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Biomedical subjects

C Bass

Publications and source records attributed to C Bass.

At least 37 records · Page 2Linked to original sources
PubMed2000

Can clinical assessment of chest pain be made more therapeutic?

We describe the referral and management of consecutive patients attending a cardiac service with the presenting complaint of chest pain. Of 610 consecutive new referrals to five Oxford cardiac clinics over 12 weeks, 202 had chest pain as the presenting complaint: 91 (45%) angina, 101 (50%) non-cardiac chest pain, 8 (4%) both and 2 (1%) uncertain diagnosis. Information in clinic letters was sometimes ambiguous and contradictory and suggested a lack of precise information to patients. Patients with non-cardiac chest pain often had long histories, including considerable previous use of services and specialist investigations. There were delays in referral and assessment of patients. There are opportunities for simple changes in assessment procedures which might have substantial advantages for outcome and resource: (i) more detailed referral information from general practitioners, with an explicit statement of the reasons for referral; (ii) minor modifications to augment the assessment by provision of unambiguous information to patients and primary care at discharge.

Angina Pectoris↗
PubMed1999

"Wheelchair" patients with nonorganic disease: a psychological inquiry.

We studied ten patients referred from the neurology service with severe disability associated with the use of a wheelchair, but with no organic disorder to account for their disabilities. All patients were assessed using rating scales as well as a standardized psychiatric interview (SCID), and all medical and psychiatric case notes were examined. We also interviewed key carers for their views on the information and assistance the patients had received. All but two of the ten patients were women, and the mean age was 45.4 years (SD=5.4). All had current diagnoses of conversion or somatoform disorders and six had previous episodes of major depression. Most patients expressed beliefs about their illness that were not consistent with the medical facts, and only two of the carers were satisfied with explanations they had been given by doctors. The results suggest that requests for psychiatric help once patients have become grossly disabled are unlikely to lead to recovery. The psychiatrist, however, can help the primary care doctor to formulate a plan of management aimed at preventing further deterioration.

Adult↗
PubMed1998

Atypical chest pain: looking beyond the heart.

Chest pain is common, and tends to be overinvestigated. Patients with normal coronary anatomy have a low mortality, but remain significantly incapacitated. We discuss ways of improving the management of such patients. An early diagnosis of a non-cardiac cause of pain should be made, ideally by the general practitioner, taking account of risk factors for cardiac as well as psychological disorders, the quality of the pain, the patient's concerns and worries and the presence of stressful life events. The minimum of investigation should be performed. Cardiological referral should be considered for patients with a high a priori risk of ischaemic heart disease. Otherwise referral, if necessary, should be to a gastroenterologist, psychiatrist or clinical psychologist, as appropriate. Treatment options are medications with musculoskeletal or oesophageal activity, simple or repeated reassurance, cognitive therapy, psychiatric drugs, and respiratory retraining. We suggest that a multidisciplinary chest-pain clinic may improve the care of such patients.

Chest Pain↗
PubMed1997

Hyperventilation syndrome: a chimera?

There is now an impressive body of research to suggest that the concept of a discrete hyperventilation syndrome is no longer tenable. The evidence for this has been carefully gathered and the scientific studies have employed innovative methodological techniques and have introduced a key psychological dimension. Both have led to a greater understanding of the respiratory correlates of anxiety, but in the process have revealed the "hyperventilation syndrome" to be a chimera. Furthermore, there is no evidence to support the view that panic attacks and hyperventilation are synonymous: on the contrary, hyperventilation rarely accompanies panic and, when it does, it is more likely to be a consequence than a cause of the panic. Finally, there is no evidence that "breathing therapy" works by normalizing pCO2; its nonspecific effects on anxiety appear to be mediated in part by slowing respiratory rate. Further research in this field might be more profitably focused on the nature of the association between anxiety disorders and organic lung disease, especially asthma.

Breathing Exercises↗
PubMed1997

A controlled trial of cognitive behavioural therapy for non-cardiac chest pain.

