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Biomedical subjects

R West

Publications and source records attributed to R West.

At least 55 records · Page 3Linked to original sources
PubMed2001

Individual differences in preferences for and responses to four nicotine replacement products.

RATIONALE: With several different forms of nicotine replacement therapy available for smokers, it is useful to know about factors that may influence choice of form. OBJECTIVE: To examine factors associated with preference for different nicotine replacement products and effectiveness of these products. The simple comparison of success rates between the products has been reported previously. METHODS: Five hundred and four smokers were invited to rank order four products (gum, patch, nasal spray and inhaler) in terms of preference and were then randomly allocated to receive one of the products for a smoking cessation attempt. They were followed up 1 week, 4 weeks, 12 weeks and 15 weeks later. Ratings of the products were repeated 1 week after the quit date. Mood and physical symptoms were assessed at baseline and at each follow-up visit. Urges to smoke were assessed at all post-quit date sessions. Abstinence was assessed by self-report with expired air carbon monoxide verification. RESULTS: The patch was the most popular product initially, followed by the spray and inhaler and then the gum. The difference was greater for women than men. However, all smokers quickly came to like whichever product they had been allocated. Smokers who initially preferred the spray or inhaler were heavier smokers than those who preferred the gum or patch. Prior experience of the gum was associated with lower initial preference for it, but did not affect outcome. Prior experience with the patch had no effect on preference or outcome. Being allocated to the preferred product did not increase success at stopping smoking. Women were more successful at stopping smoking on the inhaler than the gum. Among highly dependent smokers, those on the inhaler had a lower relapse rate than those on the other products. CONCLUSIONS: Regardless of initial preferences, whether patients obtain their preferred form of NRT or one selected for them did not seem to affect outcome. This may be because smokers came to like particular products as they got used to them. Other things being equal, women may be better advised to use inhaler rather than gum and men vice versa.

Administration, Cutaneous↗
PubMed2001

Acute respiratory distress syndrome among trauma patients: trends in ICU mortality, risk factors, complications and resource utilization.

OBJECTIVE: To evaluate trends in mortality and related factors among trauma patients who developed acute respiratory distress syndrome (ARDS). STUDY: Observational study based on data prospectively gathered in computerized trauma registry. SETTING: Trauma intensive care unit (ICU) of 48 beds in level I trauma center. PATIENTS: All trauma patients with ARDS admitted during 1985-87 (486, group 1 [G1]) and 1993-95 (552, group 2[G2]). METHODS: ARDS was defined by American-European Consensus Conference criteria and the need for 48 h or more on mechanical ventilation with FIO2 greater than 0.50 and PEEP of more than 5 cmH2O. Demographics, severity score, injury-admission delay time, first 24-h transfusion and septic and organ system failure complications were independent variables. ICU mortality was the dependent variable. ICU length of stay (LOS) and life support techniques were considered. Respiratory and renal support strategies were different in the two time periods. RESULTS: Mortality decreased over the period (G1: 29.2% vs G2: 21.4%, p < 0.04), in patients aged both over and under 65 years. Multivariate analysis showed mortality was related to age, severity and time period (G1 1.68-fold that in G2) and that the greater G1 mortality was related to more renal failure and hematologic failure/dysfunction. ICU LOS decreased from 31.7+/-26.7 days (G1) to 27.3+/-22 days (G2) (p < 0.003). CONCLUSIONS: Mortality among trauma patients with ARDS declined over the 8 years studied and was associated with less organ failure. This reduction was probably the result of new approaches to mechanical ventilation, renal failure replacement and vasoactive drug therapy.

Adult↗
PubMed2001

Effect of oral nicotine dosing forms on cigarette withdrawal symptoms and craving: a systematic review.

RATIONALE: Oral nicotine dosing forms such as nicotine gum have been found to be effective in helping smokers to stop. Some, but not all studies have also found that they reduce the severity of withdrawal discomfort. With new oral nicotine products being developed and use of existing products widening, it is important to determine the strength of evidence that these forms of nicotine replacement reduce overall withdrawal discomfort and individual withdrawal symptoms including craving. OBJECTIVES: To assess the strength of evidence that oral nicotine reduces the severity of overall withdrawal discomfort and individual withdrawal symptoms, including craving. METHODS: All published studies reporting effects of nicotine gum, inhaler, lozenge and sublingual tablet on recognised withdrawal symptoms were scanned and those that met a set of quality criteria were included in the review. The key characteristics of these studies were summarised and their findings tabulated. RESULTS: Of 27 studies that reported effects of oral nicotine products on at least one withdrawal symptom, 12 met the quality criteria (eight for nicotine gum, three for inhaler, one for microtab, none for 1 mg lozenge). Because of limitations on the reporting of the studies it was not possible to carry out meta-analyses and good data were available only for the first week of abstinence. Six out of seven studies reporting it found an effect on total withdrawal discomfort, nine out of nine found an effect on irritability, three out of four found an effect on anxiety and the only study that looked at it found an effect on depressed mood. Seven of 11 studies that looked at it found an effect on craving, but only three out of seven of the studies of nicotine gum. For other withdrawal symptoms the findings were more mixed. CONCLUSIONS: We conclude that the strength of evidence that oral nicotine forms reduce total withdrawal discomfort, irritability and anxiety is high. There is some evidence for an effect on depressed mood and craving although in the latter case the evidence is less good for gum than other forms. Future studies of nicotine effects on withdrawal should meet minimum quality standards for design and reporting to enable results to be combined and compared across studies.

