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Biomedical subjects

L Gupta

Publications and source records attributed to L Gupta.

At least 19 recordsLinked to original sources
PubMed2000

Three clusters of ciguatera poisoning: clinical manifestations and public health implications.

Between July 1997 and August 1998 we investigated three clusters (26 cases) of ciguatera poisoning in the inner Sydney area. Tropical reef fish were implicated in each cluster. Most of those affected had musculoskeletal, neurological and gastrointestinal symptoms. The clusters raise questions about the need for rapid diagnosis and enhanced surveillance mechanisms, the regulation of fish supply, and the lack of testing facilities for ciguatera toxin.

Adolescent↗
PubMed2000

Trauma exposure and psychological reactions to genocide among Rwandan children.

A total of 3030 children age 8-19 years from Rwanda was interviewed about their war experiences and reactions approximately 13 months after the genocide that started in April 1994. Rwandan children had been exposed to extreme levels of violence in the form of witnessing the death of close family members and others in massacres, as well as other violent acts. A majority of these children (90%) believed that they would die; most had to hide to survive, and 15% had to hide under dead bodies to survive. A shortened form of the Impact of Event Scale used in a group of 1830 of these children documented high levels of intrusion and avoidance. While children living in shelters were exposed to more trauma, they evidenced less posttraumatic reactions. Analyses showed that reactions were associated with loss, violence exposure, and, most importantly, feeling their life was in danger.

Adolescent↗
PubMed2000

Ectopic hamartomatous thymoma: a case study and review of the literature.

Ectopic hamartomatous thymoma is a rare and distinctive tumor found in the deep soft tissues of the neck, which is characterized histopathologically by a mixture of spindle, epithelial, and adipose cell elements. We present a case of this lesion occurring in a 39-year-old male. The characteristic histochemical and immunohistochemical findings of these tumors are demonstrated. In addition, review of the reported histological, immunohistochemical and ultrastructural findings is presented together with a table of clinical findings in the tumors so far described. A brief discussion of theories of histogenesis and possible differential diagnosis is included.

Adult↗
PubMed1999

A statewide survey of general practitioners in NSW, Australia, about immunisation and strategies to increase childhood immunisation rates.

A statewide survey was conducted to ascertain GPs' views in New South Wales (NSW), Australia, about the potential usefulness of strategies to increase immunisation rates and to facilitate providing childhood immunisation in their practice. The survey also explored the usefulness of information sources about immunisation. From September 1997-January 1998, a cross-sectional study using a four page self-administered questionnaire was undertaken. Four hundred GPs practising in NSW, Australia were randomly selected and 343 were eligible to participate. Of these, 281 returned a completed questionnaire (82% response rate). Ninety-one percent and 88% of GPs, respectively, agreed that television campaigns or registering children with the national Australian Childhood Immunisation Register (ACIR) were likely to increase immunisation rates. Sixty-two percent of respondents considered that the media created unwarranted parental concern about immunisation. GPs most commonly rated availability of an ACIR list of children overdue for immunisation, better parent educational material and better access to vaccines as strategies which would make immunisation easier. Sixty percent of respondents felt that increased GP payments would be successful in increasing immunisation rates. Only 51% indicated that they had used the "Australian Immunisation Procedures Handbook 6th edition" (a national clinical practice guideline) in the previous month. This study identified GP support for many initiatives aimed at increasing immunisation rates in Australia although GPs were sceptical about the benefits of some programmes. Studies to monitor the impact of GP incentives on immunisation rates in populations and individual practices are underway. These will be useful in determining whether GPs' opinions found in our study correlate with practice in this regard.

Adult↗
PubMed1998

Do general practitioners use prostate-specific antigen as a screening test for early prostate cancer?

