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Biomedical subjects

J Kirwan

Publications and source records attributed to J Kirwan.

At least 37 records · Page 2Linked to original sources
PubMed2001

Minimal clinically important difference in plain films in RA: group discussions, conclusions, and recommendations. OMERACT Imaging Task Force.

Analysis of progression of structural damage on an individual patient level in randomized controlled trials provides extra information in addition to the analysis on a group level. A cutoff level is required to define which patients show progression and which patients do not. The objective of the mimimal clinically important difference (MCID) module for plain films was to elaborate the various concepts to determine a MCID for plain films, and if possible, to define a MCID for specific scoring methods. The module comprised preconference reading material, a plenary session, small group discussions, and a plenary report of the group sessions, combined with interactive voting. The following conclusions and recommendations were made: the smallest detectable difference (SDD) beyond measurement error is a good starting point to define MCID; SDD is study-specific; SDD should be reported for all radiographic endpoints used in a trial as a quality control; the expert panel approach is a reasonable method to define MCID, but defined in this way MCID may be smaller than current SDD; more research is needed to validate expert panel based MCID in different datasets and with different experts; a predictive, data driven MCID is the ultimate goal, but is not yet available; the SDD can be used as a proxy for MCID until a data driven MCID is available; analysis at the group level (comparison of means or medians) should remain primary in studies that include progression of joint damage as outcome measure; the proportion of patients showing more progression than the SDD is a secondary outcome measure.

Arthritis, Rheumatoid↗
PubMed2000

Nine year follow-up study of morbidity and mortality in retinal vein occlusion.

PURPOSE: The aim of this study was to conduct a detailed retrospective follow-up of a large cohort of patients with retinal vein occlusion (RVO), examining morbidity and mortality, to investigate a possible relationship between RVO, large vessel disease and stroke, and to determine whether recurrence of RVO was influenced by treatment of associated medical conditions. METHODS: A follow-up study was undertaken in 1994 of all patients (n = 588) who presented to the medical ophthalmology clinics of the Birmingham and Midland Eye Hospital between 1982 and 1989 with a definitive diagnosis of RVO. RESULTS: Follow-up data were obtained on 549 patients (93%). Results showed that recurrence of RVO in the same or fellow eye was decreased by more than half in the follow-up group (3.3%) when compared with the known recurrence rate at initial presentation (8.8%). Comparison of the deceased with the survivors showed that the deceased patients were significantly older (mean age 70.2 vs 63.4 years). The prevalence of rubeosis iridis and smoking were statistically significantly increased when comparing the deceased with the survivors (p < 0.016 and p < 0.008 respectively). The deceased had a higher prevalence of diabetes (15.8% vs 10.1%), and there was a trend towards increased clinically evident macrovascular disease in those patients who had died (23.2% vs 19.5%). Neither hypertension nor hyperlipidaemia predicted death, as the prevalence rates of the two conditions were similar in survivors and those who had died (60.0% vs 60.6% and 48.4% vs 53.3%). The percentage of patients taking antiplatelet drug therapy was not different in the two groups (36.8% vs 38.3%). Analysis of the causes of death of the RVO population (n = 95) compared with the causes of death in the West Midlands population as a whole, showed that the percentage of deaths from myocardial infarction in the RVO population was significantly higher (23.1% vs 14.4%, p < 0.05). There was no statistical difference between the populations for ischaemic heart disease and stroke, although there was a trend for increased mortality from stroke (19% vs 13.5%). CONCLUSION: These data suggest a relationship between RVO, mortality and increased cardiovascular risk factors (smoking, diabetes and macrovascular disease), and support the possibility of an association between RVO and stroke. They also support the potential value of medical treatment of underlying medical conditions in preventing recurrence of RVO.

Adult↗
PubMed2000

Distribution of distal femoral osteophytes in a human skeletal population.

