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Biomedical subjects

C Thompson

Publications and source records attributed to C Thompson.

At least 55 records · Page 3Linked to original sources
PubMed2000

The inhibition of apoptosis in myositis and in normal muscle cells.

The mechanism of injury and death of muscle cells in the inflammatory myopathies (dermatomyositis, polymyositis, and inclusion body myositis) remains obscure. We and others have not detected apoptosis in the muscle biopsies from patients with myositis despite clear evidence of cell damage and loss. We provide evidence in this study that Fas ligand (FasL) as well as Fas is present on muscle cells and inflammatory cells in myositis biopsies: Fas is present on most muscle cells and lymphocytes, and FasL is present on degenerating muscle cells and many infiltrating mononuclear cells. The expression of both Fas and FasL in the inflamed tissue makes the absence of apoptosis more striking. To address the mechanisms of this resistance to classical apoptosis in muscle cells, we have investigated the expression of the antiapoptotic molecule FLICE (Fas-associated death domain-like IL-1-converting enzyme)-inhibitory protein (FLIP) in muscle biopsies of myositis patients and in cultured human skeletal muscle cells. Using laser capture microscopy, we have shown that FLIP is expressed in the muscle fibers and on infiltrating lymphocytes of myositis biopsies. Furthermore, we have shown that FLIP, but not Bcl-2, is expressed in cultured human skeletal muscle cells stimulated with proinflammatory cytokines, and inhibition of FLIP with antisense oligonucleotides promotes significant cleavage of poly(ADP-ribose) polymerase autoantigen, a sensitive indicator of apoptosis. These studies strongly suggest that the resistance of muscle to Fas-mediated apoptosis is due to the expression of FLIP in muscle cells in the inflammatory environment in myositis.

Apoptosis↗
PubMed2000

Glycaemic index of New Zealand foods.

AIM: To determine the glycaemic index values to a range of foods that are unique to New Zealand, and those that are grown and/or manufactured locally. METHODS: We determined the glycaemic index of 28 carbohydrate foods in both healthy subjects and those with type 2 diabetes. Venous blood samples were collected over two to three hours, and the incremental area under the blood glucose curve was used to calculate glycaemic index values. RESULTS AND CONCLUSIONS: This study has identified the glycaemic index values for a range of New Zealand foods which will be clinically useful in the nutritional management of individuals with diabetes mellitus. People with diabetes are recommended to choose foods with a low glycaemic index which is associated with optimal blood glucose control and lipid levels.

Adult↗
PubMed2000

Statistical Properties of SGR 1806-20 Bursts.

We present statistics of SGR 1806-20 bursts, combining 290 events detected with the Rossi X-Ray Timing Explorer/Proportional Counter Array, 111 events detected with the Burst and Transient Source Experiment, and 134 events detected with the International Cometary Explorer. We find that the fluence distribution of bursts observed with each instrument are well described by power laws with indices 1.43, 1.76, and 1.67, respectively. The distribution of time intervals between successive bursts from SGR 1806-20 is described by a lognormal function with a peak at 103 s. There is no correlation between the burst intensity and either the waiting times until the next burst or the time elapsed since the previous burst. In all these statistical properties, SGR 1806-20 bursts resemble a self-organized critical system, similar to earthquakes and solar flares. Our results thus support the hypothesis that the energy source for soft gamma repeater bursts is crustquakes due to the evolving, strong magnetic field of the neutron star, rather than any accretion or nuclear power.

Journal Article↗
PubMed2000

Effects of a clinical-practice guideline and practice-based education on detection and outcome of depression in primary care: Hampshire Depression Project randomised controlled trial.

BACKGROUND: Depression is a major individual and public-health burden throughout the world and is managed mainly in primary care. The most effective strategy to reduce this burden has been believed to be education of primary-care practitioners. We tested this assumption by assessing the effectiveness of an educational programme based on a clinical-practice guideline in improving the recognition and outcome of primary-care depression. METHODS: We carried out a randomised controlled trial in a representative sample of 60 primary-care practices (26% of the total) in an English health district. Education was delivered to practice teams and quality tested by feedback from participants and expert raters. The primary endpoints were recognition of depression, defined by the hospital anxiety and depression (HAD) scale, and clinical improvement. Analysis was by intention to treat. FINDINGS: The education was well received by participants, 80% of whom thought it would change their management of patients with depression. 21409 patients were screened, of whom 4192 were classified as depressed by the HAD scale. The sensitivity of physicians to depressive symptoms was 39% in the intervention group and 36% in the control group after education (odds ratio 1.2 [95% CI 0.88-1.61]). The outcome of depressed patients as a whole at 6 weeks or 6 months after the assessment did not significantly improve. INTERPRETATION: Although well received, this in-practice programme, which was designed to convey the current consensus on best practice for the care of depression, did not deliver improvements in recognition of or recovery from depression.