OBJECTIVE: To assess the proportion of prostate-specific antigen (PSA) tests being ordered for prostate cancer screening. PARTICIPANTS AND SETTING: General practitioners (GPs) in central Sydney, New South Wales, ordering PSA tests during a seven-week period. DESIGN AND METHODS: Self-administered questionnaire, attached to 179 consecutive PSA test results returned to the ordering GPs. The questionnaire assessed reasons for ordering the test, associated patient morbidity and physical findings, and intended management. RESULTS: 66% response rate with no evidence of response bias. Of 118 PSA tests, 67 (57%) were defined as screening tests on men aged 39-84 years, not otherwise indicated for clinical reasons consistent with NHMRC guidelines. "Patient request" was the sole reason for nine (13%) of the screening tests and a factor in seven others (10%). "Routine test for age" was the reason for 25 (37%) of the screening tests, on men aged 49-78 years. Results of 59 (88%) of the screening tests were normal. CONCLUSION: More than half of the PSA tests ordered during the study period were screening tests. Our method could be used to monitor the impact of guidelines and strategies for reducing PSA screening.

Adult↗
PubMed1997

Local impact of the NHMRC early breast cancer guidelines: where to from here?

OBJECTIVES: To determine clinicians' recall of the National Health and Medical Research Council's (NHMRC) Clinical practice guidelines for the management of early breast cancer six months after publication, and their reactions to its content and potential dissemination and implementation strategies. SETTING: Greater Western Region of Sydney, May 1996. METHOD: Self-administered survey of clinicians with an involvement or interest in the management of women with breast cancer. RESULTS: Of the 69 respondents to the questionnaire (77% response rate), 20% did not recall ever seeing the guidelines. Although most agreed with the defined parameters of potential strengths of the guidelines, there was less agreement as to their medicolegal implications. The four treatment sections of the guidelines were the most highly rated, followed by the sections on communication skills and investigations. Education programs, including college-based programs, as well as endorsement of the guidelines by the learned colleges and respected colleagues, were rated highly as dissemination strategies, far outranking Internet availability. Local revision of the guidelines was considered important as an implementation strategy by three-quarters of respondents. Only 20% indicated that the guidelines had influenced clinical practice, although 46% agreed that they would improve outcomes for women with early breast cancer. CONCLUSIONS: The NHMRC early breast cancer guidelines have been relatively well received in the Greater Western Region of Sydney, although local activities within public institutions and private practice will be needed to achieve implementation.

Adult↗
PubMed1997

Clinical practice guidelines in general practice: a national survey of recall, attitudes and impact.

OBJECTIVE: To determine Australian general practitioners' (GPs') views about and recall of clinical practice guidelines. DESIGN: Self-administered questionnaire survey. SUBJECTS: Randomly selected Australian GPs. RESULTS: 286 of 373 GPs returned questionnaires (77% response rate). GPs' recall of each of nine guidelines ranged from 52% to 94%; 49% considered that their practice had changed as a result of a guideline. While 92% of respondents agreed that guidelines were "good educational tools", 85% indicated that guidelines were "developed by experts who don't understand general practice". Factors most frequently identified as important in deciding whether to follow the guideline recommendations were whether the guideline was based on evidence and credible endorsement. CONCLUSIONS: Australian GPs have positive views about the purpose of clinical practice guidelines and an evidence-based approach to guidelines development. However, respondents rating of the perceived impact of available guidelines in everyday practice was low. The dissemination of specific guidelines is patchy and there is little evidence of systematic implementation.

Adult↗
PubMed1997

Prevalence and risk factors for anabolic-androgenic steroid abuse in Australian high school students.

