Search PubMed⌕ Search

Biomedical subjects

R Robinson

Publications and source records attributed to R Robinson.

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

Cervical nonorganic signs: a new clinical tool to assess abnormal illness behavior in neck pain patients: a pilot study.

OBJECTIVE: To develop and assess the reliability of a group of cervical nonorganic physical signs to be used as a simple screening tool for identifying patients with low neck pain who exhibit abnormal illness behavior. DESIGN: Survey, consecutive sample. DATA SET: Double masked. SETTING: Functional restoration program. PATIENTS: Twenty-six consecutive patients with complaints of chronic neck pain (greater than 4 months duration). Each patient was evaluated by a physician and then again by either a physical or occupational therapist, for the presence of specific cervical nonorganic signs. Both of the evaluations occurred on the same day. MAIN OUTCOME MEASURES: Five categories consisting of eight tests were appraised: (1) tenderness, (2) simulation, (3) range of motion, (4) regional disturbance, and (5) overreaction. RESULTS: The percent agreement between raters ranged from a high of 100% for regional sensory disturbance, to a low of 68% for one of the simulation tests. The average agreement between raters across all of the nonorganic test signs was 84.6%. Likewise, kappa coefficients ranged from 1.00 to .16, reflecting differences in strength of agreement. CONCLUSION: For many years, the lumbar nonorganic signs (developed by Waddell and colleagues) have been a useful screening tool in the assessment of abnormal illness behavior in the low back pain population. For the first time, a group of cervical nonorganic signs have been developed, standardized, and proven reliable.

Adult↗
PubMed2000

Health care seeking behavior following a health survey: impact on prevalence estimates of chronic diseases.

This article addresses the time sequence between a population health survey and subsequent health care use and how this changes the incidence estimates of selected chronic diseases. A cardiovascular survey of a representative sample of the adult population of Manitoba, Canada was linked with the health insurance claims database. Of the 2792 subjects in the survey, 98% were linked successfully, using an encrypted personal health insurance number. Five years of physician claims data for the survey participants were reviewed including 18 months prior to and 42 months following the survey. Survey participants started seeking confirmation of possible hypertension as soon as they received blood pressure information at the interview. Confirmation of diabetes and elevated cholesterol were not completed until 3-4 months after participants had received the laboratory test results. As many as 4.6 times more new cases of hypertension per month, 5.1 times more cases of elevated cholesterol, and 3.3 times more cases of diabetes were diagnosed following the survey. Surveys designed to determine the prevalence of specific chronic diseases generate new cases within a short time afterwards, thus affecting the original prevalence estimates. The process of assessing the burden of disease in a population is dynamic rather than static, and comparisons across populations need to take into account the frequency and recency of past surveys.

Adult↗
PubMed2000

Coma-induced bullae and sweat gland necrosis following clobazam.

Coma-induced bullae and sweat gland necrosis is a rare clinicopathological entity described in association with a variety of aetiopathological conditions all of which have resulted in an impairment of conscious level. We report the first case observed in association with clobazam, used as adjunctive therapy for resistant epilepsy in a 4-year old. The potential underlying mechanisms and previously reported associations are discussed.

Anti-Anxiety Agents↗
PubMed2000

Lumbar segmental rigidity: can its identification with facet injections and stretching exercises be useful?