Administration, Oral↗
PubMed2001

Effect of a short bout of exercise on tobacco withdrawal symptoms and desire to smoke.

RATIONALE: Previous research suggests that a long bout of vigorous intensity exercise may reduce tobacco withdrawal symptoms and desire to smoke during abstinence. OBJECTIVE: In the present study, we investigated whether a short bout of moderate intensity exercise reduced desire to smoke and withdrawal symptoms in abstaining smokers. METHODS: Seventy-eight smokers attended the laboratory in the afternoon having not smoked since the previous evening. They rated their desire to smoke and withdrawal symptoms immediately before, during and after 10 min of moderate intensity exercise on a stationary cycle (experimental condition), or after waiting passively (control condition 1) or watching a video (control condition 2). RESULTS: Ratings of desire to smoke and withdrawal symptoms decreased more in the experimental group than in both control groups, which did not differ from each other. The effect was evident at all measurement points and was maintained for at least 10 min following exercise. CONCLUSION: A single bout of 10 min of moderate intensity exercise has a rapid and measurable effect on desire to smoke and tobacco withdrawal symptoms in abstaining smokers. Short bouts of exercise may be useful in helping to reduce desire to smoke and withdrawal symptoms during smoking cessation.

Adult↗
PubMed2001

Neural activity associated with the realization of a delayed intention.

This study examines neural activity associated with the realization of a delayed intention within the context of the noticing+search model of prospective memory (PM) using event-related brain potentials (ERPs). The noticing+search model proposes that PM is supported by two related processes, noticing (the detection of a PM cue in the environment) and search (the retrieval of an intention from memory). In two experiments participants performed a PM task that permitted the dissociation of the noticing and search processes. Noticing was associated a phasic negativity over the occipital-parietal region (N320) and search was associated with a sustained modulation (slow-wave) reflecting a negativity over the right frontal region and a broadly distributed positivity over the parietal region. The amplitude of the N320 was greater when the PM cue was associated with an intention than when the cue was irrelevant to task performance, leading to the proposal that noticing may be accomplished through the attentional modulation of neural systems which support processing of the defining features of the PM cue. The topography of the slow-wave resembled that of modulations of the ERP associated with the recollection of information in studies of retrospective memory leading to the suggestion that similar neural processes may support the recovery of information from memory in both prospective and retrospective memory tasks.

Adult↗
PubMed2001

Spatiotemporal analysis of experimental differences in event-related potential data with partial least squares.

One challenge in the analysis of event-related potentials (ERPs) is to identify task-related differences in scalp topography. The multivariate Partial Least Squares (PLS) analysis was used to identify the spatiotemporal distribution of ERP differences related to experimental manipulations. Two simulations included latency shifts and amplitude changes at peaks with temporal overlap. PLS identified effects only at modeled timepoints and electrodes. In contrast, principal components analysis identified differences at most timepoints. We also demonstrated that PLS identified combinations of waveform differences, not isolated sources. ERP components in an auditory oddball task were also assessed with PLS. The primary distinction was between ERPs on hit and correct rejection trials, expressed at multiple timepoints and electrodes. PLS provides a mechanism to describe experimental differences in ERP waveforms, simultaneously across the head.

Adult↗
PubMed2001

Signal-detection analysis of group decision making.

How effectively can groups of people make yes-or-no decisions? To answer this question, we used signal-detection theory to model the behavior of groups of human participants in a visual detection task. The detection model specifies how performance depends on the group's size, the competence of the members, the correlation among members' judgments, the constraints on member interaction, and the group's decision rule. The model also allows specification of performance efficiency, which is a measure of how closely a group's performance matches the statistically optimal group. The performance of our groups was consistent with the theoretical predictions, but efficiency decreased as group size increased. This result was attributable to a decrease in the effort that members gave to their individual tasks rather than to an inefficiency in combining the information in the members' judgments.

