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Biomedical subjects

M Dewey

Publications and source records attributed to M Dewey.

At least 55 records · Page 3Linked to original sources
PubMed1993

The initial development of a health-related quality of life model as an outcome measure in epilepsy.

Patients with refractory epilepsy, despite no fixed physical deficit, are often socially and psychologically handicapped. Currently available outcome measures for epilepsy do not adequately address these manifestations or their influence on well-being and quality of life. A patient-based health-related quality of life (HRQL) model for epilepsy including physical, social and psychological domains was constructed. It contains previously validated measures of anxiety, depression, happiness, overall mood, self-esteem, mastery, social satisfaction and general health and a specifically designed seizure severity scale with patient- and carer-based components. The psychometric properties of this model were evaluated in the context of the trial of a potential new antiepileptic drug. All the scales, except the Social Problems Questionnaire, have acceptable internal consistency (alpha 0.69-0.85) in this patient population. Construct validity is indicated by the ability of the scales to differentiate between groups of patients predicted to have different levels of psychosocial function. Treatment effects were detected by the patient (P = 0.017) and carers (P = 0.035) subscales of the seizure severity scale, the happiness (P = 0.003) and the mastery (P = 0.003) scales. Despite obvious deficiencies preliminary analyses are encouraging. This model provides a framework for investigating the complex interaction between the physical, social and psychological manifestations of epilepsy. The model has potential as an outcome measure for use in longitudinal studies and as a measure of disability for use in cross-sectional studies designed to compare quality of life in different populations of people with epilepsy.

Activities of Daily Living↗
PubMed1993

Measuring the impact of epilepsy: the development of a novel scale.

The impact of a chronic illness is experienced not only through its physical symptoms, but also as a result of its effect on psychosocial functioning. In the case of an illness such as epilepsy, where the physical manifestations are transient, the psychosocial consequences may, with time, come to be of greater concern. We have been involved in developing a quality of life model for epilepsy. As part of the refinement of the initial model, we have devised a novel scale to measure the impact of the condition on a number of different aspects of daily life. The scale was administered to 75 patients attending an epilepsy out-patient clinic. Initial analysis of its psychometric properties is encouraging, although the inclusion of an item relating to employment reduced the scale's reliability. As a result, the wording of the existing item has been amended and an additional item has been incorporated. We hope the scale will be useful in investigations of treatment for epilepsy and of its psychosocial aspects.

Adolescent↗
PubMed1993

Seizure severity and the quality of life.

The efficacy of an antiepileptic drug (AED) is determined at present by the drug-elicited reduction in seizure frequency. Reduction of seizure frequency as the sole measure of efficacy does not account for treatment-induced reductions in seizure severity and positive psychological effects experienced by the patient. A clinical trial was undertaken in which seizure frequency was the primary and seizure severity and psychological well-being were the secondary measures of efficacy. Psychological assessment and seizure frequency were monitored in patients whose epilepsy was treated with lamotrigine (LTG) or placebo. The results indicate that LTG is an effective AED, causing reductions in seizure frequency and severity and improvements in mood and mastery. In addition, the study demonstrated that the use of seizure severity scales, especially the ictal subscale, may enhance the sensitivity of assessment of trials of AED treatments.

Anticonvulsants↗
PubMed1992

The prevalence of dementia among elderly people living in Zaragoza and Liverpool.

The prevalence of dementia in elderly people living in the community was compared using data from Zaragoza (Spain) and Liverpool (UK). A standardized interview, the Geriatric Mental State (GMS), was administered to a random sample of 1070 persons in Liverpool and 1080 in Zaragoza. Using diagnoses derived from the GMS-AGECAT package we found no significant difference between the prevalence of dementia in Zaragoza (7.4%) and Liverpool (5.0%). The expected increase in prevalence with age was found, but the two cities did not appear to differ in the relationship between age and prevalence. No sex difference was apparent, and the two cities do not differ in the relationship between sex and prevalence.

Aged↗
PubMed1992

Estimating the incidence of dementia in the community from prevalence and mortality results.

This paper reports a series of computer simulations of the incidence of dementia, and its relationship to age. The simulations use known prevalence and mortality data from a single source: Liverpool. Comparison is also made with additional UK, European, and international figures to add stability to the estimates. The paper concludes that with our present knowledge we can either model prevalence or incidence, but not both, and suggests that more information is especially needed for the older groups.

Age Factors↗
PubMed1992

The Work Environment Scale: a comparison of British and North American nurses.

Previous research into stress in nursing has identified different sources of stress for different specialties without specifying the source of that stress or providing comprehensive understanding of the variables that might contribute to it. This study examines the work environment of 209 nursing staff using the Work Environment Scale. Significant differences were found between a UK sample and the original American norms. Further research highlighted significant interactional effects between demographic variables and the subscales of the WES, and these may form the basis for future research.

Analysis of Variance↗
PubMed1991

Seizure frequency, patient-perceived seizure severity and the psychosocial consequences of intractable epilepsy.