OBJECTIVES: To examine objectively spatial patterns of osteophytes around the distal end of the femur and to identify distinct subgroups. METHODS: A sample of 107 human femora from a large skeletal population were selected for study. These femora included subjects with evidence of late stage osteoarthritis (that is, with eburnation present) and those with no such evidence. The location of osteophytes was recorded using a video camera and digitised computer images were extracted. Multidimensional scaling was used to identify clusters of femora based upon osteophyte location. RESULTS: A distinct subgroup of femora was identified with osteophytes present only within the intercondylar notch region. None of these subjects had any evidence of eburnation. CONCLUSIONS: This finding adds to an earlier study based on radiographs. Osteophytes located within the intercondylar notch of the femur appear to be a distinct subset, which may occur either as an early stage of knee osteoarthritis or for some independent reason.

Adult↗
PubMed2000

Telemedicine techniques can be used to facilitate the conduct of multicentre trials.

A multicentre randomized controlled trial was established in Pretoria, Bloemfontein and Edendale in South Africa, and coordinated from London. The purpose of the trial was to determine the efficacy of low-dose beta irradiation of glaucoma. Five communication modalities (telephone, fax, e-mail, videoconferencing and face-to-face meetings) were examined in terms of their benefits in a multicentre trial. The eight stages of the multicentre trial examined were: set-up and training, recruitment, standardization, patient management, data transmission, update and data dissemination, clinical follow-up and monitoring, and publication. On four-point Likert scales for rating the usefulness of the communication modalities at each of the eight stages of the trial (from 0 = not useful to 3 = very useful; maximum score 24) the telephone was given a total score of 10, fax 9, e-mail 13, videoconferencing 15 and face-to-face meetings 9. Telemedicine techniques offer considerable benefits in the coordination of multicentre trials by improving data collection, maintaining the efficacy and monitoring of trials, while potentially offering reduced costs in terms of travel and time. The realtime scrutiny of patient records helps to ensure data uniformity and completeness of data collection. Videoconferencing was most useful when considered as one of several communication tools that can be used to improve the effectiveness of a service or process.

Glaucoma↗
PubMed2000

Radiographic osteoarthritis in the elderly population of Zagreb: distribution, correlates, and the pattern of joint involvement.

AIM: To determine the prevalence of radiographic osteoarthritis on five joint groups in an urban population sample of 306 women and 304 men over the age of 45 and to assess the influence of some risk factors on osteoarthritis. The validity of concept of generalized osteoarthritis was also examined by analyzing the association of osteoarthritis on different joint sites. METHODS: Radiographs of both hands, both knees, and the right hip were taken. Osteoarthritic changes on distal interphalangeal, proximal interphalangeal, first carpometacarpal joints, knees, and hip were graded according to the Kellgren-Lawrence scale. The association among osteoarthritis on different joint sites was analyzed using logistic regression. Subjects were tested for age, duration of postmenopause, anthropometric measures, blood pressure, and smoking as risk factors for osteoarthritis. RESULTS: Hip was the most frequent site of osteoarthritis in men (27.3%), whereas distal interphalangeal joints predominated in women (43.5%). Polyarticular osteoarthritis (+/-3 joints) was present in 10.8% women and 5.9% men. There was a significant influence of age on single joint osteoarthritis, but not on multiple joint involvement. Obesity was significantly correlated with knee osteoarthritis in women and with osteoarthritis on distal interphalangeal joints in men. CONCLUSIONS. In our population sample, the prevalence of knee osteoarthritis was lower and the prevalence of hip osteoarthritis higher than reported for most of other populations. The tendency towards polyarticular osteoarthritis that is more common than would be expected by age, suggests a subset of generalized osteoarthritis.

Aged↗
PubMed1999

The shape of the distal femur: a palaeopathological comparison of eburnated and non-eburnated femora.

