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Biomedical subjects

C Leach

Publications and source records attributed to C Leach.

At least 19 recordsLinked to original sources
PubMed2003

Anger management training: the effects of a structured programme on the self-reported anger experience of forensic inpatients with learning disability.

Within the current political climate, there is an increasing burden on mental health professionals to achieve accuracy in risk assessment and prediction. The accurate assessment and treatment of anger can make a valuable contribution towards alleviating this burden as part of a comprehensive treatment package. This study describes an anger management training programme provided to a group of three forensic inpatients with learning disability. An ABA single case study design was used, with anger levels assessed at weekly intervals before, during and after the programme. The results suggested that anger management training is useful with this client group, with established tools, such as the Novaco Anger Scale, the Spielberger State-Trait Anger Expression Inventory and the Modified Overt Aggression Scale, allowing the impact of the programme on anger levels to be evaluated. There is an indication that maintenance treatment is required to prevent anger levels increasing to pretest levels following treatment.

Adult↗
PubMed2001

Service profiling and outcomes benchmarking using the CORE-OM: toward practice-based evidence in the psychological therapies. Clinical Outcomes in Routine Evaluation-Outcome Measures.

To complement the evidence-based practice paradigm, the authors argued for a core outcome measure to provide practice-based evidence for the psychological therapies. Utility requires instruments that are acceptable scientifically, as well as to service users, and a coordinated implementation of the measure at a national level. The development of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is summarized. Data are presented across 39 secondary-care services (n = 2,710) and within an intensively evaluated single service (n = 1,455). Results suggest that the CORE-OM is a valid and reliable measure for multiple settings and is acceptable to users and clinicians as well as policy makers. Baseline data levels of patient presenting problem severity, including risk, are reported in addition to outcome benchmarks that use the concept of reliable and clinically significant change. Basic quality improvement in outcomes for a single service is considered.

Benchmarking↗
PubMed2001

Analysis of repertory grids in clinical practice.

OBJECTIVES: This paper illustrates the use of several different forms of analysis of repertory grid data, using a case study of a client who completed repertory grids at various stages of therapy. METHOD: Participants in a survivors' group completed grids before and after therapy and at 3- and 6-month follow-up. Grids from one of the participants, who had been sexually abused as a child, are presented using different levels of analysis: visual inspection of the raw grid; analysis of dissimilarities between pairs of elements or constructs; hierarchical cluster analysis of elements and constructs both separately and combined; principal components analysis; biplot representation of elements and constructs combined; multidimensional scaling analysis and unfolding analysis. The latter two methods also provide ways of presenting a combined analysis of a number of grids. Computer packages are reviewed, and SYSTAT commands are presented to perform the analyses. RESULTS: The review of methods illustrates how different levels of analysis can usefully back up clients' own accounts of progress through therapy, from detailed analysis of individual ratings in the raw grid, through analyses that pull out structural patterns at the expense of detail, to the broad sweep provided by methods that combine data from a number of grids. CONCLUSIONS: Analysis of repertory grids completed at various stages of therapy can provide useful qualitative information on progress, but can also provide some simple quantitative measures (such as Self-Ideal Self discrepancy as a measure of self esteem) to track progress. Different forms of analysis can be informative, highlighting different aspects of progress, but also allowing checks on adequacy and goodness-of-fit of particular analyses.

Adult↗
PubMed2001

Personal constructs, childhood sexual abuse and revictimization.

Within the theoretical framework of Ryle's Procedural Sequence Object Relations Model and Kelly's Personal Construct Theory, this study investigates sex-role polarization of incest survivors and the centrality of abuse within survivors' constructs of men that may contribute to revictimization. Repertory grid methodology was used with 40 female survivors of childhood sexual abuse and 28 non-abused women. Grid measures and psychometric measures were compared between groups of women who had and had not experienced childhood sexual abuse, revictimized and non-revictimized survivors, and survivors who had and had not experienced incestuous abuse. Results showed significant differences between survivors and non-abused women, with survivors having higher levels of depression and perceived distress, lower self-esteem and higher self/ ideal self discrepancy. Hypothesized differences in sex-role polarization were not found. There were few differences between revictimized and non-revictimized survivors, although revictimized survivors rated 'self now' as more powerful than non-revictimized survivors. No differences were found between survivors who had and had not experienced incestuous abuse. In addition to the value of exploring personal constructs, a range of models need to be considered in understanding revictimization and women's construal of men. The implications of using repertory grid methodology for research and clinical work are discussed.

