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Biomedical subjects

H Bird

Publications and source records attributed to H Bird.

At least 19 recordsLinked to original sources
PubMed2006

Patient knowledge and misconceptions of osteoarthritis assessed by a validated self-completed knowledge questionnaire (PKQ-OA).

OBJECTIVES: To design and validate an osteoarthritis (OA) patient knowledge questionnaire (PKQ-OA) and to use it to assess the patients' level of knowledge of their disease, treatments and appropriate management techniques. METHODS: The PKQ-OA comprises 16 multiple choice questions with 30 correct answers. It was developed in two phases and tested for face validity, readability (Flesch Reading Index) and understanding, reliability (Kuder-Richardson Formula 20) and reproducibility (test/retest). The questionnaire was then used to assess knowledge of disease and management of OA in a cohort of 83 patients with established disease. RESULTS: The PKQ was found to be fairly easy to read, reliable (r = 0.75) and reproducible (r = 0.81; P < 0.01). The overall median score for the PKQ-OA was 19 ranging from 8 to 26. There was a highly significant association between the scores obtained and the number of years patients had spent in formal education, higher scores equating with greater length of education (P < 0.005). The majority of patients was knowledgeable about the symptoms of OA and exercise, but confused joint protection and energy conservation. The most worrying finding was the lack of knowledge regarding analgesics and some aspects of non-steroidal anti-inflammatory drug (NSAID) therapy. Less than a third of patients knew that analgesics could be taken prophylactically and 70% did not know that they should be taken when pain starts to build. Among the patients 34% did not know that NSAIDs should be taken with or following food. CONCLUSIONS: The PKQ-OA is a readable, reliable and reproducible questionnaire. It is quick to complete and score and could be used in out patient clinics or GP surgeries to assess knowledge of patients with OA.

Adult↗
PubMed2006

An integrated analysis of five double-blind, randomized controlled trials evaluating the safety and efficacy of a hyaluronan product for intra-articular injection in osteoarthritis of the knee.

OBJECTIVE: Five double-blind, randomized, saline-controlled trials (RCTs) were included in the United States marketing application for an intra-articular hyaluronan (IA-HA) product for the treatment of osteoarthritis (OA) of the knee. We report an integrated analysis of the primary Case Report Form (CRF) data from these trials. METHOD: Trials were similar in design, patient population and outcome measures - all included the Lequèsne Algofunctional Index (LI), a validated composite index of pain and function, evaluating treatment over 3 months. Individual patient data were pooled; a repeated measures analysis of covariance was performed in the intent-to-treat (ITT) population. Analyses utilized both fixed and random effects models. Safety data from the five RCTs were summarized. RESULTS: A total of 1155 patients with radiologically confirmed knee OA were enrolled: 619 received three or five IA-HA injections; 536 received "placebo" saline injections. In the active and control groups, mean ages were 61.8 and 61.4 years; 62.4% and 58.8% were women; baseline total Lequèsne scores 11.03 and 11.30, respectively. Integrated analysis of the pooled data set found a statistically significant reduction (P < 0.001) in total Lequèsne score with hyaluronan (HA) (-2.68) vs placebo (-2.00); estimated difference -0.68 (95% CI: -0.56 to -0.79), effect size 0.20. Additional modeling approaches confirmed robustness of the analyses. CONCLUSIONS: This integrated analysis demonstrates that multiple design factors influence the results of RCTs assessing efficacy of intra-articular (IA) therapies, and that integrated analyses based on primary data differ from meta-analyses using transformed data.

Aged↗
PubMed2006

Medicare Part D.

Explore the source record for details and available documents.

Aged↗
PubMed2003

The development and evaluation of a drug information leaflet for patients with rheumatoid arthritis.

