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Biomedical subjects

G J Boyle

Publications and source records attributed to G J Boyle.

At least 37 records · Page 2Linked to original sources
PubMed1997

Are chest radiographs and electrocardiograms still valuable in evaluating new pediatric patients with heart murmurs or chest pain?

OBJECTIVES: To determine the usefulness of electrocardiography (ECG) and chest radiography (CXR) in evaluation of patients referred to the pediatric cardiologist for the evaluation of heart murmur or chest pain. DESIGN: In this prospective study, 106 consecutive outpatients were categorized with no heart disease, possible heart disease, or definite heart disease based on history and physical examination; they then underwent ECG and CXR. Studies were reviewed and the examining cardiologist could change the diagnosis and order an echocardiogram. SETTING: Academic pediatric cardiology practice. RESULTS: In patients thought to have no heart disease, the diagnosis was changed to definite heart disease in four solely on the basis of abnormal CXR or ECG. In 25 patients thought to have possible heart disease, the diagnosis was changed to no heart disease (7) or definite heart disease (5) after review of the CXR and ECG. All 25 patients diagnosed with definite heart disease had this confirmed by abnormal CXR (2), ECG (3), both abnormal CXR and ECG, or echocardiogram (18). CONCLUSIONS: ECG and CXR helped diagnose heart disease in four patients thought to have no heart disease, helped to rule out lesions in seven patients with possible heart disease, helped diagnose heart disease in five patients thought to have possible heart disease, and helped confirm heart disease in nine patients. In these days of cost containment, routine ECG and CXR continue to be valuable tools for the pediatric cardiologist in evaluation of patients with heart murmurs or chest pain.

Adolescent↗
PubMed1997

New-onset diabetes mellitus in pediatric thoracic organ recipients receiving tacrolimus-based immunosuppression.

BACKGROUND: Tacrolimus has a negative effect on the pancreatic beta islet cell, and both glucose intolerance and diabetes mellitus are well-recognized complications of tacrolimus-based immunosuppression among adult solid organ transplant recipients. METHODS: To determine the association between tacrolimus and new-onset diabetes mellitus in childhood, we reviewed data on 78 pediatric heart and heart-lung/lung recipients receiving tacrolimus-based immunosuppression. Trough tacrolimus levels, fasting and random blood glucose levels, and corticosteroid requirements were reviewed. Diabetes was defined as glucose intolerance requiring long-term insulin treatment more than 30 days after transplantation. RESULTS: No patient had diabetes before introduction of tacrolimus. In heart-lung/lung recipients, 12 of 28 (43%) had development of diabetes at a median follow-up of 7 months (range 1 to 39). In this group diabetes developed in three of eight (38%) patients with cystic fibrosis and nine of 20 (45%) without (p = NS). In contrast, only two of 50 (4%) heart transplant recipients had development of diabetes. Of the 14 patients with diabetes, 10 had development of diabetes during augmentation of immunosuppression with pulsed corticosteroids. Tacrolimus trough levels were significantly lower in heart compared with heart-lung/lung transplant recipients (9.4 +/- 3.3 versus 15.3 +/- 0.9 ng/ml) (p < 0.01), and at latest follow-up significantly fewer heart transplant recipients were treated with maintenance corticosteroids (28% versus 75%; p < 0.01). In the heart-lung/lung group, no significant difference in tacrolimus levels was found between patients with and without diabetes, nor was there a significant difference in the average corticosteroid dose or number of pulses of corticosteroids per patient. CONCLUSIONS: New-onset diabetes mellitus is rare in pediatric heart transplant recipients receiving tacrolimus-based immunosuppression, but it occurs with a high incidence after pediatric heart-lung/lung transplantation and usually develops during pulsed corticosteroid therapy. However, it is currently not possible to predict which heart-lung/ lung transplant recipients will have development of this serious complication.

Adolescent↗
PubMed1996

Experience of FK506 immune suppression in pediatric heart transplantation: a study of long-term adverse effects.

