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Biomedical subjects

P Knapp

Publications and source records attributed to P Knapp.

At least 19 recordsLinked to original sources
PubMed2002

Provision of information about drug side-effects to patients.

To make informed decisions about taking medicinal drugs, people need accurate information about side-effects. A European Union guideline now recommends use of qualitative descriptions for five bands of risk, ranging from very rare (affecting <0.01% of the population), to very common (>10%). We did four studies of more than 750 people, whom we asked to estimate the probability of having a side-effect on the basis of qualitative and quantitative descriptions. Our results showed that qualitative descriptions led to gross overestimation of risk. Until further work is done on how patients taking the drugs interpret these terms, the terms should not be used in drug information leaflets.

Adult↗
PubMed2001

Information provision for stroke patients and their caregivers.

BACKGROUND: The provision of information has been recommended as a key component of service provision after stroke. However, research suggests that patients' understanding of stroke and associated issues remains poor. We determined to undertake a systematic review of information provision strategies for patients and their carers after stroke. OBJECTIVES: To examine the effectiveness of an information and/or education strategy to improve the outcome of stroke patients and/or their identified caregivers. SEARCH STRATEGY: Relevant trials were identified in the Cochrane Stroke Group Specialised Trials Register (last searched: June 2000). Additional intervention-based search strategies were developed for: The Cochrane Controlled Trials Register (CENTRAL/CCTR) Medline; Embase; CINAHL; ISI citation index; Science and Social Science Citation Indexes; ISI Web of Science Service; Aslib Index to UK theses; Dissertation Abstracts International, ASSIA and Psychlit/PsycINFO. We also searched the Journal of Advanced Nursing, bibliographies of retrieved papers, relevant articles and books. SELECTION CRITERIA: Two or three investigators independently assessed trials and abstracts identified for eligibility, methodological quality and other participant characteristics. DATA COLLECTION AND ANALYSIS: Data were extracted independently using piloted data extraction forms. The primary outcomes were knowledge about stroke and stroke services, and impact on health, specifically mood. MAIN RESULTS: We identified 152 abstracts, of which 36 studies were potentially relevant to this review. The current analysis includes nine completed trials, a further eight studies are ongoing. Of the nine trials, three evaluated a programme of lectures and the remaining trials evaluated the provision of information. There is some evidence that information combined with educational sessions improved knowledge and was more effective than providing information only. Information provision only had no effect on mood, perceived health status or quality of life for patients or carers. Two trials used an objective measure of satisfaction and no significant differences were found between groups. One trial reported that information and education sessions for carers improved 'family functioning'. REVIEWER'S CONCLUSIONS: The results of the review are limited by the variable quality of the trials and the wide range of outcome measures used. The general effectiveness of information provision has not been conclusively demonstrated. Future work should address the expressed needs of patients and carers and seek to identify appropriate teaching strategies which can be successfully implemented within clinical practice.

Caregivers↗
PubMed2001

Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month.

BACKGROUND AND PURPOSE: Previous studies have reported mood symptoms after stroke to be a risk factor for later mortality. The purpose of the study was to examine whether mood symptoms at 1 month after stroke may be a risk factor for mortality at 12 and 24 months. METHODS: As a cohort within a randomized controlled trial, 448 hospital patients were seen at 1 month after stroke and were randomized into a trial of psychological therapy. Follow-up was at 12 and 24 months. Mood symptoms were assessed by the Present State Examination and the General Health Questionnaire (GHQ)-28. Measures of disability before and after stroke and of cognitive impairment after stroke were also taken at 1 month. Mortality was determined at 12 and 24 months after stroke. RESULTS: In logistic regression analyses, mortality at 12 months was associated unifactorally with scoring on the GHQ-D subscale (odds ratio [OR] 2.4, 95% CI 1.3 to 4.5) and scoring in the highest quartile of the GHQ (OR 3.1, 95% CI 1.1 to 8.8). In multiple logistic regression analyses, only GHQ-D remained a significant predictor after controlling for other known predictors. At 24 months, scoring on GHQ-D (OR 2.4, 95% CI 1.4 to 4.1) and in the highest GHQ quartile (OR 2.2, 95% CI 1.0 to 4.8) was significantly associated with mortality in unifactoral analyses. Scoring on the GHQ-D remained a predictor of mortality after controlling for other variables. Psychiatric disorder, such as major depression (according to International Classification of Diseases, 10th Revision), was not statistically significantly associated with increased mortality at 12 or 24 months. CONCLUSIONS: Mood symptoms on a self-reported rating scale were associated with 12- and 24-month mortality after stroke, after adjustment for factors associated with stroke severity. The result is in keeping with other evidence that depressive symptoms are a risk factor for death from vascular disease.