OBJECTIVES: To determine the difference in shape of the distal femur, viewed axially in two dimensions, between eburnated and non-eburnated femora. METHODS: A comparison of 52 non-eburnated and 16 eburnated femora drawn from a large archeological skeletal population. Eburnation was taken to indicate late stage osteoarthritis. Shape variability, based on landmarks, was quantified using a principal components analysis after a Procrustes alignment. RESULTS: A statistically significant difference was found between the two groups. This was with respect to the patellar groove and the shape of the medial condyle. The latter difference is consistent with bone remodelling as a knee stabilising mechanism. CONCLUSIONS: Anatomical shape can be quantified using an uncomplicated statistical technique. It was used to quantify the shape of the distal femur and demonstrate shape differences associated with osteoarthritis of the knee.

Bone Remodeling↗
PubMed1999

Imaging in rheumatoid arthritis: results of group discussions.

None of the current scoring methods for radiological damage in rheumatoid arthritis (RA) is ideal. The objective for RA imaging at OMERACT IV was to start discussion about the problems and applicability of the current scoring methods for radiological damage and to start discussion on the challenge of new imaging techniques. The RA imaging module comprised preconference reading material, plenary sessions, small group discussions, and a plenary report of the group sessions, combined with interactive voting. The OMERACT filter guided the discussions. Priorities for further research in imaging studies were: (1) pathologies versus features on radiographs; (2) relation with longterm outcome; and (3) definition of minimum clinically important difference.

Arthritis, Rheumatoid↗
PubMed1998

Peritoneal fluid concentrations of interleukin-8 in women with endometriosis: relationship to stage of disease.

There is increasing evidence that immunological mechanisms play a role in the pathogenesis and pathophysiology of endometriosis. It was therefore of interest to study interleukin-8 (IL-8), a chemokine, in the peritoneal fluid and peripheral blood of women undergoing laparoscopic procedures. The presence and concentrations of IL-8 in relation to endometriosis, infertility and abdominal pain were evaluated. Samples of peritoneal fluid (n = 49) and peripheral blood (n = 50) were obtained from 50 consecutive patients undergoing laparoscopic surgery for various gynaecological indications (abdominal pain, infertility, sterilization). IL-8 was present in the peritoneal fluid of most women (87%). The concentration of IL-8 in the peritoneal fluid was higher in women with endometriosis compared to women without (P = 0.02). This difference was more pronounced in early (stage 1) endometriosis (P = 0.001). IL-8 concentrations in the peritoneal fluid were also higher in women with early endometriosis compared to women with later stages of the disease (P = 0.003). Peripheral blood concentrations did not correlate with peritoneal fluid concentrations of IL-8 and/or the presence of endometriosis. We conclude that IL-8 is an important factor that may contribute to the pathogenesis of endometriosis possibly by promoting neovascularization. This information can be a guide in the development of new therapeutic approaches for the treatment of endometriosis.

Abdominal Pain↗
PubMed1998

Scores on a statistics test and scores on the Defense Style Questionnaire.

Scores for 21 men and 41 women on a university statistics test were compared with scores on the 1993 Defense Style Questionnaire of Andrews, et al. The significant negative association between higher scores on the statistics test and higher scores on the measure of the defence mechanism of projection suggested the latter construct be considered when examining statistical achievement.

Achievement↗
PubMed1997

Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis. Consensus development at OMERACT III.

Significant progress has been made in outcome measurement procedures for osteoarthritis (OA) clinical trials, and guidelines have been established by the US Food and Drug Administration, European League Against Rheumatism, the World Health Organization/International League of Associations for Rheumatology, and the Group for the Respect of Ethics and Excellence in Science. However, there remains a need for further international harmonization of measurement procedures used to establish beneficial effects in Phase III clinical trials. A key objective of the OMERACT III conference was to establish a core set of outcome measures for future phase III clinical trials. During the conference, using a combination of discussion and polling procedures, a consensus was reached by at least 90% of participants that the following 4 domains should be evaluated in future phase III trials of knee, hip, and hand OA: pain, physical function, patient global assessment, and, for studies of one year or longer, joint imaging (using standardized methods for taking and rating radiographs, or any demonstrably superior imaging technique). These evidence based preferences, achieved with a high degree of consensus, establish an international standard for future phase III trials and will also facilitate metaanalysis and Cochrane Collaborative Project goals.

