Biomedical subjects
Publications and source records attributed to Prathap Tharyan.
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BACKGROUND: A substantial proportion of the psychiatric burden of disease falls on the world's poorest nations. Despite this, relatively little is known about the quality and content of clinical research undertaken in these countries, or the relevance of the interventions evaluated and specifically that of randomised trials. This project aims to survey the content, quality and accessibility of a sample of trials relevant to mental health conducted within low and middle-income countries; to compare these with studies conducted in high-income countries; and to assess their relevance for the needs of low and middle-income countries. METHODS: An extensive search for all trials, or possible trials, published in 1991, 1995 and 2000 with participants in low and middle-income countries has already been conducted. Studies evaluating prevention or treatment of a mental health problem within these three years will be identified and further searches conducted to assess completeness of the initial search. Data on study quality and characteristics will be extracted from each report. Accessibility will be estimated based on whether each citation is available on MEDLINE. Trials relevant to schizophrenia will be compared with a random sample of schizophrenia trials from high-income countries in the same years. Topics covered by the trials will be compared with the estimated burden of disease. CONCLUSION: Trials and systematic reviews of trials are the gold standard of evaluation of care and increasingly provide the basis for recommendations to clinicians, to providers of care and to policy makers. Results from this study will present the first assessment of the scope, quality and accessibility of mental health trials in low and middle-income countries.
In a prospective study, memory and new learning ability functions were assessed pre-operatively (17 patients) and in the early post-operative period (22 patients) at 7-26 days following surgery in patients undergoing stereotactic transcortical excision of their colloid cysts. Pre-operative assessment detected impaired memory in 5 patients, 2 of whom had no memory-related complaints. Impaired new learning ability was detected pre-operatively in 7 patients. There was a statistically non-significant trend towards improvement in the dysfunction scores post-operatively in most patients. No correlation was detected between the cyst size, presence of raised intracranial pressure at presentation, hydrocephalus and the pre-operative dysfunction scores. Stereotactic transcortical resection of colloid cysts does not impair these functions in the majority of patients and might improve these functions in some. In the absence of clinical or radiological predictors of dysfunction of memory and new learning ability, pre-operative neuropsychological assessment has a role in detecting impaired memory and new learning ability in patients with anterior third ventricular colloid cysts who may not even complain of them.
Most people with schizophrenia live in low- and middle-income countries in which clinicians/policy makers are not the first targets of marketing. Because it is years after a drug is first launched that the full effects become known with confidence, the evidence upon which to base practice in low- and middle-income countries may be less biased than that in richer nations.
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The Cochrane Collaboration's Schizophrenia Group has, since 1994, been preparing, disseminating and updating high quality systematic reviews of randomized controlled trials of interventions for people with schizophrenia. The aim of this study was to summarise the Group's methods and its output in terms of effective interventions for people with schizophrenia, and to evaluate this evidence from the perspective of the care of people with schizophrenia in developing countries. This was achieved by a search and narrative synthesis of the Cochrane Schizophrenia Group's module and database of systematic reviews in Issue 4, 2003 of the Cochrane Library. The results found that the Schizophrenia Group had, by December 2003, published 100 completed reviews, or protocols for reviews, of pharmacological, physical, spiritual, psychosocial interventions and health care delivery pertaining to those with schizophrenia. While evidence of efficacy is present for many of these interventions, evidence of efficiency is less compelling. The reviews in the Cochrane Library provide the currently best available evidence on the value of interventions for people with schizophrenia, but this may not generalize to developing country settings. Pragmatic randomized trials of interventions and evaluations of systems of health care delivery relevant to developing countries are required if the care of those with schizophrenia in these settings is to improve.
BACKGROUND: The pharmacological management of violence in people with psychiatric disorders is under-researched. AIMS: To compare interventions commonly used for controlling agitation or violence in people with serious psychiatric disorders. METHOD: We randomised 200 people to receive intramuscular lorazepam (4 mg) or intramuscular haloperidol (10 mg) plus promethazine (25-50 mg mix). RESULTS: At blinded assessments 4 h later (99.5% follow-up), equal numbers in both groups (96%) were tranquil or asleep. However, 76% given the haloperidol-promethazine mix were asleep compared with 45% of those allocated lorazepam (RR=2.29,95% CI 1.59-3.39; NNT=3.2,95% CI 2.3-5.4). The haloperidol-promethazine mix produced a faster onset of tranquillisation/sedation and more clinical improvement over the first 2 h. Neither intervention differed significantly in the need for additional intervention or physical restraints, numbers absconding, or adverse effects. CONCLUSIONS: Both interventions are effective for controlling violent/agitated behaviour. If speed of sedation is required, the haloperidol-promethazine combination has advantages over lorazepam.
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BACKGROUND: Community-based epidemiological data on post-partum depression from developing countries are scarce. AIMS: To determine the incidence of and risk factors for developing post-partum depression in a cohort of women living in rural south India. METHOD: We assessed 359 women in the last trimester of pregnancy and 6-12 weeks after delivery for depression and for putative risk factors. RESULTS: The incidence of post-partum depression was 11% (95% CI 7.1-14.9). Low income, birth of a daughter when a son was desired, relationship difficulties with mother-in-law and parents, adverse life events during pregnancy and lack of physical help were risk factors for the onset of post-partum depression. CONCLUSIONS: Depression occurred as frequently during late pregnancy and after delivery as in developed countries, but there were cultural differences in risk factors. These findings have implications for policies regarding maternal and childcare programmes.
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Systematic reviews and meta-analyses synthesize data from existing primary research, and well-conducted reviews offer clinicians a practical solution to the problem of staying current in their fields of interest. A whole generation of secondary journals, pre-appraised evidence libraries and periodically updated electronic texts are now available to clinicians. However, not all systematic reviews are of high quality, and it is important to be able to critically assess their validity and applicability. This article is an illustrated guide for conducting systematic reviews. A clear understanding of the process will provide clinicians with the tools to judiciously appraise reviews and interpret them. We hope that it will enable clinicians to conduct systematic reviews, generate high-quality evidence, and contribute to the evidence-based medicine movement.
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