Search PubMed⌕ Search

Biomedical subjects

R M Pickering

Publications and source records attributed to R M Pickering.

At least 37 records · Page 2Linked to original sources
PubMed1997

The scalability of the Rivermead Motor Assessment in nonacute stroke patients.

OBJECTIVE: To examine the scalability of the Rivermead Motor Assessment (RMA) with nonacute stroke patients in the community. DESIGN: This was a prospective study of the patients after discharge from hospital. All subjects were assessed on the RMA at six and 12 months after discharge home from hospital. Coefficients of scalability and reproducibility were calculated for each of the three sections of the RMA at each assessment. SUBJECTS: Subjects were nonacute stroke patients aged 65 years and over, nonacute stroke patients aged under 65 years, and a selected group of those aged under 65 years. RESULTS: Only the items in the gross function section met scaling criteria with nonacute strokes in both age groups, which suggests that the items in this section were in appropriate order of difficulty. The items in the leg and trunk section were not in hierarchical order and were in fact closer to scaling if the present order were reversed. CONCLUSIONS: The clinical and research value of the RMA, as an ordered scale, are questioned. Changes in treatment styles and philosophies may mean that some of the items themselves are out-dated.

Activities of Daily Living↗
PubMed1996

Thromboembolic deterrent stockings fail to prevent hypotension associated with spinal anaesthesia for elective caesarean section.

This study was carried out to determine whether the use of thrombo-embolic deterrent (TED) stockings, in combination with an intravenous crystalloid preload, would prevent hypotension following spinal anaesthesia for caesarean section. Fifty parturients undergoing elective caesarean section under spinal anaesthesia were randomly allocated into two groups. TED stockings were applied to the study group 1 h before spinal anaesthesia but none were applied to the control group. Both groups received a crystalloid preload of 15 ml kg(-1) over 15 min before spinal injection. Significant hypotension, defined as an absolute value of systolic arterial pressure (SAP) of less than 90 mmHg and a decrease of more than 20% from baseline SAP was treated with 3 mg bolus of ephedrine as required. The difference in SAO between the two groups was not statistically significant. In the control group, 80% of parturients required ephedrine as opposed to 56% in the TED group; a difference that was also not statistically significant.

Clinical Trial↗
PubMed1995

Is measuring postnatal symphysis-fundal distance worthwhile?

OBJECTIVE: to assess levels of intra-observer and inter-observer variability in the measurement of postnatal symphysis-fundal distance and establish whether the measurement is sufficiently precise for it to be of use in clinical practice. SETTING: a consultant obstetric maternity unit in the south of England which caters for approximately 6000 deliveries per annum. METHODS: in the intra-observer study 15 midwives took repeated readings of symphysis-fundal distance on 30 postnatal women. In the inter-observer study 13 midwives took readings of symphysis-fundal distances on 24 postnatal women. Repeatability coefficients (the variability to be expected in the change between two measurements) were calculated. FINDINGS: the repeatability coefficient, that is the maximum difference that is likely to occur, 95% of the time, for the difference between two measurements obtained by the same midwife on the same woman is 2.94 cm (intra-observer study). Where measurements are obtained by different midwives on the same mother the repeatability coefficient is 5.01 cm (inter-observer study). In everyday clinical practice variability is likely to be greater than that found in this study. IMPLICATIONS FOR PRACTICE: the daily measurement of the postnatal symphysis-fundal distance with a tape measure cannot be obtained with enough precision to be useful in making clinical judgements and therefore should be discontinued. Further research is required to assess the value of routine palpation of the uterine fundus to assess involution during the postnatal period.

Anthropometry↗
PubMed1995

Psychological adjunct to perioperative antiemesis.

In a prospective, randomized study, we have examined the effects of preoperative and preinduction positive suggestion on postoperative emetic sequelae. A total of 226 patients were allocated randomly to receive either positive suggestions or no suggestions. Those patients in the positive suggestion group were told before operation and on induction of anaesthesia that postoperative emetic sequelae would be greatly reduced by the use of two antiemetic drugs. Control patients were simply asked to participate in a study of postoperative well being with no mention of nausea or vomiting. Nausea, vomiting or retching, and antiemetic administration were measured in the first 24 h after operation. Antiemetic administration in the positive suggestion group was 16.5% less than in the control group (P = 0.03) but there was no significant difference between the groups in nausea or vomiting-retching.

Adult↗
PubMed1995

Low-dose droperidol reduces postoperative vomiting in paediatric day surgery.

