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Biomedical subjects

S Douglas

Publications and source records attributed to S Douglas.

At least 37 records · Page 2Linked to original sources
PubMed1999

Dynamic graciloplasty in the treatment of patients with faecal incontinence.

BACKGROUND: Dynamic graciloplasty is a recent innovation in the surgical management of faecal incontinence. This study reports further experience with this procedure in a series of consecutive patients. METHODS: Between July 1994 and February 1998, 21 dynamic graciloplasties were performed in 18 patients with total faecal incontinence. The two most recent patients were excluded because of follow-up less than 6 months. Continence scores and manometric data were collected before operation and 6 months afterwards. Subsequent clinical data were obtained at regular outpatient review. Seven patients had a three-stage procedure (vascular delay and stoma creation; gracilis transposition and implantation of stimulator and leads; stoma closure), four patients had a two-stage procedure (stoma, with transposition and implantation; stoma closure) and five underwent a one-stage procedure without defunctioning stoma. RESULTS: Mean(s.d.) follow-up was 20(10.2) months, and was complete in all patients. Eight of the 16 patients had postoperative morbidity. Thirty-three subsequent admissions and 23 reoperations were required to treat complications, to correct technical problems or to manage outcome failures. A defunctioning stoma did not protect wounds from infection (P = 0.6) or reduce the postoperative morbidity rate (P = 0.14). Continence scores were improved by the procedure (P < 0.001) and anal canal pressure increased with stimulation (mean increase 35.9 cmHO, P < 0.001). Two patients required revisional surgery for perielectrode fibrosis. Five patients had revisional surgery for electrical device failure. Thirteen of the 16 patients were either improved or fully continent after operation, and satisfied with the result of the procedure. Ultimate failure (n = 3) occurred in patients with chronic preoperative constipation or diarrhoea, or abnormal rectal sensitivity. CONCLUSION: Dynamic graciloplasty is an effective procedure in selected cases of end-stage faecal incontinence. Patient motivation is essential given the necessity for close follow-up.

Adult↗
PubMed1999

Seasonality of presentation of type I diabetes mellitus in children. Scottish Study Group for the Care of Young Diabetics.

Environmental influences are thought to have an aetiological role in onset of diabetes in children. Month of onset in over 2000 children in Scotland was established and there was an excess in colder/darker months than in warmer/lighter months. A meta-analysis of 21 previous studies with over 13,000 patients gave the same result at a much higher level of significance. A mechanism is postulated based on previous viral induced islet cell damage with ongoing progressive auto-immune destruction. There may be physiological seasonal changes with winter stress on carbohydrate and lipid metabolism. The raised winter levels of pituitary, adrenal and thyroid hormones fail to be antagonised by falling level of insulin. A role for seasonal variation in exercise and nutrition is considered.

Adolescent↗
PubMed1999

Latitude-related changes in the amplitude of annual mortality rhythm. The biological equator in man.

There is extensive literature describing the effect of season on mortality rates, especially in cardiovascular and respiratory disease. This study compares latitude with the extent of seasonal variation of monthly deaths from all causes. In developed countries, there is a peak of deaths in winter and a trough in summer. Monthly numbers of deaths were established in 89 countries in the Northern and Southern Hemisphere. Using cosinor analysis, the extent of seasonal variation (amplitude) was established and correlated with latitude. The amplitude of seasonality was greatest in mid-latitude around 35 degrees, but low or absent near the equator and subpolar regions. The amplitude can differ at the same latitude. The weather in equatorial regions and in habitations near the Arctic Circle is very different, but death has a similar seasonal rhythm. The purpose is to record this epidemiological finding even though no simple explanation is provided. Weather alone cannot explain it, and it is possible that day length (photoperiod) has an important, but complex, underlying role.

Biometry↗
PubMed1999

A quest for seasonality in presentation of leukaemia and non-Hodgkin's lymphoma.

