PubMed Health⌕ Search

Biomedical subjects

D Upton

Publications and source records attributed to D Upton.

At least 19 recordsLinked to original sources
PubMed2004

Investigation of systems to prevent diversion of opiate drugs in general practice in the UK.

BACKGROUND: Statutory regulations govern the procedures that must be followed by general practitioners (GPs) in the UK to minimise the risk of diversion of prescribed opiate drugs for illicit use. However, evidence presented at the trial of Harold Shipman, a GP convicted of murdering patients with diamorphine, suggests that the regulations and monitoring of GPs' prescribing are failing. AIM: To assess the policies followed by general practices in Leicestershire and Rutland with regard to the controlled drugs regulations. METHODS: A semi-structured interview was administered to a purposeful sample of lead GPs to explore how their practices applied the regulations. The controlled drugs registers and drug storage facilities in these practices were inspected. A questionnaire was sent to all the remaining practices to seek information about their application of the regulations, any concerns they had about the regulations, and any suggestions for improving them. RESULTS: Of the 142 general practices in Leicestershire, the lead GP in 14 took part in the interviews. Respondents expressed dissatisfaction with current policies including the design of controlled drug registers, and generally supported the reintroduction of an inspection scheme. Ninety (70.9%) of the 127 practices to whom the questionnaire was sent responded and, of these, 31 (34.4%) no longer held a supply of controlled drugs. Those that did hold controlled drugs indicated concern about the regulations, confusion about some aspects including the return and disposal of unused drugs, and a desire for advice and support in the implementation of the regulations. Forty two of the 59 respondents who held a supply of controlled drugs (71.2%) would welcome regular inspection. CONCLUSION: GPs are confused about the controlled drugs regulations and have little support in implementing them. The suspension of inspection schemes has reduced the amount of advice and support available to them and, in consequence, the regulations are interpreted differently in different practices. These findings are cause for concern about the risk of diversion of controlled drugs, and illustrate how patient safety systems can decay when they are not maintained.

Drug and Narcotic Control↗
PubMed2001

Plasma aluminum levels during sucralfate prophylaxis for stress ulceration in critically ill patients on continuous venovenous hemofiltration: a randomized, controlled trial.

OBJECTIVE: To investigate plasma aluminum levels in critically ill patients requiring continuous venovenous hemofiltration (CVVH), while receiving sucralfate for stress ulcer prophylaxis. DESIGN: Randomized, controlled study. SETTING: Cardiothoracic intensive care unit. PATIENTS: Twenty postoperative cardiac surgical patients INTERVENTIONS: Twenty patients requiring CVVH support for acute renal failure were randomized into two groups for concurrent stress ulcer prophylaxis. Group 1 (n = 10) received nasogastric sucralfate, and group 2 patients received intravenous ranitidine. Plasma aluminum samples were analyzed at baseline and on days 1, 4, 8, and 14. MEASUREMENTS AND MAIN RESULTS: In both the sucralfate and ranitidine groups, clinical characteristics, number of days the patients were on CVVH support (median, 5.5 [range, 2-32] days, and median, 3 [range, 2-18] days, respectively) and duration of prophylaxis (median, 12 [range, 4-42] days, and median, 16 [range, 3-62] days, respectively) were similar. There were no significant differences in the baseline aluminum concentrations (median, 0.37 [range, 0.15-1.63] micromol/L, vs. median, 0.32 [range, 0.11-1.0] micromol/L; p =.79). On initiation of therapy, aluminum levels in the sucralfate group increased dramatically on day 1 (median, 0.87 [range, 0.26-4.4] micromol/L) and peaked on day 4 (median, 2.84 [range, 1.52-4.44] micromol/L) with seven of the ten patients exhibiting levels of >2 micromol/L. In the ranitidine group, there were no significant elevations in aluminum levels above baseline. Analysis of the two groups at the four time points revealed that aluminum levels in the sucralfate group were up to 14 times higher, with the confidence intervals suggesting that the true value may be 2-27 times higher (p <.0001). On cessation of CVVH, a rapid decline in aluminum levels was observed. No clinical manifestations of these potentially toxic levels were observed. CONCLUSIONS: The use of sucralfate for stress ulcer prophylaxis in patients requiring CVVH results in toxic elevations in plasma aluminum levels. Alternative agents should be considered for prophylaxis in these patients.

Acute Kidney Injury↗
PubMed2000

Epilepsy and the family: a review of current literature.

