Biomedical subjects

K Busby

Publications and source records attributed to K Busby.

14 recordsLinked to original sources

PubMed2005

Detection of BRAF mutations in colorectal tumours and peritoneal washings using a mismatch ligation assay.

AIMS: To detect cells bearing BRAF mutations in colorectal tumour samples and peritoneal washings, using a mismatch ligation assay (MLA). METHODS: DNA from 46 colorectal tumours was studied. Part of exon 15 of the BRAF gene was amplified using the polymerase chain reaction, and T-->A mutations at codon 600 were detected using MLA. When a mutation was detected, the same mutation was sought in peritoneal washings from that patient. RESULTS: BRAF mutations were detected in five of the 45 analysable tumour samples. In four cases, this result was confirmed by sequencing analysis. More tumours with BRAF mutations were Dukes' stage C or D rather than A or B (p < 0.02). Dilution experiments revealed that one mutant cell could be detected in 1000 normal cells. Cells with the same BRAF mutation were present in the peritoneal washing taken at the start of the operation in four of the five patients. CONCLUSIONS: MLA is a suitable technique for the detection of BRAF mutations, and allows the detection of small numbers of isolated tumour cells shed from the primary tumour.

Aged↗

PubMed2000

Training residents for community psychiatric practice: the resident perspective.

OBJECTIVE: To capture the views and experiences of psychiatry residents in 5 Canadian training programs with respect to community psychiatric training. METHOD: We sent a questionnaire regarding respondent demography, career interests, and community psychiatry training experiences to psychiatry residents at 5 training programs in Ontario. We undertook descriptive analyses and frequency comparisons on the returned data. RESULTS: The overall response rate was 48%, with considerable variation between programs. With respect to career planning, respondents indicated highest interest in urban hospital-based practice. An interest in additional community psychiatry training was, however, expressed, particularly by junior residents. Residents' suggestions for improving community psychiatry training included better promotion of training opportunities, improved quality of supervision in community settings, and more didactic teaching. CONCLUSION: Psychiatry residents are obtaining training experiences in community psychiatry, but objectives and guidelines are quite variable, as is reflected in their understanding of the definition of "community psychiatry." Residents' career paths are still focused on urban hospital-based practice or solo private practice, which likely reflects their prevalent training experiences. There is, however, interest in community psychiatry training. Junior residents may be more open to this type of practice, and curricula should allow more exposure to community psychiatry at this stage of training.

Adult↗

PubMed1999

Clinical rating of compliance in chronic hemodialysis patients.

OBJECTIVE: To develop a clinical rating scale of treatment compliance for use in chronic hemodialysis patients and to test its reliability and validity. METHOD: Forty-eight of 65 patients undergoing hemodialysis treatment at the Ottawa General Hospital during June 1994 met criteria for inclusion and completed the study. Patients underwent a 10-15-minute interview, with 1 of 2 independent clinical interviewers, regarding diet, fluid intake, prescribed medication usage, smoking, alcohol or drug use, and hemodialysis treatment attendance. Following each interview, a predesigned 3-point rating scale evaluating compliance in each of 6 domains (yielding an 18-point total score) to the treatment regimen was completed. Compliance ratings on 10 patients assessed independently by both interviewers were used to establish scale reliability. Criterion validity was assessed by correlating compliance scale scores with 3 biological measures (weight gain [kg], K+ [mmol/l], and PO4 [mmol/l]). RESULTS: Reliability between clinical interviewers using the overall compliance scale score (Intraclass correlation coefficient = 0.825) as well as component subscales was high (kappa values, 0.33-1.00). Biological measures of compliance correlated well with each other but poorly with clinical ratings (range 0.01-0.16). Biological measures identified compliance as being poorer than that found with the clinical interview scale. CONCLUSIONS: The Compliance Rating Scale (CRS) was shown to be reliable but was not well-validated against selected biological measures. Discrepancies between these 2 methods of assessing compliance may be due to differing underlying compliance constructs or patient or interviewer biases. The CRS has value as a patient education tool in that it can be used to instruct patients regarding the benefits of adhering to the treatment regimen.

Chronic Disease↗

PubMed1997

Factors associated with unplanned discharge from psychiatric day treatment programs. A multicenter study.