The literature on presentation of seasonality of leukaemia fails to provide clear conclusions. Using the Data Collection Study organised by the Leukaemia Research Fund (LRF) Centre for Clinical Epidemiology, University of Leeds, this question was re-examined. This data has a high level of ascertainment and is population based. The results were mainly negative, there being no fit to a sinusoidal curve (Cosinor analysis) in any part of the data. Using normal approximation to Poisson there were individual months with positive findings. Such a method could not be specifically depended on to provide reliable conclusions, nevertheless, further work in this area is justified. Non-Hodgkin's lymphoma was also examined but again with mainly negative findings.

Acute Disease↗
PubMed1998

Seasonal variation in the incidence of Hodgkin's disease.

Earlier literature suggested there may be a seasonal rhythm of onset of Hodgkin's disease. This issue has been re-examined using population-based prospectively-collected data with high ascertainment levels. The Data Collection Study (DCS) of the Leukaemia Research Fund (LRF) Centre for Clinical Epidemiology (University of Leeds) generated the information used, which was based on a population of 13.5 million--about one quarter of England and Wales--over 10 years. The RYE histopathological classification was employed. The findings show that in patients with nodular sclerosing histopathology there was a highly significant circannual rhythm with a low amplitude (extent of seasonal variation) and a peak in March. A significant, but different, rhythm with a high amplitude and a peak in August was found in lymphocyte predominant Hodgkin's disease. However, this finding is less certain, due to smaller numbers and a lower significance level. The main conclusion is that there is a highly significant seasonality in nodular sclerosing Hodgkin's disease. The findings provide further evidence that nodular sclerosing and lymphocyte predominant may be two different diseases. The differing seasonality rhythms may provide aetiological clues.

Adolescent↗
PubMed1998

Tween consumers: catalog clothing purchase behavior.

The purpose of this study was to compare the catalog shopping behavior of students in their tween years (i.e., between childhood and adolescence; ages 12-14) with that of older students (ages 15-18). Junior high and high school students who had purchased clothing from a catalog in the past 12 months responded to a questionnaire that examined the label information sought and product-specific attributes considered. Results indicated that tweens were more concerned with style, brand names, and the latest fashion than were older students. This finding was especially interesting, as these attributes all relate to status; the tweens were more interested than the older students in wearing the latest fashions, being in style, and gaining the prestige of wearing brand-name clothing. This supports previous findings indicating that the tween years are a time when peer pressure and "fitting in" are very important.

Adolescent↗
PubMed1997

Nurses' job satisfaction, absenteeism, and turnover after implementing a special care unit practice model.

The purpose of the study was to compare job satisfaction, absenteeism, and turnover between nurses working in a nurse-managed special care unit (SCU) and those working in traditional intensive care units (ICU). A case management practice model with a shared governance management model and minimal technology was implemented in the SCU while contrasting features of a primary nursing practice model with a bureaucratic management model and high technology already in place in the traditional ICU. Individual nurses' perceptions of and their preferences for the SCU practice model also were examined related to job satisfaction. Using analysis of covariance, greater satisfaction with a lower absenteeism rate was found in nurses working in the SCU. Nurses' perceptions and preferences for the SCU practice model were closely related to their job satisfaction and growth satisfaction. The findings suggest that individual perception and preference should be taken into account before implementing autonomy, authority, and responsibility at the organizational level to lead to the desired nurse outcomes in a given working environment.

Absenteeism↗
PubMed1997

Sciatic pain and piriformis syndrome.

Between 70% and 80% of the population of the world experience low back pain at some time during their lives. A subgroup of patients who experience back pain also experience sciatic pain as well, with a majority of these patients seeking evaluation from their primary care clinician. One relatively new differential diagnosis to be considered when evaluating the patient with sciatica is piriformis syndrome. Piriformis syndrome has been documented for more than 50 years. Yet its diagnosis still remains confusing at times. Using a case study for the purpose of illustration, this article outlines signs and symptoms of sciatica, as well as differential diagnoses to be considered when examining a patient with sciatica. Piriformis syndrome, diagnostic tests to be performed, treatment, education, and follow-up of the patient with piriformis syndrome are all discussed in detail. Finally, implications for primary care clinicians are presented.