OBJECTIVES: To describe a method for observing lumbar segmental rigidity and to show how motion measurements and pain/disability questionnaires can be used to evaluate outcomes of combined facet injections and stretching exercises. DESIGN: Preliminary 2-part study: (1) presentation of a technique for, identifying lumbar segmental rigidity based on physical observation of the spine's lateral bending; and (2) repeated measures of motion and pain/disability self-report in a chronic lumbar spinal disorder cohort, performed before and after treatment with combined facet injections and stretching exercises. SETTING: An outpatient tertiary rehabilitation facility providing interdisciplinary functional restoration for chronic disabling work-related spinal disorders. PATIENTS: Chronically disabled patients with lumbar spinal disorder (n = 39; mean age, 41yr; 82% male) with segmental rigidity at 1 or more levels on physical examination. Subjects averaged 20 months of disability, and 51% had preinjection spine surgery (average, 1.7 procedures involving up to 3 spinal segments). Thirty-nine percent of the cohort had a fusion at levels 1 or 2. INTERVENTIONS: Bilateral facet injections were administered under fluoroscopy to all patients, and 2 or 3 levels were performed in 93% of cases (range, levels 1-4). Patients were instructed in an unsupervised stretching program and were reassessed 2 to 4 weeks later. After an intensive supervised resistance exercise training program as part of interdisciplinary functional restoration, a third set of motion, pain, and disability measures were collected. MAIN OUTCOME MEASURES: Changes in true lumbar sagittal and coronal motion (T12-S1), measured with inclinometers, and pain/disability self-report were compared statistically. RESULTS: Patients' mobility improved significantly (p < .01-.0001) across all 4 motions. A large majority (71%-97%) of individuals improved on motion. According to self-reports made over the postinjection period, most patients improved their disability (83%) and pain intensity (63%) ratings. CONCLUSIONS: A simple physical examination technique for assessing lumbar spine segmental rigidity was used in this preliminary study to select patients and levels for combined facet injection and stretching exercise, with resultant improvements in mobility and self-reported pain/disability that may extend beyond the pharmacologic duration of the corticosteroid. The efficacy of either the facet injection or stretching components alone in achieving objective mobility improvements cannot be determined from the present study, but warrants future investigation.

Adult↗
PubMed2000

Psychogenic non-epileptic seizures: management and prognosis.

AIM: To determine the outcome and identify predictive factors in children with psychogenic non-epileptic seizures (PNES). METHOD: The biographies of 35 children with PNES, attending a tertiary paediatric neurology centre, were reviewed. RESULTS: Thirty five children attending the department between 1987 and 1997 were evaluated at a mean follow up of 4.6 years. The age range was 6-18 years. Twenty four were girls and 11 were boys. Eleven patients had a diagnosis of epilepsy with PNES, the remainder having PNES alone. Cause fell into four categories: a history of violence, abuse, or neglect; a high level of anxiety; dysfunctional family relationships; and attention seeking or avoidance behaviour. Management in all but five cases involved assessment and follow up by a child psychologist or child psychiatrist. The outcome was encouraging, with 66% of patients becoming PNES free. A further 23% have > 50% reduction in the frequency of PNES. Only two have had no reduction. Outcome was best in the group without epilepsy. CONCLUSION: These results suggest that the prognosis of PNES is better in children than in adults, perhaps because causes are more likely to be external to the child, more easily identified, and more amenable to prompt intervention. The importance of good assessment, good communication, and a treatment plan that includes both symptom management and addressing the precipitating and perpetuating factors is emphasised.

Adolescent↗
PubMed2000

Comparison of cerebrovascular effects of intravenous cocaine injection in fetal, newborn, and adult sheep.

Cocaine may cause stroke, intracranial hemorrhage, seizures, and neurobehavioral abnormalities in fetuses, newborns, and adults, and there could be developmental and/or species differences in mechanisms for these cocaine-induced cerebrovascular effects. To evaluate developmental differences in responses to cocaine, we compared the cerebrovascular and metabolic responses to a 2 mg/kg iv cocaine dose in unanesthetized fetal (n = 8, previously reported, direct fetal injection), newborn (n = 6), and adult (n = 12) sheep. We measured cerebral blood flow, mean arterial blood pressure, and arterial and venous O(2) content, and we calculated cerebral O(2) consumption and cerebral vascular resistance at baseline and at 30 s and at 5, 15, and 60 min after cocaine injection. Cerebral blood flow increased 5 min after injection in the fetus and newborn, but not until 15 min in the adult. In the fetus, cocaine caused a transient cerebral vasoconstriction at 30 s; in all three groups, cocaine caused cerebral vasodilation, which was delayed in the adult. Cerebral metabolic O(2) consumption increased 5 min after injection in the fetus and newborn, but not until 15 min after injection in the adult. Arterial O(2) content decreased 5 min after injection in the fetus and 15 min after injection in the adult. We speculate that clinical differences in response to cocaine injection may be explained, in part, by these developmental differences in the cerebrovascular and metabolic responses to cocaine.

