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Biomedical subjects

A Rowlands

Publications and source records attributed to A Rowlands.

At least 19 recordsLinked to original sources
PubMed2006

Risk factors for psychological distress following injury.

OBJECTIVES: To identify predictors of psychological morbidity among injured patients admitted to an Emergency Department (ED). DESIGN: A prospective cohort study. PARTICIPANTS: Participants were consecutive male ED attenders. 210 (97.7%) patients consented to participate. At one month, 128 (61.0%) responded, at six months, 114 (54.3%), at eighteen months 96 (45.7%). MAIN OUTCOME MEASURES: Measures immediately following injury were the Hospital Anxiety and Depression Scale, the Eysenck Personality Questionnaire and the McGill pain questionnaire. Recovery at one month was recorded using the SF-36 Health Survey, COPE scale, Perceived Stress Scale and Revised Impact of Events Scale. At six and eighteen months outcome was measured using the General Health Questionnaire (28 items) and Revised Impact of Events Scale. Multivariate analysis identified pre-morbid, accident-related and recovery factors influencing outcome at six and eighteen months. RESULTS: The strongest predictors of outcome were initial levels of anxiety and depression, prior history of mental health problems, early PTSD symptoms and involvement in litigation. These factors predicted between 40-60% of the variance at six months (p<0.001), and 50-60% of the variance in psychological distress at eighteen months (p<0.001). CONCLUSION: Factors identifying individuals at-risk from psychological distress following injury include those related to the immediate response and the recovery phases of injury. Further development is needed to convert identified predictors into a comprehensive screening tool for clinical use.

Adolescent↗
PubMed2004

Evaluation of an accident and emergency teleconsultation service for north-east Scotland.

We evaluated an accident and emergency teleconsultation service provided to 14 community hospitals in north-east Scotland. Each community hospital was equipped with a videoconferencing system and a document camera to allow transmission of radiographs. The network used 384 kbit/s ISDN connections. A total of 1392 teleconsultations were recorded during a 12-month study period. Seventy-seven per cent of patients (n = 1072) were managed locally and 23% (n = 320) were transferred to Aberdeen. The majority (95%) of teleconsultations were conducted on weekdays, and 90% of these occurred between the hours of 09:00 and 16:00. The mean delay in contacting a doctor was 9 min and the mean consultation time was 10 min. The majority of patients were suffering from fractures or suspected fractures of the limbs. Radiograph transmission was used in 75% of all teleconsultations. A high degree of satisfaction was recorded by all users of the service.

Adult↗
PubMed2003

Minor injuries telemedicine.

A minor injuries telemedicine network in Grampian connects 14 accident and emergency departments in community hospitals to a teaching hospital department. In a six-month study, 407 new telemedicine consultations met the inclusion criteria. Rates of transfer for treatment to the base hospital were used as an outcome measure. Fourteen out of a total of 19 members of medical staff gave telemedical advice. They were mainly middle-grade accident and emergency doctors. Transfer rates were 16-48% (median 29%) across staff. The rates did not seem to be affected by the base doctor's seniority, but were a reflection of that doctor's experience of and confidence in using videoconferencing equipment for clinical purposes. Transfer rates decreased as experience increased. Training for doctors undertaking the provision of specialist advice should include the clinical practicalities of making remote diagnoses.

Emergency Service, Hospital↗
PubMed2003

An evaluation of a telemedicine fracture review clinic.

Telemedicine is being widely used in the treatment of patients with minor injuries in north-east Scotland. A telemedicine fracture review clinic has been developed. During a one-month study period there were a total of 67 review appointments and 88 new patients. Fifty individual patients were reviewed and 10 were seen on more than one occasion. The mean number of reviews for all patients was 2.3. Thirty-six patients had initially been seen by telemedicine, six of whom (17%) had to come to Aberdeen for part of their treatment. Fourteen patients reviewed by telemedicine had initially been seen in person. All patients were safely managed and normal guidelines were followed. There is scope for significant expansion of this service, since 131 patients were seen in a fracture clinic in Aberdeen who lived close to a minor injury unit with telemedicine and X-ray facilities. The majority of these patients were likely to have had injuries suitable to be followed up using telemedicine.