This study describes and evaluates the adequacy of sociodemographic and clinical descriptors as potential predictors of unplanned discharge from and completion of psychiatric day treatment programs. A 2-year retrospective chart review was completed on all patients (N = 327) attending three university-affiliated day treatment programs. Statistical comparisons were made between those patients who completed and those who had unplanned discharge. Logistic regression was used to generate a predictive model of unplanned discharge using identified variables. The rate of unplanned discharge was 54%. Factors associated with program completion were diagnoses of major depression or posttraumatic stress disorder, a history of completing a prior day treatment program, and higher education levels. Active substance abuse and a history of three or more inpatient admissions were associated with unplanned discharge. The predictive model was able to correctly classify 71% of patients completing day treatment programs and 43% of patients with unplanned discharges. Traditional demographic and clinical variables contribute differentially to program completion/noncompletion. Given the relatively poor predictability of unplanned discharge in this study, patient selection practices based on these factors alone may be somewhat limiting. Interactive effects of patient and program characteristics need to be addressed to improve program outcome.

Adult↗

PubMed1996

Heart rate associated with sleep onset in preadolescents.

It is well-established that heart rate is decreased in NREM sleep relative to wakefulness, but the extent and progression of variations in heart rate when NREM sleep is first initiated, i.e. at sleep onset, have not been detailed. Furthermore, since physiological variations which have been documented during the sleep onset period have been based on studies of adult subjects, developmentally related influences on this process have not been examined. The present investigation addressed these issues by examining beat-to-beat (RR interval) changes in heart rate during the transitions between wakefulness, initial Stage 1, and subsequent Stage 2 sleep in normal and reading disabled male preadolescents who participated in a four-consecutive-night baseline sleep study. To avoid the influence of sleep deprivation or the effects of multiple sleep onset attempts, only initial, uninterrupted sleep onset periods from post-adaptation nights were selected for study. For both groups the results indicated a significant slowing of heart rate beginning 30s prior to Stage 1 onset, and a further decrease within 30s of Stage 2 onset. In addition to providing new developmental data documenting heart rate variations in the wake/sleep transition, these results complement previous reports indicating motor and autonomic changes occurring in anticipation of Stage 1 onset. These data are also relevant to an ongoing controversy regarding whether initial Stage 1 or Stage 2 sleep should be considered as the time of sleep onset. To the extent that the systematic and coordinated variations across systems may be taken as an index of state change, and in the absence of remarkable differences in these variations between Stage 1 and subsequent Stage 2, the present data are most consistent with considering initial Stage 1 as the earliest EEG sign of physiological sleep onset.

Child↗

PubMed1996

Acute day hospitalization as an alternative to inpatient treatment.

OBJECTIVE: This paper describes the administrative process by which the Ottawa General Hospital (OGH) closed 6 beds and used the staff and space resources thus released to set up an acute day hospital (ADH) for the treatment of 8 acutely ill psychiatric patients. Outcome data are presented on the first 160 patients admitted to the ADH. METHODS: Demographic and clinical information including diagnostic (DSM-III-R; Global Assessment of Functioning [GAF]) and questionnaire data (Symptom Checklist-90 Revised [SCL-90R]; Beck Depression Inventory [BDI]; State-Trait Anxiety Inventory [STAI]; patient satisfaction) were obtained from 160 ADH patients at admission and discharge. Forty-two of these patients provided follow-up data 3 to 6 months postdischarge. The outcome of ADH patients was compared with that of a retrospectively obtained random sample (n = 100) of inpatients on selected diagnostic and demographic variables. RESULTS: On clinician-rated and self-report clinical scales, ADH patients showed significant clinical improvement reflected in higher GAF scores and less psychological distress, depression, and anxiety at discharge relative to admission. There were no significant group differences in outcome indices except for shorter length of stay in the ADH group compared with inpatients. The ADH group rated the program highly in help received and quality of service. Short-term follow-up showed that gains made during treatment were maintained 3 to 6 months later. CONCLUSIONS: These results show that a time-limited day hospital program is clinically effective for acutely ill psychiatric patients and leads to a more efficient use of inpatient resources. We believe that partial hospitalization for the treatment of acute psychiatric disorders may have wide application in psychiatric hospital practice.