OBJECTIVES: To develop and assess the effectiveness of a drug information leaflet (DIL) for D-penicillamine (DPA) and determine whether additional verbal information provides enhanced benefit. METHODS: Three preliminary studies were undertaken: a reading age study; the development of a DIL for DPA; and a DPA knowledge questionnaire. The primary study assessed the effect of the DIL on the knowledge of 30 patients at weeks 0 and 24 after commencing DPA. A follow-up study of 100 patients randomly assigned to receive the DIL alone (control group) or with additional verbal backup (experimental group) determined the effects of additional verbal information by comparison of DPA knowledge questionnaire scores at weeks 0 and 24. RESULTS: The reading study showed that 12% of the sample had difficulty reading and so the DPA DIL was designed to be easy to read using the Flesch Reading Index. An assessment of knowledge of DPA prior to reading the DIL resulted in scores ranging from 0 to 13 with a median of 2 (maximum possible 14). By week 24 the median score was 10 (range 6-14), which was significant at P < 0.0001. The assessment of additional verbal backup showed that both the control group and the experimental group knew little about DPA on study entry, with a median score 2 in each group. On study exit, both groups knew significantly more (P < 0.001) about the drug; the control group scored 9 and the experimental group 11 (not significantly different; P=0.109). CONCLUSIONS: A large minority of patients have poor reading skills, but when a DIL is designed to be easy to read patients gain significant amounts of knowledge from it. Providing additional verbal explanations did bring about increases in knowledge but these were not significant.

Adolescent↗
PubMed2003

Effects of rheumatoid arthritis on sexual activity and relationships.

OBJECTIVES: The primary aim of this research was to assess patients' perceptions of the effects of rheumatoid arthritis (RA) on their sexual relationship and sexual activity, the causes of any difficulties and who they would turn to for help. METHODS: A self-report questionnaire was distributed to 74 patients attending a regional rheumatology clinic and returned by prepaid post. Fifty-nine questionnaires were returned (response rate 80%) and 57 of them were usable. RESULTS: Thirty-five per cent of the cohort thought that their disease strained their relationship with their partner, and reasons for this included curtailment of daily and social activities, changes in the balance of the relationship, emotional changes and changed financial circumstances. Over half (56%) of the patients found that their arthritis placed limitations on sexual intercourse and the principal reasons cited were fatigue and pain. Sexual ability was important to 58% of the sample and ageing had a negative impact on its importance (P<0.005). Poor communication was a major problem, patients being reluctant to approach health professionals and vice versa. The topic of sexual relationships was broached with patients attending one nurse practitioner's clinic, but only one other patient had ever been offered any discussion. Thirty-nine per cent of the cohort would consider talking to someone if they had a problem and the nurse and the doctor were the professionals most often chosen. CONCLUSION: RA impacts on the sexual lives of a large minority of patients and this is a problem that patients and health professionals are reluctant to discuss face to face. However, patients do appear to be willing to complete questionnaires and this may be an acceptable format for assessment. Further training and support is needed by nurses and other health professionals in this sadly neglected area.

Adult↗
PubMed2003

An ordered BAC contig map of the equine major histocompatibility complex.

A physical map of ordered bacterial artificial chromosome (BAC) clones was constructed to determine the genetic organization of the horse major histocompatibility complex. Human, cattle, pig, mouse, and rat MHC gene sequences were compared to identify highly conserved regions which served as source templates for the design of overgo primers. Thirty-five overgo probes were designed from 24 genes and used for hybridization screening of the equine USDA CHORI 241 BAC library. Two hundred thirty-eight BAC clones were assembled into two contigs spanning the horse MHC region. The first contig contains the MHC class II region and was reduced to a minimum tiling path of nine BAC clones that span approximately 800 kb and contain at least 20 genes. A minimum tiling path of a second contig containing the class III/I region is comprised of 14 BAC clones that span approximately 1.6 Mb and contain at least 34 genes. Fluorescence in situ hybridization (FISH) using representative clones from each of the three regions of the MHC localized the contigs onto ECA20q21 and oriented the regions relative to one another and the centromere. Dual-colored FISH revealed that the class I region is proximal to the centromere, the class II region is distal, and the class III region is located between class I and II. These data indicate that the equine MHC is a single gene-dense region similar in structure and organization to the human MHC and is not disrupted as in ruminants and pigs.