Adolescent↗
PubMed2000

Antiretroviral prescribing patterns in the texas prison system.

PURPOSE: Although prison inmates are reported to exhibit substantially elevated rates of HIV infection, little is known about HIV treatment patterns, particularly pharmacotherapy, in correctional institutions. The purpose of the present study, therefore, was to describe antiretroviral prescribing patterns in one of the nation's largest prison populations.METHODS: The study population consisted of all known (n = 2,360) HIV-infected inmates incarcerated in the Texas prison system in 1998. Information on medical conditions, sociodemographic factors, and pharmacotherapy was obtained from an institution-wide medical information system. Inmates who received more than one type of pharmacotherapy in 1998 were included in the appropriate number of categories.RESULTS: In 1998, 66.8 percent (95% CI = 64.0-69.4) of all HIV-infected inmates with CD4 counts below 500 were treated with highly active antiretroviral therapy (HAART); and 31.1 percent (95% CI = 29.3-33.0) were given no antiretroviral therapy. Logistic regression results showed that HAART treatment decreased monotonically as a function of patient CD4 count category.CONCLUSIONS: A substantial proportion of HIV-infected TDCJ inmates were placed on therapies that were not consistent with the generally recommended DHHS guidelines for their disease stage. It will be important to for future investigations to assess whether such patterns continue to exist among prison populations, and to assess the determinants of these patterns.

Journal Article↗
PubMed2000

The development and piloting of a patient held record with adult mental health users.

This article reports on the development and piloting of a patient held record for adult mental health users. Development of the format and content of the record was determined in consultation with a user group. Piloting and subsequent evaluation of the record with users revealed a number of issues which need to be addressed in the promotion of a patient held record.

Adult↗
PubMed1999

Effect of formulation parameters on hydrofluoroalkane-beclomethasone dipropionate drug deposition in humans.

Chlorofluorocarbon metered dose inhalers (MDIs) and dry powder inhalers currently deliver drug that deposits primarily in the oropharynx and secondarily in the large central airways. Chlorofluorocarbon-beclomethasone dipropionate (CFC-BDP) MDIs deliver more than 90% of the drug in the oropharynx and less than 10% in the lungs. The elimination of chlorofluorocarbons from MDIs provided the opportunity to more optimally target corticosteroids directly to all inflammatory sites. Hydrofluoroalkane-BDP (HFA-BDP) MDIs (QVAR(trade mark)) deliver 50% to 60% of the drug to the lungs with approximately 30% delivered to the mouth. Additionally, the amount of drug delivered to the lungs is distributed throughout the large, intermediate, and small airways. Radiolabeled deposition studies have shown that the HFA-BDP MDI is a "forgiving" aerosol in that even the extreme discoordinated use of the press and breathe MDI still resulted in more than 30% lung deposition. The breath-actuated Autohaler inhaler provided the same lung deposition as an optimally used press and breathe MDI. The dose delivered from either the press and breathe HFA-BDP MDI or the Autohaler was consistent across a wide range of inspiratory flows (eg, flows of 26-137 L/min). Clinical studies have shown that the improvements in lung deposition of HFA-BDP result in equivalent efficacy at approximately one half of the total daily dose compared with current CFC-BDP products.

Beclomethasone↗
PubMed1999

Pacifier use and sudden infant death syndrome: results from the CESDI/SUDI case control study. CESDI SUDI Research Team.

OBJECTIVES: To investigate the relation between pacifier use and sudden infant death syndrome (SIDS). DESIGN: Three year population based, case control study with parental interviews for each death and four age matched controls. SETTING: Five regions in England (population > 17 million). SUBJECTS: 325 infants who had died from SIDS and 1300 control infants. RESULTS: Significantly fewer SIDS infants (40%) than controls (51%) used a pacifier for the last/reference sleep (univariate odds ratio (OR), 0.62; 95% confidence interval (CI), 0.46 to 0.83) and the difference increased when controlled for other factors (multivariate OR, 0.41; 95% CI, 0. 22 to 0.77). However, the proportion of infants who had ever used a pacifier for day (66% SIDS v 66% controls) or night sleeps (61% SIDS v 61% controls) was identical. The association of a risk for SIDS infants who routinely used a pacifier but did not do so for the last sleep became non-significant when controlled for socioeconomic status (bivariate OR, 1.39 (0.93 to 2.07)). CONCLUSIONS: Further epidemiological evidence and physiological studies are needed before pacifier use can be recommended as a measure to reduce the risk of SIDS.