Fractures, Bone↗
PubMed2003

A role for tele-education in the centralization of accident and emergency services.

We evaluated the use of tele-education to provide an induction programme for accident and emergency senior house officers (SHOs) in three remote locations, and compared their performance with that of SHOs receiving the same induction programme in the conventional manner. Both groups of doctors performed similarly in a pre-course multiple-choice question (MCQ) paper, and showed comparable improvement following the induction programme lectures. Sound quality and levels of interactivity were identified as areas for improvement in the tele-education programme. Tele-education might allow doctors based in peripheral units similar access to high-quality teaching to that enjoyed by those in larger hospitals. Further experience and evaluation are required to optimize this method of education delivery.

Education, Distance↗
PubMed2002

The psychological burden of injury: an 18 month prospective cohort study.

OBJECTIVES: To determine the prevalence of post-trauma psychological problems among a cohort of male accident and emergency department patients admitted to hospital. To identify the changes in their psychological symptoms over an 18 month follow up period. METHODS: A prospective cohort study of male accident and emergency department patients who were admitted for treatment of an injury. Baseline interview recorded demographic details and accident details. Standardised questionnaires measured baseline psychological state and personality type. Follow up at six weeks, six months, and 18 months after injury was by face to face interview or postal questionnaire and recorded progress since injury, and documented psychological status through the use of standardised questionnaires to detect psychiatric disorder and symptoms of post-traumatic stress disorder (PTSD). RESULTS: 210 male patients were recruited into the study. Psychiatric disorder was identified in 47.6% of responders at six weeks, and 43.4% at six months after injury. This improved significantly at 18 months. PTSD symptoms were moderate in 25%-30% and severe in 5%-14% and did not change significantly over the study period. A significant relation was found between previous psychiatric history and psychological symptoms at 18 months after injury. No relation was identified between injury severity and psychological status after injury. CONCLUSION: This study finds a high prevalence of psychological distress in male accident and emergency department patients after injury. Although some symptoms resolve over the follow up period, a proportion remain and may be related to previous psychiatric history. There was no relation identified between severity of injury and psychological morbidity.

Adolescent↗
PubMed2000

Ocular manifestations of hindbrain-related syringomyelia and outcome following craniovertebral decompression.

PURPOSE: To analyse and evaluate associated ocular symptoms and signs in hindbrain-related syringomyelia and their response to treatment. METHODS: From a database of 275 patients treated in a single institution for hindbrain hernia and syringomyelia, 39 patients (14%) had ocular symptoms and signs. Only 31 patients were included in this study; the remainder were excluded due to inadequate follow-up information. All patients had confirmed evidence of hindbrain-related syringomyelia with MRI scan or CT myelogram. Treatment included craniovertebral decompression or ventriculo-peritoneal shunting. The mean follow-up was 23 months. RESULTS: In addition to the well-recognised sign of downbeat nystagmus, classically associated with foramen magnum abnormalities, a number of other ophthalmic features were identified. Symptoms included diplopia, oscillopsia, tunnel vision and difficulty in lateral gaze. Signs included nystagmus (downbeat, horizontal, rotatory, and combinations), strabismus, disc pallor, anisocoria, ptosis and field defect. Patients were categorised into two groups depending on whether the ocular features were manifest at first presentation (group 1, n = 14) or developed later in the course of the disease (group 2, n = 17). The delay in diagnosis from first presentation was 5 and 6 years respectively. All patients underwent surgery. Craniovertebral decompression was performed in 13 patients in group 1 and in 15 patients in group 2. Ventriculo-peritoneal shunt was inserted in 1 patient in group 1 and in 3 patients in group 2, for the associated hydrocephalus. Following surgery, 100% of patients in group 1 and 82% of patients in group 2 had complete or partial resolution of their ocular symptoms and signs. CONCLUSIONS: The presence of unexplained ophthalmic features such as nystagmus or oscillopsia should alert one to the potential diagnosis of hindbrain-related syringomyelia. Delay in diagnosis is often associated with poorer outcome. Surgical treatment can offer excellent results for these patients.

Adolescent↗
PubMed2000

The effect of three different educational approaches on children's drawing ability: Steiner, Montessori and traditional.

