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Biomedical subjects

J Doyle

Publications and source records attributed to J Doyle.

At least 91 records · Page 5Linked to original sources
PubMed1997

Managing tinnitus: a comparison of different approaches to tinnitus management training.

A series of studies examining the interaction between the characteristics of individual tinnitus sufferers and the effectiveness of the methods used to assist them has been conducted. The first of these studies provided a baseline description of 96 people with tinnitus, according to a range of audiological and psychological variables. In the present paper four differing tinnitus management programmes are described and the related changes in tinnitus perception reported three months after tinnitus management training. For the majority of subjects, the tinnitus was less annoying and less distressing three months after attending tinnitus management training. However, the majority of subjects reported no change in tinnitus loudness, or tinnitus awareness and no change in their tinnitus coping ability. Subjects receiving low level white noise stimulation reported greater improvement in tinnitus coping ability than subjects who received information and relaxation training, although there was no associated improvement in tinnitus awareness. Subjects' beliefs about tinnitus and preferred coping style may have influenced the reported benefit or otherwise of the differing tinnitus management techniques.

Acoustic Stimulation↗
PubMed1997

A pharmacoeconomic comparison of UFT and 5-FU chemotherapy for colorectal cancer in South America.

The escalating role played by managed care organizations in the health-care system is reflected in the increased demand for cost-effectiveness analyses (CEAs) to assess the balance between economic impact and clinical efficacy. For example, the high incidence and costs associated with colorectal cancer in Latin America calls for a comprehensive economic evaluation to ensure appropriate allocation of limited health-care funds. In addition, the current call for a "societal" perspective of such analyses indicates the need for increased consideration of the concerns of both patient and health-care provider. The introduction of oral tegafur and uracil (UFT) provided the opportunity to evaluate the pharmacoeconomic advantage of the new agent compared with the standard fluorouracil (5-FU). Results of this study indicated an economic advantage for oral UFT vs a 5-FU-based regimen in the treatment of colorectal cancer in Brazil and Argentina. It was further noted that the mild toxicity profile of UFT reduced both the number of clinic visits and the need for venipuncture procedures. Noting that oral UFT may have a positive impact on quality of life in addition to its estimated economic benefit, it was concluded that prospective economic research and quality-of-life evaluations are needed to fully assess the pharmacoeconomic impact of oral UFT.

Argentina↗
PubMed1996

Locations of human and mouse genes encoding the RFX1 and RFX2 transcription factor proteins.

RFX transcription factors constitute a highly conserved family of site-specific DNA binding proteins involved in the expression of a variety of cellular and viral genes, including major histocompatibility complex class II genes and genes in human hepatitis B virus. Five members of the RFX gene family have been isolated from human and mouse, and all share a highly characteristic DNA binding domain that is distinct from other known DNA binding motifs. The human RFX1 and RFX2 genes have been assigned by in situ hybridization to chromosome 19p13.1 and 19p13.3, respectively. In this paper, we present data that localize RFX1 and RFX2 precisely within the detailed physical map of human chromosome 19 and genetic data that assign Rfx1 and Rfx2 to homologous regions of mouse chromosomes 8 and 17, respectively. These data define the established relationships between these homologous mouse and human regions in further detail and provide new tools for linking cloned genes to phenotypes in both species.

Animals↗
PubMed1996

Benign cervical leiomyoma leading to disseminated fatal malignancy.

A case study is reported of incomplete excision of a sessile leiomyoma of the posterior cervix followed by rapid tumor growth of the same region in a pregnancy commencing 2 months later. Cesarean section for placenta previa was followed 10 days later by hysterectomy for massive hemorrhage. The tumor was considered, following multiple review, to be a leiomyoma of the cervix with mitosis consistent with recent pregnancy. Widespread peritoneal recurrence occurred within 3 months requiring further laparotomy for excision of widespread tumor and ligation of internal iliac arteries. Death occurred 4 weeks later with widespread peritoneal occurrence. No postmortem was performed. The case emphasizes the rare potential for malignant change in histologically benign leiomyomas with no indications to this potential apart from biological behavior.

Adult↗
PubMed1996

Language codes and sense-making among deaf schoolchildren.