Animals↗
PubMed2002

Therapeutic benefit of blocking interleukin-6 activity with an anti-interleukin-6 receptor monoclonal antibody in rheumatoid arthritis: a randomized, double-blind, placebo-controlled, dose-escalation trial.

OBJECTIVE: To investigate the safety and efficacy of MRA, a recombinant human anti-interleukin-6 (anti-IL-6) receptor monoclonal antibody of the IgG1 subclass that inhibits the function of IL-6, in patients with established rheumatoid arthritis (RA). METHODS: A randomized, double-blind, placebo-controlled, dose-escalation trial was conducted in 45 patients with active RA, as defined by the American College of Rheumatology (ACR) revised criteria. Patients were sequentially allocated to receive a single intravenous dose of either 0.1, 1, 5, or 10 mg/kg of MRA or placebo. The primary efficacy end point was meeting the ACR 20% response criteria at week 2 after treatment. RESULTS: Demographic features were similar between treatment groups. At week 2, a significant treatment difference was observed between the 5 mg/kg of MRA and placebo, with 5 patients (55.6%) in the MRA cohort and none in the placebo cohort achieving ACR 20% improvement. There was no statistically significant difference in the ACR 20% response between the other 3 MRA cohorts and placebo at week 2. The mean disease activity score at week 2 in those who received 5 mg/kg and 10 mg/kg of MRA was 4.8 and 4.7 (P < 0.001 and P < 0.001 by analysis of variance), respectively. These mean scores were statistically significantly lower than those in the 0.1- and 1-mg/kg MRA and the placebo cohorts (6.4, 6.2, and 7.0, respectively). The erythrocyte sedimentation rate and C-reactive protein values fell significantly in the 5- and 10-mg/kg MRA cohorts and normalized 2 weeks after treatment. Seventeen patients (5, 4, 6, 2, and 0 patients in the placebo, 0.1-, 1-, 5-, and 10-mg/kg MRA cohorts, respectively) required corticosteroid or disease-modifying antirheumatic drug treatment because of active disease before study end. They were regarded as nonresponders from the time they received these treatments. Diarrhea was the most common adverse event, occurring in 8% of patients. Seven patients (15.6%) reported a severe adverse event (3, 1, 2, and 2 patients in the placebo, 0.1-, 1-, and 10-mg/kg MRA cohorts). There were no serious adverse events that were thought to be related to the study drug. CONCLUSION: This is the first randomized controlled trial showing that inhibition of IL-6 significantly improved the signs and symptoms of RA and normalized the acute-phase reactants. Further research with multiple dosing is necessary to define the most appropriate therapeutic regimen of MRA in RA.

Acute-Phase Reaction↗
PubMed2001

Noun-verb differences? a question of semantics: a response to shapiro and caramazza.

We presented a new model using the sensory/functional theory of semantic category deficits to explain noun/verb deficits in aphasia. The predictions arising from this model were tested on a small number of patients exhibiting grammatical and/or semantic category specific deficits in picture naming. The results lent support for the theory presented. Shapiro and Caramazza (this issue) raised several objections to this theory (which they call the "extended sensory functional theory," or ESFT). In this article we address their concerns about the validity of the ESFT and conclude that it is indeed a useful model that provides a parsimonious explanation for many diverse patterns of deficits.

Aphasia↗
PubMed2001

British consultant rheumatologists' perceptions about the hypermobility syndrome: a national survey.

