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Biomedical subjects

R West

Publications and source records attributed to R West.

At least 91 records · Page 5Linked to original sources
PubMed2000

Does exercise aid smoking cessation? A systematic review.

AIMS: To assess the effectiveness of exercise-based interventions in smoking cessation. DESIGN: A systematic review was conducted of articles published between 1980 and 1999. The review focused on randomized controlled trials (RCTs) in which the specific effects of exercise on smoking abstinence were examined. The primary dependent variable was smoking abstinence. Other studies which had both exercise programming as an independent variable and smoking behaviour as a dependent variable are briefly discussed. PARTICIPANTS: The review included interventions targeting both healthy individuals and those with specific medical conditions. SETTINGS: The interventions were delivered in both community and inpatient settings. MEASUREMENTS: Information extracted from each article included details of the participants, exercise and smoking cessation programmes, control conditions, exercise adherence rates, length of follow-up and outcomes. FINDINGS: Of the eight trials satisfying our inclusion criteria, only two trials found a positive effect for exercise on smoking abstinence. The others showed no effect. CONCLUSIONS: There is some evidence for exercise aiding smoking cessation. Of the two trials finding a positive effect one was rigorously designed, the other was found to have numerous methodological limitations. Trials showing no effect lacked sensitivity. This was principally because of small sample sizes and inadequate measurement and control of exercise adherence. There is a need for more rigorously designed studies in this area.

Exercise↗
PubMed2000

The operative management of screen-detected breast cancers.

BACKGROUND: Mammographic screening for breast cancer not only reduces the overall mortality from breast cancer but allows greater opportunities for breast-conserving operations. The predicted degree of breast conservation is not being realized, but is increasing in centres that have published their results. METHODS: The operative management of breast cancers diagnosed by BreastScreen Central and Eastern Sydney Screening and Assessment Service were compared between two time periods: January 1988-December 1992 (group 1) and January 1993-December 1995 (group 2). The rate of breast conservation, and other data were compared between the two periods. An attempt was made with multivariate analysis to identify some of the factors that made mastectomy rather than conservation more likely. RESULTS: There were 723 cancers detected that were suitable for analysis (group 1, n = 273; group 2, n = 450). In group 1 the breast conservation rate was 42.9%; this increased significantly to 60.4% in group 2 (P < 0.001). The data were examined to determine if there was any other factor that had changed over the time periods which might account for the increased rate of breast conservation. The use of pre-operative diagnostic techniques such as fine needle aspirate cytology and core biopsy increased significantly. Multivariate analysis comparing the differences in patient age, diagnostic technique, tumour type, grade, size, location and lymph node status, both independently and compositely did not account for the increase in breast conservation in group 2. CONCLUSION: The increase in breast conservation is due to other factors such as the surgeons' approach and patient attitude. The use of pre-operative, minimally invasive tissue sampling techniques is increasing.

Adult↗
PubMed2000

Rectal cancer: changing patterns of referral for radiation therapy 1982-1997.

BACKGROUND: The purpose of the present study was to evaluate the changing role of radiation therapy in rectal cancer and to determine the patterns of referral of patients during a 15-year period. METHODS: From 1982 to 1997, 464 patients with carcinoma of the rectum were referred to the Department of Radiation Oncology, Royal Prince Alfred Hospital: 79% of patients had locoregional disease alone and 21% had distant metastasis. Radiation therapy consisted of irradiation (definitive or palliative) alone to the primary tumour in 9.7% of cases; preoperative radiation in 7.3% of cases: preoperative chemoradiation in 7.5% of patients: postoperative radiation in 15.3% of patients: postoperative chemoradiation in 12.31% of patients: treatment of pelvic recurrence in 23.5% of patients and treatment of metastases in 9.1% of patients. The remainder were treated elsewhere (1.9%) or not treated (13.4%). RESULTS: There was an average annual 14% increase in referrals over the accrual period. Recurrent rectal cancer decreased from approximately 30% of referrals during 1982-91 to approximately 10% in 1995-7. The use of postoperative adjuvant radiation reached a peak of 50% in 1993. The use of preoperative radiation increased suddenly in 1994 from < 10% to a sustained rate of approximately 30% of referrals. The use of chemoradiation commenced in 1990 for postoperative adjuvant treatment and in 1994 for preoperative treatment. The median survival time from initial diagnosis was 35 months, with 2- and 5-year survival rates of 62 and 28%, respectively. Survivals at 5 years for patients treated with preoperative and postoperative radiation (with or without chemotherapy) and with recurrent disease were 56, 44 and 21%, respectively. CONCLUSIONS: The present study illustrates the changing role of radiation therapy in the management of rectal cancer. The increase in referrals over the observation period was due to increased multidisciplinary input into the initial management of these patients, based on reported clinical trials. The steady increase in the use of adjuvant therapy has paralleled a decrease in referrals for treatment of recurrence and reflects current clinical results. The sequencing of adjuvant therapy is changing currently, with greater emphasis on preoperative adjuvant treatment. Currently most adjuvant therapy includes chemotherapy.