Although the negative effect of epilepsy on patient's psychosocial well-being has been increasingly documented in the last decade, the influence of the condition on the family has attracted much less interest. This paper reviews the present state of family research, examining the influence of both childhood and adulthood epilepsy on the psychological and social well-being of family members. Studies indicate that epilepsy may cause high levels of psychosocial difficulties for all family members, including stigmatization, stress, psychiatric morbidity, marital problems, poor self esteem and restriction of social activities. Studies also suggest that the family environment may be an important intervening factor between the condition and the outcome for the family unit, and a number of family factors are reviewed which have been suggested to mediate this relationship, with recommendations being made for their use in intervention studies. Shortcomings of the family studies to date are discussed and these include: concentration on examination of issues around family life, studies being based on reports from single members of the family and the selection of subjects from clinical populations. Recommendations are made concerning methodological and conceptual issues that need addressing for future research.

Adaptation, Psychological↗
PubMed2000

The constituent structure of autobiographical memory: autobiographical fluency in people with chronic epilepsy.

A total of 59 people with chronic epilepsy recalled autobiographical episodes and personal facts (such as the names of friends or teachers) from various lifetime periods. Also tested was their verbal fluency and their fluency in generating items from semantic categories (animals, vegetables, US presidents, and British prime ministers). Results of a cluster analysis and a common factor analysis confirmed a dissociation between the retrieval of autobiographical information and that of nonpersonal semantic information. There was a similar dissociation between the recall of personal episodes and the recall of the personal information, but the corresponding factors were highly correlated with one another. Finally, verbal fluency performance was significantly correlated with the retrieval of personal information, personal episodes, and common objects, but not with that of public figures. The constituent structure of autobiographical fluency is extremely robust across different populations.

Adult↗
PubMed1999

Attitudes towards, and knowledge of, clinical effectiveness in nurses, midwives, practice nurses and health visitors.

The dual concepts of evidence-based practice and clinical effectiveness have become ever more important for nurses, midwives and health visitors in recent years. In order that suitable initiatives can be derived and future policy shaped and evaluated it is important that the current level of knowledge and attitudes towards these concepts are recorded. The current study set out to examine these variables in a large, representative sample (n = 370, response rate = 74%) of nurses, midwives and health visitors. Results indicated that although a positive attitude towards evidence-based practice exists, individuals consider themselves to be lacking in certain key skills. Specifically, these appeared to be related to research-based skills. However, despite this, respondents indicated a large take up of evidence-based practice, although this may have been greater were it not for the considerable clinical workload. The necessity for greater dissemination of key research principles to nurses, midwives and health visitors by members of their own profession is emphasized.

Adult↗
PubMed1999

Twenty questions task and frontal lobe dysfunction.

Performance on the Twenty Questions task has been assumed to be deficient in those with frontal lobe damage, although few studies have specifically examined this. In the present study, 88 participants with frontal lobe epileptic dysfunction were assessed on this task, as were 57 participants with temporal lobe epileptic disturbance and 28 participants with no evidence of any neurological damage. Results indicated that those with either left or bifrontal lobe damage were more impaired on several indexes of test performance. Analysis also revealed that participants with orbitofrontal damage were impaired on the measure of "first guess" as compared to groups with damage to other regions of the prefrontal cortex (p <.05). Overall, the results support the utility of the Twenty Questions task in assessing frontal lobe damage and may suggest that qualitatively different deficits may be recorded depending on the region of frontal lobe dysfunction.

Journal Article↗
PubMed1997

Neuropsychological test performance in frontal-lobe epilepsy: the influence of aetiology, seizure type, seizure frequency and duration of disorder.

Although frontal-lobe epilepsy accounts for a sizeable proportion of all partial epilepsies the neuropsychological characteristics have proved difficult to document. A possible explanation for this may lie in the impact of seizure-related variables. However, these have rarely been addressed in a frontal-lobe epilepsy sample. In this report the neuropsychological sequelae of the aetiology of epilepsy, seizure spread, seizure frequency and duration of disorder were examined in a sample of 74 subjects with frontal-lobe epilepsy (42 with left, 32 with right). Only a few significant results were revealed and in these cases the possibility of greater cortical dysfunction rather than specific frontal impairment would offer a viable solution. Further studies are needed in order that firmer conclusions concerning the impact of the variables investigated on neuropsychological performance in a sample of subjects with frontal-lobe epilepsy can be drawn.

Adolescent↗
PubMed1997

Age at onset and neuropsychological function in frontal lobe epilepsy.