In a prospective, randomized, blind study, we assessed the effectiveness of droperidol 20 micrograms kg-1 i.v., given at induction of anaesthesia, in preventing postoperative vomiting in paediatric day-case patients. We studied 270 children, aged 1-15 yr, undergoing body surface surgery. There was a significant reduction in the incidence of vomiting in the recovery room (1.4% vs 9.2%, P < 0.005) and in the day ward (9.4% vs 18.3%, P < 0.05) in patients receiving droperidol. There was no significant difference on the journey home (9.5% vs 17.83%, ns) or at home (16.7% vs 10.3%, ns). There was also a reduction in the severity of vomiting in the droperidol group. There were no adverse side effects.

Adolescent↗
PubMed1995

Prognostic indicators in a range of astrocytic tumours: an immunohistochemical study with Ki-67 and p53 antibodies.

The treatment and prognosis of patients with cerebral astrocytic tumours are currently guided by histopathological classification. This study evaluates immunohistochemistry using Ki-67, an antibody to a nuclear protein expressed in proliferating cells, and DO-7, an antibody to the product of the tumour suppressor gene p53, as prognostic indicators for these tumours. Immunohistochemistry with Ki-67 has been correlated with the behaviour of many different tumours, but its value as a prognostic indicator in astrocytic tumours is diminished by the conflicting results of previous studies. Immunohistochemistry with antibodies to the p53 protein has been used as a prognostic indicator in melanomas and some carcinomas, but the relation between prognosis and accumulation of this protein in astrocytic tumours has not been clarified. We have tested the hypothesis that survival is correlated with Ki-67 immunolabelling indices (LIs) and patterns of p53 immunolabelling in the cerebral astrocytic tumours of a large cohort of patients (n = 123) for whom clinical indices were well documented. Astrocytic tumours were divided into three histological types: fibrillary astrocytoma (n = 24), anaplastic astrocytoma (n = 31), and glioblastoma (n = 68). Histological type and patient age were independent predictors of survival. Median Ki-67 LIs differed significantly (P < 0.0001) between the types of astrocytic tumour, and tumours with a Ki-67 LI < 2% had a significantly (P < 0.0001) better prognosis. Ki-67 LI as a continuous variable carried a significant (P = 0.0043) unadjusted hazard to survival which was lost when adjusted for other variables, notably histological type. By contrast, no relation was found between survival and three categories of p53 labeling (p53-negative, p53 LI < 40%, and p53 LI > 60%). The results indicate that, whereas Ki-67 immunohistochemistry predicts survival in patients with astrocytic tumours, conventional histological appraisal remains the best guide to prognosis, and immunohistochemistry for p53 has no value in the assessment of these tumours.

Adult↗
PubMed1994

Orthotopic heart transplantation in children with congenital heart disease.

The early experience (February 1982 to June 1988) with transplantation for the treatment of congenital heart disease at the University of Pittsburgh was disappointing due to an excessively high perioperative mortality. From July 1988 to June 1992, a further 21 children with congenital heart disease underwent orthotopic transplantation. Thirteen had undergone multiple prior palliative procedures (mean, 2.8 per patient). In 12 of these patients, prior procedures involved the pulmonary arteries on one or more occasions. In contrast to our earlier experience, there were no deaths stemming from inadequate surgical reconstruction or pulmonary hypertension. The actuarial survival was 71% at both 1 and 3 years. This did not differ significantly from the survival among 18 patients who underwent transplantation for the management of cardiomyopathy over the same period (1-year and 3-year survival, 83%). The perioperative mortality and short-term survival are now similar for children undergoing transplantation for the treatment of either congenital heart disease or cardiomyopathy. These improved results probably reflect more careful patient selection and an increasing surgical experience with complex reconstructive procedures.

Adolescent↗
PubMed1994

Role of right ventricular endomyocardial biopsy in infants and children with suspected or possible myocarditis.

