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Biomedical subjects

P White

Publications and source records attributed to P White.

At least 19 recordsLinked to original sources
PubMed2007

Queensland psychiatrists' attitudes and perceptions of adults with intellectual disability.

BACKGROUND: Quality mental health care for adults with an intellectual disability (ID) depends upon the availability of appropriately trained and experienced psychiatrists. There have been few surveys of psychiatrists working with this population. METHOD: This Australian study obtained psychiatrists' attitudes to and perceptions of the mental health needs of adults with an ID. Training needs were also sought. The survey instrument used was a purposely designed, 28-item self-administered questionnaire featuring multiple-choice and open-ended questions. RESULTS: The majority of psychiatrists expressed concerns about treatment of this group, describing unmet needs. A total of 75% considered that antipsychotics were overused to control aggression, and 34% of psychiatrists were reluctant to treat adults with an ID. In total, 85% agreed that mental health in ID should be offered as a training option for psychiatric registrars, and that specialized mental health services would provide a high standard of care for this population. CONCLUSION: Broad concerns are raised regarding pathways to mental health care for adults with an ID in Australia. An Australia-wide training strategy needs to be developed. Partnerships between mental health, disability and community services that serve the mental health needs of this population, should actively seek to engage psychiatrists.

Adult↗
PubMed2006

Utility of the Determine Syphilis TP rapid test in commercial sex venues in Peru.

OBJECTIVES: This study sought to evaluate the utility of the Determine Syphilis TP test performed in Peruvian commercial sex venues for the detection of active syphilis; and determine the feasibility of integrating rapid syphilis testing for female sex workers (FSW) into existing health outreach services. METHODS: We tested 3586 female sex workers for syphilis by Determine in the field using whole blood fingerstick, and by rapid plasma reagin (RPR) and Treponema pallidum haemagglutination assay (TPHA) in a central laboratory in Lima using sera. RESULTS: 97.4% of the FSW offered rapid syphilis testing participated; and among those who tested positive, 87% visited the local health centre for treatment. More than twice as many specimens were RPR reactive using serum in Lima (5.7%) than tested positive by whole blood Determine in the field (2.8%), and although most were confirmed by TPHA, only a small proportion (0.7%) were RPR reactive at >or=1:8 dilutions, and likely indicating active syphilis. Sensitivity, specificity and positive predictive value of the Determine Syphilis TP test in whole blood when compared to serum RPR reactivity at any dilution confirmed by TPHA as the gold standard were 39.3%, 99.2% and 71.4%, respectively. Sensitivity improved to 64.0% when using serum RPR >or=1:8 confirmed by TPHA. Invalid tests were rare (0.3%). CONCLUSIONS: Rapid syphilis testing in sex work venues proved feasible, but Determine using whole blood obtained by fingerstick was substantially less sensitive than reported in previous laboratory-based studies using serum. Although easy to perform in outreach venues, the utility of this rapid syphilis test was relatively low in settings where a large proportion of the targeted population has been previously tested and treated.

Feasibility Studies↗
PubMed2006

Equity of access to dialysis facilities in Wales.

BACKGROUND: Demand for dialysis, particularly, in-centre haemodialysis (HD), is growing, and more units will be needed. Travel time to treatment is consistently a major area of concern for patients. AIM: To analyse access to current dialysis facilities in Wales, and use the data to help plan for new dialysis units. METHODS: We analysed a combination of UK Renal Registry, Welsh population census data, the Welsh Index of Multiple Deprivation 2005 (WIMD), travel time and geographical information systems. RESULTS: Prevalence of HD fell significantly with increasing travel time from units. This was not influenced by the WIMD. Prior to the opening of a new HD unit in Aberystwyth, prevalence in the surrounding area was significantly lower than for Wales as whole, but within 2 years, prevalence had risen to approximate national levels. In Haverfordwest, an area >30 min drive from any current facility, prevalence is consistently and significantly lower than for Wales as a whole, and has not shown the growth seen elsewhere in the country. DISCUSSION: The ability to combine data has enabled modelling of the likely immediate impact of opening a new unit in Haverfordwest, and also provided an estimate of its required capacity. This multidisciplinary approach to demand analysis should help to highlight areas of under-provision, and facilitate the planning of the sites and sizes of new dialysis units in Wales.

Health Services Accessibility↗
PubMed2006

Psychosocial outcomes derived from an acid burned population in Bangladesh, and comparison with Western norms.