PURPOSE: Previous studies into the cognitive consequences of frontal lobe epileptic dysfunction may have proved inconclusive, due to a factor not commonly accounted for: Damage or disturbance during different epochs of development may give rise to different levels of neuropsychological dysfunction. In this study, we investigated the influence of age at onset on cognitive performance in a group of subjects with frontal lobe epilepsy (FLE). METHODS: Seventy-four subjects (42 with left, and 32 with right) FLE were classified into early (0-6 years), intermediate (7-11 years) or late onset (> or =12 years) and their performance recorded on a battery of measures assessing both executive and motor skills. RESULTS: On the measures of executive functioning, no consistent pattern emerged, whereas on the measures of motor skill, the results suggested that a right-sided early onset (i.e., 0-6 years) did not impair performance compared to a later lesion within the same hemisphere. Furthermore, this sparing of performance was not observed within the left hemisphere. CONCLUSIONS: Overall, the results suggest that individuals with differing ages of epilepsy onset will be differentially impaired on certain cognitive tasks. Several tentative ramifications of these results are suggested.

Adolescent↗
PubMed1996

General neuropsychological characteristics of frontal lobe epilepsy.

The neuropsychological characteristics of frontal lobe epilepsy have rarely been reported, with neuropsychological indicators usually being related to subjects with other forms of neurological damage. In this study we assessed the performance of 74 subjects with frontal lobe epilepsy (42 with left, 32 with right frontal epileptic foci) on a series of measures thought to be sensitive to frontal lobe dysfunction and compared to 57 subjects with temporal lobe epilepsy (31 with left, 26 with right epileptic foci). The results indicated a number of measures that could be considered sensitive to frontal lobe epileptic dysfunction. However, the pattern of results did not indicate consistent deficits to be associated with frontal lobe epileptic dysfunction. There are a number of unique factors associated with epilepsy that need to be considered, and these may account for the variable pattern of results obtained. In particular, the rapid propagation of frontal lobe seizures both bilaterally and to other cortical regions has to be considered.

Adolescent↗
PubMed1996

Patient satisfaction with specialized epilepsy assessment and treatment.

The need for the assessment of patient satisfaction with specialized epilepsy services has been recognized for a number of years, in order to complement the management and medical benefits already demonstrated. We report a detailed study of patient satisfaction with the services provided in a specialised epilepsy assessment unit in the U.K. Patients were interviewed to assess their perceptions of the quality of service and the benefits they had derived from attending the unit. Close relatives were also contacted for their evaluation of the service provided. In all, 76 patients and 52 close relatives provided their views on the services offered. The results showed a positive appraisal of treatment. Almost 90% believed that their medical and social situation had been improved by attendance at the unit. However the need to assess more objective measures of "satisfaction' are stressed, in order that future developments in care can be appropriately planned.

England↗
PubMed1996

Clinical analysis of a CAD/CAM system for custom seating: a comparison with hand-sculpting methods.

A CAD/CAM system for manufacturing custom seating inserts was evaluated within a moderately to severely disabled population. Using the Otto Bock Shape System, 25 CAD/CAM seats were manufactured at a remote facility and compared to 9 seats manufactured using hard-sculpting techniques. Clinician and client questionnaires were completed for each seat to assess satisfaction, fitting/manufacturing times, and to collect demographic data. The CAD/CAM method was significantly better (p < 0.05) than the hand-sculpting method in terms of on-site fabrication time. No significant differences were found for initial fitting time, final fitting time, clinician insert rating, and client satisfaction. These results support the CAD/CAM method as an effective and clinically efficient technique for making custom wheelchair seats.

Adult↗
PubMed1995

The role of the right temporal lobe in card sorting: a case study.

It has been demonstrated previously that performance on the modified Wisconsin Card Sorting Task (Nelson, 1976) is compromised by hippocampal sclerosis, particularly of the right hemisphere (Corcoran and Upton, 1993). Further evidence in support of this claim is presented here in the form of a case study. The findings from this case demonstrated that performance on the same task was not impaired following a right sided frontal lobectomy but was found to be deficient consequent to seizure recurrence in the right temporal lobe and following right temporal lobe removal. The clinical and theoretical significance of this case is discussed.

Adult↗
PubMed1994

Neuropsychological effects of tiagabine, a potential new antiepileptic drug.

The neuropsychological effects of the GABA-reuptake blocker, tiagabine-HCl, were tested in an open trial of 22 adult patients with refractory partial epilepsy followed by a double-blind, placebo-controlled, cross-over trial in 12 subjects. Nineteen patients completed the initial open titration and fixed-dose phase of the study and 11 patients completed the double-blind phase. The median daily tiagabine dose was 32 mg during the open fixed dose and 24 mg during the double-blind periods. Neuropsychological evaluation did not show any significant effect on cognitive function in the open or double-blind phases. In this group of patients no statistically significant difference in the frequency of the total number of seizures or complex partial seizures was found in the open or double-blind stages. Seizure severity was significantly less in the open fixed dose than in the baseline period, but was not significantly different between the two double-blind periods. Reported side effects were transient, most commonly aggression/irritability, lethargy, headache and drowsiness. No significant EEG changes were observed.

