PubMed Health⌕ Search

Biomedical subjects

G Haddock

Publications and source records attributed to G Haddock.

At least 37 records · Page 2Linked to original sources
PubMed1999

The morbidity and mortality of pediatric splenectomy: does prophylaxis make a difference?

PURPOSE: The aim of this study was to analyze the incidence of postsplenectomy sepsis morbidity and mortality after prophylaxis, in comparison with our previous 13-year study (1958 to 1970, inclusive). METHODS: All patients who had splenectomy at the Hospital for Sick Children, Toronto, between 1971 and 1995, inclusive (to give a minimum of 2 years for follow-up), were reviewed for infection and mortality. The criterion for classifying a patient as "infected" was the recovery of an invading encapsulated organism from the blood culture in a patient admitted to the hospital. RESULTS: Of the 264 patients studied, 10 had a postsplenectomy infection (3.8%); nine occurred in patients who underwent splenectomy between the ages of 0 and 5 years. Infection took place within 2 +/- 3 years (mean +/- SD) after splenectomy for the immunized patients and 11 +/- 5 days (mean +/- SD) for the nonimmunized children. A significant number of patients were admitted for an apparent respiratory infection, but no serum organisms were isolated. One died of overwhelming sepsis, but the responsible organism was not identified. CONCLUSION: Although there has not been a decrease in the number of splenectomies performed per year, the incidence of infection and mortality has decreased by 47% and 88%, respectively, with prophylaxis.

Adolescent↗
PubMed1999

Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS).

BACKGROUND: Scales to measure the severity of different dimensions of auditory hallucinations and delusions are few. Biochemical and psychological treatments target dimensions of symptoms and valid and reliable measures are necessary to measure these. METHOD: The inter-rater reliability and validity of the Psychotic Symptom Rating Scales (PSYRATS: auditory hallucination subscale and delusions subscale), which measure several dimensions of auditory hallucinations and delusions were examined in this study. RESULTS: The two scales were found to have excellent inter-rater reliability. Their validity as compared with the KGV scale (Krawiecka et al. 1977) was explored. CONCLUSIONS: It is concluded that the PSYRATS are useful assessment instruments and can complement existing measures.

Adult↗
PubMed1998

Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia.

OBJECTIVES: To investigate whether intensive cognitive behaviour therapy results in significant improvement in positive psychotic symptoms in patients with chronic schizophrenia. DESIGN: Patients with chronic schizophrenia were randomly allocated, stratified according to severity of symptoms and sex, to intensive cognitive behaviour therapy and routine care, supportive counselling and routine care, and routine care alone. SETTING: Adjunct treatments were carried out in outpatient clinics or in the patient's home. SUBJECTS: 87 patients with persistent positive symptoms who complied with medication; 72 completed treatment. OUTCOME MEASURES: Assessments of positive psychotic symptoms before treatment and 3 months after treatment. Number of patients who showed a 50% or more improvement in symptoms. Exacerbation of symptoms and rates of readmission to hospital. RESULTS: Significant improvements were found in the severity (F=5.42, df =2,86; P=0.006) and number (F=4.99, df=2,86; P=0.009) of positive symptoms in those treated with cognitive behaviour therapy. The supportive counselling group showed a non-significant improvement. Significantly more patients treated with cognitive behaviour therapy showed an improvement of 50% or more in their symptoms (chi2=5.18, df=1; P=0.02). Logistic regression indicated that receipt of cognitive behaviour therapy results in almost eight times greater odds (odds ratio 7.88) of showing this improvement. The group receiving routine care alone also experienced more exacerbations and days spent in hospital. CONCLUSIONS: Cognitive behaviour therapy is a potentially useful adjunct treatment in the management of patients with chronic schizophrenia.

Adult↗
PubMed1998

Individual cognitive-behavior therapy in the treatment of hallucinations and delusions: a review.

