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Biomedical subjects

D Keegan

Publications and source records attributed to D Keegan.

At least 19 recordsLinked to original sources
PubMed2006

Infliximab therapy in Crohn's disease: a pragmatic approach?

BACKGROUND: Infliximab is recognized as an effective therapy in unresponsive luminal and fistulating Crohn's disease. The use of maintenance or 'on demand' therapy thereafter is controversial. AIM: To assess the need for maintenance infliximab therapy in a clinical setting where immunomodulatory agents are widely used and where episodic therapy is used in preference to maintenance therapy. METHODS: Ninety-three patients with Crohn's disease receiving infliximab; 72 with unresponsive luminal disease and 21 with fistulous disease. Data collected included disease site and duration, surgical and smoking history, initial response rates, duration of response maintenance and concomitant medications. RESULTS: Fifty-six of 72 (78%) patients with luminal disease and 11 of 21 (52%) with fistulous disease achieved an initial response. Ten of 67 responders required conversion to maintenance infliximab infusions, while 31 remain in remission. Patients with luminal disease and those who had not taken previous surgery had higher response rates to infliximab. Younger patients and those with small bowel disease had higher relapse rates following initial response. Three patients developed allergic reactions to infliximab and one patient died of progressive pulmonary disease 6 weeks after their first infusion. CONCLUSIONS: Many patients with Crohn's disease can be maintained successfully with an episodic infliximab regimen.

Adult↗
PubMed2005

A model for the management of an atypical endophthalmitis outbreak.

PURPOSE OF STUDY: To present a model for the assessment, investigation, and management of an atypical outbreak of infectious endophthalmitis of indeterminate aetiology. METHODS: A published statistical model was used to determine when the case-load constituted an outbreak. Intraocular surgery was discontinued and a multidisciplinary infection control team was formed aimed at identifying potential causative factors among the following categories: environment around theatre, preoperative preparation, intraoperative theatre practices, intraoperative surgical practices, postoperative practices, equipment maintenance guidelines, cleaning/sterilization practices, and microbiological screening. RESULTS: Five cases of postoperative endophthalmitis developed following uncomplicated phacoemulsification cataract surgery by different surgeons over a 7-month period. Despite full investigation no single focus of infection could be determined. Four out of five cases were culture positive. Three grew Streptococcus viridans of different strains. The fourth culture grew Staphylococcus aureus. In the absence of a single causative factor, it was postulated the combined effect of multiple potential factors may have led to an increased bacterial load and subsequent infection rate. Improved practices were initiated including new cleaning protocols to combat the build-up of debris on phacoemulsification instruments. Cataract surgery was resumed with 3-monthly microbiological monitoring. There have been no further cases in the 12 months following the changes. CONCLUSION: Outbreaks of endophthalmitis typically present over a short time period and could often be attributed to a single infective cause. We present our experience of detecting and managing this cluster and recommend a 'ground-up' multidisciplinary model to manage future outbreaks of this devastating condition.

Aged↗
PubMed2000

Systematic process and outcome evaluation of brief staff training in psychosocial interventions for severe mental illness.

This study evaluated systematically the integrity and effectiveness of a topical staff training programme. The integrity of the training was evaluated in terms of its adherence to the trainer's protocol, using an observational instrument. To assess effectiveness, multiple measures of learner satisfaction, learning, generalisation and impact were administered longitudinally to N = 45 multi-disciplinary mental health professionals in the UK. The integrity evaluation indicated that the training had been delivered appropriately. Significant effects of the training were obtained on the learning assessments (knowledge gain and skill enhancement) and on the generalisation measure. No adverse effects were found, and learner satisfaction was very favourable. The findings indicate that a brief in-service training programme can be delivered consistently and can foster good practice amongst mental health staff, leading to benefits for their clients.

Adult↗
PubMed2000

Is the practice of psychological therapists evidence-based?

An interview-based survey of evidence-based practice (EBP) and the research, continuing professional development (CPD) and audit activity that support it was conducted in the North East of England amongst a representative sample of NHS clinical psychologists and counsellors (n = 30). It profiled their participation in EBP activities over the past year and their intentions for the next year. The findings suggest that the sample had used guidelines and protocols on 56 per cent of occasions, had on average drawn on research, CPD and audit approximately half of the time, but had been only minimally influenced by research, CPD or audit. It is concluded that EBP has occurred in all defined areas and that the conditions for an increased degree of EBP are promising.

Adult↗
PubMed1997

Predictors of physician frustration in the care of patients with rheumatological complaints.

