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Biomedical subjects

M A Chamberlain

Publications and source records attributed to M A Chamberlain.

At least 37 records · Page 2Linked to original sources
PubMed2000

Audit of rheumatology services for adolescents and young adults in the UK. British Paediatric Rheumatology Group.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is associated with significant morbidity in adulthood with at least one third of children continuing to have active inflammatory disease into their adult years and up to 60% of all patients continuing to have some limitation of their activities of daily living. A survey of service provision for these young people in the transition from paediatric to adult rheumatology care was therefore undertaken. METHODS: A postal questionnaire was sent to all 92 members of the British Paediatric Rheumatology Group, representing 61 units providing a paediatric rheumatology service in the UK and Eire. RESULTS: Fifty-five replies were received representing a 60% completion rate of doctors and 84% of units on the mailing list. The majority of respondents were adult rheumatologists (n = 36, 65%) with 42% of respondents based in teaching hospitals. A median of 24 patients (new and follow-up, range 1-225) were seen in a median of two paediatric rheumatology clinics (range 0-15) per month. Eighteen per cent of units had a dedicated adolescent clinic (n = 9) with a median of one clinic per month and a median number of new patients per month of two (range 0-24) and 10 review patients (4-32). All the adolescent clinics involved an adult rheumatologist with five having a paediatrician in clinic and four having access to a paediatrician. The majority of clinics involved a specialist registrar (n = 6), a nurse specialist (n = 6), an occupational therapist (n = 6) and a physiotherapist (n = 5). The majority of clinics had flexible entry and exit criteria. In seven clinics there was a standardized process of transfer, first discussed at a median age of 13 yr (range 12-16) but no unit provided literature or organized pre-visits for this process. A demand for patient information resources (e.g. disease and drug information, careers) specifically aimed at adolescents with rheumatic diseases was identified. Generic health issues were only addressed by two clinics. Obstacles to current service provision and ideas for future developments were identified. CONCLUSIONS: This survey identifies a heterogeneity of provision of healthcare for adolescents with rheumatic disease and highlights the potential for further research and development.

Adolescent↗
PubMed2000

Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trial.

OBJECTIVES: After stroke, abnormal arm posture due to spasticity in a functionally useless arm may interfere with self care tasks. In these patients botulinum toxin treatment presents an opportunity to reduce disability. The purpose was to investigate whether reduction in spasticity after botulinum toxin treatment translates into reduction in disability and carer burden. METHODS: Forty patients with stroke with spasticity in a functionally useless arm (median duration 3.1 years) were randomised to receive intramuscular botulinum toxin type A (BT-A; Dysport) (n=20) or placebo (n=20) in a total dose of 1000 MU divided between elbow, wrist, and finger flexors. Spasticity (using the modified Ashworth scale), muscle power, joint movement, and pain were assessed. Disability and carer burden were measured using an eight item and a four item scale respectively. Two baseline and three post-treatment assessments (weeks 2, 6, and 12) were made. Concurrent treatments as far as possible remained unchanged and not optimised. RESULTS: Disability improved at week 6 with BT-A compared with placebo. This effect, present at week 2, wore off by week 12. Reduction in carer burden was seen at week 6 with BT-A and continued for at least 12 weeks. Forearm flexor spasticity was reduced with BT-A up to 12 weeks after treatment. Although significant improvement in elbow flexor spasticity was seen at week 2 with BT-A compared with placebo, this effect was not evident at weeks 6 and 12. Arm pain was not improved after BT-A. Grip strength was reduced with BT-A. No serious BT-A related adverse effects were reported. CONCLUSION: BT-A is useful for treating patients with stroke who have self care difficulties due to arm spasticity. The decision to treat should also include relief of carer burden. As muscle weakness may occur, its potential impact on functional activities must be assessed before intervention.

Adolescent↗
PubMed1999

The persistence of mood disorders following traumatic brain injury: a 1 year follow-up.

The study investigated whether the frequency of mood disorders following traumatic brain injury (TBI) increased with time. Consecutive hospital admissions completed the Wimbledon Self-Report Scale at 6 and 12 months post-injury. Scores in the 'borderline/case' range were deemed clinically significant. Seventy-seven of those assessed at 6 months completed the 12 month follow-up. Those lost to follow-up (22) were not more likely to have been classified 'borderline/case' at 6 months. They were more likely to have been 'unoccupied' pre-injury (p=0.002). The frequency of clinically significant disorders did not change significantly, being 39% at 6 months and 35% 1 year post-injury. The majority of subjects (58) maintained the same clinical classification at both assessments. Eight of the 47 (17%) classified 'normal' at 6 months changed to 'borderline/case' at 12 months. However, 11 of the 30 (37%) classified 'borderline/case' at 6 months were 'normal' at 12 months. The direction of change was not statistically significant (p=0.5). These findings are consistent with previous research. However, the present study examined a larger sample and included a wider range of injury severity, thereby increasing the generalizability of the findings. Also, a broader spectrum of mood disorders was investigated which adds to previous work specifically on depression.

