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Biomedical subjects

J Firth

Publications and source records attributed to J Firth.

31 records · Page 2Linked to original sources

Primary non-Hodgkin's lymphoma of the central nervous system: phase II study of chemotherapy (BVAM) prior to radiotherapy.

Ten patients were diagnosed as having primary non-Hodgkin's lymphoma of the central nervous system at University Hospital, Nottingham, between September 1986 and April 1989. None had clinical evidence of HIV-1 infection. All the patients started treatment with chemotherapy (BVAM), designed to cross the blood-brain barrier, followed by radiotherapy. Seven patients completed both chemotherapy and radiotherapy. Dose reduction during chemotherapy was necessary in three patients because of neutropenia. In two of the six patients with solitary tumours, complete resection was achieved surgically prior to treatment. Five of the remaining eight patients (63%) had radiological evidence of a complete response with chemotherapy. The other three patients had no response to chemotherapy but one had a complete response after radiotherapy. The two-year cause-specific survival of the 10 patients was 37%. Two of the three patients who had a postoperative performance status of 0 or 1 (ECOG/WHO) are alive and disease-free at 26 and 46 months from diagnosis. The median survival of the seven patients with a performance status of 2-4 was 10 months with two patients alive and disease-free at 19 and 26 months. The two-year cause-specific survival of these seven patients was 22%.

Adult↗

Prescriptive v. exploratory psychotherapy. Outcomes of the Sheffield Psychotherapy Project.

Prior research suggests that psychotherapeutic techniques which differ in their contents are quite similar in their outcomes. Outcome data are reported from a study designed to maximise sensitivity to technique effects on outcome in a clinically realistic setting, and to permit detailed analysis of the relations between content, immediate impact, and outcome of therapy. Forty professional and managerial workers with depression or anxiety received eight sessions of Prescriptive (cognitive/behavioural) and eight sessions of Exploratory (relationship-oriented) therapy in a crossover design, with each client seeing the same therapist throughout. Outcome was assessed by standard interview and questionnaire methods. The results favoured Prescriptive therapy, although this difference was of moderate extent. The outcome was largely unaffected by the order in which the two methods were offered.

Anxiety Disorders↗

Disposition of 3H-enisoprost, a gastric antisecretory prostaglandin, in healthy humans.

1. After oral administration of 3H-enisoprost (450 micrograms) to five healthy men, as a solution in capsules, peak 3H levels of 5624 +/- 566 pg equiv./ml (mean +/- S.E.M.) were reached within one hour. No unchanged drug was detected in plasma. 2. Enisoprost was rapidly de-esterified to SC-36067 [(+/-)11 alpha, 16 zeta-dihydroxy-16-methyl-9-oxoprost-4Z, 13E-dien-1-oic acid], a pharmacologically active analogue, which reached peak concentrations of 651 +/- 200 pg/ml within 20 min of dosing. SC-36067 was eliminated metabolically, with a half-life of 1.61 h, by a combination of beta-oxidation, omega-oxidation and 9-keto-reduction. 3. After nine days 59.0 +/- 2.98% and 17.4 +/- 1.57% of the dose was excreted in urine and faeces respectively. The majority of this excretion was complete in two days. 4. Five urinary metabolites were identified by GC-MS. These were (+/-)3-[2 beta-(4-hydroxy-4-methyl-1E-octenyl)-3 alpha-hydroxy-5-oxo-1 alpha-cyclopentanyl]propanoic acid (SC-41411; 3.6% dose), (+/-)3-[3 alpha,5-dihydroxy-2 beta-(4-hydroxy-4-methyl-1E-octenyl)-1 alpha-cyclopentanyl]propanoic acid (SC-41411 PGF analogue; 4.8% dose), (+/-)3-[2 beta-(8-carboxy-4-hydroxy- 4-methyl-1E-octenyl)-3 alpha-hydroxy-5-oxo-1 alpha-cyclopentanyl] propanoic acid (SC-41411-16-carboxylic acid; 22% dose), (+/-)3-[2 beta-(8-carboxy-4- hydroxy-4-methyl-1E-octenyl)-3 alpha,5-dihydroxy-1 alpha-cyclopentanyl] propanoic acid (SC-41411 PGF analogue-16-carboxylic acid; 8.5% dose) and its gamma lactone (2.6% dose). 5. These metabolites were also identified chromatographically in plasma, as were SC-36067, (+/-)3-[2 beta-(4-hydroxy-4-methyl-1E-octenyl)-5-oxo-1 alpha- cyclopent-3-enyl]propanoic acid and (+/-)3-[2 beta-(4-hydroxy-4-methyl-1E-octenyl)-5-oxo-cyclopent-1- propanoic acid. 6. Some 5-10% of the dose was excreted in urine as tritiated water, indicating that oxidation of the 11 alpha-hydroxy group in SC-36067 or its metabolites also occurred.