Acute Disease↗

PubMed1994

Characteristics of patients who choose between two types of group psychotherapy.

Patient selection or matching to group psychotherapy is usually done by therapists. An alternative is to allow patients to "sample" and then select from different group therapies. In the current study characteristics of patients (N = 20) who selected from two types of group psychotherapy in a day-treatment program were examined. Patients were assessed on measures of current psychiatric symptomatology (Symptom Checklist 90-Revised [SCL-90R]; Derogatis, Rickles & Rock, 1976), psychological mindedness (McCallum & Piper, 1990) and psychological defenses Mechanisms Inventory (Ihilevich & Gleser, 1986). The two groups did not differ with regard to symptomatology or psychological mindedness. It was found that patients who chose a verbal and process-oriented psychotherapy tended to have externalizing defenses (turning anger against others and projection), however. These defenses appear to be congruent with this more emotionally expressive therapy. Patients who chose a structured and activity-oriented group psychotherapy tended to have internalizing defenses (repression/denial and intellectualization). These defenses seem consistent with this group therapy, which emphasized less emotional expressiveness. The implications of patient choice for group therapy and patient selection practices are discussed.

Adult↗

PubMed1993

Sleep patterns in reading disabled children.

Sleep patterns in reading disabled (n = 24) and normal control (n = 15) 8-10-year-old boys were compared to examine suggested relationships among sleep, maturational and cognitive processes. Sleep was recorded in the laboratory for four consecutive nights (two adaptation, two baseline) using standard polysomnography. Analyses revealed variations across nights for both groups reflecting adaptation to the sleep laboratory, but such effects were attenuated in reading disabled subjects. Group comparisons on baseline sleep measures (nights 3 and 4 collapsed) revealed that reading disabled children showed significantly more stage 4 sleep, less rapid eye movement (REM) sleep, a longer REM onset latency and, related to this, an extended initial non-REM (NREM) cycle. Chronic sleep deprivation and maturational delay are prominent among factors that could result in such variations in sleep architecture, and these factors, alone or in combination, could impair information processing and contribute to cognitive deficits noted in reading disabled children.

Child↗

PubMed1991

Patient satisfaction with a psychiatric day treatment program.

Patient perceptions can contribute significantly to partial hospitalization program evaluation. A retrospective study of patients' satisfaction ratings and comments concerning a day treatment program using a discharge questionnaire yielded high degrees of satisfaction. This may reflect a priori selection biases toward patients who formed a working alliance within the program. Comparison with a group of patients admitted to the program who did not complete a discharge questionnaire failed to differentiate the two groups on the basis of demographic or clinical characteristics. Attendance by males admitted to the program who completed a questionnaire was significantly (p less than .01) more frequent than by males who did not complete the questionnaire. Consistency in individual component ratings with overall satisfaction with the program suggests nonspecific benefits, with group psychotherapy evoking polarized perceptions. The latter observation suggests the need for careful matching of patients with specific treatment modalities employed in a day treatment setting. Suggestions are made regarding the administration and construction of a patient satisfaction questionnaire as well as for the application of this measure in enhancing program efficacy.

Day Care, Medical↗

PubMed1985

Auditory arousal thresholds during sleep in hyperkinetic children.

Auditory arousal thresholds were determined throughout sleep (4-night protocol) in prepubertal nonmedicated and medicated hyperkinetic and normal control male children. The most striking result was the general inability to arouse children of all groups to behavioral response even at intensities up to 123 dB sound pressure level. Of total awakening attempts, 52.5% resulted in non-arousal, 13% resulted in partial, nonsustained physiological arousal responses, and 34.3% were associated with complete awakenings. A significant increase in proportion of awakenings and decrease in the frequency of nonarousals occurred across the night. The groups did not differ with respect to the number of arousal responses. Although nonmedicated hyperkinetic children tended to have lower arousal thresholds relative to children in both comparison groups, the only significant group difference was a lower threshold response in nonmedicated, relative to medicated, hyperkinetic subjects during stage 2 sleep. Arousal thresholds in hyperkinetic children receiving stimulant medication approximated those of normal control children. The enhanced sensitivity of nonmedicated hyperkinetic subjects to auditory stimuli during sleep is interpreted as indicating that processes responsible for elevating arousal threshold at this time are less effective in these children.