The limitations of biochemical treatments in reducing the severity of hallucinations and delusions has led to an increased interest in the investigation of psychological treatments for these symptoms. These investigations have spanned the last 4 decades and have covered a range of psychological approaches from psychoanalytically oriented psychotherapy to behavioral approaches. More recently, findings that some psychotherapies are not effective treatments for psychosis and that cognitive-behavior therapy can be an effective treatment for neurotic disorders have led to increasing interest in the investigation of the effectiveness of cognitive-behavior therapy for psychosis. This review describes and evaluates the research on the cognitive-behavioral treatment of hallucinations and delusions and describes the cognitive models from which the treatments have developed. The conclusion is that, on the whole, the literature provides fairly strong evidence for the efficacy of cognitive-behavioral approaches in the management of chronic psychotic disorders and associated symptoms, although there are a number of areas where further development is necessary.

Adaptation, Psychological↗
PubMed1998

The clinical skills of community psychiatric nurses working with patients who have severe and enduring mental health problems: an empirical analysis.

This study describes the use of reliable scales to rate the clinical skills of mental health nurses when working with individuals and families with severe mental health problems. The Cognitive Therapy Scale and the Schizophrenia Family Work Scale were adapted for the study and were shown to have good inter-rater reliability when assessing audio-taped interviews carried out by mental health nurses during their usual course of work with patients with severe mental health problems and their families. The sample of mental health nurses studied were shown to have significantly better general therapy skills than specific cognitive therapy technical skills. The implications for training are discussed.

Clinical Competence↗
PubMed1998

Is befriending by trained volunteers of value to people suffering from long-term mental illness?

People who suffer from long term mental illness may be vulnerable to loneliness and isolation when living in community settings. Befriending by volunteers may be an effective way of combating such problems and helping clients to develop social networks. The findings of a small scale project to evaluate the views of people suffering from long term mental illness of an organized befriending scheme are reported. Nine subjects who suffer from severe mental illness were interviewed, all subjects felt befriending was helpful to them, and 67% of subjects thought it had improved their confidence when in social situations. Subjects who lived alone indicated a preference to see volunteers at home, whilst those who lived with carers preferred support in going out socially. The value of befriending schemes as part of community care services for this needy client group are discussed.

Adaptation, Psychological↗
PubMed1998

A comparison of the long-term effectiveness of distraction and focusing in the treatment of auditory hallucinations.

Cognitive-behavioural interventions for patients experiencing neuroleptic resistant auditory hallucinations have fallen into two main categories: those which encourage distraction as a coping strategy, and those which encourage patients to focus on or expose themselves to their hallucinations. A 20-session distraction treatment was compared with an equal length focusing treatment for 19 patients who were experiencing chronic auditory hallucinations. Patients were followed-up for approximately 2 years. No differences were observed between the groups for outcome on symptom severity overall, although the focusers showed a greater belief that their voices were their own thoughts at the final follow-up point. When the two groups were combined, there was a significant reduction in the frequency of hallucinations and the disruption to life caused by them during treatment, although this was not maintained at follow-up. During treatment, there was a significant increase in self-esteem for focusers but a significant decrease for distracters. At 2-year follow-up, both focusers and distracters showed a reduction in self-esteem in comparison to the end of therapy. The results show no overwhelming advantage of one treatment over the other and confirm previous observations of the difficulty of treating hallucinations with cognitive-behaviour therapy (CBT). However, there was some indication that CBT influenced some important clinical variables and further investigation is warranted.

Adaptation, Psychological↗
PubMed1998

Individual cognitive-behavioural interventions in early psychosis.

BACKGROUND: Cognitive-behavioural treatments have previously been explored in the treatment of chronic psychotic problems, but recently, the effectiveness of these treatments has been investigated with regard to recent onset and acute psychosis. METHOD: The literature relating to cognitive-behavioural treatments in psychosis is explored and the application of the approach to recent onset psychosis is described in detail. RESULTS: There appears to be a growing body of evidence that the advances made in the treatment of people with chronic treatment resistant psychosis can be similarly applied to people with recent onset and acute psychosis. CONCLUSIONS: Cognitive-behavioural treatments are feasible with recent onset psychotic patients although further evaluation of their effectiveness is necessary.

Antipsychotic Agents↗
PubMed1997

Cognitive factors in source monitoring and auditory hallucinations.

