Search PubMed⌕ Search

Biomedical subjects

S Morley

Publications and source records attributed to S Morley.

At least 19 recordsLinked to original sources
PubMed2000

Availability bias in clinical formulation: the first idea that comes to mind.

This study tested whether initial client formulations are based simply on the ideas that come most readily to mind, irrespective of the validity of these ideas. This phenomenon is known in decision theory literature as availability bias. The study tested the influence of two possible sources of availability bias in formulation: (a) theoretical orientation; and (b) a suggestion in a referral letter. Forty-four qualified and 20 trainee clinical psychologists participated in a procedure designed to reflect clinical practice. Clinical materials consisted of a fictional referral letter describing a client with adult attachment difficulties and post-traumatic stress disorder. Participants recalled information from the referral letter, described their areas of further interest and initial hypotheses. Results showed no evidence of an availability bias in clinical formulation as a result of theoretical orientation. Theoretical orientation towards attachment did appear to influence the availability of attachment ideas and predicted clinicians taking a stronger attachment focus when discussing the client. In particular, a self-report measure of theoretical orientation demonstrated high predictive validity. However, orientation towards attachment did not predict bias in the sense of selective recall of attachment information or neglect of alternative psychological frameworks. The study provided an inadequate test of availability bias as a result of a suggestion in the referral letter, possibly due to a ceiling effect, and no conclusions can be drawn as to clinical materials as a potential source of availability bias. The discussion addresses implications for further research and for a scientist-practitioner approach to individual case formulation.

Adult↗
PubMed1999

Assessment of immune response to meningococcal disease: comparison of a whole-blood assay and the serum bactericidal assay.

A whole-blood assay (WBA), which assesses the complete bactericidal activity of blood, was compared with the serum bactericidal assay (SBA), which measures antibody and complement mediated cell lysis. Twenty children infected with serogroup B strains and 25 infected with serogroup C strains were studied 8-12 weeks after disease, and 29 healthy children were used as controls. The infecting strain (convalescent children only) and two reference strains, MC58 (B:15:P1.7, 16) and NCTC 8554 (C:NT:P1.5) were used. In children previously infected with a serogroup B strain, bactericidal activity was detected in 95% and 85% to their infecting strain by the WBA (>50% killing) and the SBA (s), respectively. Bactericidal activity to the reference serogroup B and C strain was detected by WBA in 70 and 75% of children, respectively, and the SBA in 45% and 20%. In contrast bactericidal activity was detected to both serogroup C strains in >80% of children previously infected with a serogroup C strain using either assay and in 48% (WBA) and 20% (SBA) to the reference serogroup B strain. Levels of bactericidal activity were detectable in fewer control children. Children convalescing from meningococcal disease develop an immune response to their infecting strain, detectable by both the WBA and SBA, which is independent of age. However, the WBA appears to be a more sensitive measure of bactericidal activity to heterologous strains than the SBA.

Adolescent↗
PubMed1999

Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache.

A computer and a hand search of the literature recovered 33 papers from which 25 trials suitable for meta-analysis were identified. We compared the effectiveness of cognitive-behavioural treatments with the waiting list control and alternative treatment control conditions. There was a great diversity of measurements which we grouped into domains representing major facets of pain. Effect sizes, corrected for measurement unreliability, were estimated for each domain. When compared with the waiting list control conditions cognitive-behavioural treatments were associated with significant effect sizes on all domains of measurement (median effect size across domains = 0.5). Comparison with alternative active treatments revealed that cognitive-behavioural treatments produced significantly greater changes for the domains of pain experience, cognitive coping and appraisal (positive coping measures), and reduced behavioural expression of pain. Differences on the following domains were not significant; mood/affect (depression and other, non-depression, measures), cognitive coping and appraisal (negative, e.g. catastrophization), and social role functioning. We conclude that active psychological treatments based on the principle of cognitive behavioural therapy are effective. We discuss the results with reference to the complexity and quality of the trials.

Adult↗
PubMed1999

Specificity of reference patterns in depressive thinking: agency and object roles in self-representation.

This study investigated A. T. Beck's (1970) negative cognitive triad as a model of depressive thinking. A mixed clinical sample (N = 126) completed the Sentence Completion Test for Depression (SCD) and self-report measures of depression and anxiety. Two reference patterns were tested: agency roles, people who are the source of thoughts, feelings, and actions (self and others); and object roles, points of reference location (self, other, world, future, and past). Cognitive effects were highly specific to depression. With self in agent role, significant correlations were observed with negative self, world, and future references but not with other people or the past. With others in agent role, only negative self references were correlated with depression (e.g., "Some people would not ... put me out if I was on fire"), suggesting an interpersonal extension to the negative cognitive triad.