Animals↗
PubMed1999

The association of the SF-36 health status survey with 1-year socioeconomic outcomes in a chronically disabled spinal disorder population.

STUDY DESIGN: The Short Form Health Survey (SF-36) was administered to patients with chronic spinal disorders both before and after tertiary rehabilitation. The association of the SF-36 with various socioeconomic outcomes was then examined. OBJECTIVES: To assess the correlation of scores on SF-36 with treatment program completion and clinically meaningful 1-year socioeconomic outcomes. SUMMARY OF BACKGROUND DATA: There has been much interest in identifying variables that can predict which disabled workers with chronic spinal disorders will have good versus poor socioeconomic outcomes after tertiary rehabilitation. Results of previous research have indicated that psychosocial factors are better predictors of such outcomes than physical factors. A more recent trend in research is assessing health-related quality of life from the health care recipient's perspective. METHODS: The SF-36 was administered to a cohort (n = 146) of patients chronically disabled by spinal disorders before entry into a tertiary functional restoration program. Of this cohort, preprogram SF-36 scores and 1-year socioeconomic data were available for 128 program completers and 18 program noncompleters. The pre- and postprogram SF-36 scores of program completers for each of the outcome variables were compared. RESULTS: Better scores on the preprogram SF-36 Social Functioning and Bodily Pain scales were found to be associated with successful completion of the treatment program. Postprogram SF-36 scores were more frequently associated with outcomes than were preprogram scores. Most SF-36 scores, especially the physical domain scales, were associated with the variables of return to work, work retention, and use of health care resources. The overwhelming majority of significant associations were between higher (i.e., better) SF-36 scores and "good" treatment outcomes (e.g., return-to-work). CONCLUSIONS: The large number of associations between SF-36 scores and outcome variables highlights the importance of assessing the health-related quality of life of patients, and supports the use of the SF-36 in accomplishing this task. Among the findings, perhaps the most significant was the value of assessing health-related quality of life, particularly the subjective physical components, after completion of a functional restoration program. Prediction of long-term socioeconomic outcomes is likely to be improved if assessment is conducted at the end of the treatment process. SF-36 is recommended for assessing general health status, and more spine-specific measures are recommended for assessing spinal pain and disability variables.

Adult↗
PubMed1999

NHS boards. The odd couple.

The appointment of chairs is seen as political and lacking in transparency. Their training is patchy. Nearly a third of chairs and chief executives in this study had experienced major difficulties in their relationship. Relationship breakdown was generally due to chairs' behaviour.

Chief Executive Officers, Hospital↗
PubMed1999

Limits to rationality: economics, economists and priority setting.

This paper investigates why economic approaches to priority setting have had only limited impact in practice. It argues that obstacles to the take-up of the economic approach centre on (1) limitations in the theory and practice of economic evaluations, and (2) the nature of the wider context within which decisions on priority setting take place. On the first point, it argues that, despite advances in research methods, there is still debate about the theoretical basis of measures typically used in economic evaluations, such as QALYs, and that much of the extant empirical data is of questionable quality. On the second point, it maintains that politicians, health care professionals and local people attach importance to other factors besides allocative efficiency. If economic approaches are to have more impact in the future, it argues that health economists need to adopt a wider research agenda, focusing on public sector decision-making and, in particular, the incentives and constraints governing the use of economic data in different types of health care organisation.

Cost-Benefit Analysis↗