Adolescent↗
PubMed1999

Behçet's disease: evaluation of a new instrument to measure clinical activity.

OBJECTIVE: Behçet's disease (BD) is a rare multisystem disorder characterized by vasculitis. At present, there are no laboratory markers that correlate well with the clinical activity in BD. This has led to the development of an instrument (BD Current Activity Form) to measure activity. Scoring is based on the history of new clinical features present over the preceding 4 weeks prior to assessment. Standardized questions were developed for all parts of the form. The face validity of the proforma was determined following worldwide collaboration with physicians and ophthalmologists managing patients with BD. The aim of this study was to evaluate the interobserver reliability of this form. METHODS: Nineteen patients fulfilling the International Study Group criteria for BD were randomly allocated, questioned and examined independently on the same day by five physicians experienced in BD. RESULTS: There was good agreement between the physicians' rating of oral [intraclass correlation coefficient (ICC) = 0.87] and genital (ICC = 0.95) ulceration, skin involvement (ICC = 0.62 for pustules and ICC = 0.66 for erythema nodosum), arthritis (ICC = 0.62), headache (ICC = 0.80), large vessel (kappa = 0.53), nervous system (kappa = 0.61) and eye involvement (kappa = 0.77). There was poor agreement for the question relating to the presence of bloody diarrhoea (ICC = 0.28). There was significant bias in the rating of fatigue by one of the physicians (F = 5.2, P = 0.001). CONCLUSION: Overall, this instrument has good interobserver reliability for assessing general disease activity. We therefore suggest that this proforma has a place in routine clinical monitoring of patients with BD, as well as assessing outcome in therapeutic trials.

Behcet Syndrome↗
PubMed1998

The vertically integrated pharmacy department.

Pharmacy's challenges and opportunities during a transition from a traditional hospital to an integrated health system are discussed with reference to the experience of a medical center in Vancouver, Washington. When a traditional hospital makes the transition to an integrated health system, pharmacy directors must consider how the core business will be affected, how pharmacy can add value, and how to best apply the skills of the pharmacy department. A well-trained staff that shares a view of the new organization and that can think outside the traditional hospital paradigm is required. New health systems will focus on quality-related outcomes at low cost and on disease management. Partnerships between providers and health care staff will be beneficial. To compete for capitated contracts, health systems will need to deliver services other than acute care to a broad geographic area, and primary care will be more prominent. There will be a shift toward outpatient services, and pharmacy departments will be under increasing pressure to develop outpatient pharmaceutical services. Pharmacy departments will also need to develop treatment guidelines for outpatients and to better manage drug costs by working with new business clients, improving continuity of care, increasing patients' access to care, having pharmacists provide hospice care, and implementing remote prescription-order entry. New health systems will need to have a clear understanding of how their core business is changing; the organizational strategy of a health system must include effective communication of change to staff members with the goal of overcoming traditional thinking.

Hospital Administration↗
PubMed1998

Children with chronic arthritis: the management of transition to adulthood.

Idiopathic juvenile arthritis occurs throughout childhood; the young child needs a major paediatric input while the adolescent, at whatever age the disease started, will need help in achieving a satisfactory transfer to adulthood, perhaps using the 'young adult team'. Throughout, an appropriate team of paediatrician, rheumatologist, physiotherapists, occupational therapists and social workers is important in dealing with such young people and their families. They not only treat the disease but give information to parents and children that will aid the day-to-day management of the condition, and help maintain normal education (progressing to further and higher education) and training leading, hopefully, to an acceptable adult lifestyle.

Adolescent↗
PubMed1998

Mood disorders following traumatic brain injury: identifying the extent of the problem and the people at risk.

The extent of mood disorders following traumatic brain injury (TBI), and the possible risk factors, are investigated. New data are presented from a prospective study of consecutive hospital admissions. Six months post-TBI, 99 adults completed a standardized assessment of emotional state, the Wimbledon Self-Report Scale. Cognitive performance and the impact of the injury on everyday functioning were also assessed. The rate of clinically significant mood disorders (caseness) was 38%. Of the demographic or injury characteristics, only pre-injury occupational status predicted post-injury caseness. Those unoccupied pre-injury were more likely to report mood disturbance post-injury. In contrast, post-injury occupational status was not related to caseness either for the whole group or the subgroup of those previously occupied, despite the adverse effects on occupational functioning for a significant proportion of subjects. Associations were found between emotional state and cognitive and everyday functioning 6 months post-injury. Psychosocial disabilities appeared more strongly associated to mood disorders than did physical disabilities. A significant level of unmet need has been highlighted, and possible risk factors identified, which may inform the purchase and provision of TBI rehabilitation services. Follow-up data on these subjects are available and will be reported separately.