Adolescent↗
PubMed1999

Coping with epilepsy: do illness representations play a role?

OBJECTIVES: To determine the relative contributions of neuroepilepsy, coping and illness representation variables to psychological adjustment in epilepsy. DESIGN: The study was a cross-sectional design, contrasting the adjustment of recently diagnosed and chronic patients. Neuroepilepsy, illness representation, coping and adjustment variable were all measured. METHOD: A total of 94 patients were studied comprising three groups: recently diagnosed patients, chronic patients cared for in hospital clinics, and chronic patients cared for by their GP. A measure was developed to assess each patient's illness representations of epilepsy. RESULTS: Overall, the epilepsy patients showed significant adjustment problems relative to a normative group. There were, however, significant differences between epilepsy subgroups: recently diagnosed and chronic (clinic) patients exhibited problems, but chronic (GP) patients were relatively well adjusted. After controlling for the effects of group membership and neuroepilepsy variables, coping and illness representations, each explained significant additional variance on measures of psychological adjustment. Patients presenting with adjustment difficulties were characterized by high seizure frequency, avoidance father than problem-focused coping, doubt about their diagnostic label and belief in poor containment. CONCLUSIONS: We conclude that the illness representations paradigm has value in understanding psychosocial adjustment to epilepsy. This approach offers the potential to identify the critical factors in patients' adaptation to illness. Such insights into the coping process may contribute to the development of effective clinical interventions.

Acute Disease↗
PubMed1998

The role of SF-1/Ad4BP in the control of the bovine gene for the steroidogenic acute regulatory (StAR) protein.

The bovine gene for the steroidogenic acute regulatory protein (StAR) was cloned and sequenced, including 2 kb of the upstream control region of the gene. The gene comprises seven exons arranged similarly to those of the human and mouse gene sequences. The sequence analysis identified three cis elements corresponding to the binding motif for the transcription factor SF-1/Ad4BP, at - 100, - 240 and - 1190 from the transcription start site. Electrophoretic mobility shift analysis (EMSA) using nuclear proteins from bovine corpus luteum and bovine adrenal as well as in vitro transcribed/translated SF-1/Ad4BP consistently showed that only the site at -1190 bound the transcription factor significantly. Very weak binding was detectable also at the - 240 site, but none at the -100 site. Heterologous transfection of StAR promoter deletion-reporter constructs into Hela cells cotransfected with an expression vector for bovine SF-1/Ad4BP, showed that this transcription factor can specifically act on the bovine StAR gene promoter, but preferentially in regions corresponding to the two proximal SF-1/Ad4BP elements at - 100 and - 240, though with only low relative effect. Furthermore, additional cotransfection of a construct expressing a constitutive protein kinase A catalytic subunit to mimic the effects of cAMP stimulation, led to a small SF-1/Ad4BP-dependent increase in reporter activity mediated only by the same proximal sites. Since the bovine StAR gene promoter does not appear to have a functional cAMP responsive element (CRE), either this effect is mediated in this system directly by SF-1/Ad4BP, or by other factors interacting with this transcription factor, but which do not involve CRE-mediated gene activation. Taken together, the results show that there is a discrepancy between the results of the EMSA experiments and those using transfection of promoter-reporter constructs, which needs to be resolved before a clear understanding of SF-1/Ad4BP-mediated regulation of the StAR gene is attained.

Animals↗
PubMed1998

Frequency of patients' consulting in general practice and workload generated by frequent attenders: comparisons between practices.

BACKGROUND: Patients who attend frequently may present a problem for general practitioners (GPs) in several ways. The frequency of patients' consulting, comparisons between practices, and the effect of frequent consulting on the clinical workload have not been quantified previously. AIMS: To examine the distribution of the number of consultations per patient in four general practices. To estimate the clinical workload generated by frequent attenders. To model the data to demonstrate the contribution of age, sex, and practice on the likelihood of attending frequently. METHOD: Analysis and modelling of a validated data set of date records of consultations collected routinely over a 41-month period from four practices in and around Leeds, representing 44,146 patients and 470,712 consultations. RESULTS: A minority of patients consulted with extreme frequency. All practices had similar distributions but varied with respect to the numbers of frequent attenders, and the frequencies of their consulting. The most frequent 1% of attenders accounted for 6% of all consultations, and the most frequent 3% for 15% of all consultations. Females and older people were more likely to be frequent attenders. CONCLUSION: Frequent attenders have an important effect on GPs clinical workload. Between one in six and one in seven consultations are with the top 3% of attenders. Further research is needed to explain the behaviour underpinning frequent attendance in order to identify appropriate management strategies; such strategies could have an important effect on clinical workload.