OBJECTIVES: To assess the diagnostic yield, sampling errors, risks, and therapeutic implications of right ventricular endomyocardial biopsy in children with suspected or possible myocarditis. DESIGN: Retrospective study. SETTING: Tertiary referral centre for paediatric cardiology, cardiac surgery, heart transplantation, and mechanical circulatory support. PATIENTS AND METHODS: Review of clinical and histological findings among 63 consecutive children with possible myocarditis undergoing right ventricular endomyocardial biopsy. Review of cardiac histology at subsequent necropsy or after explantation at time of transplantation. RESULTS: From January 1980 to December 1992, 76 biopsies were performed in 63 children (2 weeks to 18 years of age). In 41 cases, the biopsy was performed for evaluation of dilated cardiomyopathy. The median interval from onset of symptoms was one month. Eight children (20%; all with a history of less than six weeks duration) had biopsy proved myocarditis. Five of the eight children made a full recovery, including four who presented in cardiogenic shock. By contrast, only three of 33 children without evidence of myocarditis showed recovery of ventricular function. The whole heart was available for histological examination in 23 patients. Myocarditis was confirmed in one patient, and no evidence of myocarditis was found in the remaining 22 (all with negative biopsies). One procedure related death occurred in a 2 week old infant with dilated cardiomyopathy. In 22 cases, biopsy was performed for the evaluation of arrhythmia. Only one biopsy showed myocarditis. CONCLUSIONS: The diagnostic yield of a biopsy is low in children with arrhythmias. In children presenting with profound ventricular dysfunction, a diagnosis of acute myocarditis may avoid premature consideration of transplantation as this group has an important potential for full recovery. In less critically ill patients and in those with a longer duration of symptoms the justification for biopsy is not as clear and the procedure is not without risk.

Acute Disease↗
PubMed1993

A randomized trial to assess the efficacy of 5-aminosalicylic acid for the prevention of radiation enteritis.

Sulphasalazine is an effective treatment for diarrhoea occurring during pelvic radiotherapy. We report the results of a trial to assess the value of its active moiety, 5-aminosalicylic acid, (5-ASA) in a prophylactic setting. Seventy-three patients planned for external beam radiotherapy to the pelvis were randomized on a double-blind basis to receive prophylactic 5-ASA or placebo. The severity of the acute radiation bowel reaction was documented by a weekly questionnaire. Surprisingly, diarrhoea occurred in a higher proportion of patients in the 5-ASA arm than the placebo arm (91.2% versus 73.7%, P = 0.070). The maximum change in both the severity of diarrhoea and the number of days per week on which diarrhoea occurred (from pre-radiotherapy level to the worst level at any time during treatment) were both significantly greater in patients taking 5-ASA than those taking placebo (P = 0.014 and P = 0.026, respectively). The average change (the sum of the weekly scores divided by the number of weeks of treatment, minus the pre-radiotherapy score) for both severity and days per week of diarrhoea were again greater in the 5-ASA than the placebo arm, but failed to reach statistical significance (P = 0.095 and P = 0.079, respectively). The use of anti-diarrhoeal medicines was significantly greater in the 5-ASA arm (P = 0.011). Constipation was more common in the placebo arm but this did not reach significance (P = 0.20). 5-ASA thus has no protective effect against acute radiation enteritis and appears to worsen it. Possible reasons for this surprising finding are discussed.

Aminosalicylic Acids↗
PubMed1992

Digit preference in estimated gestational age.

A digit preference model is developed to describe the preference for estimating gestational age at birth as an even week during the 20th to 36th week of gestation. The model incorporates a probability of misclassification to adjacent even weeks at odd gestational ages, while even gestational ages are assumed correctly classified. The model is extended to allow the misclassification probabilities to decrease linearly with week during the period. A piecewise exponential model is used to model relative risks of delivery associated with a previous spontaneous abortion and a model incorporating digit preference is fitted as a generalized bilinear model in GLIM. The estimates of relative risk in the underlying survival model are virtually the same whether the misclassification is incorporated in the model or ignored.

Confidence Intervals↗
PubMed1992

Importance of district of residence and known primary site for bowel cancer survival: analysis of data from Wessex Cancer Registry.

STUDY OBJECTIVE: The aim was to compare survival with colon and rectal cancer across the 10 districts of Wessex taking into account the age and sex of the individual. DESIGN: The study was based on registrations on the Wessex Cancer Registry between 1979 and 1984 with colon and rectal cancer. Survival up to 31 December 1986 was examined using a Cox regression model; individuals surviving to the end of the follow up period were treated as censored in the analysis. Survival was examined in the first fortnight, the first month, and the first six months after registration separately. PARTICIPANTS: The data comprised 6239 residents of the Wessex Region who had been diagnosed with colon cancer and 3203 residents diagnosed with rectal cancer. For 140 cases survival data or age were missing and these cases were excluded. MEASUREMENTS AND MAIN RESULTS: Results are presented in the format of a league table giving the order of districts from lowest to highest survival rates. No significant differences in survival are found between districts in relation to rectal cancer. We find that one or two districts have consistently high or low survival rates with colon cancer in various periods of follow up, but cannot differentiate between the districts in the centre of the list. Site unspecified is considered as an explanatory variable; it is more predictive than district, and it approaches the importance of age in explaining survival with colon cancer. CONCLUSIONS: There are significant differences in survival with colon cancer between districts; however data on stage at registration are not available and we are unable to say whether the differences in survival are due to differences in stage at diagnosis or differences in survival with similar stage at diagnosis. We found that cases where the site of the cancer within the colon was not recorded on the register have significantly lower survival, and we suggest that site unspecified may be related to stage at diagnosis.

