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Biomedical subjects

J Young

Publications and source records attributed to J Young.

At least 217 records · Page 12Linked to original sources
PubMed1998

Loin pain haematuria syndrome: distress resolved by pain relief.

Loin pain haematuria syndrome (LPHS) is a syndrome of severe chronic pain of unknown aetiology. This study assessed pain, mood variables and psychiatric status in patients (n=26) with LPHS. Patients were assessed before and after treatment with capsaicin. Assessment inventories used were the McGill Pain Questionnaire, the Pain Discomfort Scale, the General Health Questionnaire and the Hospital Anxiety and Depression Scale. Pain relief was achieved in 65% of patients. In this group pain (P < 0.001) and psychiatric (P < 0.01) scores were significantly reduced. By comparison, in those patients who did not gain pain relief, scores remained steady (P > 0.05). In addition, most pain-free patients completely stopped their opiate analgesia without addictive symptoms. These results suggest an organic pathology to LPHS and militate against suggestions of primary psychological cause or drug addiction. The results also show that the psychiatric disturbances associated with this chronic pain disappear if the pain disappears.

Adult↗
PubMed1998

Intubation success rates improve for an air medical program after implementing the use of neuromuscular blocking agents.

To determine whether the success rate for endotracheal intubation improves after implementing the use of neuromuscular blocking (NMB) agents in an air medical program, this retrospective study analyzed all patients requiring endotracheal intubation at two air medical programs (nurse/paramedic crews) over a 5-year period. Air medical program A, the control group, had employed NMB agents throughout the entire study period. Air medical program B, which did not use NMB agents from July 1, 1989 through June 30, 1992, implemented their use starting July 1, 1992. For program A, the overall intubation success rate was 93.5% (202 successful intubations in 216 patients) and the successful intubations/total attempts ratio was 0.67 (202 of 301). For program B, the overall intubation success rate improved from 66.7% (46 successful intubations in 69 patients) before NMB agent use to 90.5% (57 in 63) after NMB agent use (P = .001). The successful intubations/total attempts ratio increased from 0.36 (51 of 141) prior to NMB agent use to 0.48 (63 of 132) after NMB agent use (P = NS). In comparing the 92 patients who did not receive NMB agents to the 40 patients who did, the intubation success rate increased from 69.6% (64 of 92) to 97.5% (39 of 40) (P < .001) and the successful intubation/total attempts ratio increased from 0.36 (73 of 202) to 0.58 (41 of 71) (P = .007). With the use of NMB agents, program B's overall intubation success rate increased significantly, matching the results of program A.

Adjuvants, Anesthesia↗
PubMed1998

Entry into clinical trials in breast cancer: the importance of specialist teams. Scottish Breast Cancer Focus Group and Scottish Cancer Therapy Network.

The aim of this study was to identify the factors influencing entry of women with invasive breast cancer into clinical trials in Scotland. Women diagnosed during 1987 and 1993 were identified from cancer registry data records and their case notes reviewed. Entry into clinical trials was recorded, along with clinical and demographic data for 4688 patients. In 1987, the proportion of women entering clinical trials was 12.3% and, allowing for shorter follow-up, this appeared unchanged in 1993. Patients seen by surgeons with a high case load and those referred to an oncologist were approximately seven times and three times, respectively, more likely to enter a clinical trial (P < 0.0001). The area of Scotland (Health Board) where the woman was first treated also influenced study entry (P < 0.0001), whereas social deprivation had no effect (P = 0.93). Older women, especially those over 80 years of age, were less likely to enter studies (P = 0.05). Extending the management of patients by specialist multidisciplinary teams should increase recruitment into clinical trials and help to identify better treatments for women with breast cancer.

Adult↗
PubMed1998

The genetic basis of tuberous sclerosis.

Tuberous sclerosis is a relatively common inherited disease that causes multiple benign tumours in different organs, frequently leading to skin rashes, seizures and mental handicap. The disease can be caused by mutations in either of two genes, TSC2, identified in 1993, and TSC1, only recently identified. Here we review the current state of knowledge of the molecular genetics of tuberous sclerosis and the spectrum of mutations seen in and the implications of recent findings for patients. Although both genes appear to function as tumour suppressors, the function of their protein products is not understood. A speculative model of how these proteins might function is briefly described.

Genes, Tumor Suppressor↗
PubMed1998

Urokinase receptor genotypes in colorectal cancer.

A previous study has reported a high frequency of rare alleles of the urokinase-type plasminogen activator receptor (uPAR) in a set of 15 colorectal cancer (CRC) cell lines. Our study investigated uPAR gene variation in 92 CRC patients and in tumour DNA from a subset of 69 patients using the PLAUR-IVS3 marker located in an intron of this gene. The overall distribution of the marker alleles in the patients did not differ significantly from a set of 105 controls. A pairwise analysis of individual allele frequencies showed, however, that the common allele 147 was significantly decreased (P = 0.027) and allele 149 was significantly increased (P = 0.033) in the patients. These results may indicate an effect of uPAR gene variation in CRC carcinogenesis and encourages further examination of this marker in an independent series of patients.