Adolescent↗
PubMed1997

Responses of consecutive patients to reassurance after gastroscopy: results of self administered questionnaire survey.

OBJECTIVE: To study the time course and prediction of responses to reassurance after gastroscopy showing no serious illness. DESIGN: Selection of consecutive patients were assessed before gastroscopy, immediately after reassurance, and at follow up at 24 hours, 1 week, 1 month, and 1 year. Responses of subgroups of patients identified as high, medium, and low health anxiety by the health anxiety questionnaire were analysed. SETTING: Endoscopy clinic in a general hospital. INTERVENTION: Oral reassurance that there was "nothing seriously wrong." SUBJECTS: One consultant physician and 60 patients aged 18-74 referred for gastroscopy. MAIN OUTCOME MEASURES: Physician's and patients' ratings of the extent of the reassurance and patients' ratings of their anxiety about their health and of their illness belief. RESULTS: There was good agreement between the patients and the physician about whether reassurance had been given. Health anxiety and illness belief decreased markedly after reassurance. Patients with high health anxiety showed a significant resurgence in their worry and illness belief at 24 hours and 1 week, and these levels were maintained at 1 months and 1 year later. Patients with medium levels of health anxiety showed a reduction in worry and illness belief after reassurance, and this was generally maintained during follow up. Patients with low health anxiety maintained low levels of health worry and illness belief throughout the study. Partial correlation analyses showed that the levels of worry and illness belief after reassurance were predicted by the health anxiety questionnaire. This measure also had predictive value beyond that of a measure of general anxiety. CONCLUSIONS: Medical reassurance results in a reduction of worry about health and of illness belief, but this may be very short term. Measurable individual differences in health anxiety can be used to predict the response to reassurance.

Adolescent↗
PubMed1997

The relationship between laparoscopic disease, pelvic pain and infertility; an unbiased assessment.

OBJECTIVES: To measure the relationship between laparoscopically detected pelvic pathology and pelvic pain or infertility. METHODS: Women undergoing diagnostic laparoscopy either for the investigation of pelvic pain, for sterilisation or for the investigation of infertility were studied. The indication for surgery was recorded before laparoscopy. At operation a series of 35-mm slide photographs were taken of the pelvis and later scored by two independent assessors without knowledge of the indication for surgery. RESULTS: Satisfactory photographs were obtained in 298 women. Minimal endometriosis was not associated with pain (adjusted OR 1.3; 0.5-2.8), although moderate disease was non-significantly so (2.5; 0.4-7.1). Severe disease was significantly more common and never occurred in patients being sterilised (P = 0.02). The odds of pain were not increased in the presence of dilated veins > 9 mm diameter (OR 1.1; 0.4-3.2) or adhesions (OR 0.6; 0.2-4.7). The odds of infertility were non-significantly increased in the presence of minimal and moderate endometriosis (OR 2.0; 0.8-5.3, and OR 4.2; 0.6-25 respectively) and again significantly more common in the presence of advanced disease (P = 0.002). The odds of infertility tended to be lower in the presence of severely dilated veins (OR 0.2; 0.032-1.2). There was no clear effect of adhesions (OR 0.9; 0.1-5.9). CONCLUSIONS: The long established associations between severe endometriosis and pelvic pain, and between endometriosis in general and infertility are confirmed. However there is little or no association between minimal endometriosis, pelvic adhesions or dilated pelvic veins and pain. Previously reported associations may have been an artefact of the surgeon's knowledge of the indication for operation when assessing the pelvis.

Endometriosis↗
PubMed1997

Systematic review of outpatient services for chronic pain control.