There are at least two languages (American Sign Language [ASL], English) and three modalities (sign, speech, print) in most deaf individuals' lives. Mixing of ASL and English in utterances of deaf adults has been described in various ways (pidgins, diglossia, language contact, bilingualism), but children's mixing usually is treated as the 'fault' of poor input language. Alternatively, how might language mixing serve their communication goals? This article describes code variations and adaptations to particular situations. Deaf children were seen to exhibit a wide variety of linguistic structures mixing ASL, English, Spanish, signing, and speaking. Formal lessons supported a recoding of English print as sign and speech, but the children who communicated English speech were the two who could hear speech. The children who communicated ASL were those who had deaf parents communicating ASL or who identified with deaf houseparents communicating ASL. Most language produced by the teacher and children in this study was mixed in code and mode. While some mixing was related to acquisition and proficiency, mixing, a strategy of many deaf individuals, uniquely adapts linguistic resources to communication needs. Investigating deaf children's language by comparing it to standard English or ASL overlooks the rich strategies of mixing that are central to their communication experience.

Journal Article↗
PubMed1996

Endonasal premaxillary osteotomy.

In our hands, the endonasal premaxillary osteotomy is an improvement over the buccal sulcus tunnel and transpalatal techniques not only because of preservation of the blood supply but also because of improved visualization to the premaxilla. We have found the technique to be particularly useful in the bilateral cleft patient in whom the palate has been closed before Le Fort I osteotomy.

Cleft Lip↗
PubMed1996

The effect of ketorolac on microvascular thrombosis in an experimental rabbit model.

This study was undertaken to evaluate the effect of ketorolac (Toradol), a potent cyclooxygenase inhibitor used for postoperative pain, on microvascular thrombosis in an established thrombosis model. Bilateral 3-mm arterial inversion grafts (n = 66) were constructed in the femoral arteries of New Zealand White rabbits. ALZET (ALZA Corporation, Palo Alto, Calif.) osmotic pumps were implanted in the external jugular veins for drug delivery. The blinded protocol called for the experimental animals to receive intravenous doses of ketorolac of 1.72 mg/kg per day (group 1) or 3.44 mg/kg per day (group 2), while control animals received equivalent volumes of saline. Patency was assessed at 7 days. Whereas 52 percent (13 of 25) of control vessels remained patent, 70 percent (14 of 20) and 86 percent (18 of 21) of group 1 and group 2 vessels, respectively, were patent at 1 week. This decrease in microvascular thrombosis with delivery of ketorolac was statistically significant (p = 0.0094). Ketorolac, at experimental doses approximating 9 and 18 mg IV q6h in a 70-kg man, demonstrated a statistically significant reduction in microvascular thrombosis. This study supports its use in clinical microvascular surgery.

Animals↗
PubMed1996

Patient satisfaction with time use in audiological consultations.

An analysis of how time was used in and around 60 consultations was carried out for the purpose of exploring the relationship of time use to patient satisfaction. Sixty patients across two practice settings were surveyed, immediately following their interaction with the audiologist, regarding satisfaction with the consultation. Satisfaction was measured via: (1) a four-point scale, which yielded a satisfaction rating; and (2) a check list of satisfaction with 11 aspects of the consultation, which yielded a satisfaction score. Satisfaction ratings and scores were correlated significantly (rs = 0.76 corrected for ties, P = 0.0001). The majority of patients were either 'very satisfied' (63%) or 'satisfied' (31.6%) with the consultation experience. Temporal pictures of the consultations of 'very satisfied', 'satisfied' and 'dissatisfied' patients were clearly different. For the present sample it appeared that patient satisfaction ensued when the total consultation time was equal to or exceeded 0.6 of the sum of total consultation time and the time spent waiting at the clinic immediately prior to the consultation. Regression analyses showed that of the temporal variables studied, total consultation time (TCT) and the amount of time waiting immediately pre consultation (WT) contributed most to the variation in patient satisfaction ratings and scores. Forty-two per cent of the variance in satisfaction ratings and 36% of the variance in satisfaction scores could be explained by TCT/(WT + TCT).

Adult↗
PubMed1996

The persisting communicative difficulties of 'remediated' language-impaired children.

This study addresses the effiacy of dismissal criteria used by speech and language pathologists by investigating communicative functioning in children declared 'remediated'. A battery of measures comprising the Language Assessment and Remediation Procedure (LARSP); the Behavioural inventory of Speech Act Performances (BISAP); the BISAP Addendum and the Devereux School Behaviour Rating Scale (DESB) was conducted on five children with language impairment who had been declared 'remediated'. Findings for certain 'remediated' subjects revealed persisting problems. The results suggest that decisions about dismissal from therapy may, in some cases, be premature and point to the need for a broad-based perspective concerning remediation dismissal decisions. An additional study on larger populations and the use of designs which investigate long term outcomes would further inform clinical decision-making concerning dismissal from therapy.