Alleles↗
PubMed1998

Mutations in DPC4 (SMAD4) cause juvenile polyposis syndrome, but only account for a minority of cases.

Juvenile polyps are present in a number of Mendelian disorders, sometimes in association only with gastrointestinal cancer [juvenile polyposis syndrome (JPS)] and sometimes as part of known syndromes (Cowden, Gorlin and Banayan-Zonana) in association with developmental abnormalities, dysmorphic features or extra-intestinal tumours. Recently, a gene for JPS was mapped to 18q21.1 and the candidate gene DPC4 (SMAD4) was shown to carry frameshift mutations in some JPS families. We have analysed eight JPS families for linkage to DPC4. Overall, there was no evidence for linkage to DPC4; linkage could be excluded in two of the eight pedigrees and was unlikely in two others. We then tested these eight families and a further 13 familial and sporadic JPS cases for germline mutations in DPC4. Just one germline DPC4 mutation was found (in a familial JPS patient from a pedigree unsuitable for linkage analysis). Like all three previously reported germline mutations, this variant occurred towards the C-terminus of the DPC4 protein. However, our patient's mutation is a missense change (R361C); somatic missense mutations in DPC4 have been reported previously in tumours. We therefore confirm DPC4 as a cause of JPS, but show that there is considerable remaining, uncharacterized genetic heterogeneity in this disease.

DNA-Binding Proteins↗
PubMed1998

Australian general practitioners' views and use of tests to detect early prostate cancer.

To describe general practitioners' current beliefs, knowledge and self-reported practices in prostate cancer screening, we conducted a national survey of 1,271 general practitioners, obtaining 855 completed questionnaires (67% response rate). Available tests for prostate cancer screening, namely DRE and PSA alone and in combination, were indicated to be effective by 49%, 43% and 68% of respondents respectively, with older GPs significantly more likely to hold these views. The effect of guidelines was mixed. Less than 8% of respondents indicated they did not recommend screening. Although the majority of GPs were unlikely to adopt an opportunistic approach to prostate cancer screening, 63%, 57% and 46% indicated they would recommend DRE, PSA or both respectively during a dedicated health check up. Awareness of relevant guidelines was low, with nearly half of respondents unable to recall publications from the RACGP or ACS. Counter-intuitively, awareness of ACS guidelines for prostate cancer screening (which advise against screening) was significantly associated with the converse behaviour. Findings from this first national study behove proactive and highly targeted dissemination in general practice of the AHTAC policy announced by the Commonwealth Health Minister in August 1996.

Adult↗
PubMed1998

Morphology of sporadic colorectal cancer with DNA replication errors.

BACKGROUND: Up to 15% of colorectal cancers are characterised by DNA microsatellite instability (MIN), shown by the presence of DNA replication errors (RERs). AIMS: To identify pathological features that are discriminating for colorectal cancer (CRC) showing extensive MIN. SUBJECTS: A prospective series of 303 patients with CRC and no family history of either familial adenomatous polyposis or hereditary non-polyposis colorectal cancer. METHODS: DNA was extracted from fresh tissue samples and the presence of MIN was studied at nine loci that included TGF beta RII, IGFIIR, and BAX. The 61 cases showing RERs were compared with 63 RER negative cases with respect to a comprehensive set of clinical and pathological variables. Predictive utility of the variables was tested by decision tree analysis. RESULTS: Twenty seven patients with CRC showed extensive RERs (three loci or more) (RER+) and 34 had limited RERs only (28 = one locus; 6 = two loci) (RER+/-), yielding a bimodal distribution. RER+ cancers differed from RER- and RER+/-) cases. Tumour type (adenocarcinoma, mucinous carcinoma, and undifferentiated carcinoma) (p = 0.001), tumour infiltrating lymphocytes (p = 0.001), and anatomical site (p = 0.001) were the most significant of the discriminating variables. Algorithms developed by decision tree analysis allowed cases to be assigned to RER+ versus RER- and +/- status with a global sensitivity of 81.5%, specificity of 96%, and overall accuracy of 93%. CONCLUSIONS: Pathological examination of CRC allows assignment of RER+ status; assignment is specific and relatively sensitive. Conversely RER- and RER+/- CRC are indistinguishable.

Adenocarcinoma↗
PubMed1998

Do the beliefs of Australian general practitioners about the effectiveness of cancer screening accord with the evidence?

A national random sample of 855 Australian general practitioners was surveyed about their belief in the effectiveness of cancer screening tests in reducing premature mortality. Responses were then compared with scientific evidence of effectiveness for each test. 92% of respondents believed mammography to be effective compared with only 38% for faecal occult blood testing, despite comparable evidence of effectiveness from randomised controlled trials. Seven tests outranked their belief in faecal occult blood testing, despite weaker evidence. Further efforts are required to align general practitioners' beliefs better with the evidence.