Three hundred and nineteen UK-based consultant rheumatologists, members of the British Society for Rheumatology (a response rate of 76%), responded to a questionnaire concerning their perceptions of the (benign joint) hypermobility syndrome (HMS). The questions were wide-ranging and covered the nature of the condition, its clinic prevalence, criteria for diagnosis, the efficacy of chosen treatments, the impact of the syndrome on affected individuals and the contribution that it makes to the overall burden of rheumatic disease morbidity. Ninety-two per cent of the respondents believed in the HMS as a distinct clinical entity but only 39% accepted it as a distinct pathological entity. Only 42% were prepared to comment on whether the HMS and Ehlers-Danlos syndrome, hypermobility type (formerly EDS type III) were one and the same entity. There was striking variability in estimated clinic prevalence and no consensus about the diagnostic criteria being used. There was little enthusiasm for treatments currently available. Nearly one-half of the respondents were sceptical about a significant impact of the HMS on people's lives and three-quarters about a significant contribution to the overall burden of rheumatic disease. There was little sign of awareness of findings in recent published studies. It seems unlikely, therefore, that evidence-based medicine is being practised in this area of rheumatology. An unexpected finding was a refreshing enthusiasm for joining regional interest groups on hypermobility (25% of all UK consultants expressed interest).

Diagnosis, Differential↗
PubMed2001

Hypopharyngeal perforation: an uncommon cause of pneumoperitoneum.

Endotracheal intubation is common practice being performed both electively and as an emergency. Complications of this procedure are uncommon. A case is described of hypopharyngeal rupture after emergency intubation that presented with a pneumoperitoneum. The clinical signs, relevant investigations and management options are discussed for this injury and the need is emphasised for a high index of suspicion in order to make an early diagnosis.

Adolescent↗
PubMed2001

Age of acquisition and imageability ratings for a large set of words, including verbs and function words.

Age of acquisition and imageability ratings were collected for 2,645 words, including 892 verbs and 213 function words. Words that were ambiguous as to grammatical category were disambiguated: Verbs were shown in their infinitival form, and nouns (where appropriate) were preceded by the indefinite article (such as to crack and a crack). Subjects were speakers of British English selected from a wide age range, so that differences in the responses across age groups could be compared. Within the subset of early acquired noun/verb homonyms, the verb forms were rated as later acquired than the nouns, and the verb homonyms of high-imageability nouns were rated as significantly less imageable than their noun counterparts. A small number of words received significantly earlier or later age of acquisition ratings when the 20-40 years and 50-80 years age groups were compared. These tend to comprise words that have come to be used more frequently in recent years (either through technological advances or social change), or those that have fallen out of common usage. Regression analyses showed that although word length, familiarity, and concreteness make independent contributions to the age of acquisition measure, frequency and imageability are the most important predictors of rated age of acquisition.

Aged↗
PubMed2001

Effect of patient education on adherence to drug treatment for rheumatoid arthritis: a randomised controlled trial.

OBJECTIVE: To determine whether a patient education programme (PE) would improve rates of adherence to a slow acting antirheumatic drug and to assess any subsequent effect on patient outcome. METHODS: A randomly controlled study comprising 100 patients with rheumatoid arthritis (49 control CG; 51 experimental EG) requiring D-penicillamine (DPA). The same practitioner saw patients on seven occasions, for the same length of time. The EG received 7 x 30 minute one to one sessions of PE, while the CG received standard management. The primary measure of adherence was a pharmacological marker (phenobarbitone) encapsulated with the DPA assayed at monthly intervals for six months. Plasma viscosity (PV), C reactive protein, articular index, morning stiffness, and pain score were used to assess outcome. RESULTS: 454 blood samples were collected and assayed and the pharmacological marker showed the EG to be significantly more adherent on more occasions than the CG (p<0.05). Patterns of adherence over time showed that at 12 weeks 86% (38/44) of those in the EG compared with 64% (29/45) of the CG remained adherent (p=0.01). These trends continued and by the end of the study 85% (29/34) of the EG compared with 55% (23/42) of the CG were taking their DPA as prescribed. Fifteen patients (12 from the EG) experienced side effects requiring study withdrawal and 14 patients requested study withdrawal (two from the EG). On study entry patients in the CG had significantly higher levels of PV than the EG and this remained so throughout the research. However, on completion, the health status of patients in both groups had improved significantly (p<0.01). CONCLUSIONS: PE significantly increased adherence to DPA and its effects persisted over a period of six months. No additional clinical benefit was detected in the EG in comparison with the CG.