BACKGROUND: The majority of patients presenting to cardiac clinics with chest pain who are reassured they do not have heart disease or other serious physical disorder continue to experience symptoms, worry about heart disease and restrict their activities. This randomized trial investigated the effectiveness of psychological treatment within routine cardiac care. METHODS: Consecutive patients presenting with chest pain and reassured by a cardiologist they do not have heart disease were reassessed 6 weeks later. Those with persistent limiting symptoms were offered the opportunity to participate in a trial of cognitive behavioural therapy. RESULTS: Thirty-seven subjects agreed to take part. A number of subjects were unenthusiastic about psychological intervention or, following explanation of the study, regarded further treatment as not being necessary. At 3 months there were significant differences between the treatment group and the control group on key outcome measures of symptoms, mood and activity. At 6 months there were fewer differences but significant advantages of treatment in terms of limitation of activities and worry about physical symptoms. CONCLUSION: We conclude that there is a need for 'stepped' further care following reassurance in the cardiac clinic and that cognitive behavioural treatment is effective with those with persistent disabling symptoms.

Adult↗
PubMed1997

Non-cardiac chest pain: why was a brief intervention apparently ineffective?

BACKGROUND: Patients who present with chest pain but have normal coronary angiography and who are told by their cardiologist that they do not have heart disease, have a poor symptomatic, psychological and quality of life outcome and remain concerned about a serious cause of their symptoms. They frequently complain they have not had enough information. The study aimed to test the effectiveness and acceptability of a brief psychological intervention based on cognitive behavioural principles. METHODS: Consecutive patients with chest pain and normal angiograms were assessed and invited to take part in a randomized controlled evaluation. The intervention consisted of an individualized information and discussion session by a specially trained cardiac nurse, together with a handout and cassette providing information and advice and telephone follow-up to discuss progress, answer questions and reiterate advice. RESULTS: The treatment proved to be unacceptable to some patients and there was no evidence of efficacy. CONCLUSIONS: Implications for the preparation of patients undergoing angiography and for the timing and delivery of information and advice following a negative result are discussed.

Analysis of Variance↗
PubMed1997

Emphysematous chorioamnionitis diagnosed by ultrasonography.

Preterm labor, cervical cerclage (especially when performed as an emergency procedure), and diabetes mellitus are all associated with an increased risk of chorioamnionitis. It might be expected that the combination of all 3 could lead to especially severe infection. We report such a case. A woman with a history of two spontaneous midtrimester abortions had had cervical cerclage performed at 13 weeks. She was referred at 24 weeks' gestation with preterm labor, and the cervix was found to be dilated. An emergency repeat cerclage was performed. The following day, ultrasonography revealed the presence of intra-amniotic gas. Infection was confirmed by the presence of a purulent cervical discharge, a neutrophilia with a left shift, and an elevated C-reactive protein level. The cervical stitch was removed and labor induced. The infant was liveborn, but succumbed to the complications of prematurity and sepsis. E. coli was isolated. In her subsequent pregnancy, severe gestational diabetes was diagnosed and following pregnancy, permanent diabetes mellitus was confirmed. The combination of infection, diabetes, and intact membranes may lead to a particularly severe form of chorioamnionitis, with the production of gas within the amniotic cavity. Infection should be excluded before emergency cervical cerclage, especially in the woman with diabetes mellitus.

Adult↗
PubMed1995

Somatoform and personality disorders: syndromal comorbidity and overlapping developmental pathways.

We review the literature on the relationship between somatoform disorders and personality disorders, which reveals that approximately two in three patients with a somatoform disorder meet criteria for a personality disorder. We suggest that the most clinically salient problems presented by patients with somatoform disorders reflect dysfunctions of personality. We also examine research on the childhood antecedents of somatoform disorders and argue for reconsidering somatoform disorders, along with personality disorders, as disorders of development. Our argument involves rejecting the traditional approach to classification in favour of a prototypical polythetic view. We also suggest that the perspectives of developmental psychopathology and life-span research offer more to this field than the search for biological substrates or principles based on descriptive psychopathology, which to date have yielded meagre research findings with limited clinical utility.

Adolescent↗
PubMed1995

Recombinant adenovirus-mediated gene transfer to genitourinary epithelium in vitro and in vivo.