BACKGROUND: In order to elucidate further the cognitive processes underlying auditory hallucinations, an experiment investigating delayed and immediate source monitoring for positive, negative and neutral verbal material was conducted with schizophrenic patients. METHODS: Patients experiencing auditory hallucinations, patients not experiencing auditory hallucinations and normal subjects participated in a word association task, rating their responses for how much a self-generated thought was their own, how controllable and involuntary it was and their confidence in these ratings. A delayed source monitoring test in which subjects had to recall the source (self or experimenter) of the words from the association task was also administered. RESULTS: Hallucinators showed a greater bias towards external attribution of their thoughts compared with both control groups for immediate attributions of source, but not for delayed attributions. Hallucinators showed a bias towards external attribution of emotional material for immediate source monitoring and all subjects showed a bias towards misattribution of positive material to an external source and negative material to an internal source for the delayed source monitoring task. CONCLUSIONS: These findings appear to be most consistent with theories proposing that hallucinations result from an external attributional bias for internal events. The implications of these results for research and practice are also discussed.

Adult↗
PubMed1996

Perfectionism in weight-concerned and -unconcerned women: an experimental approach.

OBJECTIVE: The primary purpose of the study was to explore, experimentally, the common clinical observation that anorexics are highly perfectionistic. METHOD: Extremely weight-concerned and control college student subjects (as defined by scores on the Eating Attitudes Test [EAT]) were assigned high or low goals or they selected their own goals in a performance situation. After a series of 10 trials on which personal performance goals were measured, subjects in the high and low goal groups received false feedback indicating success or failure, and mood was measured. RESULTS: High (vs. low) EAT subjects were more likely to persist in accepting an unrealistically high imposed goal, set lower personal goals in the absence of external standards, and were more strongly affected by the feedback. DISCUSSION: Many characteristics of anorexics (including pursuit of thinness) can be accounted for in terms of their strong need for social approval and conformity to external standards.

Adolescent↗
PubMed1996

Gastroschisis in the decade of prenatal diagnosis: 1983-1993.

Fifty cases (24 males, 26 female) of gastroschisis were admitted to the Regional Neonatal Surgical Unit at the Royal Hospital for Sick Children in Yorkhill, Glasgow, between January 1983 and October 1993. The mean birthweight was 2.17 kgs and mean gestation was 35.8 weeks. Prenatal diagnosis was made by ultrasound scan in 39 cases (78%) and 33 (66%) were delivered in the Regional Obstetric Unit and Fetal Medicine Centre at the Queen Mother's Hospital, Yorkhill, Glasgow, immediately adjacent to the neonatal surgical unit. Spontaneous vaginal delivery occurred in 23 (46%) but Caesarean section was performed in 27 (54%). Sixteen Caesarean sections were emergencies and 11 elective (5 on account of dilated bowel loops). Associated bowel problems were noted in 11 (22%)--atresia (5), stenosis (2), ischaemia (1), duodenal perforation (1), ileal perforation (1) and jejunal band obstruction (1). Primary closure was achieved in 42 (84%) and there were 5 deaths (10%). Prenatal diagnosis and mode of delivery showed no direct correlation with mortality (10%) in this series. Emergency Caesarean section was necessary for fetal indications in 28%. The prediction of compromised or damaged intestine by prenatal ultrasound was unreliable and the majority of cases of atresia and stenosis escaped detection. However, it is concluded that prenatal diagnosis and delivery in a regional centre offers the best outcome for the fetus. Further study is needed to define "at risk" pregnancies and fetuses and to determine the role of intervention.

Abdominal Muscles↗
PubMed1995

Tobogganing injuries in children.

AIM: To undertake a retrospective review of tobogganing-related injuries in children requiring admission to the Hospital for Sick Children, Toronto. MATERIALS AND METHODS: Twenty-two children with tobogganing-related injuries were admitted between December 1991 and December 1993. There were 13 boys and 9 girls (median age, 10 years; range, 3 to 17 years). Their charts were reviewed using a structured proforma. RESULTS: Nine patients (41%) sustained injuries by striking a tree, 8 struck other objects, and 5 fell from the toboggan. Only 1 was wearing protective headgear. The initial site of impact was the head in 13 patients (59%), the trunk in 5, and the extremities in 4. Major injuries were sustained in all body systems. Thirteen patients (59%) required surgical treatment and two patients died, one of cerebral edema and the other of acute renal failure and subsequent multiorgan failure. CONCLUSION: Tobogganing-related injuries represent a small fraction of all injuries in children who require hospitalization. However, such injuries can be serious and can cause significant morbidity and mortality. Better public awareness of the risks of tobogganing is required and simple safety guidelines should be developed to reduce the risks of this popular winter pastime.

