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Biomedical subjects

C J Patterson

Publications and source records attributed to C J Patterson.

At least 19 recordsLinked to original sources
PubMed2005

Characterization of familial Waldenstrom's macroglobulinemia.

BACKGROUND: Familial clustering of B-cell disorders among Waldenström's macroglobulinemia (WM) patients has been reported, though the frequency and any differences in disease manifestation for familial patients remain to be defined. PATIENTS AND METHODS: We therefore analyzed clinicopathological data from 257 consecutive and unrelated WM patients. Forty-eight (18.7%) patients had at least one first-degree relative with either WM (n = 13, 5.1%), or another B-cell disorder including non-Hodgkin's lymphoma (n = 9, 3.5%), myeloma (n = 8, 3.1%), chronic lymphocytic leukemia (n = 7, 2.7%), monoclonal gammopathy of unknown significance (n = 5, 1.9%), acute lymphocytic leukemia (n = 3, 1.2%) and Hodgkin's disease (n = 3, 1.2%). Patients with a familial history of WM or a plasma cell disorder (PCD) were diagnosed at a younger age and with greater bone marrow involvement. RESULTS: Deletions in 6q represented the only recurrent structural chromosomal abnormality and were found in 13% of patients, all non-familial cases. Interphase FISH analysis demonstrated deletions in 6q21-22.1 in nearly half of patients, irrespective of familial background. CONCLUSIONS: The above results suggest a high degree of clustering for B-cell disorders among first-degree relatives of patients with WM, along with distinct clinical features at presentation based on familial disease cluster patterns. Genomic studies to delineate genetic predisposition to WM are underway.

Humans↗
PubMed2001

Screening for cognitive impairment and dementia in the elderly.

OBJECTIVE: To review the evidence available to support or refute the recommendation to screen for cognitive impairment (cognitive deficits which do not affect daily function) and dementia in primary care. DATA SOURCES: Medline search using terms listed at the end of this article; consultation with experts in the field; review of other published recommendations. STUDY SELECTION: There were no articles which described a randomized controlled trial of screening versus no screening. Studies were therefore chosen which aided in the definition; natural history; interventions and outcomes including possible negative effects. DATA SYNTHESIS: No systematic synthesis was performed. Background papers were circulated to a panel of experts prior to the Canadian Consensus Conference on Dementia and conclusions endorsed by consensus. CONCLUSIONS: 1. There is insufficient evidence to recommend for or against screening for cognitive impairment or dementia. (C); 2. Memory complaints should be evaluated and the individual followed to assess progression. (B); 3. When caregivers or informants describe cognitive decline in an individual, these observations should be taken very seriously; cognitive assessment and careful follow-up are indicated. (A) (See Appendix).

Aged↗
PubMed2001

Too many pre-discharge home assessment visits for older patients? A postal questionnaire survey.

OBJECTIVE: To investigate current practice of pre-discharge home assessment visits for older patients. DESIGN: Postal questionnaire survey. SETTING: NHS Trust hospitals in the United Kingdom. SUBJECTS: Occupational therapy departments in 265 NHS Trust hospitals which admit acutely ill older patients. MAIN OUTCOME MEASURES: The number of pre-discharge home visits done, who went, and therapy time spent on home visits. RESULTS: Of 265 NHS Trusts contacted, 239 (90%) replied. Of 238 units, 155 (65%) do between 11 and 40 visits per month, with 25 (11%) doing more than 60. The equivalent of one day per week or more is spent doing home visits by Senior I occupational therapists in 107 (45%) units and by Senior II staff in 126 (53%) units. Carers or relatives, unqualified occupational therapists, social workers and home care managers accompany the patient and occupational therapist on most home visits. CONCLUSION: Therapy perception is that pre-discharge home assessment visits are increasing in number, complexity and involvement of professional time despite little evidence for their effectiveness. Controlled trials are required to assess which patients are likely to benefit.