Antidepressive Agents, Tricyclic↗
PubMed2000

Support for carers of people with Alzheimer's type dementia.

BACKGROUND: Research has highlighted the problems for carers of people with dementia. These include the effective loss of companionship and support of a life partner, social isolation and complex financial, legal and social decision making. The burden of caring is financially, emotionally and physically significant. Studies of the effects of ways of supporting carers and reducing the burden of caring often examine a range of outcomes. Probably because of these characteristics, no formal overview of this area of service provision has been undertaken. Moreover, the term 'intervention' in relation to caregivers of people with Alzheimer's disease is open to wide variations in interpretation at the level of service provision. Interventions range from the application of 'hi-tech' computer technology for socialy isolated carers, to the formation of specialist support groups and respite services. OBJECTIVES: The objective of this review is to provide an assessment of the effectiveness of health and/or social interventions designed to help support the carers of people with Alzheimer's-type dementias. SEARCH STRATEGY: The Cochrane Controlled Trials Register was searched using the terms 'carer*' and 'caregiv*'. See the Cochrane Dementia & Cognitive Impairment group's details for the full search strategy. SELECTION CRITERIA: All randomised trials in which primary carers of people with Alzheimer's disease are allocated to either intervention or non-intervention/control groups and where the intervention was provided by healthcare and/or social services. DATA COLLECTION AND ANALYSIS: Data was extracted by both reviewers and was found to be unsuitable for quantitative synthesis. A qualitative overview is presented and structured according to the comparisons used in the review. Weighted Mean Differences (weighted by sample size) for each outcome and its subcategories are also presented. MAIN RESULTS: The results of the review are inconclusive. No evidence was found for the following comparison interventions: 1) individualised service assessment and planning versus conventional support 2) technology-based carer networking (via computers or telephones) versus conventional support 3) carer-education/training versus conventional support 4) multi-faceted/dimensional strategies (such as specialised carer assessment and training) versus conventional support Whilst the overview suggests little or no evidence that interventions to support caregivers of people with Alzheimer's disease are of quantifiable benefit, the poor quality and small sample sizes of the studies, as well as the diversity of interventions examined and outcomes reported, mean that this conclusion cannot be put forward without the need for caution, particularly as some of the studies put forward qualitative evidence which contradicts this conclusion. REVIEWER'S CONCLUSIONS: With the limited nature of the research evidence in mind, it is not possible to recommend either wholesale investment in caregiver support programmes or withdrawal of the same. With the addition of further studies in future updates of this review, expected in early 1999, this presently inconclusive picture may become clearer. A number of conclusions relating to future areas of research can be put forward with more conviction. Specifically, 1) Future trials need to examine interventions included in the existing knowledge base on Alzheimer's carer-supportive interventions. 2) Outcome measures used should mirror those in similar studies. 3) Outcome measures need to be clinically and 'lay' relevant. 4) Trials need to be of longer duration given the 7-10 years median life expectancy of people with Alzheimer's Disease. 5) Sample sizes need to be increased and calculated properly given the likelihood of a moderate intervention effect (if any). 7) Blinding at the outcome assessment stage needs to be a part of future basic trial designs if bias is to be avoided. 8) If reviews are to have their power increased then quality o

Alzheimer Disease↗
PubMed2000

Electroconvulsive therapy in adolescence.

The aim of this work is to discuss the ethical issues regarding the use of electroconvulsive therapy (ECT) in adolescents. Ethical implications of ECT in adolescents are analyzed in the light of general medical ethics, which include five prominent principles with respect to autonomy, nonmaleficence, beneficence, justice, and cautiousness. As adults, adolescents with acute psychotic impairment raise an inherent conflict between the respect for the patient's autonomy, on the one side, and the principle of beneficence on the other. However, this age group presents particular dilemmas: (i) As any adolescent suffering from a psychiatric illness is a highly vulnerable subject, society asks for particular attention. The consequence of potential overprotection is that the adolescent may remain untreated because of unrealistic fears regarding ECT. (ii) Some of these fears are linked to the cognitive secondary effects of ECT. Although preliminary data are reassuring, more empirical research on this population should be encouraged. (iii) Cautiousness recommends the use of ECT in limited indications catatonia, mood disorders, and intractable acute psychotic disorders. We conclude that there is no ethical reason to ban the use of ECT in adolescents. Ethical options in clinical practice must be evaluated empirically with respect to the consequences for the patient. Dogmatic views should be set aside.