Abuse of anabolic-androgenic steroids (AAS) is reportedly increasing in prevalence and spreading from sportsmen to cosmetic and recreational use, though there are few accurate estimates of the extent of AAS use outside North America. In order to identify the prevalence of, and risk factors for, 'ever' (lifetime) or 'recent' (within last month) use of AAS among Australian high school students, 13,355 students (51.3% male, median age 13.8 years) in 203 schools constituting a stratified random sample of all high schools in New South Wales and Victoria completed a self-report questionnaire about drug use. Lifetime ('ever') use of AAS was reported by 213 boys (3.2%; 95% CI, 2.7-3.6%) and 74 girls (1.2%; 95% CI, 0.9-1.5%). Factors associated with 'ever' use were truancy [odds ratio (OR) 17.7 (95% CI, 9.4-31.6) for 7 or more truant days compared with no trauncy over the last fortnight], unsupervised recreation [OR 8.4 (5.9-11.9) for 6 or more compared with 2 or fewer nights per week], speaking only a non-English language at home [OR 7.75 (4.4-13.1)], Aboriginality [OR 3.4 (2.0-5.5)], male gender [OR 2.8 (2.1-3.7)], higher student income [OR 2.3 (1.7-3.0)], overseas born [OR 2.2 (1.6-3.0)] and low level of social support [OR 2.5 (1.7-3.5)]. Use of AAS within the last month ('recent') was reported by 113 boys (1.7%; 95% CI, 1.4-2.0%) and 28 girls (0.4%; 95% CI, 0.3-0.6%) and virtually identical risk factor patterns except ORs were uniformly higher. We conclude that AAS abuse is relatively uncommon among Australian high school students but has distinctive and strong socio-economic and cultural predictors. Further studies of the behavioural epidemiology of AAS abuse are required to clarify the origins and significance of our findings and to identify potentially effective interventions.

Absenteeism↗
PubMed1997

Differential effectiveness of telephone prompts by medical and nonmedical staff in increasing survey response rates: a randomised trial.

We conducted a randomised trial to determine the differential effectiveness of a telephone prompt by a medical researcher compared with a nonmedical research assistant in improving response rates of general practitioners to a survey and to compare personnel costs. A national random sample of Australian general practitioners was allocated randomly to two intervention groups. In advance of a self-administered questionnaire, Group A (n = 184) received a telephone prompt by a medical researcher and Group B (n = 189) a prompt by an experienced nonmedical research assistant. Other aspects of survey administration were identical for both groups. The five-month cumulative response rate obtained by the medical researcher (81 per cent) was not significantly different from that of 72 percent obtained by the research assistant (chi 2 = 3.3, 1 df, P = 0.07). For Group A, 279 telephone calls, consuming 23 hours 15 minutes, were made. Group B required more calls (384) and more time (32 hours). Using the relevant award pay scales, the estimated personnel costs for each group were $631 and $601 respectively. We conclude that an experienced nonmedical research assistant is as effective as a medical practitioner in administering telephone prompts to enhance survey response rates, although savings are not necessarily made.

Costs and Cost Analysis↗
PubMed1997

Future directions for clinical practice guidelines: needs, lead agencies and potential dissemination strategies identified by Australian general practitioners.

There has been an increasing interest in developing clinical practice guidelines for general practitioners as a means of improving health outcomes. We conducted a survey of a national random sample of Australian general practitioners in May 1995 to determine their needs, preferred formats and dissemination strategies and to identify potential lead agencies for guidelines development. Of 373 eligible general practitioners, 286 (77 per cent) returned completed questionnaires. At least 50 per cent of respondents considered guidelines in angina, psychotic illness, skin cancer and attention deficit disorder as 'extremely' or 'very' useful. However, three other topics identified as areas for future guidelines development in Better health outcomes for Australians were so rated by less than half of the general practitioners surveyed. The Australian Cancer Society and the Australian Medical Association outranked nine other organisations in terms of credibility in guidelines development. Innovative formats, including computerised medical records or text, were not highly rated, consistent with our finding that only 27 respondents (9 per cent) had Internet access. Strategies nominated as likely to increase the adoption of a guideline included a personal visit by a trained nurse, a lecture about its content or a Medicare rebate being available when a patient was managed in accordance with the guideline. Public health practitioners and nominated lead agencies are encouraged to respond to these findings and recognise potential strategies to enhance the effective dissemination of guidelines. Interventional studies are required to demonstrate and allow understanding of changes in clinical practice attributable to guidelines.

Adult↗
PubMed1996

Nonlinear alignment and averaging for estimating the evoked potential.