Age Factors↗
PubMed1991

Risks of delivery during the 20th to the 36th week of gestation.

Using routinely collected maternity discharge data from 250,000 women in Scotland, we examined the risks of late spontaneous abortion and preterm delivery during the period 20 up to 36 weeks of gestation. Gestational age is treated as a fetal survival time and the risks of delivery associated with a history of spontaneous abortion, induced abortion and perinatal death are examined in a survival model controlling for several demographic and socioeconomic variables. The main objective of the study is to identify factors which are associated with high relative hazard of delivery early in the period, but with decreasing relative hazard of delivery as pregnancy progresses. The factor most clearly associated with converging hazards is a history of two or more spontaneous abortions, and this may reflect the tendency to repeat pregnancy outcome.

Abortion, Induced↗
PubMed1990

Prognostic factors in stage AO B-cell chronic lymphocytic leukaemia.

85 patients presenting to a single centre with stage AO B-cell chronic lymphocytic leukaemia (B-CLL) have been studied. The duration of follow-up has ranged from a minimum of 1 year to a maximum of 18 years with a mean of 6 years. 14 patients have had progressive disease and 23 patients have died, of whom nine had CLL-related deaths. We assessed the prognostic significance of the following parameters: age at presentation, sex, haemoglobin concentration, initial lymphocyte count, surface membrane phenotype, serum immunoglobulin levels at presentation and karyotype. None of these factors were predictive of survival, but there was a correlation between initial lymphocyte count, surface immunoglobulin MD lambda phenotype, and complex karyotypic abnormalities and disease progression. Two patients with a complex karyotype have been followed for more than 5 years without evidence of progression.

Adult↗
PubMed1990

Correlation of chromosome abnormalities with laboratory features and clinical course in B-cell chronic lymphocytic leukaemia.

141 patients with B-cell chronic lymphocytic leukaemia (B-CLL) have been studied for a minimum of 12 months and a maximum of 25 years. 30 of 133 patients (32.5%) had greater than 10% FMC7 positive peripheral blood lymphocytes and 19 of 131 patients (14.5%) had a serum or urinary paraprotein. At presentation 88 patients were stage A0, 18 A1, 18 A2, 11 B and six C. 44 (31%) had progressive disease and 42 (30%) died during the study period. 63 patients had a normal karyotype, 75 a clonal abnormality and in three no metaphases were obtained. The finding of a complex karyotypic abnormality was significantly associated with lambda surface phenotype (P less than 0.01), the presence of greater than 10% FMC7 positive cells (P less than 0.025), and the presence of a paraprotein (P = 0.025). Patients whose leukaemic cells had a complex karyotype and those with structural abnormalities of chromosomes 14 and 6 required treatment earlier than those with a normal karyotype.

Aged↗
PubMed1988

Development of a neonatal case-mix classification.

This article introduces a neonatal classification based on latent class analysis. The neonatal classification generates five distinct classes ranging from the normal-birth-weight, full-term, healthy baby to the low-birth-weight preterm infant with many life-threatening problems. Unlike several suggested neonatal classifications, latent class analysis accommodates the range and severity of illness typically encountered in neonatal populations. It also provides a classification based solely on the personal characteristics of the newborn that can be used to investigate variation in the use of neonatal services.

Child Health Services↗
PubMed1988

Predictive value of screening for different areas of development.

Associations between the results of developmental screening at five ages between 30 weeks and three years and the children's educational and behavioural status in normal primary schools at 6 1/2 to 7 1/2 years were examined in two samples of children living in Dundee and born in 1974 and 1975. In one sample the screening results for 417 children with moderately severe or severe school problems were compared with the screening results for a control group without school problems. Positive associations were found between school problems and motor and adaptive screening test results (from 39-week screening onward), language (from 15 months), preschool behaviour (at 39 weeks and two years) and neurological status (at 39 weeks and three years). In the second sample the questionnaire scores of 570 children known to be suspect on screening were compared with the scores of a control group whose screening results had been considered within the normal range. Adaptive and neurological screening tests provided the best predictors of behaviour problems in school and of educational failure. It is suggested that more thorough developmental and neurological assessments, at less frequent intervals, than is common in most screening programmes would facilitate identification of (and intervention for) preschool neurodevelopmental disability among children at risk of early schooling problems.

Child↗