BACKGROUND: Immunosuppression with FK506 for pediatric heart transplantation has been used in this institution since 1989. This study reports the unique toxicity of this macrolide agent in these heart transplant recipients. METHODS: Between October 1989 and August 1994, 49 patients were managed with FK506, which was the initial primary agent in 38 patients. The remaining 11 were switched from cyclosporine A because of persistent rejection or side effects from the cyclosporine A or prednisone. Data were obtained retrospectively from medical records. RESULTS: Mean duration of follow-up was 29 months (median 37 months, range 3 to 96 months). Twenty-nine patients (59%) were receiving FK506 alone; 20 patients (41%) were receiving additional treatment with azathioprine, prednisone, or methotrexate. There were seven deaths. Twenty patients (41%) had elevated creatinine levels between 1 to 2 mg/dl. Five patients (11%) had levels greater than 2 mg/dl. Two patients with preexisting renal dysfunction while receiving cyclosporine A had chronic renal failure 32 and 36 months after switching to FK506 and required kidney transplantation. Hyperkalemia was a persistent finding in 26 patients. Of eight patients with hypertension, four had preexisting disease while receiving cyclosporine A; two had impaired renal function, and two were receiving prednisone. Severe anemia developed in eight patients (16%), two of whom had parvovirus. Moderate anemia developed in 21 patients (43%). Eosinophilia occurred in 19 patients; 11 of 19 patients (58%) had allergic symptoms. There was one case of diabetes mellitus. There were 12 significant infections with four infection-related deaths. Lymphoproliferative disease was noted in three patients, two of whom survived. Gastrointestinal symptoms, including chronic diarrhea, recurrent abdominal pain, and reflux esophagitis were present in 10 patients. CONCLUSIONS: In our experience, anemia, renal toxicity, hyperkalemia, chronic diarrhea, and allergies were the most common adverse effects of FK506. Unlike cyclosporine A, hypertension, gingival hyperplasia, coarsening of facial features, and hirsutism were not seen.

Anemia↗
PubMed1995

Method of test administration as a factor in test validity: the use of a personality questionnaire in the prediction of cancer and coronary heart disease.

This study examines the predictive accuracy of four different methods of administration of a questionnaire designed to predict cancer and coronary heart disease (CHD) in healthy probands. The method of administration uses the establishment of trust and the explanation of questions as variables in all four possible combinations, i.e. trust and explanation, trust only, explanation only, and neither, the prediction being that the combination of trust and explanation would produce the most accurate prediction, the treatment using neither the worst prediction, with methods using either trust alone or explanation alone intermediate. The criterion was the successful prediction of cancer and CHD. A total population of 3563 men and women was used, and followed up over 15 years, death certificates being used to establish cause of death. As predicted, the combination of trust and explanation did best, use of neither worst. Explanation seemed more important than trust, and the combination seemed to have a synergistic effect. It is apparent that method of administration had an important effect on the outcome of the experiment.

Adult↗
PubMed1995

A structural model of the dimensions of teacher stress.

A comprehensive survey of teacher stress, job satisfaction and career commitment among 710 full-time primary school teachers was undertaken by Borg, Riding & Falzon (1991) in the Mediterranean islands of Malta and Gozo. A principal components analysis of a 20-item sources of teacher stress inventory had suggested four distinct dimensions which were labelled: Pupil Misbehaviour, Time/Resource Difficulties, Professional Recognition Needs, and Poor Relationships, respectively. To check on the validity of the Borg et al. factor solution, the group of 710 teachers was randomly split into two separate samples. Exploratory factor analysis was carried out on the data from Sample 1 (N = 335), while Sample 2 (N = 375) provided the cross-validational data for a LISREL confirmatory factor analysis. Results supported the proposed dimensionality of the sources of teacher stress (measurement model), along with evidence of an additional teacher stress factor (Workload). Consequently, structural modelling of the 'causal relationships' between the various latent variables and self-reported stress was undertaken on the combined samples (N = 710). Although both non-recursive and recursive models incorporating Poor Colleague Relations as a mediating variable were tested for their goodness-of-fit, a simple regression model provided the most parsimonious fit to the empirical data, wherein Workload and Student Misbehaviour accounted for most of the variance in predicting teaching stress.

Adult↗
PubMed1995

Alcohol consumption and health: synergistic interaction with personality.

In this study, 6,386 males and 5,990 females, with a mean age of 55 years, constituting a random sample, were administered questionnaires by interviewers relating to amount of self-regulation and drinking status. They were then followed up over a 20-yr. period, and health status (living well, chronically ill, or deceased) was ascertained. It was hypothesized that the deleterious effect of alcohol would be worse for those low on self-regulation; that health status would be worse for those in whom drinking diminished self-regulation, as compared with those for whom drinking improved self-regulation; and that smoking would have greater effects in lowering health status in those in whom drinking diminished self-regulation than in those in whom drinking improved self-regulation. All predictions were borne out by the data at high statistical significance. The results confirmed findings from an earlier study to the effect that psychological factors like self-regulation powerfully influence the kind of effects drinking has with respect to health.