Assault by acid burns typically results in severe disfigurement, yet the psychosocial impact of this injury is so far unreported. This study provides the first empirical data using standardised assessment scales, from 44 acid burns survivors in Bangladesh. Compared with published norms, individuals show high levels of psychological distress including social anxiety and avoidance, anxiety and depression. Consistent with the published literature, there is no relationship between severity of injury and level of psychological distress. One interesting feature of this population is the relative preservation of perceived self-concept, and this is discussed with relation to the supportive and therapeutic environment of the clinic where this group were studied. We also note an interesting sub-group who were attacked by members of their own family and for whom psychological morbidity seems particularly pronounced.

Acids↗
PubMed2006

Could neuroimaging help us to interpret the clinical effects of acupuncture?

One of the problems in assessing acupuncture efficacy has been the lack of a standardised placebo/control. Despite the lack of 'proof', acupuncture is widely used; hence it would seem that a large proportion of the public are not too concerned with the question of efficacy. Patients and researchers approach the issue of whether acupuncture "works" in an entirely different way. It may be that the management of chronic pain as a whole is largely context driven and non-specific. Therefore, research should focus on areas such as pragmatic/comparative trials and the non-specific effects of treatment. Improving our understanding of the neural mechanisms and substrates of acupuncture, placebo and non-specific effects might enable us to better define a "true placebo" and improve trial design. Imaging studies, however, need to be much more pragmatic. Because of the large overlap in areas of brain activated through acupuncture, pain, placebo and non-specific factors, separating these out in an attempt to pinpoint the mechanisms behind acupuncture will be difficult. Ultimately we need a balance between efficacy, comparative and mechanistic trials using imaging work to inform the whole picture. A broader view of research is therefore necessary to yield meaningful answers and we need to look at the whole package that acupuncture delivers.

Acupuncture Therapy↗
PubMed2006

Bristol COPD Knowledge Questionnaire (BCKQ): testing what we teach patients about COPD.

Health professionals recommend education of patients about COPD. There is no satisfactory instrument to measure their knowledge and therefore to assess the results of education. A multiple-choice questionnaire (BCKQ) has been designed and tested. Each of 13 topics contains five statements for which there is a right or wrong answer. Its validity and consistency has been assessed, and the test re-test reliability and responsiveness measured after an interval of eight weeks. A copy of the multiple-choice questionnaire is given in the Appendix. The questionnaire was judged by patients and health professionals to have good content and face validity. It has good internal consistency for the 65 items. (Cronbach's alpha 0.73). It can be completed and scored within twenty minutes. The average score in subjects who had not received prior education was 54.7%. In a group not receiving education there was good test-retest reliability (r = 0.71). Following an eight-week education programme there was a significant improvement of 18.3 percentage points, and most of the increase was maintained for six months without any further formal education. BCKQ is suitable for both clinical and research purposes. It will test knowledge that is appropriate for COPD patients and can be used as an assessment tool for individual patients, or as a broad cross-sectional survey instrument. It will enable the effectiveness of education to be assessed and will be of value in developing and comparing different educational interventions.

Aged↗
PubMed2006

Consensus on diabetes management in primary care.

Diabetes management in Irish Primary Care is in the early stages of development. This study used a Delphi technique with a panel of experts working in diabetes in primary care in order to reach a consensus on its future development. There was strong agreement on the need for multidisciplinary professional advocacy to improve services for people with diabetes. The panel indicated a preference for the development of shared models of care and emphasised the importance of research, audit and professional education. The results of this study can be used by health planners to develop services in a way that reflects the experience and opinion of those working as experts in the field of primary care diabetes.

Delphi Technique↗
PubMed2005

Endoscopic-assisted probing for congenital nasolacrimal duct obstruction.

PURPOSE: To determine the success rate of initial probing in children with congenital nasolacrimal duct obstruction (CNLDO) at different ages using nasal endoscopy, and to identify the anatomical sites of blockage within the drainage system. METHODS: A total of 87 eyes from 67 consecutive children with CNLDO underwent endoscopic nasolacrimal duct (NLD) probing under general anaesthetic. Patients who had had previous probings were excluded from the study. Diagnosis was based on history of epiphora since birth or shortly after, and fluorescein dye disappearance test (FDDT). Cure was judged as complete or near-complete remission of symptoms and signs and a normal FDDT. RESULTS: The age range was 12-91 months (mean 32.3 months). The success rates of probing were: 100% (58/58) for atresia and stenosis at the lower NLD, 100% (13/13) for punctal stenosis, 55.6% (5/9) for functional epiphora, and 0% (0/7) for canalicular and upper NLD obstruction. Age was not found to significantly affect the outcome of probing, whereas site did. Obstruction at canalicular or upper NLD level became more common with increasing age. CONCLUSION: Probing of the nasolacrimal system using the endoscopic approach allows direct visualisation of the distal nasolacrimal duct, which facilitates diagnosis of the anomaly at this site. More complex proximal anomalies became increasingly prevalent in older children, which accounted for the poorer results with increasing age. Site of obstruction has a greater bearing on outcome than patient age.