Adult↗
PubMed1993

The excitatory amino acid antagonist D-CPP-ene (SDZ EAA-494) in patients with epilepsy.

The amino acids L-glutamate and L-aspartate have been shown to be excitatory neurotransmitters in mammalian central nervous systems. Antagonists acting selectively at excitatory amino acid receptors have shown antiepileptic properties in several animal models. We report the results of the first therapeutic trial of the competitive NMDA antagonist, D-CPP-ene (SDZ EAA-494), in eight patients with intractable complex partial seizures. All patients withdrew prematurely because of side-effects, including poor concentration (8), sedation (7), ataxia (6), depression (3), dysarthria (2), amnesia (2) and unilateral choreo-athetosis in a patient with contralateral Sturge-Weber syndrome. Seizures were unchanged in four patients and worse in three. A further patient with apparent improvement in seizures in the first week developed complex partial status epilepticus on withdrawal of DCPP-ene. EEG on treatment (5) or in the immediate post-treatment period (2) showed slowing of background activity and, in five cases, an increase in epileptiform activity. Serum concentrations of DCPP-ene were found to be unpredictable and higher than expected from pharmacokinetic data on normal subjects. There was no clear relationship between serum concentrations and the severity of side-effects. Preliminary experience with DCPP-ene in patients with refractory partial seizures is not promising. Evaluation of related compounds is warranted.

Adult↗
PubMed1993

A role for the hippocampus in card sorting?

This study examines the performance of three groups of patients with epilepsy on three measures typically used to assess the integrity of the frontal lobes: the Modified Wisconsin Card Sorting Test (MWCST), verbal fluency and the Stroop test. The groups comprised sixteen patients with clearly defined hippocampal sclerosis, thirteen patients with unilateral temporal lobe seizure onset and eighteen patients with unilateral frontal lobe onset. Results demonstrated that performance on the MWCST was most compromised by hippocampal sclerosis. These patients took longer to complete the task, achieved fewer categories and made more perseverative errors than patients in the other groups. In contrast, verbal fluency and performance on the Stroop test were less affected by the presence of hippocampal sclerosis. These results have both clinical and theoretical significance. It is argued that patients with hippocampal damage perform poorly on the MWCST because of the heavy working memory requirements of the test. Cautious use of this test as a tool to localise seizure origin in patients with complex partial seizures is therefore recommended. The findings are discussed in terms of Gray's (1982) model of the hippocampus as a comparator of actions.

Adolescent↗
PubMed1992

The impact of chronic epilepsy on the family.

The emotional impact of intractable epilepsy on family members is a neglected topic, with the majority of studies confined to childhood epilepsy. Our clinical experience suggests that family members, particularly parents, may at times be under considerable emotional strain, especially when seizures are frequent and accompanied by injury. The purpose of this study was to explore the psychological and physical well-being, satisfaction with social circumstances and perceived level of support in families with an adult member with intractable epilepsy. Forty-four families were administered rating scales of mood and answered questions relating to their social situation and physical health. Levels of stress and dissatisfaction with their social situation was high, particularly in primary carers (the mother in most instances). Respite periods away from their caring role were few and the perceived level of support was low. Poor emotional adjustment was associated with severity of tonic and atonic seizures and episodes of status. Additionally, perceived low levels of support were associated with depression.

Acute Disease↗
PubMed1984

Exercise training improves insulin sensitivity in the obese Zucker rat.

The effect of exercise on in vivo insulin sensitivity was examined in lean and obese Zucker rats. Rats (6 to 7 weeks of age) were swum two hours per day or kept sedentary for 8 weeks. Exercise decreased body weight gain as well as percent of fat in both genotypes. Sedentary obese rats had 62% higher gastrocnemius citrate synthase activity per gram of muscle than did lean rats. Exercise increased activity of this oxidative enzyme similarly in both genotypes. Compared to lean rats, obese rats had higher plasma-insulin levels and were less sensitive to insulin during an insulin tolerance test. Although training had no effect on plasma-insulin levels, exercise trained obese rats showed a greater drop in plasma glucose relative to sedentary controls following intravenous injection of three concentrations of insulin. It was concluded that moderate exercise training improved the insulin sensitivity of the obese Zucker rat.

Animals↗