopsy in the UK, and to estimate the rate of occurrence of important complications. DESIGN: Postal questionnaire enquiring about practice in the previous 2 years. SUBJECTS: Consultant members of the British Society of Gastroenterology. MAIN OUTCOME MEASURES: Bleeding or perforation following sigmoidoscopy and rectal biopsy. RESULTS: Completed replies were received from 277 consultants, giving a response rate of 84%. Of the sigmoidoscopies performed, 71% were rigid and the remainder fibreoptic flexible sigmoidoscopy (FOS). The complication rate after sigmoidoscopy and rectal biopsy was 0.01%. Perforation was significantly more common in FOS than in rigid sigmoidoscopy (eight in 134,482 sigmoidoscopies versus five in 328,815, chi2 = 5.18, P < 0.05). The distance from anal margin and wall of biopsy did not influence perforation rates. Significant bleeding was similar with both techniques (eight in 134,482 versus 35 in 328,815, chi2 = 2.27, NS). CONCLUSION: Rigid sigmoidoscopy is still more widely used than FOS in the UK, and is probably safer. Complications resulting from rectal biopsy are uncommon but perforation occurs more frequently with FOS than with rigid sigmoidoscopy. The site of biopsy appears to be unimportant.

Biopsy↗
PubMed1996

Long-term therapy with sulphasalazine protects against colorectal cancer in ulcerative colitis: a retrospective study of colorectal cancer risk and compliance with treatment in Leicestershire.

OBJECTIVES: The aims of this study were to (i) estimate the prognosis of a 10-year cohort as expressed by risk of colectomy and risk of development of colorectal cancer, and (ii) assess the impact of long-term sulphasalazine on the natural course of ulcerative colitis. PATIENTS: One hundred and seventy-five patients diagnosed between 1972 and 1981 with either total colitis (n = 143) or with limited ulcerative colitis but deceased (n = 32) were identified. Overall there was 98% case ascertainment and verification. RESULTS: A total of 49 patients underwent a colectomy, 6 as emergency laparotomies, 36 for failed medical management and 7 for known colorectal cancer, giving a crude colectomy rate of 23.2%. The colectomy rate was 7.2% in the year of diagnosis, decreasing in frequency over the next 4 years, then reaching a steady state of approximately 1.7% per year. In the total cohort, colorectal cancer occurred in 10 patients within the study period. The cumulative incidence of colorectal cancer 10 years after diagnosis was 2.1% and at 20 years 7.4% for the total group of patients excluding those with a colectomy. The mean duration of ulcerative colitis before diagnosis was 7.9 years (range 5-12). The crude proportions developing cancer were 5/152 (3%) in the group who took long-term sulphasalazine but 5/16 (31%) in the those who had had their treatment stopped or who did not comply with therapy. This is highly significant using a simple chi 2 test (chi 2 = 20.2, df = 1, P < 0.001). Two methods were used for survival analyses, the log-rank and the generalized Wilcoxon methods. Both give highly significant values for the crude effect of compliance (P < 0.001). CONCLUSION: Patients with ulcerative colitis who were not on long-term sulphasalazine or 5-aminosalicylic acid therapy (either because a doctor stopped it or they did not comply with treatment) were significantly more likely to develop colorectal cancer than their compliant counterparts.

Adult↗
PubMed1996

Does Crohn's disease need differentiation from tuberculosis?

Crohn's disease (CD) and tuberculosis (TB) of the gastrointestinal tract pose major diagnostic problems for clinicians where these conditions coexist. Clinically and radiologically, the diseases are similar. In the West, TB is considered in the differential diagnosis of all suspected cases of CD, particularly among Asian migrants. Earlier age of presentation, perianal disease and enteric fistulae favour a diagnosis of CD. Aphthoid ulceration, pseudopolyps and filiform mucosa at endoscopy are suggestive of CD and a negative tuberculin test us useful. The final diagnosis depends largely on histopathology and the presence or absence of acid fast bacilli. Tuberculosis is more common in developing countries and intestinal TB frequently coexists with pulmonary tuberculosis. TB is known to affect all age groups and fistulous communication, although uncommon, does occur. In addition to radiology and endoscopy, laparotomy may be required to establish the diagnosis. In developing countries, CD is uncommon and remains largely a diagnosis of exclusion. A trial of anti-tuberculosis therapy may often be prescribed before definitely diagnosing CD. The development of molecular biology techniques had led to a revival of interest in mycobacteria as a possible aetiological agent in CD. DNA from Mycobacterium paratuberculosis and Mycobacterium kansaii have both been identified in CD cases but the significance of this finding has not been established. However, in the near future polymerase chain reaction will become increasingly useful in differentiating CD from intestinal TB because it allows the amplification and identification of very small quantities of mycobacterium DNA.

Crohn Disease↗
PubMed1996

Female fertility, obstetric and gynaecological history in coeliac disease: a case control study.

OBJECTIVES: The purpose of this study was to investigate the incidence of infertility, abortions and perinatal mortality, age at menarche and menopause in coeliac disease. METHOD: This was a case control study in which patients and controls, matched for age and sex, were sent questionnaires about their fertility profile and other obstetric and gynaecological problems. All 80 patients and 70 controls replied, but only 68 pairs could be matched for this study. RESULTS: The mean age of menarche in patients was significantly older (13.6 years) than in controls (12.7 years). The mean ages at menopause in patients and controls were 47.6 and 50.1 years, respectively. The mean number of children born to patients was significantly less at 1.9 (SD +/- 0.9) compared to 2.5 (SD +/- 1.2) in controls. Before diagnosis the mean number of children born to patients was 1.4 and 1.8 in controls. After diagnosis and treatment, patients had 0.5 children (SD +/- 0.9) compared to 0.7 in controls (SD +/- 1.2). It seems likely that the overall difference in fertility is due to relative infertility prior to diagnosis and its correction by a gluten-free diet. Significantly more conceptions amongst women with coeliac disease (15%) ended in miscarriage prior to diagnosis than amongst controls (6%). After diagnosis and treatment the rate of miscarriage was similar. There were 120 live babies and 7 stillbirths to patients compared with 161 live babies and 1 stillbirth to controls. CONCLUSIONS: Patients with CD are subfertile and have an increased incidence of stillbirths and perinatal deaths.

Adolescent↗
PubMed1995

The compulsory removal of elderly people in England and Wales under Section 47 of the National Assistance Act and its 1951 Amendment: a survey of its implementation in England and Wales in 1988 and 1989.

Section 47 of the National Assistance Act 1948 and its 1951 Amendment allow for the compulsory removal from their homes of predominantly elderly people to a place of safety. The Amendment has been in use for over 40 years. Little information is available on the workings of the Acts in England and Wales. For the period 1988 to 1989 inclusive, 771 requests for compulsory removal were received by 148 'proper officers'. We examined referrals and removals under the Acts. During this time 165 people were removed. The majority of referrals were from family practitioners (46%), but social workers also played a role (18%). Of the 165 people who were actually removed from their homes, 41 were removed under Section 47 of the National Assistance Act and 124 under its 1951 Amendment. The outcome of compulsory removal was only known in 126 instances. In 34% of cases the person was transferred to residential care and 24% returned home; 18% of the detainees died during their compulsory admission. The outcome varied significantly between health regions (chi 2 = 72; p < 0.001), with for example apparently high death rates in the North West, Trent and South West regions. For a disturbing 24% of people nothing is known of their fate. A mandatory reporting system to examine the use of this legislation is required.

Activities of Daily Living↗