Attitude of Health Personnel↗
PubMed1998

Training to enhance partnerships between mental health professionals and family caregivers: a comparative study.

A training program for mental health staff was collaboratively developed and delivered by family caregivers and professionals. It addressed calls for less blaming attitudes toward families and increased contact between professionals and families. Two levels of training were compared. Twenty-seven staff members completed a 30-hour extended 12-week program. Eighty-two percent of all eligible staff from area teams attended a brief program involving three or six hours of training. Self-ratings of competence and attitudes toward families improved only for staff receiving extended training. Contacts with families increased for those in the extended program but not for all types of teams, suggesting that length of training and service type may limit the impact of training.

Analysis of Variance↗
PubMed1998

Development of an aromatherapy service at a Cancer Centre.

The aromatherapy service at the Cancer Support and Information Centre (CSIC) of this regional Cancer Centre has been continually assessed since its inception in 1993. New methods of assessing complementary therapies, based on the 'therapy-as-practised', have been explored. The present study evaluates the service following changes made after an initial pilot. The professional aromatherapist developed an evaluation tool, and formal questionnaires were limited to the Hospital Anxiety and Depression Scale (HADS). HADS was completed before and after a course of six aromatherapy sessions. Of 89 patients referred, 58 patients completed the six sessions. Referrals were made by health professionals working in the Cancer Centre and in the CSIC. The majority of patients were female with breast cancer and were receiving radical oncological treatment. Tension, stress and anxiety/fear were the most common reasons for referral, and this was reflected in high initial HADS scores. There were significant improvements in HADS scores in the 58 patients completing the course (mean anxiety, depression, and combined scores dropped from 8.9 to 6.2 6.1 to 4.0 and 15.0 to 10.2, respectively, P < 0.001). Fifty per cent or more of the sample reported a significant improvement in the eight most commonly assessed symptoms. The therapist was initially cautious about using questionnaires, but she gained confidence in using HADS as an assessment tool. The areas covered by her own evaluation tools were broadly comparable to established instruments such as the EORTC QLQ-C30. We conclude that aromatherapy massage has a role in reducing psychological distress, and improving symptom control in cancer patients. Further service evaluation is needed to promote appropriate referral and effective planning of treatment, and to justify cost. Given the multifaceted nature of complementary therapies, the need to develop new research methodologies is acknowledged.

Adult↗
PubMed1998

Absence of activating mutations in the GnRH receptor gene in human pituitary gonadotroph adenomas.

The monoclonal origin of gonadotropin-secreting pituitary adenomas has been well demonstrated but only few molecular abnormalities have so far been recognized in these tumors. For many years, several authors have suggested a role for GnRH and/or GnRH receptors (GnRH-R) in the development of these pituitary adenomas. To test the hypothesis that mutant genes encoding a constitutively activated GnRH-R might be involved in the pathogenesis of these tumors, the sequence of the GnRH-R gene was analyzed in tumoral pituitary tissue obtained from ten patients (six female, four male). The pituitary gonadotropin-secreting adenoma was associated with in vivo hypersecretion of FSH, LH and/or free alpha-subunit (n = 7) or was clinically silent (normal plasma levels of gonadotropins or free alpha-subunit, n = 3). In all cases, immunocytochemical studies of the removed adenoma confirmed their gonadotroph nature by revealing positivity for FSH, LH and/or alpha-subunit. Genomic DNA was extracted from the pathological tissue obtained at neurosurgery. Eight sequencing primers were used to amplify the three exons of the GnRH-R gene from tumoral DNA. The entire coding sequence of the GnRH-R gene was sequenced in the ten adenomas. No mutation was found in any of the tumor specimens examined. In conclusion, mutations in the GnRH receptor coding sequence occur infrequently if at all in gonadotropin-secreting pituitary adenomas.

Adenoma↗
PubMed1998

Establishing ambulatory chemotherapy at home.

The use of infusional ambulatory chemotherapy is increasing. Careful patient selection and a structured programme of teaching and home support is required. Continuous ambulatory chemotherapy can improve clinical outcomes and provide both psychological and financial benefits.

Ambulatory Care↗
PubMed1998

The effects of primary division, student-mediated conflict resolution programs on playground aggression.

This study examined the effects of a student-mediated conflict resolution program on primary school (junior kindergarten to grade 5) playground aggression. Mediation teams of grade 5 students (approximately age 10) participated in 15 hours of training according to the model developed by Cunningham, Cunningham, and Martorelli (1997). Following baseline observations, mediation was introduced onto the playgrounds of three schools according to a multiple baseline design. Mediators successfully resolved approximately 90% of the playground conflicts in which they intervened. Direct observations suggest that the student mediation program reduced physically aggressive playground behavior by 51% to 65%. These effects were sustained at 1-year follow-up observations. Teacher and mediator satisfaction questionnaires provided strong support for impact, feasibility, and acceptability of this program.

Aggression↗