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Biomedical subjects

E Churchill

Publications and source records attributed to E Churchill.

8 recordsLinked to original sources
PubMed2000

Symptom-specific effects of fluoxetine in post-traumatic stress disorder.

The selective serotonin reuptake inhibitors have become a first line treatment for post-traumatic stress disorder (PTSD). In a recent double-blind study in civilians, fluoxetine produced clinically and statistically significant effects on all general measures of PTSD. We examined the specific effects of fluoxetine versus placebo in the above mentioned study of PTSD clusters and individual symptoms. Individuals were included if they met criteria for PTSD according to the Structured Clinical Interview for DSM-III-R (SCID). Symptoms were assessed at sequential time points by the Structured Interview for PTSD (SIP), a clinician interview based assessment, and a self-report scale, the Davidson Trauma Scale (DTS). A total of 53 patients were included in the analysis. On the SIP and DTS, fluoxetine was found to produce statistically significant changes on all clusters. Significant effects for fluoxetine were noted on 10 items of the DTS, and 8 items of the SIP. The SIP and DTS had 6 items in common that were significant. Fluoxetine exerts a broad spectrum effect in reducing all the symptom clusters of PTSD in this sample. The symptoms of being physically upset at reminders of the trauma, avoiding thoughts of the trauma, having difficulty enjoying things, feeling distant/estranged, having a sense of foreshortened future, and impaired concentration, were the symptoms most responsive to the effects of treatment with fluoxetine on both scales.

Adult↗
PubMed1999

Derivation of the SPAN, a brief diagnostic screening test for post-traumatic stress disorder.

The Davidson Trauma Scale (DTS) is a validated 17-item self-rating scale used in the diagnosis of post-traumatic stress disorder (PTSD), which is sensitive to the effects of treatment. It was felt that a shorter version of the scale might provide a better diagnostic screening tool. Subjects were drawn from a sample of 243 patients obtained from multiple cohorts that included a group of survivors of various forms of trauma, including natural disaster, rape and combat. All subjects had diagnostic assessments for PTSD with a clinical interview and completed the DTS. The data were randomly divided between two subsamples, and frequency and severity scores were calculated for the DTS. A four-item scale, the SPAN (named for its top four items: Startle, Physiological arousal, Anger, and Numbness), was developed. It demonstrated an efficiency of 0.88, sensitivity of 0.84, specificity of 0.91 and positive likelihood ratio of 9.1. In a replication sample, values were slightly lower but still acceptable (efficiency = 0.80). A subgroup of PTSD patients received either fluoxetine or placebo in a clinical trial, and a significant SPAN score improvement was observed on fluoxetine. The SPAN, which correlated significantly with the Impact of Events Scale, the Sheehan Disability Scale, and the Structured Interview of PTSD, was found to have a diagnostic accuracy of 88%.

Adult↗
PubMed1999

Nefazodone in post-traumatic stress disorder: results from six open-label trials.

Nefazodone, an antidepressant which blocks serotonin (5-HT)2 receptors and 5-HT reuptake, was evaluated in the treatment of post-traumatic stress disorder (PTSD) in six open-label studies involving both civilians and combat veterans. Our objective was to report this available pooled data to characterize the response of this drug in PTSD. Specifically, we looked at response rates using three different criteria, the effect of nefazodone on each PTSD cluster and individual symptoms and, lastly, variables that might predict response. One hundred and five outpatients with chronic PTSD were treated with nefazodone titrated up to 600 mg/day, 92 of whom were entered in an intent to treat analysis. We used the percentage drop in score between baseline and endpoint on main scale as a common measure to evaluate outcome. The response criterion of a drop in score of at least 30%, 40% and 50% revealed response rates of 46, 36 and 26%, respectively. Nefazodone showed a broad spectrum of action on PTSD symptoms. This profile might make nefazodone a useful drug to treat PTSD. Predictors of response include age, sex and trauma type. Double-blind, placebo-controlled clinical trials in PTSD are in progress to assess the utility of nefazodone as a treatment in this disorder.

Adult↗
PubMed1998

Effect of continuous lateral rotational therapy on lung mucus transport in mechanically ventilated patients.

PURPOSE: Continuous lateral rotational therapy (CLRT) <40 degrees is a method of altering the position of the ventilated patient to help clear secretions from the lung. CLRT has not been shown to reduce the incidence of atelectasis or pneumonia but potentially offers a way to maximize positional drainage in these patients without producing adverse effects. Treatment intervention, bracketed by two (nonrotational) control periods. The purpose of this study was to determine if CLRT alters mucus transport in critically ill, intubated patients in the intensive care unit of a teaching hospital. MATERIALS AND METHODS: Thirteen critically ill, but stable, mechanically ventilated patients, mean age 74 years, were enrolled. They were placed supine on a Biodyne bed (KCI, San Antonio, Texas) and pressures in the cushions adjusted to patient's weight. A radiolabeled aerosol was delivered by bagging for 2 to 3 minutes and repeated measurements of lung radioactivity were obtained by imaging of the thorax over the following 3 hours. A 90-minute period of rotation of the bed, 30 degrees to either side was preceded and followed by two 45-minute control periods during which the patient remained supine and stationary on the bed. Coughs and suctions were recorded and blood gases obtained pre and post study. RESULTS: (1) The mucous clearance was slower than that reported in normal subjects and in ambulatory patients with COPD; (2) there was a slight, but not significant, increase in clearance during CLRT; (3) clearance reverted to pre-oscillation levels following therapy. Lack of significant effect may be attributed to too shallow an angle for rotation or too short an intervention period. CONCLUSION: Positional drainage effected by short duration CLRT did not appear to stimulate significant mucous removal from the lung in critically ill patients but also did not cause any adverse effects.

Administration, Inhalation↗
PubMed1994

Non-invasive quantitative EMG.

The EMG information obtained by surface recording is compared to needle derived data processed in an identical manner. Such quantitative analysis of EMG activity has been undertaken using needle electrodes and is a well recognised technique for clinical purposes (16). Results of a study comparing data collected simultaneously by surface and needle electrodes from normal healthy volunteers are presented as a preliminary to a similar study of neuropathic and myopathic patients. The EMG interference pattern during maximum voluntary contraction was analysed for turns and zero crossings as well as from frequency spectral data, and the results displayed on-line using an inexpensive novel transputer aided PC. It was found that quantitative studies of surface and needle data were directly comparable in one muscle such as tibialis anterior but very different in another, such as rectus femoris, where there were changes in signal characteristic at different depths. The variability between individuals appeared to be less marked when surface electrodes were used. Data from surface recordings also show a high degree of repeatability when collected over a period of time.

Adult↗
PubMedDate not supplied

Quantitative surface EMG in the diagnosis of neuromuscular disorders.

This paper describes a non-invasive quantitative method for the diagnosis of neuromuscular disorders using surface EMG (sEMG). We found sEMG to be a reliable method that can be used to differentiate neuropathic and myopathic patients from the normal subjects. The multivariate discriminant analysis of sEMG data assisted in separating myopathic from neuropathic disorders. Nevertheless sEMG is not robust enough to replace needle EMG as a stand-alone diagnostic tool. However quantitative sEMG that is described in this paper could be adopted as a simple, rapid and non-invasive technique to be used in the out patients clinic by EMG-naive clinicians as a screening method for neuromuscular disorders, before referring the patients for detailed clinical neurophysiological examinations.

Differential Threshold↗