Age Factors↗
PubMed2001

Pathways from child maltreatment to internalizing problems: perceptions of control as mediators and moderators.

Using a prospective longitudinal design, we examined internalizing problems and perceptions of control in a community sample of 785 children, 59 of whom had been maltreated. Children's internalizing problems and perceptions of control were measured via self-report at annual assessments in third grade through seventh grade (modal ages 9-13 years). Children's experiences of multiple types of maltreatment were rated based on social service records, using a standard coding system. Results of longitudinal analyses examining the roles of specific types of maltreatment (neglect, harsh parenting, and sexual abuse) revealed that neglect and sexual abuse were each associated with more internalizing problems, especially among children who experienced both these maltreatment types. Neglected children reported higher levels of perceived external control than other children did. Sexual abuse was associated with higher levels of perceived external control, but only among children who had also been neglected. Results of mediation analyses showed that higher levels of perceived external control accounted substantially for associations between specific maltreatment types and children's internalizing problems. Results of moderator analyses revealed that, among maltreated children, greater perceived internal control predicted fewer internalizing problems, suggesting that perceived internal control functioned as a protective factor. Children maltreated early in life were less likely to have this protective characteristic. Results are discussed in terms of their implications for understanding the developmental consequences of specific and co-occurring types of maltreatment.

Adolescent↗
PubMed2000

Infective discitis as an uncommon but important cause of back pain in older people.

CASE REPORTS: two elderly patients (aged 70 and 80 years) presented with severe back pain and restriction of spinal movements. Inflammatory markers were raised and in each case computed tomography findings confirmed infective discitis. One patient improved with antibiotics but the second developed paraplegia, a recognized complication of discitis. CONCLUSION: the association of back pain, restricted spinal movements and raised inflammatory markers should act as 'red flags', alerting the clinician to the presence of serious, but potentially treatable pathology.

Age Factors↗
PubMed1999

The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia.

OBJECTIVE: To develop evidence based consensus statements on which to build clinical practice guidelines for primary care physicians toward the recognition, assessment and management of dementing disorders and to disseminate and evaluate the impact of these statements and guidelines built on these statements. OPTIONS: Structured approach to assessment, including recommended laboratory tests, choices for neuroimaging and referral, management of complications (especially behavioural problems and depression) and use of cognitive enhancing agents. POTENTIAL OUTCOMES: Consistent and improved clinical care of persons with dementia; cost containment by more selective use of laboratory investigations; neuroimaging and referrals; and appropriate use of cognitive enhancing agents. EVIDENCE: Authors of each background paper were entrusted to perform a literature search, discover additional relevant material, including references cited in retrieved articles, consult with other experts in the field and then synthesize information. Standard rules of evidence were applied. Based on this evidence, consensus statements were developed by a group of experts, guided by a steering committee of 8 individuals, from the areas of Neurology, Geriatric Medicine, Psychiatry, Family Medicine, Preventive Health Care and Health Care Systems. VALUES: Recommendations have been developed with particular attention to the context of primary care, and are intended to support family physicians in their ongoing assessment and care of patients with dementia. BENEFITS HARM AND COSTS: Potential for improved clinical care of people with dementia. A dissemination and evaluation strategy will attempt to measure the impact of the recommendations. RECOMMENDATIONS: Forty-eight recommendations are offered that address the following aspects of dementia care: early recognition; importance of careful history and examination in making a positive diagnosis; essential laboratory tests; rules for neuroimaging and referral; disclosure of diagnosis; importance of monitoring and providing support to caregivers; cultural aspects; detection and treatment of depression; observation and management of behavioural disturbances; detection and reporting of unsafe motor vehicle driving; genetic factors and opportunities for preventing dementia; pharmacological treatment with particular emphasis on cognitive enhancing agents. VALIDATION: Four other sets of consensus statement or guidelines have been published recently. These recommendations are generally congruent with our own consensus statements. The consensus statements have been endorsed by relevant bodies in Canada.