Clinical Trials, Phase III as Topic↗
PubMed1995

Dissatisfaction, disability, and rheumatoid arthritis.

OBJECTIVES: To investigate dissatisfaction with function in patients with rheumatoid arthritis (RA), and to see if dissatisfaction can be adequately explained by level of function. METHODS: Fifty patients with RA were assessed for disease activity, psychological status, disability, expectation of future disability, and satisfaction with both global function and individual activities of daily living (ADL). RESULTS: Fifty percent of patients expressed dissatisfaction with global function, which correlated more strongly with pain (r = 0.474) and psychological status than with function (r = 0.398). Only 10% predicted improvement in global function. Seventy-two percent expressed dissatisfaction with performing at least one ADL. CONCLUSIONS: Patient dissatisfaction with both global function and individual ADL function is high and cannot adequately be explained by disability alone. Correlation with pain and psychological status implies that modifying these variables (perhaps through education programs about pain relief or relaxation) could reduce dissatisfaction.

Activities of Daily Living↗
PubMed1994

DC-ART: preventing or significantly decreasing the rate of progression of structural joint damage.

Progressive joint damage, increasing deformity, and declining function characterize rheumatoid arthritis (RA). The evidence suggests structural joint damage is the predominant cause of functional impairment. Structural changes of joints are evaluated by imaging methods. Plain joint radiographs remain the best method for determining the extent and nature of structural changes at present. Newer technologies such as magnetic resonance imaging may eventually replace them. Clinical studies of antirheumatic drugs involving the assessment of prevention or significant decrease in the rate of progression of structural joint damage in RA should meet several standards. All patients who enter a study, whether they continue medication or not, must be assessed on its completion. Studies require sufficient power to determine realistic differences due to therapy. They should last long enough for a reliable analysis of the effects of joint damage; 1 year would be the minimal period for such a study, and 2 years would be preferable. Evaluation should concentrate on erosions and related structural changes in juxtaarticular bone; mapping osteoporotic areas in early disease may be a sensitive and objective measure. Assessments ought to use changes within the hands and wrists to indicate overall progression, with the feet included in evaluating early disease. There should be different therapeutic aims at various stages of RA, focussing on preventing new erosions developing in early disease (< 2 years from diagnosis), preventing new erosions occurring in established disease (2-5 years from diagnosis), reducing the rate erosions develop in established disease (< 5 years from diagnosis), and reducing the rate of joint destruction in late disease (> 5 years from diagnosis).

Antirheumatic Agents↗
PubMed1994

Mechanical and constitutional risk factors for symptomatic knee osteoarthritis: differences between medial tibiofemoral and patellofemoral disease.

OBJECTIVE: The generation of effective preventive strategies against knee osteoarthritis (OA) requires precise understanding of the individual risk factors for the condition. To identify these risk factors, we performed a population based case-control study of the disorder. METHODS: We compared 109 men and women with symptomatic, radiographically verified OA in the tibiofemoral (TFJ) and/or patellofemoral (PFJ) compartments of the knee joint with 218 community controls matched for age and sex. Information on risk factors was obtained by a structured interview and examination. RESULTS: Independent risk factors for knee OA included obesity (odds ratio [OR] 3.3; 95% confidence intervals [95% CI] 1.6-6.9), previous knee injury (OR 3.4; 95% CI 1.7-6.7), meniscectomy (OR 4.0; 95% CI 1.0-16.4), family history (OR 2.7; 95% CI 1.3-5.5) and Heberden's nodes (OR 2.0; 95% CI 1.1-3.6). Obesity and meniscectomy were stronger risk factors for medial TFJ disease, while Heberden's nodes and family history were more closely associated with PFJ involvement. CONCLUSION: Although based on small numbers, our results suggest that the relative contribution of mechanical and constitutional factors in the pathogenesis of OA in different compartments of the knee joint might vary. They also confirm the importance of significant knee injury and meniscectomy as risk factors for medial TFJ disease in the general population.

Aged↗