Aged↗
PubMed2000

[The value of computerized topographic evaluation for CIN changes in the cervix of young women based on effectiveness of CO2 laser therapy].

OBJECTIVES: Cervical cancer is one of the commonest neoplasms occurring in the female population of Poland. The discontinuance of radical treatment in CIN (Cervical Intraepithelial Noeplasia) cases for several years now is of particular importance for young women who are still in the reproductive age. DESIGN: The aim of the study was to evaluate early changes in the epithelium of the cervix by means of computer analysis of the fluorocolposcopic pattern. MATERIALS AND METHODS: The study included 164 young women (out of 2,098 women with cervical lesions) aged 18-35 years with a diagnostic of incipient CIN I-III changes in the cervix. The precise topography of the lesions was determined in fluorocolposcopy by the Berthalanffy technique using acridine orange. In the method the fluorocolposcopy made by "Polskie Zakłady Optyczne" was used. The analysis of the picture was made on the basis of a "MicroScan" programme. The florocolposcopic ones was transferred directly to the IBM Pentium II computer by means of a highly sensitive colour CCD OSCAR 35 camera. The image analysis was made simultaneously using a monochromatic camera CCD 6012P basing on a defined scale of greyness that corresponded to the luminescent of the method. The patients were treated exclusively with CO2 laser in the clinical reference centre. RESULTS: Of all the patients treated, a cure after one application of CO2 laser was achieved in 94.6%. 1 women with a pretreatment diagnosis of a CIN III lesions required further therapy. In all the 9 women (5.4%) requiring also further treatment, the degree of progression of the lesions was never greater than that found in the pretreatment evaluation. CONCLUSIONS: Extended colposcopic techniques (especially fluorocolposcopy) give a good insight into the biology of tissues involved in CIN processes. The introduction of computer analysis of fluorocolposcopic patterns permits precise determination of the topography of the lesions; especially to increased the efficacy of destructive treatment by CO2 laser. After the introduction of computer techniques in evaluation patterns of lesions, the efficacy of CO2 laser treatment of CIN lesions in young women is expected to rise to 99%.

Adult↗
PubMed1999

Effect of a urinary control insert on quality of life in incontinent women.

The aim of the study was to evaluate the efficacy, safety and effect on quality of life of the Reliance urinary control insert (Uromed Corp., Needham, MA) in women with genuine stress incontinence. Efficacy was evaluated at baseline and at the end of the 12-month study period by standardized pad-weight studies and by rating scales measuring acceptability, incontinence symptom improvement, ease of learning, comfort and time to habituation, recorded in diaries at monthly intervals in 63 women. The SF-36 Health Survey questionnaire was used to assess quality of life status at baseline without the device and after 12 months of device use. A significant decrease in urine loss at 12 months compared with baseline was shown by standardized pad-weight studies, with and without the device in situ. Urine loss was reduced by more than 80% in 91% of the 63 patients, and 79% were completely dry. Patient diaries showed significant improvement in control of leakage, comfort, and ease of device use during the study period. Short-term-36 Health Status data also indicated significant improvement in the physical functioning score at 12 months. Urinary tract infection and hematuria were the most common adverse effects. The Reliance urinary control insert is an efficacious and safe means of controlling genuine stress incontinence in women. The device was perceived as easy to use and comfortable for these 63 women, and resulted in improved quality of life.