Adult↗
PubMed1995

Use of the Booklet Category Test to assess abstract concept formation in schizophrenic disorders.

The relationship of concept formation abilities to the presence or absence of delusions in schizophrenic disorders was investigated. Twenty-six schizophrenic patients and 14 normal individuals were administered a short form of the Booklet Category Test (BCT). Patients were grouped into those with and without delusions. It was hypothesized that the delusional group would perform significantly better on the BCT (obtain lower error scores) than the nondelusional group. Normal and delusional groups obtained significantly lower BCT error scores than the nondelusional group, even when differences in IQ scores were statistically partialled out. The two schizophrenic groups also differed significantly on BCT error scores with the delusional group performing better than the nondelusional group.

Journal Article↗
PubMed1994

Aerobic exercise, mood states and menstrual cycle symptoms.

This study examined the effects of regular, moderate exercise on mood states and menstrual cycle symptoms. A group of female regular exercisers (N = 97), and a second group of female nonexercisers (N = 159), completed the Menstrual Distress Questionnaire (MDQ) and the Differential Emotions Scale (DES-IV) premenstrually, menstrually and intermenstrually. Multivariate analyses of covariance (MANCOVAs) revealed significant effects for exercise on negative mood states and physical symptoms, and significant effects on all measures across menstrual cycle phase. The regular exercisers obtained significantly lower scores on impaired concentration, negative affect, behaviour change and pain. No differences were found between groups on positive affect and other physical symptoms.

Adolescent↗
PubMed1994

Role of right ventricular endomyocardial biopsy in infants and children with suspected or possible myocarditis.

OBJECTIVES: To assess the diagnostic yield, sampling errors, risks, and therapeutic implications of right ventricular endomyocardial biopsy in children with suspected or possible myocarditis. DESIGN: Retrospective study. SETTING: Tertiary referral centre for paediatric cardiology, cardiac surgery, heart transplantation, and mechanical circulatory support. PATIENTS AND METHODS: Review of clinical and histological findings among 63 consecutive children with possible myocarditis undergoing right ventricular endomyocardial biopsy. Review of cardiac histology at subsequent necropsy or after explantation at time of transplantation. RESULTS: From January 1980 to December 1992, 76 biopsies were performed in 63 children (2 weeks to 18 years of age). In 41 cases, the biopsy was performed for evaluation of dilated cardiomyopathy. The median interval from onset of symptoms was one month. Eight children (20%; all with a history of less than six weeks duration) had biopsy proved myocarditis. Five of the eight children made a full recovery, including four who presented in cardiogenic shock. By contrast, only three of 33 children without evidence of myocarditis showed recovery of ventricular function. The whole heart was available for histological examination in 23 patients. Myocarditis was confirmed in one patient, and no evidence of myocarditis was found in the remaining 22 (all with negative biopsies). One procedure related death occurred in a 2 week old infant with dilated cardiomyopathy. In 22 cases, biopsy was performed for the evaluation of arrhythmia. Only one biopsy showed myocarditis. CONCLUSIONS: The diagnostic yield of a biopsy is low in children with arrhythmias. In children presenting with profound ventricular dysfunction, a diagnosis of acute myocarditis may avoid premature consideration of transplantation as this group has an important potential for full recovery. In less critically ill patients and in those with a longer duration of symptoms the justification for biopsy is not as clear and the procedure is not without risk.

Acute Disease↗
PubMed1994

Psychometric properties of Russell's short form of the Booklet Category Test.

Russell's short form of the Booklet Category Test was administered to 26 diagnosed schizophrenic patients and 14 normal individuals along with a test of premorbid intelligence. IQ correlated significantly (inversely) with errors and in particular with Subtests 3, 4, and 6. Age related directly to errors, especially for Subtests 3, 4, and 5. The mean Cronbach coefficient alpha was .71, indicating moderate item homogeneity across subtests. In sum, the shortened form appears to be an efficient and effective measure of concept formation among schizophrenic individuals.

Adult↗
PubMed1989

Sex differences in the prediction of academic achievement using the Children's Motivation Analysis Test.

