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Biomedical subjects

J Robertson

Publications and source records attributed to J Robertson.

At least 127 records · Page 7Linked to original sources
PubMed1995

Efficacy of tricyclic drugs in treating child and adolescent depression: a meta-analysis.

OBJECTIVE: To examine whether tricyclic antidepressants are superior to placebo in the treatment of child and adolescent depression. DESIGN: Meta-analysis of 12 randomised controlled trials comparing the efficacy of tricyclic antidepressants with placebo in depressed subjects aged 6-18 years. MAIN OUTCOME MEASURES: Most studies employed several depression rating scales. For each study the "best available" measure was chosen by using objective criteria, and individual and pooled effect sizes were calculated as the number of standard deviations by which the change scores for the treatment groups exceeded those for the control groups. Where authors had reported numbers "responding" to treatment we calculated individual and pooled ratios for the odds of improvement in treated compared with control subjects. RESULTS: From the six studies presenting data which enabled an estimation of effect size the pooled effect size was 0.35 standard deviations (95% confidence interval of -0.16 to 0.86) indicating no significant benefit of treatment. From the five studies presenting data on the number of "responders" in each group, the ratio of the odds of a response in the treated compared with the control subjects was calculated and the pooled odds ratio was 1.08 (95% confidence interval of 0.53 to 2.17); again indicating no significant benefit of treatment. The pooled sample had more than an 80% chance of detecting a treatment effect of 0.5 standard deviations or greater. There was an inverse relation between study quality and estimated treatment effect. CONCLUSIONS: Tricyclic antidepressants appear to be no more effective than placebo in the treatment of depression in children and adolescents.

Adolescent↗
PubMed1995

Response to a specific antioestrogen (ICI 182780) in tamoxifen-resistant breast cancer.

We treated 19 patients with advanced breast cancer resistant to tamoxifen with a new specific antioestrogen (ICI 182780) which, in animal studies, has no agonist activity. 13 (69%) patients responded (7 had partial responses and 6 showed no change) to monthly intramuscular injections of ICI 182780 after progression on tamoxifen, for a median duration of 18 months with minimum side effects. Preliminary evidence suggests that the agent is without effects on the liver or the hypothalamic-pituitary axis. ICI 182780 appears to be a promising new agent for treatment of advanced and early breast cancer.

Aged↗
PubMed1995

The value of serological testing for Lyme disease in the UK.

Although the prevalence of Lyme disease (LD) in the UK is low, patients with clinical presentations compatible with the condition are common. Arthritis often complicates LD in North America, however it is a very rare complication of the condition in the UK. Many patients seen at St George's Hospital, London have visited endemic areas for LD within the UK, Europe and North America. To determine the value of serological testing for LD in the UK, we prospectively studied 120 patients seen at this hospital with clinical manifestations suggestive of LD (12 of whom were recruited to the LD clinic from outside the hospital catchment area), regardless of whether an alternative diagnosis seemed likely. A history of tick bite was obtained and serum antibodies to Borrelia burgdorferi detected initially by enzyme-linked immunosorbent assay (ELISA) and reactive samples immunoblotted to further assess antibody specificity. Tick bites were reported by 22 patients, 16 of whom were bitten in endemic areas for LD. A further 11 patients had exposure to tick habitats in endemic areas, but were unaware of a tick bite. Raised antibody levels were detected by ELISA in 14 individuals (seven of whom had a history of tick bite or tick exposure in an endemic area); however, only four of these had specific antibodies to B. burgdorferi confirmed on immunoblot. All of these four had a history of tick bite in an endemic area, all had arthritis and in three of the four, this was the only manifestation of the condition.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Justifying the cost of a computer-based patient record.

Computer-based patient records (CPRs) that integrate financial and clinical information are important tools for improving the quality and lowering the cost of care. However, purchasing, implementing, and maintaining a CPR requires a significant investment that must be justified. At The University of Texas M. D. Anderson Cancer Center, a cost-benefit analysis of a CPR involved identifying the goals of a CPR, determining its quantifiable and nonquantifiable benefits, estimating its initial costs, projecting its costs and benefits over 10 years, calculating its net present value, and monitoring its results.

Cancer Care Facilities↗
PubMed1994

The determination of cocaine and related substances by micellar electrokinetic capillary chromatography.

A quantitative method for the determination of cocaine and related substances by micellar electrokinetic capillary chromatography (MECC) is described. Quantitative results obtained for both monitor materials and a number of actual drug seizures by this new capillary electrophoretic method are comparable to a gas chromatography (GC) run in parallel, both in the values and coefficient of variation achieved. The advantages of this new method include minimal use of solvents, the ability to readily automate the procedure and the ability to quantitate illicit heroin seizures under the same conditions with the exception of detector wavelength alteration. The method has proved rugged and reliable for both heroin and cocaine in a number of inter-laboratory proficiency studies.

Buffers↗
PubMed1994

Utah Growth Study: growth standards and the prevalence of growth hormone deficiency.