Automobile Driving↗
PubMed1999

The effectiveness of predischarge home assessment visits: a systematic review.

OBJECTIVE: To evaluate the effectiveness of predischarge home assessment visits for elderly patients. DESIGN: Systematic review. METHODS: A computer-aided search was conducted using the databases of Medline and Cinahl. Any studies investigating predischarge home assessment visits were included in the analysis. RESULTS: No randomized controlled trials were found. Only five studies (two retrospective surveys, three observational surveys) were identified. In four of these, a possible benefit for home visiting was suggested. CONCLUSIONS: Little evidence exists for the effectiveness of predischarge home assessment visits. Further research is needed to establish their value.

Activities of Daily Living↗
PubMed1998

Families of the lesbian baby boom: children's contact with grandparents and other adults.

In an exploratory study of 37 lesbian-mother families, the frequency of children's contact with adults in their extended family and friendship networks was found to counter stereotypes of such children as isolated from parents' families of origin. Children were more likely to have regular contact with relatives of the biological than nonbiological mother. Mothers rated those in regular contact with grandparents as having fewer behavior problems, and those in more regular contact with unrelated adults rated themselves more positively on general well-being.

Adoption↗
PubMed1998

Retrospective study of radiotherapy for lung cancer in patients aged 75 years and over.

BACKGROUND: Radiotherapy is widely used in the management of lung cancer but there are few data on its use in elderly patients. METHODS: Retrospective review of case notes of all patients aged 75 years and over referred to a regional centre for radiotherapy with a diagnosis of lung cancer over 1 year. RESULTS: Of 149 patients referred, full information was available on 144 (97%); age range 75-93 years (mean 79). Main referral sources were chest physicians [68 (44%)], general physicians [40 (28%)] and geriatricians [20 (14%)]; all patients were accepted for radiotherapy. One hundred and thirty-four (93%) had palliative treatment with most [129 (90%)] receiving 1-5 fractions over 1 week and 117 (81%) having treatment as an outpatient. Palliation appeared good for haemoptysis but less effective for the more common symptoms of dyspnoea and cough. Side effects were reported by 25 patients (18%) and were usually mild. CONCLUSION: Radiotherapy for lung cancer in this selected group of elderly patients is well tolerated with responses similar to those in younger patients.

Age Factors↗
PubMed1998

Psychosocial adjustment among children conceived via donor insemination by lesbian and heterosexual mothers.

This study examined the relations among family structure (e.g., number of parents, parental sexual orientation), family process (e.g., parents' relationship satisfaction, interparental conflict), and the psychological adjustment of children who had been conceived via donor insemination. The 80 participating families, all of whom had conceived children using the resources of a single sperm bank, included 55 families headed by lesbian and 25 families headed by heterosexual parents. Fifty families were headed by couples and 30 by single parents. Participating children averaged 7 years of age. Results showed that children were developing in normal fashion, and that their adjustment was unrelated to structural variables such as parental sexual orientation or the number of parents in the household. These results held true for teacher reports as well as for parent reports. Variables associated with family interactions and processes were, however, significantly related to indices of children's adjustment. Parents who were experiencing higher levels of parenting stress, higher levels of interparental conflict, and lower levels of love for each other had children who exhibited more behavior problems.

Adaptation, Psychological↗
PubMed1998

Peer relationships and self-esteem among children who have been maltreated.

A prospective longitudinal design was employed to assess risks associated with maltreatment in a representative community sample of 107 maltreated children and an equal number of nonmaltreated comparison children. Heightened difficulties in peer relationships and self-esteem were associated with greater severity and chronicity of maltreatment. For example, children who experienced chronic maltreatment were less well-liked by peers. Type of maltreatment was also related to specific aspects of children's adjustment. For instance, sexual abuse predicted low self-esteem, but not problems in peer relationships. Emotional maltreatment, on the other hand, was related to difficulties in peer relationships, but not to low self-esteem. Thus, the best predictions of specific aspects of children's adjustment were provided by considering timing, type, and severity of maltreatment. For some groups of maltreated children, having a good friend was associated with improvement over time in self-esteem.