Adenocarcinoma↗
PubMed2000

Addressing regulatory barriers to licensing nicotine products for smoking reduction.

This paper examines the current regulatory obstacles to extending the permitted use of NRT, and to include smoking reduction ways of addressing these. There are major differences between different countries in regulations concerning NRT. These differences appear to be due to different attitudes to cigarette smoking as an issue and different preconceptions about nicotine as an addictive and potentially toxic drug. The paper considers how existing WHO and American Psychiatric Association definitions of mental disorders may be used in submitting proposals for use of NRT as an aid to smoking reduction and how concerns over safety and abuse and dependence liability can be addressed. It also examines what new evidence may be needed. Coordinating the efforts of the pharmaceutical industry, clinicians and researchers will probably be important in moving regulatory authorities further in the direction of accepting NRT for widespread use in smoking reduction.

Attitude to Health↗
PubMed2000

Evidence for the transient nature of a neural system supporting goal-directed action.

Disruption of a neural system supporting goal-directed action gives rise to lapses of intention in healthy individuals and disorganized behavior in patients with prefrontal lesions. Evidence from behavioral studies indicates that the occurrence of lapses in selective attention, working memory and prospective memory tasks is transient in nature. In the current study, we used event-related brain potentials to demonstrate that lapses are associated with a slow wave over the frontal region that begins well before stimulus onset and lasts for several hundred milliseconds. The magnitude of this slow wave was modulated by task demands, indicating that attentional processes can be flexibly allocated in the service of goal-directed action. Together the findings of these experiments indicate that lapses result from a transient inability to bring to bear the goals of the individual upon the action selection system.

Adult↗
PubMed2000

Do social support interventions ("buddy systems") aid smoking cessation? A review.

OBJECTIVE: To provide an overview of the role of social support in smoking cessation and to critically review evidence regarding the use of "buddy systems" (where smokers are specifically provided with someone to support them) to aid smoking cessation. DATA SOURCES: Studies were located by searching Medline and Psyclit using the key words "smoking", "smoking cessation", "social support", and "buddy". Additional studies were identified through reference lists. Only studies reported in English and published since 1980 were included. STUDY SELECTION: Studies were selected on four criteria: publication in a peer reviewed journal; randomised controlled trial using smokers who wanted to stop; the use of a social support intervention, including a "buddy"; dependent variable of smoking abstinence. Most research in this area does not use a randomised design so only a small proportion of the originally identified studies were included. DATA SYNTHESIS: In view of the diverse nature of the studies, a meta-analysis was not attempted. Ten studies were identified: nine were clinic based smoking trials, eight used a group format, and nine used buddies from among smokers' existing relationships. Support training varied from role play and rehearsal to a simple instruction to call each other regularly. Intervention and follow up periods varied between studies. Two studies showed a significant benefit of the intervention in the short term. CONCLUSIONS: Research methodology in many cases was poor. The evidence would suggest that in the context of a smokers clinic the use of buddies may be of some benefit. There is a lack of evidence regarding the efficacy of the use of buddies in community interventions. This is an important area for future research.

Humans↗
PubMed2000

Smoking cessation guidelines for health professionals: an update. Health Education Authority.

This paper updates the evidence base and key recommendations of the Health Education Authority (HEA) smoking cessation guidelines for health professionals published in Thorax in 1998. The strategy for updating the evidence base makes use of updated Cochrane reviews supplemented by individual studies where appropriate. This update contains additional detail concerning the effectiveness of interventions as well as comments on issues relating to implementation. The recommendations include clarification of some important issues addressed only in general terms in the original guidelines. The conclusion that smoking cessation interventions delivered through the National Health Service are an extremely cost effective way of preserving life and reducing ill health remains unchanged. The strategy recommended by the guidelines involves: (1) GPs opportunistically advising smokers to stop during routine consultations, giving advice on and/or prescribing effective medications to help them and referring them to specialist cessation services; (2) specialist smokers' services providing behavioural support (in groups or individually) for smokers who want help with stopping and using effective medications wherever possible; (3) specialist cessation counsellors providing behavioural support for hospital patients and pregnant smokers who want help with stopping; (4) all health professionals involved in smoking cessation encouraging and assisting smokers in use of nicotine replacement therapies (NRT) or bupropion where appropriate. The key points of clarification of the previous guidelines include: (1) primary health care teams and hospitals should create and maintain readily accessible records on the current smoking status of patients; (2) GPs should aim to advise smokers to stop, and record having done so, at least once a year; (3) inpatient, outpatient, and pregnant smokers should be advised to stop as early as possible and the advice recorded in the notes in a readily accessible form; (4) there is currently little scientific basis for matching individual smokers to particular forms of NRT; (5) NHS specialist smokers' clinics should be the first point of referral for smokers wanting help beyond what can be provided through brief advice from the GP; (6) help from trained health care professionals specialising in smoking cessation such as practice nurses should be available for smokers who do not have access to specialist clinics; (7) the provision of specialist NHS smokers' clinics should be commensurate with demand; this is currently one or two full time clinics or their equivalent per average sized health authority, but demand may rise as publicity surrounding the services increases.