BACKGROUND: Although there is a national curriculum for art education in the UK there are also alternative approaches in the private sector. This paper addresses the issue of the effect of these approaches on children's drawing ability. AIM: To compare the drawing ability in three drawing tasks of children in Steiner, Montessori and traditional schools. SAMPLE: The participants were 60 school children between the ages of 5;11 and 7;2. Twenty children were tested in each type of school. METHOD: Each child completed three drawings: a free drawing, a scene and an observational drawing. RESULTS: As predicted, the free and scene drawings of children in the Steiner school were rated more highly than those of children in Montessori and traditional schools. Steiner children's use of colour was also rated more highly, although they did not use more colours than the other children. Steiner children used significantly more fantasy topics in their free drawings. Further observation indicated that the Steiner children were better at using the whole page and organising their drawings into a scene; their drawings were also more detailed. Contrary to previous research Montessori children did not draw more inanimate objects and geometrical shapes or fewer people than other children. Also, contrary to the prediction, Steiner children were significantly better rather than worse than other children at observational drawing. CONCLUSION: The results suggest that the approach to art education in Steiner schools is conducive not only to more highly rated imaginative drawings in terms of general drawing ability and use of colour but also to more accurate and detailed observational drawings.

Aptitude↗
PubMed1995

Nephrotic syndrome associated with N-hydroxyureas, inhibitors of 5-lipoxygenase.

The N-hydroxyurea derivatives 70C ((E)-N-[3-[3- (4-fluorophenoxy)phenyl[-1-(R,S)-methylprop-2-enyl]-N-hydroxyurea) and its (R) 225C and (S) 404C enantiomers, which were being developed as 5-lipoxygenase inhibitors for the treatment of certain allergic and inflammatory conditions, were found to cause severe glomerulonephropathy in the rat. The lesion appeared to be of greater severity in female rats compared with male rats. In addition, 70C and 225C treated animals appeared more severely affected than 404C treated animals. Detailed examination of the lesion in animals dosed with 225C showed that there was a clear relationship between the onset of the lesion and the dose given, i.e. the higher the dose the sooner the lesion developed. The earliest changes detected in the kidney by transmission electron microscopy were noted in the glomeruli, in which the visceral cells appeared enlarged and showed varying degrees of foot process loss. In the more advanced lesion, the degree of foot process loss became more obvious and changes in the kidney tubules were seen by light microscopy. The morphological changes were mirrored by a dose-related increase in water consumption, an increased kidney to body weight ratio and gastrointestinal oedema, suggesting impaired renal function. Shortly after the onset of foot process loss, decreases in the total plasma protein and albumin and increases in the plasma cholesterol, triglycerides, urea and creatinine were recorded. These changes, particularly the foot-process loss, together with increased proteinuria, hypoalbuminaemia, hypercholesterolaemia and lipaemia, are all characteristic of "minimal change nephrotic syndrome". Because of the serious nature of the kidney lesion caused by these N-hydroxyureas in the rat, it was considered that it precluded their development as therapeutic agents for use in man.

Administration, Oral↗
PubMed1992

Comparison of sexual behaviour and risk of HIV transmission of Scottish inmates, with or without a history of intravenous drug use.

The sexual behaviour and intravenous drug use (IVDU) of a sample of 559 inmates (480 males and 79 females) was investigated. Sexual behaviour and IVDU prior to imprisonment, during imprisonment, and that expected after release, was assessed. Alterations in sexual behaviour as a means of HIV risk reduction was also assessed in relation to IVDU status. Prior to imprisonment most IVDUs and non-IVDUs engaged in unprotected intercourse. Sexual behaviour during imprisonment, as reported by inmates, was almost negligible for both groups. Expected sexual behaviour after imprisonment differed little from that before imprisonment for both IVDUs and non-IVDUs. Selecting partners more carefully and reducing their number was the most common method of HIV risk reduction for both IVDUs and non-IVDUs prior to imprisonment and was expected to be increasingly so after release. There was little difference in the sexual behaviour of IVDUs and non-IVDUs prior to imprisonment, during imprisonment, and as expected after release. However, IVDU inmates were more likely to have had an IVDU sexual partner than did non-IVDU inmates. Those IVDU inmates who had an HIV test, and those who had an IVDU sexual partner, were more likely to expect to continue IVDU after imprisonment. IVDU inmates, who had an IVDU sexual partner, were also more likely to have shared injected equipment but no more likely to have sterilized injecting equipment than did IVDU inmates whose sexual partner was not involved with IVDU. Results are discussed in relation to risk of HIV transmission for IVDUs and their sexual partners.