Adult↗

Levels and sources of stress in medical students.

Levels of stress, as measured by the general health questionnaire, were assessed in 318 medical students in their fourth year at three British universities. Mean scores were higher than those in other groups within the general population, and the estimated prevalence of emotional disturbance was 31.2%, a proportion similar to that reported in medical students in the United States. There were no differences in prevalence or in mean scores of stress between the sexes. Twelve (4%) students reported high intake of alcohol, and almost half of the students had increased their intake in the past two years. The four categories most commonly cited in answers to an open ended question on recent stressful events were talking to psychiatric patients, effects on personal life, presenting cases, and dealing with death and suffering. Relationships with consultants raised the strongest negative feelings, with 102 (34%) students finding these particularly stressful. Stress among medical students should be acknowledged and attempts made to alleviate it.

Alcohol Drinking↗

What stresses health professionals? A coding system for their answers.

The reliabilities of a coding system derived from open-ended descriptions of stresses and of satisfactions within the medical role are reported as acceptable. The method is considered useful where defences may be raised by direct questioning, and at times of transition where questionnaires derived from previous literature may miss new sources of stress.

Career Choice↗

The case of the anxious executive: a study from the research clinic.

Most psychotherapists are neither active researchers nor consumers of research findings. Research approaches are needed which build a bridge between clinical realism and independent evidence, but which are applicable in National Health Service settings by clinicians lacking substantial research resources. A new method of clinical inquiry is described which combines measurement techniques developed in psychotherapy research with the therapist's session notes and client perceptions of helpful events in therapy. The method is illustrated by a case study which examines the content of helpful and unhelpful therapy sessions.

Adult↗

Routine colonoscopy service.

We report our experience of 50 paediatric colonoscopies in a relatively unselected group of patients. Collaboration between an experienced colonoscopist and a paediatrician has provided a smooth, routine service and the examination has proved extremely useful for the diagnosis and management of children with colonic symptoms.

Child↗

Attributions and recovery from depression: a preliminary study using cross-lagged correlation analysis.

Cross-lagged correlation analysis was employed to test the hypothesis that attributions for symptoms and life-events would exercise a causal influence on the recovery of depressed patients. Patients rated their symptoms and their three most upsetting recent life-events on the dimensions of internality, stability, globality and uncontrollability. These ratings were significantly more global and uncontrollable than those of controls. Among female depressed patients the dimensions of stability and uncontrollability appeared in addition to play a causal role in determining level of depression six weeks later.

Adult↗

Civil commitment practices in 1977: troubled semantics and/or troubled psychiatry.

This paper examines the practice of involuntary mental hospitalization through examination of criteria used for committment in a sample of 200 civil commitment certificates. Special reference is made, following previous research, to criteria used to describe the person deemed dangerous to himself or to others. The relevance of the findings of present practices in mental health is discussed. New procedures which facilitate presentation of factual evidence, and which eliminate gratuitous information, are required without delay.

Commitment of Persons with Psychiatric Disorders↗