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Biomedical subjects

D Fielding

Publications and source records attributed to D Fielding.

At least 19 recordsLinked to original sources
PubMed2006

The effect of dermatology consultations in secondary care on treatment outcome and quality of life in new adult patients with atopic dermatitis.

BACKGROUND: The prevalence of atopic dermatitis (AD) is increasing worldwide, and many patients present to secondary care in adult life. This is a significant contribution to the workload of all dermatology departments. There are no studies investigating the impact of a dermatology consultation within secondary care. OBJECTIVES: To examine the effect of dermatology consultations in secondary care on treatment outcome and quality of life in new adult patients with AD. METHODS: This prospective observational study recruited new adult patients with AD referred from primary care. Eczema severity was assessed using the SCORAD (Severity Scoring of AD) index and subjective good or poor clinical outcome. The Dermatology Life Quality Index (DLQI) was used to quantify the impact of AD on adult patients. Patients were assessed at initial consultation (T1), 6 weeks (T2) and 3 months (T3). Statistical analysis was performed using independent t-tests, repeated-measures analysis of variance, correlation coefficients and Bonferroni post hoc comparisons. RESULTS: Sixty-three patients were recruited (37 women, 26 men) with a mean age of 34 years. Mean SCORAD at T1 was 48.2 and the majority (51%) had severe eczema (objective SCORAD>40). Mean SCORAD reduced by 52% from T1 to T2 (P<0.001) but there was no significant change in SCORAD from T2 to T3. A subjective good clinical outcome was validated by a decrease in SCORAD of >20 (P<0.001). Patients in the good clinical outcome group were significantly older than those in the poor clinical outcome group (38 vs. 27 years, P<0.05). The mean age at presentation of women was significantly younger than men (29 vs. 43 years, P<0.01). Women's mean SCORAD improved over all three visits, while men's mean SCORAD improved from T1 to T2 but worsened from T2 to T3 (P<0.001). The mean DLQI reduced over all three visits, from 9.5 at T1 to 8.8 at T2 and 7.0 at T3, and was significantly correlated with SCORAD at T1 and T2 (P<0.01). Patients accurately self-scored their eczema on a body map as shown by a significant correlation between these scores and SCORAD at T1 and T2 (P<0.001). CONCLUSIONS: We have shown that within the first 3 months of referral to secondary care, new adult patients with AD have the greatest improvement in AD, measured by SCORAD, after their initial appointment. Quality of life, as measured by DLQI, continued to improve over all three visits.

Adolescent↗
PubMed2002

A multicentre phase II study of cisplatin and gemcitabine for malignant mesothelioma.

Our previous phase II study of cisplatin and gemcitabine in malignant mesothelioma showed a 47.6% (95% CI 26.2-69.0%) response rate with symptom improvement in responding patients. Here we confirm these findings in a multicentre setting, and assess the effect of this treatment on quality of life and pulmonary function. Fifty-three patients with pleural malignant mesothelioma received cisplatin 100 mg m(-2) i.v. day 1 and gemcitabine 1000 mg m(-2) i.v. days 1, 8, and 15 of a 28 day cycle for a maximum of six cycles. Quality of life and pulmonary function were assessed at each cycle. The best response achieved in 52 assessable patients was: partial response, 17 (33%, 95% CI 20-46%); stable disease, 31 (60%); and progressive disease, four (8%). The median time to disease progression was 6.4 months, median survival from start of treatment 11.2 months, and median survival from diagnosis 17.3 months. Vital capacity and global quality of life remained stable in all patients and improved significantly in responding patients. Major toxicities were haematological, limiting the mean relative dose intensity of gemcitabine to 75%. This schedule of cisplatin and gemcitabine is active in malignant mesothelioma in a multicentre setting. Investigation of alternative scheduling is needed to decrease haematological toxicity and increase the relative dose intensity of gemcitabine whilst maintaining response rate and quality of life.

Aged↗
PubMed2001

The relevance of lowered personal control for patients who have stoma surgery to treat cancer.