Adolescent↗
PubMed2000

Effects of dietary fat on the urinary risk factors of calcium stone disease.

OBJECTIVES: To assess the association between dietary fat and various urinary risk factors of calcium stone disease in a group of calcium stoneformers attending an outpatient stone clinic. METHODS: Mean daily fat intake from self-recorded 4-day dietary food records and mean 24-hour urinary risk factors from two separate collections were evaluated in 476 patients selected randomly from an adult population attending an outpatient stone clinic for the first time. RESULTS: Mean daily total fat intake for men and women was significantly different at 105.6 and 78.1 g, respectively. Examination of the relationship between total fat intake and 24-hour urinary volume, pH, and excretions of magnesium, citrate, oxalate, calcium, and uric acid revealed no significant regressions in men and only a weak association between fat intake and urinary uric acid in women. CONCLUSIONS: Dietary fat does not have a significant effect on the urinary risk factors of calcium stone disease.

Adolescent↗
PubMed2000

Hepatitis B and HIV/AIDS in Zagreb: a district level analysis.

This study examines the presence of hepatitis B as a possible precursor marker for HIV/AIDS in 10 districts of Zagreb, Croatia. There were a total of 931 cases of hepatitis B in Zagreb in the period 1979-1995, the annual rate ranging from 3.1 to 15.4 per 10,000. The highest relative risk for hepatitis B for the 1979-1995 period was in the Pescenica district (Relative risk (RR): 1.4). There were 108 cases of HIV/AIDS diagnosed in Croatia in the period 1986-1996, with 34% from Zagreb. The highest relative risk for HIV/AIDS was within the Pescenica district (RR: 2.3). Pescenica had also a significantly higher incidence of hepatitis B when compared to other districts (p = 0.005). The cumulative incidence of hepatitis B in Zagreb was directly related to levels of neighborhood discomfort as determined by an index including unemployment, inflation and housing conditions (p = 0.005). This research demonstrates that the poor areas of the city with higher incidence of hepatitis B hold the greatest threat for the spread of HIV/AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Compliance with tricyclic antidepressants: the value of four different methods of assessment.

AIMS: To assess the advantages and disadvantages of four methods for studying compliance with antidepressants: self-report scores, tablet counts, a microprocessor (MEMS) container system and the assay of nordothiepin and dothiepin concentrations in plasma. METHODS: The techniques were used in 88 patients commencing tricyclic antidepressants in the setting of UK general practice. RESULTS: The MEMS system proved to be the most informative technique allowing identification of the precise time of container opening, the demonstration of 'drug holidays' and early cessation of therapy. Self-report scores (Morisky) proved a useful screening technique with a sensitivity of 72.2% and specificity of 74.1% for > or = 80% compliance. Although tablet counts were possible in 84 patients (95. 5%) they were unreliable in 19 (21.6%). Blood concentration assays proved the least acceptable method to patients and were possible in only 53 (60.2%). A ratio of nordothiepin:dothiepin > or = 1.1 claimed, by others, to identify noncompliance was only reliable when concentrations were low. CONCLUSIONS: Both the MEMS system and self-report scores proved useful methods for identifying noncompliant patients in the setting of UK general practice. Although compliance was higher than reported in previous studies with 70 patients (79.5%) completing 6 weeks treatment, general practitioners tended to prescribe subtherapeutic doses.

Adult↗
PubMed2000

The dietary habits of idiopathic calcium stone-formers and normal control subjects.

OBJECTIVES: To examine the relationship between 12 macro- and micro-nutrients and the risk of recurrent calcium stone formation by comparing the diets of a large outpatient clinic-based group of patients who had formed calcium-based urinary tract calculi with that of a population-based control group matched for age, gender and body mass index. PATIENTS, SUBJECTS AND METHODS: The dietary intake of 500 patients (cases) randomly selected from the adult population attending an outpatient renal-stone clinic and being evaluated and/or treated for biochemically or radiologically diagnosed calcium-based upper urinary tract calculi were compared with those of 500 control subjects selected to match for age, sex and body mass index from a stratified probability sample of 2212 adults (not institutionalized) living in the same geographical area. RESULTS: Comparing the mean nutritional intakes showed a statistically higher consumption of energy, carbohydrates, sodium, fibre, vitamin C, fat and folic acid among cases than in controls. The intake of calcium, alcohol and vitamin A was significantly higher among the controls. There were no significant differences in the intake of protein, niacin or iron. The results of these comparisons varied when the groups were stratified by sex, age and body mass index. CONCLUSIONS: Dietary risk factors for calcium-based urinary tract calculi are many and complex, and a detailed consideration of sex, age and body mass index is important in interpreting such data. While it is difficult to draw firm conclusions about causes and effects of individual nutrients from the available data, this study indicates a possibly more important role for dietary fat in stone formation than has been previously recognized. This relationship needs to be further explored in relation to urinary risk factors, as it may be possible to advise patients to reduce dietary fat as a prophylactic measure for stone formation. As dietary fat has been associated with cardiovascular diseases and possibly cancer, an overall recommendation to these patients for a low dietary fat intake may be easier to follow.