This paper addresses the problems associated with averaging brain responses evoked through a repetitive application of an external stimulus. In order to improve the estimate of the evoked potential (EP) through signal averaging, a method which incorporates nonlinear alignment of the EP's into the averaging operation is developed. The method makes no prior assumptions about the properties of the EP or which response in the set best characterizes the EP to be estimated. The nonlinear alignment procedure is designed to pairwise generate optimally aligned EP's by backtracking along the optimal alignment path. The nonlinear alignment and averaging operations are systematically combined to develop methods to estimate the EP. Results from a series of experiments conducted on simulated and real sets of responses show that, through nonlinear alignment and averaging, the events in the EP's are preserved and the estimates of the EP are quite robust.

Adult↗
PubMed1995

An artificial neural network approach to ERP classification.

Artificial neural network-based approaches were developed to classify event-related potential (ERP) waveforms. The networks utilized scalp-recorded ERP returns from six electrode sites. These ERPs were evoked as one individual responded to a series of auditorily presented object names while viewing various objects on a computer screen. The ERPs at the electrode sites were classified as a match decision or a no-match decision. A three-layer backpropagation neural network model was selected to formulate a global and a local classification approach. The backpropagation network in the global approach was designed to operate on a single ERP response which was the average of the ERP responses generated at the six electrode sites. The local ERP classification system consisted of six three-layer backpropagation networks. Each network was designed to operate on the ERPs generated at a single electrode site. A small data base consisting of eight match and eight no-match ERP responses was used to train and test the networks in a variety of ways. The results obtained clearly show that the neural network-based classifiers are able to discriminate with a high degree of accuracy between match and no-match conditions in ERP waveforms.

Brain↗
PubMed1994

Quality of life in osteosarcoma survivors.

Charts of 89 osteosarcoma survivors from Massachusetts General Hospital and The Children's Hospital/Dana Farber Cancer Center, who had received primary treatment more than 1 year previously and had no evidence of disease, were reviewed. Sixty-two patients, mean 12 years from diagnosis, agreed to structured interviews. Rates of psychopathology did not differ significantly from the general population. High distress was noted in 13%. Twenty-three normal progeny had been born postchemotherapy to eight women and the wives of five male patients. One pregnancy was complicated by doxorubicin-induced cardiac toxicity. Only two with previous childhood tumors believed themselves infertile. All felt the effort to save the limb was worthwhile. In most, ongoing pain was mild; phantom pain and neuralgia common. Most survivors were in good mental and physical health with the capacity to bear children.

Adolescent↗
PubMed1993

Detection of aneuploidy and polyploidy in non-Hodgkin's lymphoma by computer video image analysis.

Thirty-six cases of histologically intermediate and low grade non-Hodgkin's lymphoma, classified according to the International Working Formulation, were examined using image analysis cytometry. Aneuploidy was detected in 21 cases (58%). No significant difference in either the incidence or extent of aneuploidy was seen for cases that entered remission when compared to cases that did not. Bone marrow examinations, by either aspiration or trephine biopsy, were conducted on 34 cases, with 11 showing lymphocytic infiltration. Aneuploidy was detected in 6 of the 11 cases having bone marrow involvement, while 5 cases with bone marrow infiltration were euploid. Polyploid cell distributions were detected in 3 cases, and the remaining 12 cases were diploid. The biologic significance of polyploidy among non-Hodgkin's lymphomas is not well understood, and its detection is limited to static techniques for DNA quantitation. With further investigation, awareness of its presence may reveal some insight into the clonal evolution of this neoplasm.

Adolescent↗
PubMed1988

Humoral concepts of mental illness in India.

Based on interviews with patients at three allopathic psychiatric clinics in Bombay, Bangalore and Varanasi, employing a preliminary version of the Explanatory Model Interview for Classification (EMIC) to elicit indigenous explanations of illness and patterns of prior help seeking, we discuss popular humoral theories of mental disorder. Even though most laypersons are unfamiliar with the content of the classical treatises of Ayurveda, the humoral traditions which they represent influence current perceptions. Case vignettes clarify the nature of the relationship between cultural, familial and personal factors that influence the experience of illness.

Adolescent↗