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Biomedical subjects

T Burns

Publications and source records attributed to T Burns.

At least 109 records · Page 6Linked to original sources
PubMed1991

Cost of schizophrenia in a randomized trial of home-based treatment.

A randomized trial of acute psychiatric care was conducted to compare home-based interventions with standard care. The setting of the study was a comprehensive urban psychiatric service in London. Sixteen of the 172 patients in the study had schizophrenia--11 in standard care (SC) and 5 in community care (CC). Care for patients with schizophrenia was, on average, twice as expensive as care for nonschizophrenic patients. This large and statistically significant difference was mainly the result of increased inpatient care, which averaged 33 days for the schizophrenic group compared to 7.6 days for non-schizophrenic patients. There was a modest increase in general practice and outpatient contacts among the schizophrenic patients compared with nonschizophrenic patients, but surprisingly little use of day hospital facilities. The SC schizophrenic care cost nearly twice as much as CC care, but this was not a statistically significant difference. These results suggest that provision of active community services for schizophrenic patients may lead to overall savings in care costs, mainly by a reduction in inpatient stays.

Ambulatory Care↗
PubMed1991

Care of chronic neurotic out-patients by community psychiatric nurses. A long-term follow-up study.

Ninety-nine neurotic patients from a controlled trial of CPN v. psychiatric out-patient aftercare were followed up seven years later. Of the 92 survivors, 76 were successfully interviewed. Few differences were found between the groups. Chronic mild symptoms and moderate social disability persisted, and tended to worsen a little. Treatment patterns persisted for one to two years beyond the original study; the CPN group had more CPN contacts, fewer psychiatric out-patient contacts and less psychiatric care. Thereafter, more out-patients were discharged from psychiatric care and care patterns for the two groups became similar. Out-patients attended more non-psychiatric out-patient clinics than the CPN group, but it is possible that this reflected pre-existing differences. About a third of patients remained in contact with the psychiatric service during follow-up.

Activities of Daily Living↗
PubMed1990

Studies on leukocyte beta-adrenergic receptors in depression: a critical appraisal.

Alterations in beta-adrenergic receptors (BAR) of human mononuclear leukocytes (MNL) are considered to reflect changes in central noradrenergic function and have been studied in a number of diseases. This paper critically reviews the results of recent studies on MNL-BAR in depression, with particular emphasis on the biochemical and clinical methodologies used. Despite considerable differences in these methods, a number of laboratories report consistent decreases in MNL-BAR density and significantly reduced functional response in patients as compared to controls. These studies used MNL, isolated from patients who had a greater than 14 day drug washout, and BAR-densities were measured in membrane preparations, using full Scatchard analyses, and 125I-ICYP or 3H-DHA as the ligand. Functional response of MNL-BARs was assessed by the determination of isoproterenol-stimulated cyclic AMP accumulation. A comparison of methods used by these groups further indicates that additional biochemical parameters such as lymphocyte preparation and standardized experimental conditions for the binding assays are also important for obtaining consistent results. The clinical methods in rigorous study designs also include clearly stated inclusion/exclusion criteria for patients, and age-, and gender-matched patient-control populations. Whether the reduced MNL-BAR density and function is an inherited abnormality in depressed patients, or results from downregulation by elevated catecholamines is at present not known. Studies are needed to characterize further the changes in MNL-BARs in depression and to evaluate the effects of caetcholamines and hormones on this system. Based on critical assessment of the methods reviewed we propose specific biochemical and clinical guidelines, and recommend, that these be followed in future studies on MNL-BARs in this disease.

Cell Count↗
PubMed1990

Normal variation of P300 in children: age, memory span, and head size.

The P300 (P3) event-related brain potential was elicited in a group of 50 children and young adults (4-20 years). A simple auditory task was employed in which subjects indicated with a finger movement when a randomly occurring target tone (high pitch) was presented in a series of standard (low pitch) tones. The probability of the target tone was varied across conditions at 10%, 30%, or 50% to assess possible developmental changes in P300 amplitude. Memory capacity was assessed with forward and reverse digit spans. Circumference of the head also was measured. P300 latency decreased with age, and P300 amplitude tended to become larger with age. Polynomial regression analyses revealed significant quadratic trends in these relationships, with changes leveling off for older subjects. Digit span and head circumference also were related curvilinearly to P300 values. Multiple regression analysis indicated that changes in age and memory span both predicted significant changes in P300 latency and amplitude. Target stimulus probability generally affected all subjects in a similar fashion, although the strength of the correlational relationships tended to decline with increases in probability. Developmental changes for the N1, P2, and N2 components from the standard stimuli also were obtained. The results are discussed in terms of previous P3 findings for children and their implications for future studies.