The Children's Motivation Analysis Test (CMAT), together with standardised achievement tests in mathematics and reading, was administered to a large sample of Australian elementary school children. Stepwise forward regression analyses were conducted on subsamples of 209 males and 179 females (cases with missing data previously excluded). Several of the CMAT dynamic traits significantly predicted achievement scores. The most useful predictors were conscientiousness (Superego) and family (Home) orientation. These results, based on objective motivation measurement, represent the beginnings of a new approach for research into children's motivation structure.

Achievement↗
PubMed1989

Which employment interview skills best predict the employability of schizophrenic patients?

To examine the effects of verbal and nonverbal interview microbehaviors and interview characteristics on employability, Simulated Employment Interviews were conducted with 46 psychiatric inpatients who each met the DSM-III criteria for a diagnosis of schizophrenia. Each interview was videotaped and shown to two raters, who generated independent ratings for six microbehaviors (eye-contact, facial gestures, body posture, verbal content, voice volume, and length of speech) and six subject characteristics (motivation, self-confidence, ability to communicate, manifest adjustment, manifest intelligence and overall interview skill). A panel of three Commonwealth Employment Service psychologists viewed the same videotaped interviews and generated employability ratings. Verbal and nonverbal microbehaviors were relatively independent while subject characteristics were highly interdependent. Microbehaviors and characteristics correlated at a high level. Of the 12 interview microbehaviors and characteristics, manifest adjustment and ability to communicate accounted for 64% of the total variance in predicting employability. Interviewees who were perceived as behaving in an adjusted manner and as being good communicators were rated as more employable.

Adult↗
PubMed1989

Are employment-interview skills a correlate of subtypes of schizophrenia?

46 inpatients with a DSM-III diagnosis of schizophrenia were assessed in the week prior to discharge from hospital on measures of positive and negative symptoms and on 12 measures of employment interview skills (i.e., eye contact, facial gestures, body posture, verbal content, voice volume, length of speech, motivation, self-confidence, ability to communicate, manifest adjustment, manifest intelligence, over-all interview skill), and a global measure of employability. A cluster analysis based on the total positive and negative symptom scores produced two groups. The group with the lower mean negative symptom score exhibited better employment-interview skills and higher ratings on employability.

Adult↗
PubMed1988

What does the neuropsychological category test measure?

The Halstead Category Test of brain dysfunction is one of the most sensitive neuropsychological measures currently available. While the instrument has received widespread use, nevertheless, the exact nature of what it measures has been poorly delineated. The present brief report presents the results of separate factor analyses of the Category Test along with other neuropsychological measures from the Halstead-Reitan battery. Despite considerable differences in samples, as well as in the particular neuropsychological measures included in the separate analyses, the Category Test consistently lined-up with general intellectual and memory components, in each instance.

Journal Article↗
PubMed1986

Clinical neuropsychological assessment: abbreviating the Halstead Category Test of brain dysfunction.

The present paper reports both quantitative and qualitative data on an abbreviated 84-item version of the Halstead Category Test (HCT) (N = 51). The HCT is a sensitive indicator of organic brain impairment and is included as part of the important Halstead-Reitan neuropsychological test battery. Unfortunately, the HCT is burdened by excessive length and may take up to 2 hours to administer to brain-damaged patients. While a number of attempts to reduce the length and concomitant administration time of the HCT have been reported in the Journal of Consulting and Clinical Psychology over recent years, none of these studies has resulted in a sufficiently shortened HCT to allow practical application with many brain-damaged patients. The proposed version of the HCT takes only 10 to 15 minutes to administer and leaves enough items from the full HCT to enable a parallel form to be developed.

Adolescent↗
PubMed1985

Self-report measures of depression: some psychometric considerations.

This paper examines some aspects of the psychometric adequacy of existing self-report depression measures, so that clinicians might better appreciate their reliability and validity. Issues addressed include the desirability of moderate rather than maximum test-retest and item homogeneity/internal consistency estimates; the distinction between measurement at the surface syndrome level vs. that at the fundamental source state/trait level; the importance of appropriate rather than arbitrary factor analytic procedures; and the need for multivariate measures instead of the single-scale instruments so often employed to measure depression in isolation from interacting emotions such as anxiety or stress. Apart from these more general issues, a number of specific criticisms is considered, along with recommendations for better self-report measures of depression.

Depressive Disorder↗