Age Factors↗
PubMed2004

Intensity-modulated radiation therapy: overlapping co-axial modulated fields.

The Varian multi-leaf collimator has a 14.5 cm leaf extension limit from each carriage. This means the target volumes in the head and neck region are sometimes too wide for standard width-modulated fields to provide adequate dose coverage. A solution is to set up asymmetric co-axial overlapping fields. This protects the MLC carriage while in return the MLC provides modulated dose blending in the field overlap region. Planar dose maps for coincident fields from the Pinnacle radiotherapy treatment planning system are compared with planar dose maps reconstructed from radiographic film and electronic portal images. The film and portal images show small leaf-jaw matchlines at each field overlap border. Linear profiles taken across each image show that the observed leaf-jaw matchlines from the accelerator images are not accounted for by the treatment planning system. Dose difference between film reconstructed electronic portal images and planning system are about 2.5 cGy in a modulated field at d(max). While the magnitude of the dose differences are small improved round end leaf modelling combined with a finer dose calculation grid may minimize the discrepancy between calculated and delivered dose.

Film Dosimetry↗
PubMed2004

An ultrasonic transducer array for velocity measurement in underwater vehicles.

A correlation velocity log (CVL) is an ultrasonic navigation aid for marine applications, in which velocity is estimated using an acoustic transmitter and a receiver array. CVLs offer advantages over Doppler velocity logs (DVLs) in many autonomous underwater vehicle (AUV) applications, since they can achieve high accuracy at low velocities even during hover manoeuvres. DVLs require narrow beam widths, whilst ideal CVL transmitters have wide beam widths. This gives CVLs the potential to use lower frequencies thus permitting operation in deeper water, reducing power requirements for the same depth, or allowing the use of smaller transducers. Moving patterns in the wavefronts across a 2D receiver array are detected by calculating correlation coefficients between bottom reflections from consecutive transmitted pulses, across all combinations of receiver pairings. The position of the peak correlation value, on a surface representing receiver-pairing separations, is proportional to the vessel's displacement between pulses. A CVL aimed primarily for AUVs has been developed. Its acoustical and signal processing design has been optimised through sea trials and computer modelling of the sound field. This computer model is also used to predict how the distribution of the correlation coefficients varies with distance from the peak position. Current work seeks to increase the resolution of the peak estimate using surface fitting methods. Numerical simulations suggest that peak estimation methods significantly improve system precision when compared with simply identifying the position of the maximum correlation coefficient in the dataset. The peak position may be estimated by fitting a quadratic model to the measured data using least squares or maximum likelihood estimation. Alternatively, radial basis functions and Gaussian processes successfully predict the peak position despite variation between individual correlation datasets. This paper summarises the CVL's main acoustical features and signal processing techniques and includes results of sea trials using the device.

Journal Article↗
PubMed2004

Initial experience with a new soft stretch-resistant coil.

The UltiPaq very soft, stretch-resistant coil is a useful new addition to the coil range available to neurointerventionists. Its highly compliant character makes it very suitable for small, ruptured aneurysms, which can easily rerupture during coiling, and for packing the necks of larger aneurysms. It has the advantage of a rapid detachment and does not leave any tail in the parent vessel. The high density of packing achieved in these cases should result in good long-term results, but further follow up is awaited.

Adult↗
PubMed2004

Delineating disability, labour force participation and employment restrictions among persons with psychosis.

OBJECTIVE: To delineate at a population level: activity restrictions, labour market participation, educational attainment, employment restrictions and employment characteristics of persons with psychosis compared with healthy non-disabled persons. METHOD: Confidentialized data files were provided by the Australian Bureau of Statistics. The data were collected in a national survey titled "Survey of Disability, Ageing and Carers, Australia 1998". Multi-stage sampling strategies obtained a probability sample of 42 664 individuals. Trained interviewers using ICD-10 computer-assisted interviews identified household residents with psychosis. RESULTS: Among householders with psychosis aged 15-64 years, 75.2% were non-participants in the labour market, 21.1% were employed and 3.7% were looking for work. Completing school years 10 and 11, and vocational training, appeared to offer an employment advantage. CONCLUSION: Persons with psychotic disorders have low rates of labour force participation and may benefit from greater participation in educational and vocational services. Implications for policy development are discussed.