Child↗
PubMed1996

Mismatch between aspects of hearing impairment and hearing disability/handicap in adult/elderly Cantonese speakers: some hypotheses concerning cultural and linguistic influences.

This paper addresses the observation that some Cantonese-speaking adults do not perceive a hearing problem even when hearing screening identifies hearing loss. A sample of 49 Cantonese speakers was surveyed about their self-perceptions of hearing prior to a 25 dB HTL pure-tone screening test. All 49 persons failed the screening test, yet 34 (69.4%) reported that they had no problems hearing during conversations. Persons who admitted hearing difficulties tended to have mean hearing levels in excess of 45 dB HTL. A number of hypotheses concerning cultural and linguistic influences are proposed as explanations for the apparent lack of significance of auditory sensitivity loss for some Cantonese speakers. Ways in which these hypotheses might be tested are suggested.

Aged↗
PubMed1995

Co-amplification of MYCN and a DEAD box gene (DDX1) in primary neuroblastoma.

DEAD box proteins are putative RNA helicases that have been implicated in cellular processes involving alteration of RNA secondary structure, such as translation initiation and splicing. These proteins share eight conserved amino acid motifs, including Asp(D)-Glu-(E)-Ala(A)-Asp(D) which is part of a more extended motif. Recently, we have shown that the novel DDX1 gene containing a DEAD box motif maps to the same chromosome band as MYCN at 2p24 and is co-amplified with MYCN in retinoblastoma cell lines. Here, we show that the DDX1 gene is co-amplified with the MYCN gene in 2 of three neuroblastoma cell lines and that DDX1 RNA levels correlate with DDX1 gene copy number. Since amplification of MYCN is an indicator of poor prognosis in neuroblastoma, it was of interest to determine whether co-amplification with DDX1 occurred in clinical samples of neuroblastoma and whether such a finding carried any additional prognostic significance. We determined the gene copy number of DDX1 in 32 neuroblastoma patient samples (representative of all stages): 13 were MYCN amplified and 19 had normal copy numbers of the MYCN gene. Of the 13 neuroblastomas that were MYCN amplified, seven were also DDX1 amplified. Of the 19 that were not MYCN amplified, none were DDX1 amplified. This is the first example of a gene that is co-amplified with MYCN at a high frequency in neuroblastoma. While there was a trend towards a worse clinical outcome with co-amplification, the numbers were too small to reach significance.

Child↗
PubMed1995

Prostate cancer screening in a large corporation population.

The Polaroid Medical Department conducted a prostate cancer screening program of all male employees over the age of 49 years. The screening consisted of a World Health Organization (WHO) questionnaire, a digital rectal examination (DRE) by an occupational medicine doctor, and a serum prostate-specific antigen (PSA) study. There were 2241 eligible employees (males between 50 and 65 years of age). 1219 (54%) took part in the screening. Thirty-seven PSAs above the 3.9 level were found (3%) and were further evaluated with ultrasound and/or biopsy. Twelve previously unknown cancers of the prostate (1%) were discovered. The cost of the entire program to the Polaroid Medical Department, including ultrasound and biopsy studies, was $72,130 ($6,012 per cancer detected). Of the 12 cancers, two were discovered by abnormal DRE alone, eight by an elevated PSA alone, and two by both an abnormal DRE and elevated PSA. There appeared to be no correlation between the WHO symptom score and the detection of prostate cancer. Our final conclusion was that a corporate medical department screening for cancer of the prostate is both effective and cost efficient.

Aged↗
PubMed1995

Anaphylactoid reactions in children receiving high-dose intravenous cyclosporine for reversal of tumor resistance: the causative role of improper dissolution of Cremophor EL.