Acoustic Stimulation↗
PubMed1990

A structured programme for out-patient alcohol detoxification.

An out-patient alcohol detoxification service based in a psychiatric emergency clinic is described. Of 173 patients referred during the first year, 76 (44%) were accepted for the programme; 60 (79%) of these successfully completed detoxification with no medical complications. Compared with previous years, during the year of operation of the service there was a 50% fall in the number of in-patient admissions for detoxification to the local hospital. We conclude that a structured out-patient detoxification programme is safe and effective, and may obviate the need for many patients to be admitted, freeing psychiatric beds for other uses.

Adolescent↗
PubMed1990

Community ward rounds.

The shift to community care in psychiatry has resulted in more work with seriously ill patients outside hospital settings. Clinical experience suggests that traditional outpatient working practices cannot adequately meet the needs of such patients and recent research confirms this. This paper describes the development of a community round by a small suburban catchment area team. The introduction of the round avoided displacement of chronic patients by acute referrals and brought a multidisciplinary perspective to the management of all patients. A more pressing need was found for structuring the review process in the community than in the inpatient setting. Community rounds are recommended as a means of reducing professional isolation, absorbing stress and ensuring effective training and audit. Finally the primary aim of the community round is achieved by providing patients in the community with the same comprehensive treatment plan provided to inpatients.

Chronic Disease↗
PubMed1989

Psychosocial adjustment after mastectomy and breast-conserving treatment.

The possible advantages of breast-conserving surgery over mastectomy with respect to psychosocial adjustment were assessed in an interview study. Consecutive patients 40 to 80 years of age with invasive breast cancer of Stages I and II were eligible for the study. Of 161 women, 99 agreed to participate; 37 received breast-conserving treatment and 62 received a modified radical mastectomy. The study method consisted of a semistructured interview at 4 and 13 months after primary treatment based on the Social Adjustment Scale (SAS) and two scales for the estimation of anxiety, depression, and adjustment to a sexual relationship. The women's ratings in the SAS inventory for adjustment to work, social life, marriage, sexual relationship, and parental role showed no statistically significant differences between the two groups. In the interviewer's global rating in the SAS protocol of the overall adjustment after 13 months, 22.0% of the women in the mastectomy group versus 5.4% of those with a preserved breast were rated as having significant disturbances. A statistically nonsignificant tendency (P greater than 0.05) emerged for the other ratings in the interviewer's assessment in SAS and in the estimation of anxiety, depression, and adjustment to sexual relationships. The consistent tendency indicates that there might be clinically important differences in the psychosocial adjustment after the two treatment methods. Larger trials focused more sensitively on the problems after breast loss versus breast preservation in breast cancer surgery are needed to further explore this field.

Adult↗
PubMed1988

Becker muscular dystrophy recombinant DNA studies in identical twins.

Two identical twins with Becker Muscular Dystrophy are reported. Both twins had the same red cell types for ABO, Rh, CDE, MNSs, Kelly, Lewis, Duffy, and Kidd. HLA typing detected the same antigens in both twins: A1, A26, B8, B17, DR3, DR7. Family history was negative. The twin patients showed identical haplotypes that were different from the haplotypes of the normal male members of the family. The sister of the twins showed a recombinant X chromosome. The informative haplotype with respect to the gene of BMD, present in the twins, was ascertained in their mother as well. Our findings strongly suggest that a mutation has occurred either in the mother or in the twins.

Biopsy↗
PubMed1988

The patient's appraisal of the cosmetic result of segmental mastectomy in benign and malignant breast disease.

Women's appraisal of the cosmetic result and their psychosocial adjustment after a standardized segmental mastectomy for benign or malignant breast disease was analyzed on the basis of a mailed questionnaire, which was satisfactorily answered by 263 (92%) of 285 women operated on consecutively. The overall result was favorable: 96.5% of the patients found the new appearance of their breast very good (30.7%), good (44.0%), or acceptable (21.8%). Women with a benign diagnosis ran a two-fold higher risk of being discontented with the new appearance of the breast than those with breast cancer. Complications of radiation therapy, preoperative concern that the breasts are important for the appearance, and anxiousness about the cosmetic result were associated with a significantly elevated risk of being less satisfied with the outcome. The main finding that it is possible to perform a locally radical operation that is highly acceptable to the woman is relevant to the surgical management of potentially malignant mammographic lesions and also to the scientific strategies for future evaluation of breast-conserving treatment modes in malignant disease.