Activities of Daily Living↗
PubMed1997

Prevalence of hip problems in the population aged 55 years and over: access to specialist care and future demand for hip arthroplasty.

To determine the prevalence of hip problems in the population aged 55+, a postal questionnaire was sent to a multistage stratified random sample of residents of a health district with an over-55 population of 210,000. An initial four page postal questionnaire produced an 86% response rate from 18,827 eligible cases. A subsequent detailed questionnaire (with a response rate of 78%) then determined the prevalence of severe pain and severe disability amongst those with hip problems. The prevalence of those with existing hip replacements is estimated at 32.1/1000 (95% CI 29.5-34.9). An estimated 13.5/1000 (95% CI 12.4-14.7/1000) displayed levels of pain and disability consistent with a current need to consider arthroplasty. In addition, it appears that the over 75s are less likely to have access to appropriate surgery. Unless health authorities and, increasingly, general practitioners consider purchasing more hip replacements, the prevalence pool of those who could benefit will inexorably rise.

Age Distribution↗
PubMed1997

Life-threatening transient neonatal Behçet's disease.

This case report describes transient neonatal Behçet's disease, with life-threatening complications in the neonate. Male Baby R developed blood-streaked diarrhoea 5 days after birth, followed by recurrent severe scarring orogenital ulceration and vasculitic skin lesions. In this sixth week of life, he developed stridor leading to a respiratory arrest and necessitating assisted ventilation. No infective cause was isolated. Baby R responded well to i.v. and subsequent oral steroid therapy. At 8 weeks old he had fully recovered and remains well. Baby R's mother was not previously known to have Behçet's disease. During the pregnancy, she began to suffer orogenital ulceration, associated with skin lesions typical of Behçet's disease. Mild orogenital ulceration has become recurrent.

Adult↗
PubMed1997

Factor VII, cholesterol, and triglycerides. The CARDIA Study. Coronary Artery Risk Development in Young Adults Study.

Cross-sectional studies have shown that factor VII coagulant activity (VIIc) is positively associated with plasma total cholesterol (TC), LDL cholesterol, and triglycerides (TG) as well as body mass index (BMI) and diastolic blood pressure. To determine whether changes in VIIc parallel changes in coronary risk factors over a period of 2 years, we examined data from 1514 participants in the Coronary Artery Risk Development in Young Adults Study (CARDIA), an ongoing investigation of lifestyles and evolution of cardiovascular risk factors. Subjects were 23 to 35 years old at the year 5 examination. Cross-sectional analyses at these examinations showed that VIIc was positively correlated (P < .001) with TC and TG in all race/sex groups except for TC in black women at the year 5 examination. Changes in VIIc over the 2-year period were correlated positively with changes in TC in all except black men and TG in all groups; the association of VIIc change with change in TC and TG was reduced only slightly with adjustment for age and BMI at year 5 and 2-year change in BMI. To determine whether the higher levels of VIIc in subjects with higher lipid values were due to activation of the factor or to an increase in the concentration of the factor VII clotting protein, we measured factor VII antigen (VIIag) in a randomly selected subsample of 223 subjects at the year 7 examination. In all sex/race groups, VIIag correlated with VIIc (r = .69 to 0.81). After adjustment for sex and race, the partial correlation coefficient between TG and VIIc was .28 (P = .0001); between TG and VIIag, .35 (P = .0001); between TC and VIIc, .39 (P = .0001); and between TC and VIIag, 0.43 (P = .0001). No associations were observed between lipid levels and the ratio of VIIc to VIIag. We conclude that the raised VIIc with higher lipid levels occurs in blacks as well as whites, in men and women, persists over time, and represents a true increase in the plasma concentration of this clotting factor.

Adult↗
PubMed1997

Outcome following stroke.

A community study based on an age-stratified sample of those aged 55 years and older in a northern health district in the United Kingdom has been used to consider the implications for purchasing health-care services for those who have survived a stroke. The study showed that while almost a quarter of those reporting a stroke had made a full recovery, a wide range of impairments and disabilities persisted. Almost half reported needing help at least daily. A logistic regression model to predict this level of dependency found that impairments, disabilities and other factors, such as locality, were also predictive of dependency. A second model predicting mobility handicap (dwelling restricted) was found to have a similar mix of predictors. These results show how purchasers must consider the broad outcome in terms of a continuum of impairment, disability and handicap. The results also show that handicap is a distinct concept that draws together many influences which act upon the individual.

Aged↗