Recent studies of the doctor-patient relationship have shown that certain patients are perceived as frustrating or difficult by their doctors; however, little is known about the characteristics of these patients that elicit this dissatisfaction. As part of a larger study of rheumatology clinic patients with fibromyalgia or rheumatoid arthritis (N = 68) we used stepwise multiple regression to select the factors most associated with physician frustration while controlling for the effects of other variables. Variable domains included demographics, psychiatric diagnoses, personality factors, functional disability, disease state, and trauma history. These domains as well as individual variables within these domains were systematically evaluated for their unique contribution to the prediction of physician frustration as measured by the Difficult Doctor-Patient Relationship Questionnaire (DDPRQ). Initial bivariate correlates of physician frustration included marital status, current dysthymia and agoraphobia, lifetime panic disorder and obsessive-compulsive disorder, adult rape and physical abuse, somatization disorder, physical and social disability, the presence of fibromyalgia, as well as neuroticism, illness impact, and perceived loss of control. The best multivariable model for estimating frustration magnitude included somatization disorder, perception of lack of control over illness, and a lifetime history of obsessive-compulsive disorder. These factors explained 48% of the variance in DDPRQ score. Physicians in this study were most frustrated with patients who had ongoing preoccupation with multiple medically unexplained physical symptoms as well as the perception of greater impact and lack of control over their illness. These findings suggest that treatment of somatization in patients with chronic symptoms may decrease physician frustration.

Adult↗
PubMed1997

Use of the Brief Psychiatric Rating Scale to measure success in a psychosocial day program.

This study contrasted six subscales of the Brief Psychiatric Rating Scale (BPRS) to determine their sensitivity to psychosocial treatment outcome. An expanded version of the BPRS was administered to 216 clients on admission to a day program. The subscale measuring hostility and suspiciousness discriminated at intake clients who were therapeutically discharged from clients who did not complete the program and predicted discharge status after the investigators controlled for the effects of demographic variables. Significant reductions in scores were obtained on five subscales for a subset of clients to whom the BPRS was readministered before discharge. The results support the use of the expanded BPRS as an evaluative tool in psychosocial rehabilitation programs.

Adult↗
PubMed1994

Risperidone: neurochemical, pharmacologic and clinical properties of a new antipsychotic drug.

Risperidone, a novel antipsychotic with high binding affinity for serotonin 5-HT2 and a lesser affinity for dopamine D2 receptors, is described and clinical studies are reviewed. In two large-scale trials in North America and Europe, risperidone 6 mg and 4 mg to 8 mg/day compared favourably with haloperidol 20 mg or 10 mg/day in controlling the positive symptoms of schizophrenia. In the North American trial, risperidone produced a significant improvement in negative symptoms; no comparable improvement was reported among haloperidol-treated patients. Risperidone would, thus, appear to offer a potential advantage over other neuroleptics, although the place of this new compound in the pharmacological armamentarium of schizophrenia must be clarified in clinical practice.

Antipsychotic Agents↗
PubMed1993

Plasma catecholamine levels during temperature biofeedback training in normal subjects.

Thirty-nine normal volunteers of both sexes were randomly assigned to receive 8 sessions of temperature biofeedback or autogenic training to increase finger temperature. Temperature biofeedback subjects produced significant elevations in finger temperature during training, whereas those who received autogenic training did not. Temperature feedback subjects had significantly higher heart rates and diastolic blood pressures during training compared to autogenic subjects. There were no significant changes or group differences in plasma catecholamine levels. These data do not support the hypothesis that feedback-induced vasodilation is accompanied by decreased sympathetic activation in normal populations, when only temperature biofeedback is employed.

Autogenic Training↗
PubMed1991

A comparison of fluoxetine and amitriptyline in the treatment of major depression.

Fluoxetine, a new serotonin uptake blocking antidepressant, was compared with amitriptyline in a double-blind study. Patients were diagnosed as having major depression, according to DSM-III criteria, when interviewed with the Diagnostic Interview Schedule. There was significant improvement in patient and observer ratings of depression in both groups, with no difference between groups. Recent memory improved significantly in the fluoxetine group but not in the amitriptyline group. Numbers of patients reporting side-effects were similar but the profiles of side-effects were different, with more patients on amitriptyline reporting anticholinergic and intolerable side-effects.

Adolescent↗
PubMed1988

The teaching of psychiatric epidemiology in Canadian psychiatry residency programs.

In an attempt to evaluate the current state of the training residents receive in psychiatric epidemiology in Psychiatry Residency programs, the Canadian Academy of Psychiatric Epidemiology sent a questionnaire to the 16 Canadian Residency Program Directors. Thirteen of the 16 directors (82%) responded. Program directors identified a number of the common components to the training, although there was wide variation in the time allocated and the availability of resources. The biggest single obstacle to the teaching was a perceived lack of interest on the part of the residents.