Serial measurements of elementary-school children were conducted for 2 consecutive years to assess height and growth velocity and to determine the prevalence of growth hormone deficiency (GHD) in American children. Trained volunteers measured 114,881 children the first year; 79,495 growth rates were calculated after the second measurements. The height and growth velocity curves generated were very similar to the currently used charts. We examined 555 children with short stature (< 3rd percentile) and poor growth rates (< 5 cm/yr). Five percent had an endocrine disorder. The presence of GHD (peak level, < 10 ng/dl with two provocative tests) was found in 16 previously unrecognized children; 17 children from this school population were already known to have GHD. Boys outnumbered girls 2.7:1 (p = 0.006). Six girls with Turner syndrome also were identified. We conclude that (1) the growth curves generated in the 1960s and 1970s are valid for children of the 1990s; (2) most children growing < 5 cm/yr (a commonly used threshold rate) will not have an endocrine disorder; (3) many children (48% in this study) with GHD and others with Turner syndrome may currently be unrecognized and untreated; (4) GHD appears to be more common in boys; and (5) the prevalence of GHD in the United States is at least 1:3480.

Child↗
PubMed1994

Intermittent intravenous therapy: a comparison of two flushing solutions.

In the light of evidence which linked heparin induced thrombocytopoenia (HIT) to the prolonged flushing of intermittent i.v. cannula with heparinised saline, a randomised control trial was mounted to determine whether this solution was a superior flushing agent to normal saline. 152 inpatients between the ages of 2 months and 18 years were allocated to a control group which had heparinised saline prescribed as a flushing agent, or an experimental group which was prescribed normal saline. Each day i.v. sites were examined for signs of phlebitis and on removal each cannula was flushed to check for fibrin. In total 200 cannulae representing 510 i.v. days were assessed. No significant differences were detected in either the duration of IV therapy, the patency of the i.v. line or the incidence of phlebitis when normal saline was used to flush the i.v. cannulae. On chi square testing however, highly significant associations emerged between the incidence of phlebitis and the use of the i.v. antibiotics tobramycin (p = 0.05) and/or Timentin (p = 0.008). In addition, young children were found to have a significantly higher incidence of blocked cannulae--regardless of the flushing solution used.

Adolescent↗
PubMed1994

Paraffin ingestion--the problem.

Paraffin ingestion is the commonest cause of accidental childhood poisoning in South Africa. Children from the lower socio-economic group are affected most. They drink paraffin in the summer months from bottles or intermediate containers, mistaking it for water or cold-drink. The children are predominantly male with a mean age of 24 months. The clinical picture is one of respiratory distress with a hospital case fatality rate of 0.74%. The use of paraffin as a source of household energy in South Africa is on the increase. Based on a modernisation index it would seem that this trend will continue into the next century. It can therefore be expected that the number of cases of paraffin ingestion will steadily increase if no active steps are taken to address the problem. Prevention should entail a wide spectrum of measures, the basis of which should be a child-resistant container. An effective durable, low-cost child-resistant container which is easy to pour from should be made available by petroleum companies and/or entrepreneurs and distributed through their network. This should be combined with health education on the danger of paraffin. Health care workers and administrators should be made more aware of the problem and become involved in health education and prevention. Further research should be undertaken on the effect a change in the colour of paraffin and the use of child-resistant caps would have on the incidence of paraffin ingestion in South Africa.

Accidents, Home↗
PubMed1994

The impact of child-resistant containers on the incidence of paraffin (kerosene) ingestion in children.

The commonest cause of accidental poisoning in the South African black paediatric population is paraffin ingestion. In this intervention study a specifically designed child-resistant container (CRC) was introduced to evaluate whether its use would decrease the incidence of paraffin ingestion. CRCs were distributed to 20,000 households in the study area (Gelukspan district). No CRCs were distributed in the control area (Lehurutshe district). Health education about paraffin poisoning prevention was given in both the control and the study areas. The monthly incidence rates of paraffin ingestion were monitored during the 14-month intervention period after the distribution and were compared with the pre-intervention incidence rates in the study and control areas. The main finding was that the incidence of paraffin ingestion dropped by 47% in the study area during the intervention period. The circumstances surrounding the cases of paraffin ingestion that still occurred in the study and control areas were investigated by means of a questionnaire. We recommend that paraffin be sold in CRCs, and suggestions are made for improving health education to prevent paraffin poisoning.

Accidents, Home↗
PubMed1993

Prediction of visual function in eyes with mild to moderate posterior pole residua of retinopathy of prematurity. Cryotherapy for Retinopathy of Prematurity Cooperative Group.

OBJECTIVE: The Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) assigned eyes with macular heterotopia to the "favorable" outcome category and eyes with retinal fold involving the macula to the "unfavorable" outcome category. This binary assignment did not agree well with measured visual acuity outcome. We tested the hypothesis that rating structural outcome on a continuum from less to more severe would improve prediction of visual acuity in eyes with macular heterotopia or retinal fold. DESIGN: Fundus photographs of the 69 eyes in the CRYO-ROP trial that had macular heterotopia (n = 55) or retinal fold (n = 14) at the 1-year follow-up were analyzed for severity of macular heterotopia, macular elevation, and pigmentary disturbances. Each physician author estimated each eye's predicted Snellen acuity, based on the photographic findings and clinical expertise. These results were compared with the grating acuity obtained at ages 1 and 3 1/2 years with the Teller Acuity Card procedure and with letter acuity obtained at age 3 1/2 years with the crowded HOTV test. PATIENTS: The 69 eyes were from 59 patients in the randomized portion of the CRYO-ROP trial. RESULTS: Although eyes with retinal fold tended to have greater visual impairment than eyes with macular heterotopia, there was a wide variation in acuity in both groups, and physicians were unable to predict visual acuity from retinal appearance. CONCLUSION: The physician cannot reliably predict either grating acuity or letter acuity in eyes with macular heterotopia or macular fold due to retinopathy of prematurity. There is no substitute for periodic visual acuity testing in these eyes.

Child, Preschool↗