Adolescent↗
PubMed1999

[In Process Citation]

Mesenteric cysts are a rare cause of disease. In our hospital we treated one patient who suffered from bilateral ureteral obstruction followed by hydronephrosis, caused by a large mesenteric cyst. Because of its extent complete enucleation--the surgical procedure of choice--was not possible. We opened the cyst and made an external percutaneous drainage. After this treatment the patient recovered and even after 6 months there was no recurrence.

Journal Article↗
PubMed1999

Disagreement in patient and carer assessment of functional abilities after stroke.

BACKGROUND AND PURPOSE: The aims of this study were to describe differences between functional ability assessments made by stroke patients and their informal carers and to investigate the psychological associates of the difference in assessments. METHODS: A prospective design was used, with repeated assessments of function, mood, and carer strain. Thirty hospital stroke patients and their main carer were interviewed 3 times: within 1 month of stroke, 1 month after discharge, and 6 months after discharge. RESULTS: There were significant differences between patient and carer assessments at all 3 time points, with patient self-assessment less disabled than carer assessment (at least P<0.02). The disagreement in assessment was unrelated to patient or carer mood (P>0.05) but greater disagreement was associated with greater carer strain (P<0.05). The source of the disagreement in functional ability assessment remains unclear. CONCLUSIONS: The method of assessment affects the rating of functional abilities after stroke. Carer strain is potentially increased when the patient or carer makes an unrealistic assessment of the patient's level of independence.

Activities of Daily Living↗
PubMed1999

[The effectiveness of conservative treatment of cervical lesions using the LLETZ and CO2 laser].

Development made on the carcinogenesis process of the cervical lesions and increased detection of the early precancerous lesions enable discontinuance of radical treatments for non-radical techniques which it is of vital importance to young women of the child-bearing capacity. The aim of this study was to determine the efficacy of the non-radical treatment of the cervical lesions using LLETZ procedure (Large Loop Excision of Transition Zone) and laser CO2 vaporisation. 2046 women aged 18-46 who were diagnosed for cervical lesions were treated in the Institute of Obstetrics and Gynaecology Medical School of Bialystok in the years 1994-97. 216 of which were histologically confirmed for CIN I-III diagnosis. The choice between LLETZ or laser CO2 was made based on a pre-treatment examination (cytology, colposcopy, microbiology test and punch biopsy). The final results were evaluated from 6 months to 4 years after the treatment. The effectiveness of CO2 laser was 94.6% and was similar to LLETZ--96.4%. In spite of almost complete agreement in both procedures, the LLETZ seems to be more preferred because of the possibility of histological post-treatment verification.

Adult↗
PubMed1998

Psychological associations with emotionalism after stroke.

The psychological associations with emotionalism were examined, 1 month after stroke, in 448 stroke survivors who met inclusion criteria for a randomised trial of psychological treatment. One hundred and one (21.5%) patients had emotionalism. Thirty eight (38%) of those with emotionalism had a clinically significant mood disorder, compared with 64 of 347 (18%) of those without emotionalism. Emotionalism was associated with 10 other psychiatric syndromes, the presence of most of which could be accounted for by the coexistence of depression with emotionalism. In a logistic regression analysis, irritability and ideas of reference were associated with emotionalism after adjustment for the presence of depression. These psychological associations with emotionalism may be incorporated into a psychological model of emotionalism as a disorder of emotional control, and they may help in the understanding of the socially disabling effects of this common condition.

Adolescent↗
PubMed1997

[The organization of the database and data flow in mass screening for cervical cancer].