Breast Feeding↗
PubMed1999

Validation of the Hospital Anxiety and Depression Scale for use with adolescents.

BACKGROUND: The Hospital Anxiety and Depression Scale (HADS), developed for use with adults, has potential with adolescents. AIMS: To test the HADS's validity with adolescents. METHOD: The HADS was given to 248 schoolchildren and to 48 psychiatric out-patients and 38 deliberate self-harm in-patients aged 12-17, and validated against ICD-10 diagnoses for the out-patients. RESULTS: The HADS has adequate test-retest reliability and factor structure, and discriminates between adolescents diagnosed with depressive or anxiety disorders and those without these diagnoses. CONCLUSIONS: The psychometric properties of the HADS and its shortness make it useful for screening and in clinical settings with adolescents.

Adolescent↗
PubMed1999

Asthma management with HFA-BDP (Qvar).

This report reviews the role of hydrofluoroalkane-beclomethasone dipropionate (HFA-BDP; Qvar, 3M, Laughborough) in the management of asthma, based on pharmacokinetic, efficacy and safety clinical trial data presented at a satellite symposium to the European Respiratory Society in 1998. Qvar provides equivalent efficacy and safety to chlorofluorocarbon-BDP at about half the dose.

Anti-Asthmatic Agents↗
PubMed1998

Targeting inhaled steroids.

Asthma is a disease of the entire respiratory tract and successful asthma therapy requires drug delivery throughout the large and small airways. The most commonly prescribed inhaled corticosteroid for the treatment of asthma is beclomethasone dipropionate (BDP) delivered by a metered-dose inhaler (MDI) containing chlorofluorocarbons (CFCs). CFC-BDP MDIs produce relatively large particles and when used optimally deposit less than 10% of the dose in the lungs, primarily in the large airways, with more than 90% being deposited in the oropharynx. The new hydrofluoroalkane (HFA)-BDP inhaler developed by 3M Pharmaceuticals (Qvar) delivers a particle size of approximately 1.1 microns. Animal and mechanical models predict more than 50% lung deposition with this formulation. Clinical results, with radiolabelled Qvar in patients with asthma and volunteers, have demonstrated that 50-60% of the dose is deposited throughout the airways with approximately 30% being deposited in the oropharynx. 3M Pharmaceuticals have developed the breath-actuated Autohaler which provides the same lung deposition as an optimally used Qvar MDI by automatically delivering the drug very early in the inhalation. Neither device routinely requires the use of a spacer.

Administration, Inhalation↗
PubMed1997

Partial liquid ventilation and nitric oxide in congenital diaphragmatic hernia.

PURPOSE: In congenital diaphragmatic hernia (CDH) there is immature lung development with a resulting clinical picture of pulmonary hypoplasia, surfactant deficiency, and pulmonary hypertension. Pulmonary hypoplasia and surfactant deficiency both have been successfully treated using partial liquid ventilation (PLV). Pulmonary hypertension associated with CDH has proven difficult to treat, but inhaled nitric oxide, which is a potent highly selective pulmonary vasodilator, may have potential. The aim of this study was to assess PLV in CDH and to document the effect of nitric oxide when administered through perfluorocarbon. METHODS: This study using the lamb CDH model consisted of two groups; a conventional mechanically ventilated (CMV) group and a PLV group. At 1 and 3 hours, nitric oxide (80 ppm) was given for 15 minutes. Data collected included blood gases, pulmonary function tests, pulmonary and systemic blood pressure. RESULTS: After 30 minutes of ventilation, blood gases in the PLV group were all significantly improved (P < .001): pH, CMV 6.92 +/- 0.15 versus PLV 7.24 +/- 0.11; P(CO2), CMV 139 +/- 26 mmHg versus PLV 52 +/- 11 mmHg; P(O2), CMV 26 +/- 15 mmHg versus PLV 184 +/- 60 mmHg. In addition, there was a significant increase in dynamic compliance and a reduction in pulmonary hypertension. Nitric oxide was only efficacious in the PLV group, causing a further increase in oxygenation and a decrease in pulmonary hypertension. These effects were reversed when the nitric oxide was stopped. CONCLUSION: This study shows that PLV both improves gas exchange and pulmonary mechanics in CDH and allows the effective delivery of nitric oxide to reduce the pulmonary hypertension associated with CDH.