AIM OF REPORT. This report reviews the evidence about the effectiveness of treatments for chronic pain. While treatment of chronic pain is usually seen as an integrated service, this report concentrates on the individual interventions that constitute the service. HOW THE RESEARCH WAS CONDUCTED. Searches of databases and journals identified over 15,000 randomised studies with pain as an outcome, and many more which were not randomised. Over 150 systematic reviews relevant to chronic pain treatment were identified and their quality assessed using a simple scoring system. Systematic reviews conducted for this report were based mainly on randomised trials. The number needed to treat (NNT) was chosen as the output for the report. NNTs of 2-4 indicate effective treatments. Because NNT is treatment-specific it overcomes problems associated with highly variable placebo or control event rates in pain trials. Such variability is predominantly due to the limited numbers of patients in the clinical trials. Dichotomous outcome measures are important in synthesising information from many studies, and in deriving NNTs. Methods have been developed which allow mean information on pain relief and intensity to be converted reliably into the simple dichotomous outcome of at least 50% pain relief. RESEARCH FINDINGS. PHYSICAL INTERVENTIONS. Transcutaneous electrical nerve stimulation (TENS) has been shown not to be effective in postoperative and labour pain. In chronic pain, there is evidence that TENS effectiveness increases slowly, and that large doses need to be used. There is lack of evidence for the effectiveness of TENS in chronic pain. There is a lack of evidence for the effectiveness of relaxation. Intravenous systemic regional blockade with guanethidine has been shown to be without effect. Epidural corticosteroids are effective in the short term for back pain and sciatica. Injections of corticosteroids in or around shoulder joints for shoulder pain have been shown not to be effective. There is a lack of evidence supporting spinal cord stimulators. Case series are of poor quality and do not provide evidence of effectiveness, although at least 50% pain relief at 5 years is reported in over 50% of patients. PHARMACOLOGICAL INTERVENTIONS. Minor analgesics are important in chronic pain. NNTs were calculated for analgesics given orally for moderate or severe acute postoperative pain. The NNTs found ranged from 17 (poor) for codeine, 60 mg, to 2.5 (good) for ibuprofen, 400 mg. Anticonvulsant and antidepressant drugs are prescribed for neuropathic pains like diabetic neuropathy. NNTs are of the order of 2.5, showing them to be effective treatments. However, there are too few studies with too few patients to determine which is the best drug. Minor adverse events are common, and major adverse events occur in about 1 in 20 patients. There are no studies comparing antidepressants and anticonvulsants directly. Systemic local anaesthetic-type drugs have been shown to be effective in nerve injury pain but there is little or no evidence to support their use in migraine or cancer-related pain. Topical NSAIDs (for example, gels, creams) are effective in rheumatological conditions with an overall NNT of 3. There are too few studies to determine which is the best agent. Topical NSAIDs have few adverse events; most importantly they are without the major gastrointestinal adverse events found with oral NSAIDs, which might make them an important choice for some patients with peripheral arthritis. (ABSTRACT TRUNCATED)

Ambulatory Care↗
PubMed1996

Vascular damage without hypertension in transgenic rats expressing prorenin exclusively in the liver.

We have developed a transgenic animal model to investigate the effects of overexpression of rat prorenin on the cardiovascular system. Two transgenic rat lines were generated in which rat prorenin expression was directed to the liver by a human alpha1-antitrypsin promoter. Liver-specific expression was confirmed by RNase protection assay. Plasma prorenin concentrations in transgenic rats were increased 400-fold in the males of both lines but were increased only two- to threefold in the females. Thus, transgene expression exhibited sexual dimorphism. Blood pressures were not significantly higher in transgenic rats than in nontransgenic controls. The ratio of heart weight to body weight was greater in male transgenic rats than in the nontransgenic controls. Histological analysis revealed severe renal lesions and hypertrophic cardiomyocytes in transgenic males only. This transgenic model demonstrates a likely role of prorenin in the development of cardiac and renal pathology independent of hypertension. These animals will facilitate studies of the effects of blockade of the renin-angiotensin system and other pharmacological interventions on the development and treatment of cardiac, vascular, and renal lesions induced by changes in this system in the absence of chronic hypertension.

Angiotensinogen↗
PubMed1996

Real world data--retrieval and validation of consultation data from four general practices.

OBJECTIVE: We aimed to retrieve data on consultations from general practice databases and to develop and use appropriate methods of validation for these data. METHOD: MIQUEST software was used to retrieve the data from four practices. The data were validated by comparing them with figures generated by practice-based searches, measuring the uptake of recording of consultations over time, and comparing records of consultations in the case notes with those on the practice computers. RESULTS: The required data were retrieved from general practice databases, but the path to success was difficult, and typified by uncertainty and unpredictability. The recording of consultations on the computers of four practices was more complete than the recording in the paper case records. There was a time period in the early months of computer use when the recording of consultations was less complete. There were differences in the completeness of recording consultations between practices, doctors, and patients. CONCLUSIONS: This study confirms the potential of general practice databases for research, demonstrates how MIQUEST software can be a useful tool in retrieving data from general practice databases, and indicates how the completeness of data recording permitted further analysis for the purposes of our study.

Data Collection↗