PURPOSE: An unusually high incidence of anaphylactoid reactions was observed during a phase I/II trial of high-dose intravenous cyclosporine (CsA) therapy to attenuate tumor multidrug resistance (MDR). Five of 21 children experienced severe anaphylactoid reactions shortly after initiation of the first or second CsA infusion. We hypothesized that improper dissolution of the vehicle Cremophor EL may have been a cause for these anaphylactoid reactions. METHODS: All nurses who had administered intravenous CsA were interviewed regarding their technique of preparing the infusion and the occurrence of an anaphylactoid reaction. The responses were statistically analyzed. The effect of various mixing techniques on the distribution of Cremophor EL in the infusion was experimentally evaluated. Different mixing techniques were used to assess their effect on the distribution of Cremophor EL in the solution. RESULTS: Analysis of the preparation techniques of the CsA infusion showed significant correlation between suboptimal mixing of CsA by nurses and the occurrence of anaphylactoid reactions (P = .02). Experimental simulation showed that suboptimal mixing results in an uneven distribution of Cremophor EL, which subsequently sinks to the bottom of the vial. CONCLUSION: Improper mixing of high-dose CsA infusions causes nonsolubilized Cremophor EL to sink to the outflow area of the bottle. An initial bolus infusion of highly concentrated Cremophor EL may produce an anaphylactoid-like response. This mechanism of toxicity is important to recognize, because it is easily preventable by proper preparation of the infusion, thus reducing the incidence of potentially life-threatening anaphylactoid reactions.

Adolescent↗
PubMed1995

Choosing talkers for the BKB/A Speechreading Test: a procedure with observations on talker age and gender.

A procedure is described for choosing talkers for the BKB/A (BKB/Australian version) Speechreading Test. The main aims were: to select several talkers from a pool of potential talkers, to avoid adventitiously choosing a markedly atypical single talker; to assess speechreading as a general skill rather than as talker-specific; and to select talkers who were acceptable to speechreaders, relatively easy to speechread, and comparable in their speechreadability. Because of the number of variables involved and the demanding nature of the task for speechreaders, a three-stage selection procedure was adopted. In the resulting BKB/A 21-sentence list Speechreading Test, four of the 16 sentences in a list are each spoken by four talkers, chosen as follows. In Stage 1, 16 talkers (four of each age/gender set: older men, older women, younger men, younger women) were selected from an original pool of 40 (10 of each set), via rankings made by eight hearing-impaired judges with speechreading experience. In Stage 2, the final four talkers (one of each set) were selected from the 16 via the speechreading scores of further hearing-impaired subjects with speechreading experience. In Stage 3, the order of talker appearance within lists (in random order versus over blocks of four consecutive sentences) was determined. This three-stage approach to talker selection identified differences between talker candidates within sets, except for younger men, and suggested that, overall, younger women were the easiest to speechread. The discussion addresses the merits and disadvantages of this approach to talker selection, and suggests some reasons for the documented differences in speechreadability among talkers of different age and gender.

Cross-Over Studies↗
PubMed1995

Cytogenetic and molecular studies of Down syndrome individuals with leukemia.

There is an increased risk of leukemia in Down syndrome (DS) patients, with estimates ranging from 14 to 30 times the incidence rate observed for chromosomally normal children. Furthermore, one type of leukemia, called "transient leukemia" (TL), occurs almost exclusively in DS infants. The basis of the association between DS and leukemia is unknown, but we and others have hypothesized that it may be influenced by the mechanism of origin of the extra chromosome. Therefore, we initiated a cytogenetic and molecular study of nondisjunction in leukemia DS individuals. To date, we have obtained blood and/or tissue samples from 55 individuals consisting of 17 cases with TL, 7 cases of acute nonlymphocytic leukemia subtype M7 (ANLL-M7, or acute megakaryoblastic leukemia, postulated to be related to TL), and 31 cases of other forms of leukemia. Analysis of these cases suggests differences between DS children with TL and those with other types of leukemia or DS individuals with no history of leukemia. Specifically, the TL and ANLL-M7 cases have a highly significant increase in the frequency of "atypical" constitutional karyotypes (i.e., mosaic trisomies, rings, and/or isochromosomes) and are almost always male. Additionally, genetic mapping studies suggest an increase in the frequency of disomic homozygosity, especially in proximal 21q, in DS individuals with TL and ANLL-M7.

Adolescent↗
PubMed1995

Economic and quality of life outcomes: the four-step pharmacoeconomic research model.

Increasingly, economic data are being considered in formulary decisions. In oncology, pharmacoeconomic evaluations are essential to help decision makers weigh the associated costs and outcomes of competing chemotherapeutic interventions. In this article, we present a four-step pharmacoeconomic research model that can be customized for specific provider or payer systems. The model encompasses problem identification, clinical management analysis, three pharmacoeconomic analyses (cost consequence, expected cost, and cost effectiveness), and a sensitivity analysis--the rank order stability analysis (ROSA)--to validate the findings.

Antineoplastic Agents↗