Adult↗
PubMed1996

Relationship between pretransplant noncompliance and posttransplant outcomes in renal transplant recipients.

Approximately 5% to 18% of kidney transplant recipients do not comply with their posttransplant medical treatment. This study examined the relationship between pretransplant noncompliance and posttransplant outcomes. Using a longitudinal retrospective chart audit, pretransplant and posttransplant data were collected for 126 kidney transplant recipients over a 3-year period. Sixty-one percent of those identified as noncompliant before transplant lost their graft or died after transplant. Significant relationships between pretransplant noncompliance and graft loss and between pre- and posttransplant noncompliance were found. Clinicians must identify those with pretransplant noncompliance, as they are at risk for poor outcomes and might benefit from an intensive posttransplant follow-up regimen.

Adult↗
PubMed1995

Clinical characteristics and natural history of symptomatic but not excess gastroesophageal reflux.

Esophageal pH monitoring in patients with gastroesophageal reflux symptoms identifies some who have normal esophageal acid exposure but nevertheless a convincing correlation between symptoms and those reflux events that do occur. These patients may exhibit enhanced sensory perception of physiological reflux. Little is known about the natural history of reflux symptoms in this group, which in our experience comprises up to 6% of those referred for diagnostic pH monitoring. We have therefore followed up by postal questionnaire 70 patients whose initial pH study had demonstrated normal acid exposure but a symptom index > or = 50% and 58 patients found to have excess reflux, for a median of 4.4 and 6.5 years, respectively. The presenting character and frequency of symptoms and endoscopic and manometric findings were similar in the two groups. At review overall symptom frequency had improved (P < 0.01) for both groups similarly. However, 87% of those with normal acid exposure and 79% of those with excess reflux remained symptomatic, 53% and 47%, respectively, recording their symptoms to be the same or worse than at original presentation, despite over 60% in each group continuing to take regular medication. Only six patients in each group were asymptomatic and receiving no therapy at the time of review. The results demonstrate that patients with symptomatic but not excess gastroesophageal reflux constitute a significant clinical problem. Both the persistence of their symptoms and their requirement for therapy are similar to that observed in "genuine" refluxers.

Case-Control Studies↗
PubMed1995

Heightened visceral sensation in functional gastrointestinal disease is not site-specific. Evidence for a generalized disorder of gut sensitivity.

Alteration in visceral sensation locally at the site of presumed symptom origin in the gastrointestinal tract has been proposed as an important etiopathological mechanism in the so-called functional bowel disorders. Patients presenting with one functional gastrointestinal syndrome, however, frequently have additional symptoms referable to other parts of the gut, suggesting that enhanced visceral nociception may be a panintestinal phenomenon. We measured the sensory thresholds for initial perception (IP), desire to defecate (DD), and urgency (U) in response to rectal balloon distension, and the thresholds for initial perception and for discomfort in response to esophageal balloon distension in 12 patients with irritable bowel syndrome (IBS) and 10 patients with functional dyspepsia (FD), in comparison with healthy controls. As expected, IBS patients exhibited lower rectal sensory thresholds than controls (P < 0.0001), but in addition had significantly lower sensory thresholds for both perception and discomfort evoked by balloon distension of the esophagus (mean +/- SEM: 8.8 +/- 1.3 ml vs 12.1 +/- 1.5 ml (P < 0.05) and 12.2 +/- 1.4 ml vs 16.4 +/- 1.4 ml (P < 0.02) respectively. Patients with FD showed similarly enhanced esophageal sensitivity, with thresholds for perception and discomfort of 8.1 +/- 0.9 ml (P < 0.02), and 10.1 +/- 1.0 ml (p < 0.001), respectively, but were also found to have sensory thresholds for rectal distension similar to those observed in the IBS group, significantly lower than in controls: IP 45.0 +/- 17.6 vs 59.3 +/- 1.5 ml (P < 0.001), DD 98.0 +/- 17.9 vs 298.7 +/- 9.0 ml (P < 0.0001), U 177.2 +/- 25.4 vs 415.1 +/- 12.6 ml (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

The cost-effectiveness of a special care unit to care for the chronically critically ill.