Behavior Therapy↗
PubMed2000

A randomized, controlled trial of child psychiatric assessments conducted using videoconferencing.

We used a PC-based videoconferencing system to conduct child psychiatry assessments. The telecommunications link was six digital lines, giving a total bandwidth of 336 kbit/s. Twenty-three patients (aged 4-16 years), accompanied by their parents, completed two psychiatric assessments, one via videoconferencing and another face to face (FTF). The order of assessments was randomized. Questionnaires were used to record the diagnosis, treatment recommendations and the psychiatrists', patients' and their parents' satisfaction with each assessment. An independent evaluator concluded that in 22 cases (96%) the diagnosis and treatment recommendations made via the videoconferencing system were the same as those made FTF. The psychiatrists stated that videoconferencing assessments were an adequate alternative to FTF assessments and did not interfere with diagnosis. However, the responses from the psychiatrist satisfaction questionnaire showed that they preferred FTF assessments. No significant difference was found in the patients' or parents' satisfaction responses after the two types of assessment. The majority of children (82%) 'liked' using the telepsychiatry system and six (26%) preferred it to a FTF assessment. Most parents (91%) indicated that they would prefer to use the videoconferencing system than to travel a long distance to see a psychiatrist in person.

Adolescent↗
PubMed2000

Age-related decline in inhibitory control contributes to the increased Stroop effect observed in older adults.

Past research has demonstrated an age-related increase in the Stroop effect. Some theorists have suggested that this increase results from a decline in the ability to inhibit word information on incongruent trials, whereas others have suggested that the decline reflects general slowing. These two hypotheses were evaluated using event-related brain potentials (ERPs) measured while younger and older adults performed the Stroop task. As expected, the Stroop effect was greater for older than younger adults. The ERP data revealed a selective age-related attenuation of two modulations reflecting the inhibition of word information on incongruent trials. Latency of the P3 wave did not increase to a greater extend for older than younger adults from the congruent to incongruent trials as expected based on the general slowing hypothesis. Taken together, these findings support the inhibitory deficit hypothesis by demonstrating an age-related decline in a conceptual level inhibitory process that supports the suppression of word information in the Stroop task.

Adult↗
PubMed2000

Could conditional release of new drugs provide the information required to study drug effectiveness? - A discussion paper.

Conditional release is the approval of a new drug onto the market, subject to specific conditions relating to effectiveness and safety that, if achieved, will lead to full approval. Conditional approval of a new drug, during which time it is used in normal clinical practice, should allow the collection of data on effectiveness and safety to provide a genuine cost effectiveness evaluation. Proposals put forward in 1977 in the United Kingdom for approving a drug on a conditional basis while monitoring for adverse drug reactions are examined, and issues that would affect a present day conditional release scheme are identified. These issues are: who would do the evaluation and who would pay for it; how would patients be identified and registered; would all new drugs be monitored and for how long; what data would be reported and evaluated; and who would do the reporting? How a conditional release scheme would work in Canada in light of these questions is considered and a method based on pharmacists registering patients and on physicians and/or patients reporting data to an independent organization funded by governments and the pharmaceutical industry is outlined. Under certain conditions, conditional release would provide the information to allow true cost effectiveness and safety assessments instead of the current inadequate predictions based on efficacy and safety data from clinical trials. It is important that academics and drug approval and monitoring agencies work together to develop active systems to improve the postapproval evaluation of effectiveness, safety and cost effectiveness of new drugs in Canada.

Canada↗
PubMed1999

Randomized comparative trial of nicotine polacrilex, a transdermal patch, nasal spray, and an inhaler.