Aged↗
PubMed1988

P300 and the risk for alcoholism: family history, task difficulty, and gender.

P300 event-related brain potentials (ERPs) were obtained from 20 pairs of male and 20 pairs of female undergraduate subjects. One member of each pair reported having a father who was alcoholic (FHP), the other reported no known alcoholic biological relative (FHN). Pair members were matched on age, height, weight, grade point average, and personal drinking history. Three auditory tasks which differed in stimulus discrimination difficulty were presented to each subject. All tasks employed 20% target and 80% standard tones with the subject required to move their index finger whenever a target stimulus was detected. No significant differences in P300 amplitude or latency were obtained between the family history subject groups, although female FHP subjects tended to have smaller P300 amplitudes than their FHN counterparts. P300 amplitude decreased with increases in the amount of self-reported alcohol consumed for FHP subjects but significantly so only for the most difficult task situation. The results suggest that the relationship between the P300 ERP and the inheritability of alcoholism is not yet clear and may be subject to modulation by task requirements, population differences, and subject sex.

Adolescent↗
PubMed1988

Recombinant DNA study of Duchenne muscular dystrophy occurring in a myotonic dystrophy family.

A recombinant DNA study was performed in a three-generation family with 8 typical cases of late onset myotonic dystrophy (DM) and with one case of Duchenne muscular dystrophy (DMD). The study with DNA markers for chromosome 19 showed linkage of DM locus to the 3.8 Kb allele of apolipoprotein C2 (APOC2) probe and to 9 Kb allele of pSC11 probe (APOC2 lod score = 0.69 at theta = 0). The 21-year-old DMD patient showed no myotonic signs. His clinical history revealed onset with weakness around 4 years of age, progressive course with wheelchair confinement at 11, and cardiomyopathy. His karyotype was normal (46, XY). The study with 10 DNA markers for the chromosome X found a deletion limited to XJ 1.1, XJ 1.2, and XJ 2.3 probes. His 22-year-old sister with typical clinical, EMG and recombinant DNA findings characteristic for myotonic dystrophy was also a carrier of DMD deletion.

Adult↗
PubMed1987

Association of serotonin concentration to behavior and IQ in autistic children.

Twenty-five boys meeting DSM-III criteria for infantile autism were evaluated for IQ, age, and behavior score on the Autism Behavior Checklist (ABC), in order to determine the ability to predic platelet-rich plasma (PRP) serotonin concentrations. Multiple regression techniques were used to adjust the PRP serotonin concentration for medication and whole blood platelet count to allow meaningful comparisons of serotonin concentrations among the autistic children. Though we found no significant correlation between the adjusted serotonin concentration and the IQ, or between the adjusted serotonin concentration and the various ABC scale scores, four individual items of the ABC did correlate with the adjusted serotonin concentration. Individuals with all of these items appear to be more severely affected with the disorder of autism and have a tendency to higher adjusted PRP serotonin concentration.

Adolescent↗
PubMed1987

P300 from identical twins.

The P300 component was obtained from ten pairs of identical twins and matched control subjects with an auditory discrimination task. The event-related brain potentials (ERPs) from the identical twins were strikingly similar in amplitude and latency compared to control subject pairs. The data suggest that individual variations in ERP waveform morphology are determined by the structure of the neurophysiological mechanisms responsible for P300 generation.

Adolescent↗
PubMed1986

Primary anorexia nervosa in the male and female: a comparison of clinical features and prognosis.

The clinical characteristics of a consecutive series of 36 male anorectics were compared with those of a similar series of 100 female cases. Social class background and mean age of onset were found to be similar as were the majority of clinical features at presentation. Anorexia nervosa was associated with diminished differences between the sexes in terms of physical, experiential and behavioural characteristics directly related to the condition, and in terms of general psychoneurotic characteristics. The condition is one within which the individual is sadly reduced to an existence rooted in the experience, behaviour and impulses of starvation including the impulse to ingest and the consequent defences against this latter propensity and its implication of weight gain. Only the 'choice' of defence relates to premorbid 'personality' characteristics and thereby continues to characterize the individual. Overall the same background and presentation factors in both sexes predict similar outcomes, though a vomiting defence at presentation predicts good outcome for males and poor outcome for females. The condition is very rare in the male and such presentations may help to shed light on its overall nature.

Adolescent↗