Adolescent↗
PubMed1992

Intravenous drug use and HIV transmission amongst inmates in Scottish prisons.

The intravenous drug use behaviour and HIV risk reduction strategies used by a group of Scottish inmates prior to prison, during imprisonment and as expected after release was investigated. From a sample of 559 inmates (480 males and 79 females) 27.5% were involved in IVDU prior to imprisonment, 7.7% on at least one occasion during a period of imprisonment and 14.7% expected to do so after release. Prior to imprisonment 17.3% had shared needles, 5.7% at some time during imprisonment and 4.3% expected to do so after release. Some form of HIV risk reduction strategies were practised by the majority of IVDU inmates prior to imprisonment, during imprisonment and were expected to continue after release. The most at risk inmates were those who continued to share injecting equipment without reduction and without sterilizing. The reduction in IVDU and needle sharing during imprisonment in comparison to prior to imprisonment was paralleled by a self-perceived reduction of personal risk from HIV during imprisonment.

Adult↗
PubMed1983

The haemophilic patient's self-perception of changes in health and life-style arising from self-treatment.

Twenty three adults and twenty children with haemophilia, all on self-treatment, participated in the present study. They were interviewed as to how they perceive the effects of self-treatment upon various aspects of their life. It was found that the ability to treat themselves was perceived by patients as a great improvement over their previous treatment regimes for which they had had to go to hospital. Twelve of the adult patients had participated in our previous studies concerned with the social an psychological aspects of haemophilia. The analysis of the responses of these twelve patients showed that self-treatment is perceived so positively that some of the patients' earlier perceptions were distorted to correspond with their present and more optimistic perceptions of their condition. However, the number and type of psychosomatic symptoms was found to be unchanged by self-treatment and the unemployment rate has not decreased.

Adolescent↗
PubMed1980

Dietary management of chronic renal failure with oral amino acids.

6 patients in end-stage renal failure of varying aetiologies have been studied on low protein dietary regiments according to a P 6 formulation. All patients had part of their daily protein allowance substituted by an essential amino acid capsule also containing histidine and glutamic acid. All patients were maintained in nutritional balance as a result of the regiments prescribed. No toxic effects were noted and patient compliance was good. Our studies suggest the amino acid formulation given is safe and did not cause any fluctuations in patient plasma amino acid profiles. Our studies suggest an improved method of low protein dietary management for chronic renal failure patients together with a greater flexibility and wider range of prescribing possibilities. It is recommended that amino acid supplements according to the formula produced here constitute an improvement on currently prescribed Giovannetti regimens.

Adult↗
PubMed1979

Apparent hexosaminidase B deficiency in two healthy members of a pedigree.

A family is described in which all members have decreased serum and leukocyte hexosaminidase activity. Two individuals, the mother and the younger daughter, have a normal ratio of hexosaminidase B (HEX B) to total hexosaminidase, but their serum enzymes display respectively partial or complete lability to heat. It is proposed that the proband is a double heterozygote for the Sandhoff allele and for an allele producing thermolabile beta subunits.

Adolescent↗
PubMed1978

Comparison of the effects of keto acid analogues and essential amino acids on nitrogen homeostasis in uremic patients on moderately protein-restricted diets.

Comparisons of isonitrogenous supplements (1.2 g N) of essential amino acids and five keto acid analogues with four essential amino acids were made in seven patients with stable chronic renal failure (creatinine clearance, 4.6 to 16 ml/min) on moderately protein-restricted diets (4.60 to 7.8 g N per day). Full nitrogen balance data on the four patients who have already completed studies lasting 24 weeks are presented. No benefits of keto acid over amino acid supplements were observed. Two transient episodes of hypercalcemia occurred during keto acid treatment. There was no improvement of renal function with keto acids. Also, no carry-over effects were seen after keto acid treatment. It is concluded that any beneficial effects of keto acids in patients with chronic renal failure are only likely to occur in those taking a diet of less than 30 g protein daily.

Adult↗