BACKGROUND: There are several nicotine replacement products on the market, and physicians are likely to be asked with increasing frequency about which of these products their patients should use. OBJECTIVE: To provide a basis for rational advice by comparing nicotine polacrilex (gum), a transdermal patch, nasal spray, and an inhaler. DESIGN: Randomized trial with assessments at the quit date and 1, 4, and 12 weeks later. SETTING: Hospital smokers' clinic. PATIENTS: Male and female community volunteers (N = 504) smoking 10 or more cigarettes per day and seeking help to stop smoking. INTERVENTIONS: Patients were given brief advice, and purchased their nicotine replacement treatment at approximately half the regular retail price. MAIN OUTCOME MEASURES: Nicotine replacement treatment use, ratings of withdrawal symptoms, ratings of product characteristics and helpfulness, and biochemically validated continuous lapse-free abstinence. RESULTS: The products did not differ in their effects on withdrawal discomfort, urges to smoke, or rates of abstinence. The continuous validated 12-week abstinence rates were 20%, 21%, 24%, and 24% in the gum, patch, spray, and inhaler groups, respectively. Compliance with recommended nicotine replacement treatment use was high for the patch, low for gum, and very low for the spray and the inhaler. The spray was underused because of adverse effects more often than the other products. In the subjects using the spray, the level of use among abstainers at week 1 predicted outcome at week 12. The inhaler was rated as more embarrassing to use than the other products, but provided at least as much nicotine as the gum. CONCLUSION: When asked about nicotine replacement treatment products available, physicians should note that, despite low compliance with the recommended dose of the spray and inhaler and differences in product ratings, overall, there are no notable differences between the products in their effects on withdrawal discomfort, perceived helpfulness, or general efficacy.

Administration, Cutaneous↗
PubMed1999

Event-related neural activity associated with the Stroop task.

The time course of neural activity supporting performance during the Stroop task was investigated using event-related brain potentials (ERPs). Four spatially and temporally distinct modulations were observed differentiating the ERPs elicited by incongruent trials from the ERPs elicited by congruent, neutral, or word identification trials. Two of these modulations reflected increased negativity over the fronto-central region and positivity over the fronto-polar region for incongruent trials and may reflect conflict detection and resolution processes. The other modulations, distributed over the left parietal and temporo-parietal regions, may reflect the activity of a meaning-based conceptual level system active during congruent, neutral, and word identification trials; and the activity of a perceptual level system supporting task performance when only color information can guide an efficient response on incongruent trials.

Adult↗
PubMed1999

Acute effect of glucose tablets on desire to smoke.

RATIONALE: Previous research suggests that glucose may reduce desire to smoke during periods of abstinence but a definitive test is needed. OBJECTIVE: The present study aimed to determine whether a single administration of oral glucose would reduce desire to smoke in abstaining smokers. METHODS: Thirty-eight smokers attended the laboratory in the afternoon having not smoked since the previous evening. They rated their desire to smoke immediately before and at 5-min intervals for 20 min after chewing four 3-g glucose tablets (experimental group) or four matched placebo tablets (control group). RESULTS: Ratings of desire to smoke decreased to a greater extent in the experimental than the control group. The effect was apparent after 10 min. There was no difference between the groups in terms of feeling "sick" or "satisfied". CONCLUSION: A single dose of glucose has a relatively rapid and detectable effect on desire to smoke and the effect is not mediated by feeling sick. Glucose tablets may be useful in helping to control desire to smoke during periods of abstinence.

Adult↗
PubMed1999

Shoulder pain in wheelchair users with tetraplegia and paraplegia.

OBJECTIVE: To compare the prevalence and intensity of shoulder pain experienced during daily functional activities in individuals with tetraplegia and individuals with paraplegia who use manual wheelchairs. DESIGN: Self-report survey. SETTING: General community. PARTICIPANTS: Fifty-five women and 140 men, 92 subjects with tetraplegia and 103 subjects with paraplegia who met inclusion criteria of 3 hours per week of manual wheelchair use and at least 1 year since onset of spinal cord injury. MAIN OUTCOME MEASURES: Respondents completed a demographic and medical history questionnaire and the Wheelchair User's Shoulder Pain Index (WUSPI), a measure of pain during typical daily activities. RESULTS: More than two thirds of the sample reported shoulder pain since beginning wheelchair use, with 59% of the subjects with tetraplegia and 42% of the subjects with paraplegia reporting current pain. Performance-corrected WUSPI scores were significantly higher in subjects with tetraplegia than in subjects with paraplegia. CONCLUSIONS: Both the prevalence and intensity of shoulder pain was significantly higher in subjects with tetraplegia than in subjects with paraplegia. Efforts to monitor and prevent shoulder pain should continue after rehabilitation.

Activities of Daily Living↗
PubMed1999

Age-related decline in prospective memory: the roles of cue accessibility and cue sensitivity.

In two experiments the authors evaluated the hypothesis that age-related decline in prospective memory reflects momentary lapses of intention (MLIs), and explored two factors, cue sensitivity and accessibility, that may contribute to MLIs. MLIs were reliably greater than zero in Experiment 1, indicating that performance fluctuated over the course of the task. Analysis of the response latency data (RL) revealed that older adults demonstrated elevated RL for missed prospective cues and were much slower to respond correctly to prospective cues than younger adults. These findings indicate preserved cue sensitivity in later adulthood and an age-related decline in cue accessibility. Experiment 2 demonstrated that cue sensitivity did not result from an orienting response to the perceptual novelty associated with the prospective cues.

Adult↗