Adult↗
PubMed2000

Evaluating the reliability and utility of cumulative intake and output.

During times of scarce resources available for providing patient care, it becomes necessary to validate the effectiveness of standard practices that consume caregivers' time and efforts. Three nurse managers of nursing units serving diverse patient populations studied the effectiveness of continuous intake and output in estimating daily fluid balance. They examined 48-hour records of daily weight and intake and output of 73 patients and correlated the two. Their findings suggest that even when caregiver charting compliance is optimal, daily intake and output recording provides unreliable results. The authors recommend daily weights alone be adopted for all patients who are not experiencing acute renal conditions.

Adult↗
PubMed2000

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Journal Article↗
PubMed2000

Intuition and analysis in decision making and choice.

PURPOSE: To discuss the need for a shift in focus from intuitive to more analytic ways of examining both the process and outcomes of professional decisions based on "best evidence." SCOPE: Different assumptions inherent in intuitive and analytic explanations of nurses' decision making are outlined, and the two approaches are compared. The benefits and limitations of such approaches to decision making in nursing and health care are discussed, using available research evidence to show that in most instances the analytical approaches are more effective. CONCLUSIONS: A systematic approach to decision making in health care is needed, so that both health professionals and patients have a means for knowing the basis of decisions about treatment.

Decision Making↗
PubMed2000

Outcome of patients with chronic abdominal pain referred to chronic pain clinic.

OBJECTIVE: We determined the outcome of patients with chronic abdominal pain of unknown etiology referred by gastroenterologists to a chronic pain clinic. METHODS: A retrospective chart review of 43 consecutive patients seen by a university-based gastroenterology group was referred to our Chronic Pain Clinic for evaluation and treatment. Pain character and location, the referring diagnosis, and initial Chronic Pain Clinic diagnosis was compared between responders and nonresponders. Early and long-term pain relief was scored by standard questionnaire. RESULTS: Of the 43 patients with chronic abdominal pain of undetermined etiology, 70% reported complete or substantial pain relief by the end of chronic pain management. Pain character and location and the referring diagnosis were not predictors of pain relief. Long-term pain relief was reported by 35% of patients. CONCLUSION: A substantial group of patients with chronic abdominal pain of unknown etiology benefited from Chronic Pain Clinic services.

Abdominal Pain↗
PubMed2000

Compliance with antidepressant medication in the treatment of major depressive disorder in primary care: a randomized comparison of fluoxetine and a tricyclic antidepressant.

OBJECTIVE: Many claims have been made for superior compliance with selective serotonin reuptake inhibitors (SSRIs) compared with tricyclic antidepressants, but to date meta-analyses have not confirmed reduced dropouts in randomized controlled trials. The authors used a randomized study design to evaluate differential compliance with antidepressant medications in a primary care setting. METHOD: A total of 152 patients treated in 10 primary care practices in the United Kingdom were included in a randomized, open-label, parallel-group study of fluoxetine and dothiepin at therapeutic doses for 12 weeks. Compliance was assessed by using pill count, patient questionnaires, and the Medication Event Monitoring System. RESULTS: The level of compliance with fluoxetine was numerically higher than the level of compliance with dothiepin on all three primary outcome measures, although the differences were not significant. In a secondary analysis using data from the Medication Event Monitoring System, both a survival analysis for length of time without a gap in medicine taking and a derived compliance index showed a significant advantage to fluoxetine. Patients in the fluoxetine group reported superior response on the health transition scale of the 36-item Short-Form Health Survey Questionnaire and numerically greater improvement on the Hamilton Depression Rating Scale. In both treatment arms patients with a superior compliance index were more likely to have improved in Hamilton depression scale scores by the last study visit. CONCLUSIONS: This study supports recent meta-analyses of SSRIs versus tricyclic antidepressants in finding no significant differences in crude indices of compliance between fluoxetine and dothiepin, despite marked differences in side effect profile and dose regimen. However, both a survival analysis and a new measure that takes account of prolonged periods of noncompliance distinguished between the treatments and was associated with improvement in both groups.

Adolescent↗