It is generally recognised that the assessment of treatment effects in epilepsy using seizure frequency as the only outcome measure may lack sensitivity. A patient-based seizure severity scale has been developed and initial results confirm its reliability and validity. As part of the further development of this scale it is important to explore the relationship between seizure severity, seizure frequency and the psychosocial consequences of intractable epilepsy. One hundred patients with medically refractory partial seizures completed a quality of life questionnaire including measures of physical (seizure severity and frequency), social and psychological well-being (anxiety, depression, self-esteem, locus of control and happiness). Multivariate analysis demonstrated that individual psychological variables were best predicted by other psychological variables. However, when these were removed from analysis, seizure severity was the most significant predictor of self-esteem (P = 0.005), locus of control P = 0.039) and anxiety (P = 0.048). Seizure frequency did not contribute significantly to the variance of any of the psychological factors. These results highlight the importance of considering seizure severity when assessing treatment effects in epilepsy and provide further evidence for the construct validity of a novel patient-based seizure severity scale.

Activities of Daily Living↗
PubMed1991

The development of a seizure severity scale as an outcome measure in epilepsy.

In controlled trials of antiepileptic drugs (AEDs) seizure frequency is often the only variable considered. With little prospect of improving assessment of AEDs, using seizure counts as the only end-point, there is a need for the development of new outcome measures. Clinical experience indicates that seizure severity is equally important to the patient and, by preventing seizure spread, AEDs can influence seizure severity without necessarily reducing seizure frequency. A scale capable of measuring seizure severity and change of severity attributable to treatment could be a useful additional outcome measure. Such a scale should exhibit the basic properties of validity and reliability. An easily administrable 16-point scale, containing 2 subscales--perception of control and ictal/post-ictal effects--has been developed. This scale has been tested on a patient population (n = 159) representative of that seen in trials of novel AEDs. Using standardised statistical methods, the scale has been shown to be both reliable and valid.

Adolescent↗
PubMed1989

Aspects of personality of soldiers presenting to an endoscopy clinic.

Eysenck Personality Questionnaires were completed by a consecutive series of 60 soldiers attending a military endoscopy clinic. Each individual was pair-matched with a non-endoscoped soldier from a medical ward and a soldier from the hospital alcohol treatment unit. Alcohol dependence and related disabilities were measured using the MAST, CAGE and SADQ questionnaires and liver function tests and MCV estimates were performed. Alcohol questionnaire scores and laboratory tests were analysed by discriminant function analysis and by applying 'cut-off' scores of the questionnaires. Analyses of the personality dimensions were carried out by analyses of variance and were examined in relation to sample, alcohol questionnaire scores and endoscopic findings. The soldiers from the alcohol treatment unit had the highest neuroticism score, followed by the soldiers attending the endoscopy clinic. Of the endoscoped soldiers, those diagnosed as non-ulcer dyspeptics had higher neuroticism scores than soldiers with ulcers. This finding was not associated with increased prevalence of alcohol dependence and related disabilities.

Adult↗
PubMed1985

Children with end-stage renal failure: psychological effects on patients, siblings and parents.

Thirty-two children diagnosed as suffering from renal failure, their parents and siblings were the subjects of this study. Anxiety, depression and psychosomatic complaints were examined in the parents and behaviour problems in the child and siblings using standardised tests. The personality characteristics (EPQ) of the child and the child's view of the family (modified family relations test) were also ascertained. Parents showed greater levels of anxiety and depression than a normal sample and more psychosomatic problems than a control group consisting of parents of children with other chronic physical conditions. Siblings and the sick child did not have more behaviour problems at school than a normal control group. Positive correlations were found between age on diagnosis of renal failure and fathers' depression and anxiety scores. Mothers' anxiety and depression scores were also positively correlated with those of father. Negative correlations were found between age on diagnosis of renal failure and lie scores on the EPQ.

Adolescent↗
PubMed1984

Fate of infants with transposition of the great arteries in relation to balloon atrial septostomy.

The palliation afforded by balloon atrial septostomy to 124 infants with transposition of the great arteries was assessed in terms of survival to 6 months of age without the need for further intervention. Prediction of success or failure in relation to palliation was significantly affected by the presence of associated ventricular septal defect, left ventricular outflow tract obstruction, or persistent ductus arteriosus and by the maximum volume of balloon used to perform the septostomy. There was a significant association between balloon volume and size of atrial defect found at subsequent surgery or necropsy.

Ductus Arteriosus, Patent↗
PubMed1982

Correlation of clinical and in vitro erythropoietic responses to androgens in renal failure.

To assess in vitro erythropoietic cultures as a tool to discriminate between patients whose anemia improves with and those whose anemia fails to improve with androgens, bone marrows of 24 anemic patients receiving maintenance hemodialysis in hormone-depleted plasma clots were cultured. While erythroid colony proliferation in the presence and absence of androgens by cells of seven patients with good clinical outcomes who were initially studied was similar to that of normal donors, it was reduced (P less than 0.001) in cultures of cells from seven patients whose clinical responses were ultimately poor. Fewer than 25 colonies/6 X 10(4) cells at optimal erythropoietin concentrations, and less than a 25% enhancement in colony growth by androgens were observed in only those cultures derived from clinical nonresponder marrows. Using these criteria, nine of ten prospectively classified patients (five clinical responders and four nonresponders) were identified correctly.

Adult↗