Animals↗
PubMed1995

Properties of the reversible K(+)-competitive inhibitor of the gastric (H+/K+)-ATPase, SK&F 97574. I. In vitro activity.

SK&F 97574 (3-butyryl-4-(2-methylamino)-8-(2-hydroxyethoxy)quinoline), is a potent inhibitor of the (H+/K+)-ATPase in membrane vesicles isolated from porcine gastric mucosa. It inhibits (H+/K+)-ATPase activity in lyophilised vesicles in a kinetically competitive manner with respect to the activating cation, K+, with an inhibition constant (Ki) of 0.46 +/- 0.003 microM. Inhibition of (H+/K+)-ATPase activity is freely reversible. Binding of SK&F 97574 was shown to be mutually exclusive and the previously reported reversible (H+/K+)-ATPase inhibitors, SCH 28080 and MDPQ. Therefore, despite its structural dissimilarity, SK&F 97574 appears to bind to the same lumenal region of the (H+/K+)-ATPase identified as the binding site for these compounds. SK&F 97574 is a weak base (pKa = 6.86), and would therefore be expected to accumulate in the acidic compartment at the lumenal face of the parietal cell. In intact gastric vesicles (which have the lumenal face of the ATPase on the interior), SK&F 97574 inhibited ATP-dependent H(+)-transport with a similar potency to ATPase activity. SK&F 97574 is therefore relatively membrane permeable, and would be predicted to gain access readily to its site of action in vivo. The effect of pH on inhibition of H+/K(+)-ATPase activity by SK&F 97574 is consistent with its being active only in its protonated form. The selectivity of SK&F 97574 for the gastric (H+/K+)-ATPase was tested by examining its ability to inhibit a closely related p-class pump, the (Na+/K+)-ATPase from dog kidney. SK&F 97574 was found to have a 60-fold greater sensitivity for the former enzyme. The (Na+/K+)-ATPase was not inhibited in a K(+)-competitive manner by SK&F 97574, indicating an entirely different, probably nonspecific, mechanism.

Adenosine Triphosphate↗
PubMed1995

Properties of the reversible, K(+)-competitive inhibitor of the gastric (H+/K+)-ATPase, SK&F 97574. II. Pharmacological properties.

SK&F 97574 [3-Butryl-4-(2-methylamino)-8-(2-hydroxyethoxy) quinoline] is a potent, reversible inhibitor of the gastric (H+/K+)-ATPase. In an anaesthetised lumen-perfused rat preparation, it inhibited pentagastrin-stimulated gastric acid secretion with intravenous and intraduodenal inhibitory ED50 values of 2.40 mumol/kg and 4.43 mumol/kg, respectively. In the conscious fistula rat model, doses of 10 mumol/kg IV and 25 mumol/kg PO produced mean peak inhibitions of basal acid output of 91% and 97%, respectively. In these experiments, the duration of action of SK&F 97574 was much shorter than that of the covalent (H+/K+)-ATPase inhibitor, omeprazole. In the conscious Heidenhain pouch dog, SK&F 97574 inhibited histamine-stimulated gastric acid secretion after both intravenous and oral administration with ED50 values of 0.49 mumol/kg and 0.89 mumol/kg, respectively. In this model, duration of action studies showed that significant residual inhibition of acid secretion remained 8 hours after intravenous dosing with SK&F 97574 (producing peak inhibition of 92%). However, 24 hours after oral dosing of SK&F 97574 (10 mumol/kg), no significant inhibition remained. These data indicate that the duration of action of SK&F 97574 is longer than that of the histamine H2 receptor antagonists such as cimetidine, but shorter than that of covalent (H+/K+)-inhibitors such as omeprazole. Overall, the pharmacological properties of SK&F 97574 suggest that it could be a potentially useful clinical treatment for acid-related diseases.