Canada↗
PubMed1986

Multicentre study of piroxicam versus naproxen in juvenile chronic arthritis, with special reference to problem areas in clinical trials of nonsteroidal anti-inflammatory drugs in childhood.

Clinical trials of nonsteroidal anti-inflammatory drugs (NSAIDs) are necessary in juvenile chronic arthritis (JCA) but pose certain problems highlighted and discussed in this study, including recruitment, the assessment of efficacy, and the heterogeneity of the disease. In a multicentre 8-week double-blind cross-over study using the double-dummy technique, piroxicam was compared with naproxen in 47 children with seronegative JCA aged 5-16 years. No significant difference between the two treatments was found in either the clinical variables measured or the parent/patient and physician preference at the end of the study. Side-effect profiles of the two drugs were similar, mainly gastrointestinal disturbances. Piroxicam may be a useful alternative NSAID in JCA, particularly in view of its once-daily dosage.

Adolescent↗
PubMed1980

Dopamine-beta-hydroxylase and its apparent endogenous inhibitory activity in the plasma of some psychiatric patients.

The "apparent" and "absolute" levels of dopamine-beta-hydroxylase (DBH) in 62 psychiatric patients and 20 healthy control subjects have been investigated. No significant differences could be detected between control subjects and patients diagnosed as schizophrenic, unipolar depressive and bipolar depressive, when DBH was assayed in the presence of the anti-inhibitors Cu++ and N-ethylmaleimide (i.e., "absolute" DBH activity). In the absence of these anti-inhibitors, however, the levels of plasma DBH (i.e., "apparent" DBH activity) were considerably reduced in all cases, with the schizophrenic group also being significantly reduced (p less than 0.02) in comparison with the control group.

Adult↗
PubMedDate not supplied

A controlled trial of cognitive behavioral treatment of panic in alcoholic inpatients with comorbid panic disorder.

Patients entering a 4-week inpatient alcoholism treatment program were screened for anxiety symptoms. Those with panic disorder with or without agoraphobia were randomly assigned to two groups. The treatment group received 12 hours of cognitive-behavioral treatment (CBT) for panic disorder in addition to the regular alcoholism treatment program: the control group received the regular program. Dropouts from the treatment group were also followed. Problem drinking and anxiety symptoms were measured at the start of the study, and at 3, 6, and 12 months posttreatment. Abstinence from drinking, and anxiety and mood symptoms improved after treatment in all of the groups; there were few differences in outcome between the groups. We concluded that this particular intervention had not been more effective than the regular alcohol treatment program in reducing problem drinking in those with panic disorder.

Adult↗
PubMedDate not supplied

Stress-induced desensitization of alpha 2-adrenergic receptors in human platelets.

Although agonist-induced desensitization of adrenergic receptors has been previously demonstrated, the regulation of adrenergic receptors during acute psychological stress has not been investigated in humans. We studied 30 first year medical students during final examination week and one month earlier. Platelet alpha 2 receptor binding was measured using 3H-yohimbine and leukocyte beta 2 receptor binding was measured with 125I-CYP (Iodocyanopindolol). During final examination week, platelet alpha 2-receptor binding affinity was significantly reduced, while levels of plasma catecholamines and reported anxiety were significantly increased, compared with the earlier period. Students showing the greatest increases in plasma norepinephrine and in reported anxiety also demonstrated the greatest reductions in alpha 2 receptor binding affinity. These data show that acute psychological stress can produce adrenergic receptor desensitization, possibly through increased levels of circulating norepinephrine.

Adult↗
PubMedDate not supplied

Plasma catecholamines during behavioral treatments for Raynaud's disease.

We have previously demonstrated that the vasospastic attacks of Raynaud's disease can be induced despite blockade of efferent digital nerves and that feedback-induced vasodilation is mediated through a non-neural, beta-adrenergic mechanism. Here, we sought to determine the role of sympathetic activity, as measured by plasma epinephrine and norepinephrine, during finger temperature feedback and autogenic training. Thirty-one female patients with idiopathic Raynaud's disease were randomly assigned to receive finger temperature feedback or autogenic training over 28 days. Half of each group began and finished training during the follicular phase of the menstrual cycle, the other half during the luteal phase. During training, significant temperature elevations were shown by feedback patients but not by autogenic patients. There were no significant effects for norepinephrine and epinephrine for either group. Cycle phase did not interact with training effects or with catecholamines. These findings do not support the role of decreased sympathetic activation in behavioral treatments for Raynaud's disease.

Adult↗