Mass screening, because of very many potential patients, requires storing and processing a great deal of medical and population information. That is why it should be supported not only by human resources but by computer techniques as well. The example of a computer science application in medicine is Populations Database System (PDB) which was designed and implemented in the Department of Institute of Mother and Child in Białystok. The aim of this work is to evaluate PDB System's effectiveness in mass screening for cervical cancer. Population database contains several standard database files (DBF) and indexes. All the data is organized as a relational database. Every data relationship is at least in 1NF (first normal form). Functional dependency holds for the structures of database. Because of great variety of stored data it was essential to design how to enter information and how to combine database files to avoid redundancy. It has particular importance for the special functions of system, for example printing and sending individual invitation for an examination. In addition the system can realize all standard database functions and some statistical analysis. Special attention was paid to the problem of data security which is particularly important for medical information. Thanks to PDB system we could realize mass and active screening for cervical cancer in Białystok. Without computer techniques it would be impossible to store, process and interpret so much data.

Databases as Topic↗
PubMed1996

Effectiveness of a urinary control insert in the management of stress urinary incontinence: early results of a multicenter study.

OBJECTIVES: The purpose of this study was to test the safety and effectiveness of a urethral insert for managing stress or mixed urinary incontinence. METHODS: We performed a prospective, multicenter study of 135 female patients who were treated for 4 months with the Reliance Urinary Control Insert. The effectiveness of the insert was measured objectively at the time of first use and after 4 months' use by standardized pad weight studies. Insert effectiveness was also measured by reports of symptom improvement during patient interviews and on patient diaries. Urine microscopy and culture were obtained monthly; cystoscopy and urodynamics were conducted at study entry and at 4 months. RESULTS: Significant improvement in involuntary urine loss was observed. Objective measurement of urine loss revealed that 80% of the patients were completely dry, and 95% of the patients achieved greater than an 80% decrease in urine loss. In addition, patients' perceptions of acceptability, incontinence symptom improvement, ease of learning, comfort, and time to habituation also showed improvements. Untoward events reported during the study included hematuria, bacteriuria, and bladder irritation. These events did not require significant medical intervention and did not result in any long-term clinical sequelae. CONCLUSIONS: These preliminary results indicate that the Reliance Urinary Control Insert may be a safe, effective, and well-tolerated alternative to other available methods for the management of stress or mixed incontinence in women. Additional long-term follow-up will be required to substantiate this conclusion.

Adolescent↗
PubMed1992

Organization of the screening programme in Bialystok Province.

This paper describes the new "model" of the cervical cancer screening introduced as pilot study in the Białystok Province. The new programme was carried out to choose which "model" was better: computerized monitoring and invitation to the women to the outpatient clinic for the Pap-test performed by screeners on full integration into gynecologic health care. The new system introduced in the chosen outpatients clinics increased the acceptance (of the screening) by women especially in younger age groups.

Adult↗
PubMed1990

[Characteristics of "high risk" group in carcinomas of the uterine body].

Forty nine patients with carcinoma of the uterine body were examined. Four hundred ninety one normal females served as controls. The risk factors included: age over 30, premenstrual tension syndrome and postmenopausal uterine bleeding, advanced age at first pregnancy, infertility, hormonal treatment, mammary gland disorders, irregular prophylactic follow-up.

Adult↗
PubMed1986

Extracorporeal shock wave lithotripsy in patients with a solitary kidney.

Extracorporeal shock wave lithotripsy was used to treat 68 patients with renal calculi in a solitary kidney. Epidemiological information, including stone number, size and location, was similar to that of other patients treated with extracorporeal shock wave lithotripsy. Renal function as measured by serum creatinine changed negligibly in the majority of the patients. Three patients had transient serum creatinine elevations greater than 2 mg. per dl. that were caused by obstruction from stone fragments. There were 2 perirenal hematomas that required transfusion. One patient required retrograde manipulation of a ureteral stone before extracorporeal shock wave lithotripsy, while 6 required stone manipulations after therapy for steinstrasses. Of 59 patients evaluable after extracorporeal shock wave lithotripsy 58 (98.3 per cent) had a successful result: 38 (64.4 per cent) were completely free of stones and 20 (33.9 per cent) had clinically insignificant residual fragments. Extracorporeal shock wave lithotripsy is effective and safe in a solitary renal unit. We believe that in most patients it is the procedure of choice. Attention to fever, urine output and fragment size perioperatively is crucial.

Adolescent↗