Aminoquinolines↗
PubMed1995

Perfluorocarbon-associated gas exchange improves pulmonary mechanics, oxygenation, ventilation, and allows nitric oxide delivery in the hypoplastic lung congenital diaphragmatic hernia lamb model.

OBJECTIVES: To determine the efficacy of perfluorocarbon-associated gas exchange and the effects of inhaled nitric oxide during perfluorocarbon-associated gas exchange in the congenital diaphragmatic hernia lamb model. DESIGN: Prospective, nonrandomized, controlled, nonhuman trial. SETTING: Animal research facility. SUBJECTS: Fetal lambs of 16 time-dated pregnant ewes, at 80 days gestation (term 140 to 145 days). MEASUREMENTS AND MAIN RESULTS: The congenital diaphragmatic hernia lamb model was created in 16 animals. Twelve animals survived to be studied. All animals were mechanically ventilated for 4 hrs with a time-cycled, pressure-limited ventilator. Perfluorocarbon-associated gas exchange was started after 15 mins of ventilation (n = 6). Blood gases were analyzed at 30 mins and then hourly. The perfluorocarbon-associated gas exchange animals had dynamic compliance and tidal volumes measured. After 1 hr, inhaled nitric oxide (80 parts per million) was delivered to the perfluorocarbon-associated gas exchange animals for 10 mins. All blood gas parameters, including pH (6.72 +/- 0.06 vs. 7.14 +/- 0.07), PCO2 (186 +/- 12 vs. 70.5 +/- 16.7 torr [24.8 +/- 1.6 vs. 9.5 +/- 2.1 kPa]), and PO2 (48 +/- 17 vs. 156 +/- 48 torr [6.4 +/- 2.3 vs. 20.8 +/- 6.4 kPa]) were significantly improved in the perfluorocarbon-associated gas exchange-treated group at 4 hrs (p < .005). Dynamic compliance (0.13 +/- 0.02 vs. 0.32 +/- 0.06 mL/cm H2O/kg) and tidal volume (3.5 +/- 0.35 vs. 7.22 +/- 0.61 mL/kg) were also significantly (p < .001) increased in the perfluorocarbon-associated gas exchange group. In the perfluorocarbon-associated gas exchange animals, nitric oxide caused a significant (p < .05) increase in oxygenation and a reduction in pulmonary hypertension. This effect was reversed by stopping the inhaled nitric oxide. CONCLUSIONS: Perfluorocarbon-associated gas exchange significantly improved gas exchange, dynamic compliance, and tidal volumes. Furthermore, inhaled nitric oxide can be effectively delivered during perfluorocarbon-associated gas exchange to reduce pulmonary hypertension and enhance oxygenation.

Animals↗
PubMed1993

Effect of age on progression through temporary prostheses after below-knee amputation.

Forty six patients that underwent below knee amputation for diabetes, trauma/osteomyelitis or peripheral vascular disease were studied. Healing was estimated by the rate of progression through temporary prostheses as determined weekly by the amputee rehabilitation team (physiatrist, orthopedist, physical therapist, nurse, and prosthetist). For all groups combined, mean days +/- standard error from amputation to above knee cast with pylon and foot (AKPy) were 22.9 +/- 1.9, to below knee cast with pylon and foot (BKPy) 41.6 +/- 2.8 and to laminated temporary prostheses 66.5 +/- 4.5. A regression analysis of these variables on age (range: 29 to 84 yr) showed significant positive correlations for AKPy (r = 0.34, P = 0.0214) and BKPy (r = 0.40, P = 0.0056). An analysis of variance with contrasts (Tukey's protected t) showed significant lower values (P < 0.05) for amputation to BKPy in the trauma/osteomyelitis group when compared to diabetes or peripheral vascular disease and no difference among the last two groups. However, when variables were adjusted for age (analysis of covariance with age as a covariate), the differences among groups disappeared (covariance F(2,44) = 0.9, P > 0.4). In conclusion, age, not the cause of the amputation, correlated with healing after below knee amputation as estimated by the rate of progression through temporary prostheses.

Adult↗