Decision Making↗
PubMed2001

Randomized controlled trial of a midwife-delivered brief smoking cessation intervention in pregnancy.

OBJECTIVE: To evaluate the efficacy of a brief smoking cessation intervention with pregnant women practicable routinely by midwives. DESIGN: Midwives were randomized to deliver the experimental intervention or usual care. The 10-15-minute intervention was based on brief counselling, written materials, arrangements for continuing self-help support and feedback on expired-air carbon monoxide levels. The intervention was tailored to the women's needs: those who did not want to stop smoking received a brief motivational intervention, those who wanted to stop received an intervention designed to assist them and those that had stopped recently (recent ex-smokers) received a relapse prevention intervention. SETTING: Booking interviews with pregnant women in nine hospital and community trusts. SUBJECTS: A total of 1120 pregnant women in the third month of pregnancy (249 recent ex-smokers and 871 current smokers). MAIN OUTCOME MEASURES: Three indicators of biochemically validated abstinence were collected. Continuous abstinence for at least 3 months prior to delivery, point prevalence abstinence immediately post-delivery, and continuous abstinence from 3 months pre-delivery to 6 months post-delivery. RESULTS: Only a small proportion of the women who would have been eligible to take part in the trial were actually recruited by 178 recruiting midwives, with lack of time being cited as the main barrier. The intervention and usual care groups differed in post-delivery point prevalence abstinence rates for recent ex-smokers (65% vs. 53%, p < 0.05, one-tailed), but not in other outcome measures. Overall, 54% of "recent ex-smokers" at booking and 7% of "current smokers" at booking had been abstinent for at least 3 months at the time of delivery, and 23% and 3%, respectively, were still abstinent by the time the child was 6 months old (i.e. 12 months post-intervention). Smoking status at follow-up was predicted by dependence indexed by time to first cigarette in the morning. CONCLUSIONS: A brief "one-off" smoking cessation intervention by midwives does not seem to be a practicable or effective method of helping pregnant smokers to stop. Other options such as tailored self-help materials and telephone counselling and other specialist treatments should be examined. Current smoking cessation rates in pregnancy are very low.

Birth Weight↗
PubMed2001

Smoking cessation and smoking patterns in the general population: a 1-year follow-up.

OBJECTIVE: To assess the prevalence of motivation and behaviours relating to smoking cessation and attempts at harm minimization and the stability of these over a 1-year period; to identify demographic, social, behavioural and psychological predictors of attempts to stop smoking and the success of these attempts. DESIGN: Face-to-face interviews were carried out with a national sample of UK smokers in April/May 1996 with follow-up 1 year later. SUBJECTS: The original response rate was 61% (1478 of 1911 adult smokers), and of these 1012 were followed-up 1 year later (68% of those who were originally contactable). RESULTS: Thirty-one per cent of smokers reported making at least one quit attempt during the follow-up period and 17% made a quit attempt in the first 9 months of that period. Of these 29% were still not smoking at least 3 months later. Fifty-one per cent of smokers had tried to cut down in the year leading up to the first survey. There was a fair degree of consistency over time in individual smokers' desires and intentions to stop smoking across both surveys and in the incidence of quit attempts and attempts to cut down. Beliefs about the effects of smoking on future health and having a partner who disliked their smoking were positively associated with making a quit attempt at follow-up while reporting enjoying smoking at baseline was negatively associated with making a quit attempt at follow-up. Time to first cigarette of the day and age of starting smoking were positively associated with success of quit attempts. CONCLUSIONS: Motivation and behaviours relating to smoking cessation are prevalent and fairly stable over time. Different factors appear to be related to attempts to stop and the success of those attempts. Interventions to increase smoking cessation in the population should take account of this.

Adult↗
PubMed2001

General Practitioners' views on the English national smoking cessation guidelines.

OBJECTIVES: Several countries have followed the US example in publishing national guidelines on smoking cessation interventions. Gauging responses to these guidelines can provide important lessons for future implementation and revision internationally. This study sought to assess General Practitioners' (GPs') views on recently published English smoking cessation guidelines that form the foundation of the UK National Health Service's smoking cessation strategy. DESIGN: Postal survey in which GPs were asked to judge the appropriateness, effectiveness and practicability of key recommendations for primary care in recent national smoking cessation guidelines. SETTING: General practice, England and Wales. SUBJECTS: Random national sample of GPs; 236 GPs completed the questionnaire; effective response rate: 62%. RESULTS: Only 16% of GPs accepted that all the recommendations in the guidelines were appropriate; 43% accepted that it was appropriate to check the smoking status of known smokers when they visit the surgery and only 30% thought it was practicable to advise smokers to stop at every opportunity. However, 77% of GPs thought that they should provide assistance for smokers wanting to stop; 74% believed that they should refer smokers to specialist services if appropriate and a similar proportion (77%) believed that it was appropriate to recommend nicotine replacement therapy. CONCLUSIONS: There was greater acceptance by GPs that they should assist smokers wanting to stop than that they should routinely monitor smoking status and give opportunistic advice to patients to stop. Given that opportunistic advice is a cornerstone of the national guidelines there is a need to find ways of reconciling what is being recommended and what GPs feel is appropriate.