Adult↗
PubMed2000

The rise and fall of frequency and imageability: noun and verb production in semantic dementia.

This study examines the impact of progressive degeneration of conceptual knowledge on the content words used in connected speech elicited using the Cookie Theft picture description (Goodglass & Kaplan. 1983). We began with an analysis of control subjects' descriptions with regard to word types and their frequency and imageability. Because the impairment of conceptual knowledge in semantic dementia is graded by concept familiarity, we created a model of a standardized normal Cookie Theft description that was then progressively degraded by the systematic removal of lower bands of word frequency. We drew two main predictions from this model: reduced availability of the lower bands of word frequency should result in (a) an apparent deficit for noun retrieval in relation to verb retrieval and (b) an apparent reverse imageability effect. Results from a longitudinal study. in which three patients with semantic dementia each described the Cookie Theft picture on three occasions during the progression of their disease, confirmed these predictions. An additional cross-sectional analysis, adding narratives from a larger number of cases, demonstrated that the decline in ability to produce suitable words for the picture description is closely related to the extent of semantic impairment as measured in tests of word comprehension and production. Both verbs and nouns are affected by the degradation of semantic memory; the fact that the impairment to noun production is manifested earlier and more catastrophically may be attributed to the relatively lower frequency of these terms.

Aged↗
PubMed2000

Why is a verb like an inanimate object? Grammatical category and semantic category deficits.

Semantic category effects, such as difficulties in naming animate things relative to inanimate objects, have been explained in terms of the relative weightings of perceptual and functional features within the semantic representations of these concepts. We argue that grammatical category deficits, such as difficulties in naming nouns relative to verbs, can be explained within the same framework. We hypothesize that verb concepts are richer in functional than sensory features and present a model of the semantic representations of animate nouns, inanimate nouns, and verbs. The model demonstrates that sensory feature damage results in a deficit for naming living things but spares verb naming, and functional feature damage results in a deficit for naming inanimate objects and verbs. We then report the assessment results of two patient groups. In accordance with the model's predictions, the "verb spared" patients were consistently worse at naming living things than inanimate objects, and their definitions of both living and nonliving items were lacking in sensory information. We conclude that damage to sensory features in semantic representations causes difficulties in naming concrete nouns relative to action verbs, and within the grammatical category of nouns, animate items will be more severely affected. Imageability was shown to be a strong predictor of naming performance in the "verb deficit" patients, and when this variable was controlled no class effect remained. Production of definitions revealed no differential damage to sensory or functional features, and no consistent effect of animacy in naming was shown. While the model suggests that verb deficits might occur in patients for whom functional features are damaged relative to sensory features, we conclude that the "verb deficit" shown in our patients (and potentially in many previously reported cases) was an artifact of the lower imageability of verbs in confrontation naming tasks.

Aged↗
PubMed2000

Age and gender differences in oppositional behavior and conduct problems: a cross-sectional household study of middle childhood and adolescence.

Behavior problems among youths cannot be understood without explaining their age and gender differences, but age and gender differences cannot be explained until they have been accurately described. In a household survey of 1,285 youths aged 9 to 17 years, there were no gender differences in oppositional behavior, but aggression, property offenses, and status offenses were more common among boys. Levels of oppositional behavior were greater at younger ages, aggression peaked near the middle of this age range, and property and status offenses were more prevalent at older ages. These findings are generally consistent with developmental models of conduct problems but are inconsistent with a recent model of gender differences and raise questions about the external validity of current taxonomies.

Adolescent↗