Child↗
PubMed1995

An in vitro assessment of tooth preparation for porcelain veneer restorations.

OBJECTIVES: This in vitro study aimed to examine the depth of preparation and incidence of dentine exposure resulting from the use of a 'freehand' technique to prepare maxillary central incisors for porcelain veneers. METHODS: Twenty-two maxillary central incisors were selected. Prior to preparation an index of the labial surface of each tooth was recorded and the tooth secured in a jig to permit accurate relocation. Two operators each prepared 11 teeth aiming to reduce the labial thickness evenly by 0.5 mm. Low viscosity silicone impression material was then placed on the index and the teeth relocated into the jig. Upon removal, this material was sectioned in the cervical, middle and incisal thirds of the tooth and its thickness measured using a toolmaker's microscope. The teeth were acid etched and also stained with a dentine dye to identify any area of dentine exposed during preparation. RESULTS: Significant differences (P < 0.001) in the depth of preparation at different sites, with least reduction in the mid-incisal region, were found. Greater reduction was found at the cervical and proximal margins with areas of dentine exposed at those sites in the majority of teeth. CONCLUSIONS: In view of the incidence and position of dentine exposure found in this study, the use of a dentine bonding system during the placement of porcelain veneers would appear essential when employing a 'freehand' preparation technique.

Dental Cavity Preparation↗
PubMed1995

Community survey of home nebulizer technique by elderly people.

To determine the prevalence and nature of difficulties elderly subjects experience using home nebulizers we have studied all patients in the Leeds Health District aged 70 years and older loaned a nebulizer from the hospital for at least 6 months. Of 42 subjects with a nebulizer, 40 (95%) agreed to assessment. They had a mean age of 79 years (range 70-84 years) and mean duration of nebulizer use of 38 months (range 6-120 months). Twenty subjects had one or more problems with 14/40 (35%) rated as moderate or severe; difficulties with cleaning 16/40 (40%) and filling 7/40 (18%) were the most frequent; 13/40 (33%) were sometimes or always dependent on their carers to administer their nebulizers. Elderly subjects often experience practical difficulties, or require help from a carer, when using a home nebulizer.

Activities of Daily Living↗
PubMed1995

Childhood aggression and peer relations in the context of family and neighborhood factors.

4 models (risk, protective, potentiator, and person-environment fit) comparing the associations among ethnicity, income, and structural characteristics of families and neighborhoods on childhood aggression and peer relations were explored. The 1,271 second- through fifth-grade (M = 9.9 years) children were assigned to 1 of 8 family types based on ethnicity, income, and household composition, and their addresses were used to define low- or middle-SES neighborhoods using neighborhood census data. Middle-SES neighborhoods operated as a protective factor for reducing aggression among children from high-risk families, interacted with family type to produce poor person-environment fit resulting in a greater likelihood of being rejected by one's peers, and potentiated the development of home play companions for children from low-risk families. Developmental and gender differences were also explored. Results are discussed in terms of the need for broader contextual factors to be considered in studying children's social and behavioral development.

Black or African American↗
PubMed1995

A continuing medical education strategy for care of the elderly by the surgical specialties.

As the absolute numbers and percentage of older people rises in Canada, surgeons are required to treat an increasing number of elderly patients. Recognizing the need to enhance the quality of health care for these people by continuing medical education of health care professionals, the Canadian Medical Association sponsored an invitational workshop in May 1992. The workshop group addressing surgery and its specialties identified three essential underprinnings: knowledge of the aging process (altered physiology and response to illness); decision analysis for interventions (risks, benefits and ethical dimensions); and communication skills. Three priorities for continuing education were recommended: improving knowledge of the physiologic changes that impact on the recovery of elderly patients from surgery; management of postoperative care; and improved knowledge and skills in prescribing medications for older surgical patients. Strategies to implement these priorities are outlined.

Aged↗