Adolescent↗
PubMed2004

A survey of the quality of information leaflets on hayfever available from general practices and community pharmacies.

BACKGROUND: Hayfever affects at least one in 10 people. The majority of hayfever is managed in the community setting where the management options are pharmaceutical and behavioural. Hayfever medications are available over the counter and on prescription from the general practitioner. Patient information leaflets are published to augment the advice given and to promote self-management, but these leaflets have rarely been subjected to critical review. OBJECTIVE: To assess the quality of patient information leaflets written for people with hayfever and available from general practices and from community pharmacists. METHOD: A structured review of patient information leaflets about hayfever. During the peak grass pollen season copies of all leaflets available were collected from a random sample of community pharmacists and general practices in Wessex. The characteristics of the leaflet were recorded and the contents and presentation of each one was reviewed using the British Medical Association patient information appraisal system. Readability was assessed using the Simple Measure of Gobbledegook (SMOG). Two allergy-accredited specialists assessed each leaflet for accuracy. RESULTS: During the peak pollen season no leaflets were available in 30% of the Community Pharmacists and 23% general practices. In total, 38 different leaflets were identified. All the leaflets reviewed were written for adults. Forty-seven percent of the leaflets had no publication date and one-third of those dated were at least 5 years old. In general the leaflets scored highly on issues of presentation, but less than half contained information on the full range of management and treatment options, many being biased towards a single or limited range of interventions. Seventy-nine percent leaflets were produced or sponsored by pharmaceutical companies and gave prominence to their own products. All the leaflets had readability scores requiring at least secondary education (SMOG score equal or greater than 9). At least one factual inaccuracy was identified in four-fifths of leaflets. CONCLUSION: A large number of leaflets are published for people with hayfever, but they are of variable quality and not accessible to all patients because of limited distribution or high readability scores. If all patients are to benefit from written information the authors and publishers of leaflets need to follow published recommendations, especially with respect to content and readability. In the absence of a national public health information strategy or a body that systematically vets patient information materials, clinicians must pay attention to the quality of information provided for or obtained elsewhere by their patients.

Adult↗
PubMed2003

Exploring the psychosocial concerns of outpatients with disfiguring conditions.

OBJECTIVE: This study was undertaken to establish the extent and type of psychosocial need in outpatients attending for treatment for a variety of disfiguring conditions. METHOD: A total of 220 outpatients receiving treatment for burns, skin conditions or head and neck cancer, together with those seeking plastic surgery for other appearance concerns, completed standardised measures of anxiety, depression, social anxiety and quality of life. Participants also completed a semi-structured interview exploring individual concerns and satisfaction with care. RESULTS: A considerable proportion of the outpatients with disfiguring conditions experienced psychosocial difficulties, displaying raised levels of anxiety, depression, social anxiety and social avoidance and reduced quality of life. Levels of psychosocial distress were not well predicted by the severity of disfigurement. CONCLUSION: The psychosocial needs of these patients are not well met in the outpatient setting. Recommendations are made on how patients' concerns might be more effectively addressed.

Adult↗
PubMed2002

Phase I study of weekly oxaliplatin plus irinotecan in previously treated patients with metastatic colorectal cancer.

BACKGROUND: In vitro synergy between Oxal (oxaliplatin) and CPT-11 (irinotecan) has been reported. Oxaliplatin exerts its antineoplastic activity through the formation of platinum-DNA adducts. Resistance to oxaliplatin is through repair of these adducts, which is inhibited by irinotecan. PATIENTS AND METHODS: Oxaliplatin and irinotecan were administered weekly for 4 weeks followed by a 2-week rest period. The dose of oxaliplatin was escalated first, starting at 30 mg/m(2). Once a dose of 60 mg/m(2) was attained, the weekly dose of irinotecan was escalated, from 40 mg/m(2) to 85 mg/m(2). A total of 49 previously treated patients with metastatic colorectal cancer were entered in order to establish the maximum tolerated dose. Pharmacokinetics of oxaliplatin and irinotecan were analyzed. RESULTS: Forty-nine patients were evaluable for toxicity. The recommended phase II doses for this combination are oxaliplatin 60 mg/m(2) and irinotecan 50 mg/m(2), weekly x 4 q 6 weeks. Diarrhea was the most common dose-limiting toxicity. No pharmacological interactions were noted between oxaliplatin and irinotecan. Twelve of the 47 evaluable patients (26%) achieved a partial response. CONCLUSION: Weekly combination of oxaliplatin and irinotecan appears to be a well tolerated and active regimen in patients previously treated for metastatic colorectal cancer. Further investigations of this regimen are warranted.

Adult↗