Transitional cell carcinoma (TCC) of the bladder is associated with characterized lesions in dominant and recessive oncogenes. The understanding of the molecular basis of tumorigenesis in these instances makes possible the application of gene therapy strategies for TCC. In this regard, the ability to directly access the epithelium of the genitourinary (GU) tract via the urethra provides a practical means to implement these various gene therapy approaches. We thus explored vector strategies to accomplish direct in vivo transduction of GU epithelium. Initially, three human (HT 1197, HT 1376, T24) and one mouse (MBT-2) TCC cell lines were transduced using a recombinant adenoviral vector expressing the firefly luciferase reporter gene, rAd-CMV-Luc. In these studies, reporter gene expression was found to be significantly elevated above background for all four cell lines. Of note, the TCC cell lines HT 1197 and HT 1376 showed expression levels comparable with the cervical carcinoma cell line HeLa, a cell line previously shown to be highly susceptible to recombinant adenovirus-mediated gene transduction. An in vitro time course for T24 and MBT-2 using rAd-CMV-Luc showed peak expression 1 day after transduction for the T24 line and 3 days after transduction for the MBT-2 line, with detectable levels of expression persisting for at least 7 days. As a next step, human and mouse primary tissue deriving from the GU epithelium were transduced using rAd-CMV-Luc. In this assay, luciferase expression levels significantly above background were observed in both instances.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoviruses, Human↗
PubMed1994

User charges for rural health services in Papua New Guinea.

This paper reports on a review of user charges for health services in rural areas of Papua New Guinea. Facilities implementing both fee for service and community risk sharing schemes were studied. This study found that there is a lack of any policy framework or practical guidelines on cost recovery. In some areas fees are being used as a fiscal tool rather than to further health policy. This study from Papua New Guinea raises serious questions about the virtue of cost recovery for health services in rural areas. Equity is an issue and the fees are creating a barrier both for entry and continuation in the health system; accountability is poor, and issues of cross subsidization are not addressed; fee revenues from rural health services are small and primarily of local significance; and are not being used to improve quality of health services. Cost recovery schemes in rural areas have the potential to provide a valuable contributory source of income to operate and improve health services. In practice, few are achieving this. It is concluded that health sector financing focus could be more fruitfully directed to financing mechanisms with greater potential to improve and expand health services.

Community Health Services↗
PubMed1993

Attitudes of British psychiatrists to the diagnosis of somatisation disorder. A questionnaire survey.

A postal questionnaire was sent to 195 senior British psychiatrists who were asked about their attitudes towards the DSM-III-R diagnosis of somatisation disorder (SD) and the ICD-10 diagnosis of multiple somatisation disorder. Of the 148 respondents, 98 (66%) had experience of liaison psychiatry, and these psychiatrists used the diagnosis significantly more often than those without liaison sessions. More than half the respondents perceived SD as both a personality disorder and a mental state disorder, although 27% thought that patients with SD had an undiagnosed physical disease. The marked discrepancy between British and North American psychiatrists in diagnostic practices was perceived to be a consequence of both the difference in health care systems and the interest shown in the disorder by North American psychiatrists, rather than a reflection of genuine differences in prevalence.

Attitude of Health Personnel↗
PubMed1993

The management of chronic somatisation.

'Somatisation' is a process in which there is inappropriate focus on physical symptoms and psychosocial problems are denied. In some patients this process becomes chronic (in excess of six months). Special skills and strategies are required by non-psychiatrists to manage these patients, for whom the acceptance of psychiatric treatment should be facilitated. When taking the history, doctors should be aware of psychosocial cues; thereafter they should be consistent and unambiguous in their management. An agenda should be set early on, with limits on investigations. Failure to manage this group of patients is costly, and further intervention studies are required not only to reduce health service and other costs, but also to relieve the non-monetary burden of physical and psychosocial disability on patients and their relatives.

Adaptation, Psychological↗
PubMed1993

Personality disorders in patients with somatisation disorder. A controlled study.

Twenty-five women with somatisation disorder (SD) were compared with matched patient controls for the presence of personality disorders. Personality was assessed with the Personality Assessment Schedule (PAS). Interviewers were unaware of the patients' diagnoses. All controls had DSM-III-R axis I diagnoses of depressive or anxiety disorders. The prevalence of personality disorders among patients with somatisation disorder was 72% compared with 36% among controls. Certain personality disorders, including passive-dependent, histrionic, and sensitive-aggressive, occurred significantly more often in the SD patients than controls.

Adult↗