Arousal↗

PubMed1983

Sleep patterns in children of superior intelligence.

To examine the relationship between superior intellectual functioning and physiological patterns and events during sleep, male children (8-12 years old) of superior (mean IQ: 133.3) and average (means IQ: 111.0) intelligence were recorded for five consecutive nights using standard electrographic measures. Compared to normal controls, superior IQ subjects had greater amounts of TST, stage 2, stage 3, total NREM sleep, a longer average NREM cycle length and significantly less average REM density. In addition, significant negative relationships were obtained between full-scale IQ and REM density, and between verbal IQ and REM density. The results suggest that patterns and amounts of sleep stages in superior IQ children do not differ in any dramatic fashion from those of children with average IQ. However, the negative correlations between IQ measures and eye movement density during REM sleep are consonant with previous notions relating eye movement density to waking information processing strategies and suggest a carry-over of such strategies from wakefulness to sleep.

Child↗

PubMed1983

Failure of high intensity auditory stimuli to affect behavioral arousal in children during the first sleep cycle.

Behavioral and physiologic indices of arousal to auditory stimuli were examined during the first cycle of sleep in 8-12-year-old hyperactive children and nonhyperactive controls. No behavioral responses or sustained awakenings were obtained for any child during the first cycle of sleep to stimuli at intensities up to 123 dB sound pressure level re 0.0002 dynes/cm2), i.e., at intensities more than 90 dB above waking threshold values. Half of the arousal attempts in stage 2 and a quarter of those in stage 4 elicited a partial or momentary physiologic arousal response (i.e., EEG desynchronization and/or change in skin potential response or respiratory activity rates). These arousals were shortlived, with the subjects returning to sleep even with continuing or increased stimulus intensity. Neither the incidence of partial arousals nor the associated threshold intensities differentiated subject groups. Although increased skin potential response activity and decreased respiratory rates were observed during sleep relative to wakefulness, and a predominance of skin potential response activity was noted in stage 4 sleep, no significant differences in frequency (rate/min) of autonomic response measures were obtained when rates before and during auditory stimulation were compared.

Acoustic Stimulation↗

PubMed1981

Sleep patterns in hyperkinetic and normal children.

Sleep patterns in nonmedicated hyperkinetic (n = 11) and normal control (n = 11) male children (8-12 years old) were compared to document possible sleep disturbance in hyperkinetic children. Electroencephalographic, electro-oculographic, electromyographic, and autonomic measures were monitored continuously for five consecutive nights. Analysis of sleep pattern variables revealed a significantly longer rapid eye movement onset latency (p less than 0.05) and marginally significant greater absolute and relative amounts of movement time (p less than 0.07) for the hyperkinetic group relative to controls. No other sleep parameters differentiated the groups. It was concluded that baseline tonic sleep parameters do not indicate marked sleep disturbance in hyperkinesis. The results are discussed within the context of hypothesized arousal dysfunction underlying this disorder. Key Words: Hyperkinetic children--Hyperkinesis--NREM and REM sleep cycles--Spontaneous skin potential responses.

Arousal↗

PubMedDate not supplied

Predictors of outcome in a short-term psychiatric day hospital program.

This study assessed selected chronicity, social support, and personality variables as predictors of outcome in a 3-week psychiatric day hospital program. Measured outcome included pre- and post-treatment scores on the BDI, STAI, and SCL-90-R from 224 patients. A single outcome variable based on the average standardized residual changes scores for these measures was derived to assess whether symptom severity at discharge was greater or less than predicted. Predictor variables were analysed using multiple regression. Chronicity variables predicted outcome, with patients hospitalized more than once and those with personality disorders more symptomatic than expected after treatment. Social support and personality variables failed to predict outcome; however, patients who scored higher on the MMPI Si scale were more symptomatic than expected at discharge. Although these results possess marginal clinical utility in terms of accounting for symptom change variation, this study overcame some methodological difficulties seen in prior day hospital literature. Future research should consider a prospective approach, including random treatment assignment, comprehensive and diverse outcome measures, and exploration of specific diagnostic groups.

Adult↗