Attitude of Health Personnel↗
PubMed2001

Atypical retinal microvasculopathy after bone marrow transplantation.

OBJECTIVE: Typical early ischaemic retinal microvascular changes with cotton wool spots after allogeneic bone marrow transplantation (BMT) are well recognised. In the study an atypical non-ischaemic late retinopathy is described. METHODS: Sequential cases of late retinal microvasculopathy following allogeneic BMT were reviewed. Demographic features and clinical and angiographic data were collected. RESULTS: Of 399 patients undergoing allogeneic BMT between 1992 and 1999, eight eyes of four patients developed atypical retinopathy. All patients were male and the age range was 27-50 (mean 37.5) years. The indications for BMT were acute lymphoblastic leukaemia (two patients), chronic myeloid leukaemia (one patient) and chronic lymphocytic leukaemia (one patient). Two patients had conditioning regimens including irradiation. All had cyclosporine and methotrexate as graft-versus-host disease prophylaxis. All but one had cyclophosphamide and busulphan as conditioning treatment. One had interferon. No patients had sustained hypertension or diabetes mellitus. Atypical retinopathy was identified 13-62 (mean 50) months after BMT and clinical features consisted of microaneurysms (MA; 4/4), hard exudates (1/4) and macular oedema (1/4). No patient had cotton wool spots. The median acuity was 6/5. Angiographic features were MA (4/4), late leak (2/4) and peripheral (1/4) or central (1/4) ischaemia. One patient underwent focal photocoagulation for macular oedema. CONCLUSION: Retinal microvascular incompetence (without cotton wool spots) with good vision may occur in a small number of patients as a late complication of allogeneic BMT

Adult↗
PubMed2001

Adult respiratory distress syndrome among blunt and penetrating trauma patients: demographics, mortality, and resource utilization over 8 years.

PURPOSE: The purpose of this study was to compare demographics, resources used, and mortality rates among a subset of trauma patients (blunt versus penetrating) who developed adult respiratory distress syndrome (ARDS) and over two time periods, 8 years apart. PATIENTS AND METHODS: This retrospective observational study was based on an analysis of the computerized Trauma Registry of the Shock Trauma Center of the University of Maryland Medical Systems. All trauma patients with ARDS admitted to a 48-bed trauma intensive care unit (ICU) at a Level I Trauma Center during two time periods of 3 consecutive years each were considered: from January 1, 1985, to December 31, 1987 (G1), and January 1, 1993, to December 31, 1995 (G2). Data were collected in the two time periods on demographics, severity (Revised Trauma Score), injury-admission delay time, first 24-hour transfusion fluids and blood, septic and organ system failure complications, life-support techniques, ICU mortality, and length of stay (LOS). The independent variables were the age, type of trauma, severity scores, transport time, fluid therapy, infectious and organ system failure complications, and life-support techniques. The dependent variable was ICU mortality. RESULTS: A total of 1,108 patients satisfied the entry criteria, 486 in period G1 and 552 in period G2; 929 (89.5%) suffered blunt trauma and 109 (10.5%) penetrating trauma. Mean age was lower for the penetrating trauma populations. There were no significant differences in ICU mortality between the blunt and penetrating trauma patients with ARDS. A significant decrease in ICU mortality was observed between the time periods studied among both blunt (29.5% vs. 21.7%, P <.001) and penetrating trauma patients (25.7% vs. 18.9%, P <.001). A similar rate of renal, hematologic, and cardiovascular organ system failure was observed for both blunt and penetrating trauma patients. Resource utilization measured by ICU LOS and time on mechanical ventilation was also similar in the two groups. The multivariate analysis showed that ICU mortality was related to age, RTS-measured severity, and time period (G1 mortality 1.68-fold that in G2). Renal and hematologic failures entered a second analysis, replacing the time period variable (G2). CONCLUSIONS: ARDS in patients with blunt and penetrating trauma showed similar trends in ICU mortality, complications, and resource utilization. The ARDS mortality rate decreased over the time period studied in both blunt and penetrating trauma.

Adult↗