OBJECTIVES: The objective of this study was to explore the experience of patients who had stoma surgery to treat cancer in order to explicate why problems associated with stoma surgery are not decreasing despite technical improvements in stoma care. DESIGN: A longitudinal design was used in order to capture the process of preparing for surgery and dealing with its aftermath. Participants were interviewed using a semi-structured protocol on three occasions; 1-2 weeks before surgery (eight participants), 1-2 weeks after surgery (seven participants), and 3 months after surgery (four participants). METHOD: Transcripts were analysed guided by the procedures of grounded theory. This involved developing categories from the data and linking them together to form a conceptual understanding of our participants' experience. RESULTS: Lowered personal control was the most important concept to emerge from the analysis. We identified perceived causes of lowered control, its mitigating factors, the strategies used to manage this experience and the consequences of these processes. CONCLUSIONS: We make three recommendations based on the conclusion that improvements could be implemented in the psychological aspects of stoma care and, in particular, the enabling of patient perceived self-efficacy. First, improvements could be made in doctor-patient communication with doctors becoming more aware of their psychological impact on patients. Second, specialist stoma care nurses could be trained to recognize patients with dysfunctional self-efficacy beliefs and/or delayed psychological adaptation. Finally, we identify a need for more prolonged practical and emotional support for at least some stoma out-patients.

Adaptation, Psychological↗
PubMed1999

Factors related to psychosocial adjustment in children with end-stage renal failure.

Psychological functioning and adjustment to dialysis were assessed in the families of 60 children and adolescents undergoing chronic dialysis. Sociodemographic factors, treatment variables, health status and satisfaction with health care provision were also measured. Correlation analyses identified a number of important factors associated with poor adjustment to dialysis and/or anxiety and depression in children and parents. Particularly at risk are parents in lower socioeconomic status households, parents with large families, parents with limited support and parents of young children. Children were more at risk where there was greater functional impairment caused by illness.

Adaptation, Psychological↗
PubMed1998

An activity week for children with cancer: who wants to go and why?

Many children now live with cancer rather than die from it, and such children need both to continue their social, emotional and cognitive development and to make long-term psychological adjustments. This paper presents the findings of a research project set up to explore issues pertinent to the current provision of an activity week experience for a group of British paediatric cancer patients. The aims of the study included finding out which factors discriminate between families who apply for a place to attend the week for their child and families who do not, and to develop a knowledge of what factors are considered by parents and children. The findings suggest that the week appeals to children who are confident, active and able to separate from parents and whose parents are keen to encourage independence and new experiences. Children diagnosed and treated at a younger age and further away from treatment were more likely to express concerns about being homesick and safety and to not apply for the week. Issues of protection, independence and disability are discussed with reference to the importance of parental attitude on children's psychological accommodation to disease and treatment and to the experiences of adult survivors of childhood cancer.

Adaptation, Psychological↗
PubMed1997

Role and management of donkeys in Samburu and Turkana pastoralist societies in northern Kenya.

A survey was carried out in northern Kenya to obtain data on the role and management of donkeys in Samburu and Turkana pastoralist societies and to identify potential areas, if any, for interventions. Sixty-seven women owning or closely associated with 583 donkeys were surveyed during July/August 1994. The median donkey herd sizes in Samburu and Turkana societies were 4 and 10 respectively. Pack transport of water and domestic materials were the major reasons for keeping donkeys. Donkey milk, meat and blood were consumed widely by the Turkana but not by the Samburu. The major problems in donkey management were donkeys getting lost, being stolen, predation and being affected by diseases, in particular a disease condition involving unthriftiness, emaciation and slow growth. Traditional methods of treating donkey diseases were generally used. It was concluded that donkeys were an important component in the pastoralist societies surveyed although donkey numbers and transport capacity were not limiting factors in pastoralists activities. Potential areas for intervention were identified as disease investigation and stimulation of community based initiatives to tackle general management problems.

Animal Husbandry↗
PubMed1997

Prospects for plant anthelmintics in tropical veterinary medicine.

The current use of anthelmintic plants in tropical veterinary medicine is reviewed and attention is drawn to the lack of scientific evidence for the effectiveness of many now in use. The case for anthelmintic plants as a means of overcoming some of the serious limitations of manufactured anthelmintics is outlined. Reasons why anthelmintic plants are not generally used in veterinary medicine, in contrast to their greater acceptance in human medicine, are considered. Strategies for their development and use are discussed, in particular the need for in vivo trials to identify those plants which are effective and suitable for general use: attention is drawn to possible candidates, including pyrethrum and papaya latex. Those helminths of most economic importance should be targeted first. Anthelmintic plants offer a traditional alternative to manufactured anthelmintics that is both sustainable and environmentally acceptable. Such plants could have a more important role in the future control of helminth infections in the tropics.