Accidental Falls↗
PubMed1995

Effect of emotional salience on thought disorder in patients with schizophrenia.

BACKGROUND: This study examined the effect of emotional salience on the severity of thought disorder in schizophrenic patients. METHOD: Ten thought disordered and ten non-thought disordered schizophrenic patients were interviewed under two conditions: a personal interview involving material which was emotionally salient and an impersonal interview involving material which was not emotionally salient. RESULTS: Both groups exhibited some thought disorder during both interviews. The thought disordered patients exhibited significantly more thought disorder during the emotionally salient interview. CONCLUSIONS: Thought disorder in schizophrenic patients is affected by the emotional salience of the material being discussed. Clinical implications are discussed.

Adult↗
PubMed1994

Acute pancreatitis in children: a 15-year review.

AIM: To review the aetiology, presentation, diagnosis, management, and sequelae of acute pancreatitis (AP) in children and to assess the relevance of prognostic criteria used to assess severity in adult AP. METHOD: A retrospective review (1978 through 1992) of childhood AP managed in three Scottish paediatric centres. RESULTS: Forty-nine cases of AP (34 male, 15 female) were reviewed (mean age, 7.1 years). The presenting features were abdominal pain and vomiting (80%), abdominal tenderness (73%), and parotid enlargement (22%); back pain was rare (8%). Ultrasound scan (US) findings were abnormal for 24 of 34 patients. Forty-one (82%) were managed conservatively. Six (12%) underwent early laparotomy; three (6%) underwent laparotomy after trauma. Five required subsequent definitive surgery. One patient died. Thirty-five (70%) suffered no sequelae, and five (10%) had further acute pancreatitis. Only half of the eight Imrie prognostic criteria had been recorded in these patients; only three were judged to have severe AP by the criteria. Other "clinically severe" cases were not identified. CONCLUSION: The most common causes of AP were mumps (39%) and trauma (14%); in 12, no cause was identified. US was the most useful imaging tool. The Imrie criteria were of doubtful value but warrant further prospective analysis and possible modification for children.

Acute Disease↗
PubMed1994

An audit of sickle cell screening in a paediatric hospital population.

Current UK guidelines for the detection of sickle cell disease (SSD) recommend pre-operative screening of patients of African or Afro-Caribbean descent and of patients from the Middle East, South Italy, Greece and India. These recommendations have considerable cost implications for the NHS. We have undertaken a retrospective audit of the use of SSD screening in our own institution. Between January 1987 and August 1992, 1305 patients under 15 years of age (mean 3.8 years) underwent screening for SSD. Surgical patients accounted for 1120 tests (85.8%). The majority of patients tested were of Asian descent (n = 955; 73%); only 350 (27%) were of African or Afro-Caribbean descent. Only four patients (0.3%) tested positive (all sickle cell trait); three of Afro-Caribbean descent and one from Bahrain. We conclude that, in our population, the incidence of HbS is low. Patients of African or Afro-Caribbean descent should continue to be tested but a selective policy may be indicated in other ethnic groups.

Adolescent↗
PubMed1993

Changing trends in the management of extrahepatic cholangiocarcinoma.

A series of 107 patients with cholangiocarcinoma diagnosed between January 1980 and December 1991 is reported. Changing patterns of investigation and treatment in the periods 1980-1985 and 1986-1991 are analysed. There was a decrease in the use of percutaneous transhepatic cholangiography in the second period (86 versus 51 per cent of patients) but increased use of endoscopic retrograde cholangiography (19 versus 71 per cent) and computed tomography (8 versus 59 per cent). The overall resectability rate (17 per cent) was similar to those of other reported series but greater in the second period (8 versus 21 per cent). Palliation by endoscopic and percutaneous stenting was associated with a high incidence of recurrent cholangitis (55 per cent) and jaundice (35 per cent). During the second 6-year period, more effective palliation was achieved by segment III cholangiojejunostomy with a lower incidence of recurrent cholangitis (19 per cent) and jaundice (19 per cent). Overall prognosis for patients with this condition is grim and efforts must usually be aimed at providing the most appropriate palliation.

Adenoma, Bile Duct↗