To assess the relative value of healthcare programs, technologic innovations, and clinical decisions, policymakers are searching for ways to evaluate cost-effectiveness. What constitutes cost-effectiveness and how should it be measured? The authors discuss ways in which the cost-effectiveness of clinical programs can be measured and describes various methods of assessing both costs and effectiveness. Comparison of the cost-effectiveness of a nurse managed special care unit with that of traditional intensive care units illustrates some of these methods.

Chronic Disease↗
PubMed1995

Evidence for a seasonal variation in the presentation of Hodgkins disease.

An analysis by month of diagnosis was made of 1359 cases of Hodgkins disease (HD) on the Scotland and Newcastle Lymphoma Group (SNLG) registry 1979-1992 to look for evidence of seasonality. A March peak was evident when all cases were analysed (p < 0.01). The histological subtypes nodular sclerosing (NS) and mixed cellularity (MC) showed a similar pattern (p < 0.05) while lymphocyte depleted (LD) and lymphocyte predominant (LP) had no demonstrable seasonal variation. In a breakdown by age and sex there was evidence of seasonality in both sexes but only under the age of 40. This provides further evidence for the heterogeneity of HD and supports the hypothesis that different factors are involved in the aetiology of this condition in younger compared to older patients.

Adolescent↗
PubMed1995

Twenty-four hour esophageal pH monitoring: technique and application.

In the last three decades, esophageal pH monitoring has progressed from an exclusively laboratory-based physiological research tool to a routine outpatient clinical investigation in patients with one of the most common gastrointestinal disorders. Technological advancement has considerably simplified both the procedure and the interpretation of data obtained, and there is currently reasonable consensus as to the parameters that best discriminate between physiological and pathological gastroesophageal reflux. There remains a need for internationally agreed definitions and standards, particularly with regard to calculation of these parameters, which would improve comparability of future research studies from different centers. Clinical applications of the technique have increased with our enhanced knowledge of the protean clinical manifestations of reflux disease. The advent of potent pharmacotherapy and the recognition of a need for ongoing treatment in many patients will ensure that the most sensitive test for the diagnosis of gastroesophageal reflux disease will remain an essential part of the investigation of upper gastrointestinal symptoms.

Esophagus↗
PubMed1994

The hazard of starting smoking: estimates from a split population duration model.

Understanding the determinants of the hazard of starting smoking is of great importance in developing policy to reduce the number of smokers. This paper develops a split population duration model of the decision to start smoking. Using data from the 1978 and 1979 Smoking Supplements to the National Health Interview Survey, we find some evidence that lifetime educational attainment, gender, and race are important determinants of both whether and when the smoking habit is initiated. The study finds no evidence that higher cigarette prices would have a significant impact on teenage decisions to pick up the smoking habit.

Adolescent↗
PubMed1994

The incidence of reporting consent rates in nursing research articles.

The study described the incidence of reporting consent rates (CRs) in nursing research articles, ascertained the mean CR for nursing research articles, ascertained differences between those studies that reported a CR and those that did not report a CR, and compared studies that used clinical populations to studies that used nonclinical populations. Research articles (371) from three nursing research journals were examined. Results showed that: (a) 40.7 percent of articles reported a CR, (b) the mean CR was 71.8 percent, (c) 41.1 percent reported inadequate CRs, (d) studies reporting a CR differed from those that did not on five of nine variables, and (e) studies employing clinical populations reported higher consent rates than did studies that employed nonclinical populations.

Bias↗