Animals↗
PubMed1996

Familial Wolf-Hirschhorn syndrome resulting from a cryptic translocation: a clinical and molecular study.

We present three cousins who have normal karyotypes, despite having clinical features of Wolf-Hirschhorn syndrome. Fluorescence in situ hybridisation techniques confirmed that all three relatives were monosomic for the distal short arm of chromosome 4 and that a cryptic translocation involving chromosomes 4 and 11 was segregating within the family. Segregation analysis indicated that the risk of an affected child being born to a parent carrying the translocation was 15%. Molecular analysis showed that loci D4S111 and D4S115 were not deleted in the proband, thus excluding these loci from the "Wolf-Hirschhorn critical region". Surprisingly, DNA studies also suggested that the translocation breakpoint on chromosome 4 was within the region of a preexisting paracentric inversion.

Abnormalities, Multiple↗
PubMed1995

Bridging the professions: an integrated and interdisciplinary approach to teaching health care ethics.

In 1993, the authors introduced an interdisciplinary course in health care ethics at the University of British Columbia. They were motivated by two convictions: (1) an interdisciplinary approach to health care decision making is best; and (2) every significant health care decision has an ethical component. They wanted to encourage students from the various health care disciplines to participate in interdisciplinary decision making in their future practices by giving them an opportunity to study health care ethics together during their training. The authors give detailed descriptions of the objectives, format, curriculum, and evaluation of this innovative course in the hope that other educators who may want to develop similar courses can learn from their experience.

British Columbia↗
PubMed1994

Eucalyptus: a sustainable self-delivery molluscicide?

Attention is drawn to the limitations of conventional methods of controlling important trematode infections such as schistosomosis and fasciolosis. Plant molluscicides could have a role in the future control of these infections. There are, however, major problems with most plant molluscicides in that their use is labour-intensive, in many cases relatively skilled workers are required, they must be applied regularly and arable land may be required for their cultivation. Thus, little progress is to be expected until plant species with sustainable self-delivery systems are identified. Eucalyptus is proposed as a likely candidate. The leaves of many species in this genus have molluscicidal properties and their intermittent fall could effect self-delivery if the trees were planted in appropriate places. Relatively little work has been carried out on this possibility and much more is necessary, especially field trials. Before field trials are started, more laboratory testing is also necessary to determine the LC50 values for different snail species and to study toxicity to non-target organisms.

Animals↗
PubMed1987

Adherence to medical regime and related factors in youngsters on dialysis.

A pilot study is reported in which 18 children in end-stage renal failure, undergoing either haemodialysis or continuous ambulatory peritoneal dialysis were assessed with regard to adherence to their treatment regime. Measures were used to assess level of depression, locus of control and social desirability. Adherent behaviour was significantly related to high social desirability, and a shorter length of time on dialysis. There was no relationship between adherence and depression or locus of control.

Adjustment Disorders↗
PubMed1985

The treatment of scriptophobia by in vivo exposure and cognitive restructuring.

A 23-year-old woman with a debilitating fear of signing her name in public was treated in 8 weeks and six treatment sessions using graded exposure in vivo and cognitive restructuring. Progress was maintained in all settings, at home and at work and when the patient was unaccompanied. Treatment gains were maintained at 6-month and 2-year follow-ups.

Adult↗
PubMed1985

Children with end-stage renal failure: psychological effects on patients, siblings and parents.

Thirty-two children diagnosed as suffering from renal failure, their parents and siblings were the subjects of this study. Anxiety, depression and psychosomatic complaints were examined in the parents and behaviour problems in the child and siblings using standardised tests. The personality characteristics (EPQ) of the child and the child's view of the family (modified family relations test) were also ascertained. Parents showed greater levels of anxiety and depression than a normal sample and more psychosomatic problems than a control group consisting of parents of children with other chronic physical conditions. Siblings and the sick child did not have more behaviour problems at school than a normal control group. Positive correlations were found between age on diagnosis of renal failure and fathers' depression and anxiety scores. Mothers' anxiety and depression scores were also positively correlated with those of father. Negative correlations were found between age on diagnosis of renal failure and lie scores on the EPQ.

Adolescent↗