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Biomedical subjects

M Shepherd

Publications and source records attributed to M Shepherd.

At least 19 recordsLinked to original sources
PubMed1992

In vivo assessment of the metabolic alterations in glucagonoma syndrome.

Stable-isotope methodology and indirect calorimetry were used to evaluate metabolic abnormalities in a patient with glucagonoma syndrome manifested by 17% body weight loss, hypoaminoacidemia, and hyperglycemia. Energy expenditure (26 kcal/kg) was the same as that predicted by the Harris-Benedict equation. The rate of appearance (Ra) of intracellular leucine (2.70 mumol/kg/min), an index of protein breakdown, was normal, although the percentage of leucine flux oxidized (31%), an index of amino acid catabolism, was 50% greater than the normal mean value. Glucose Ra in plasma (12.9 mumol/kg/min), representing hepatic glucose production, and glycerol Ra in plasma (3.04 mumol/kg/min), a measurement of whole-body lipolysis, were 15% and 25% greater, respectively, than mean values found in normal volunteers. These results suggest that long-term alterations in energy, leucine, glucose, and lipid metabolism in patients with glucagonoma are minimal. However, small long-term metabolic alterations caused by glucagon excess, in conjunction with chronic negative energy balance, could be responsible for the weight loss, hypoaminoacidemia, and hyperglycemia observed in this patient population.

Adult↗
PubMed1992

Psychiatric journals and the evolution of psychological medicine.

The history of psychiatric journals is outlined from their inception in the late eighteenth century. In the development of psychological medicine they serve as intellectual markers of the complex relations between institutional psychiatry, neurology, the psychosocial sciences and the psychotherapeutic movement. Their current status is briefly discussed.

Europe↗
PubMed1992

Light microscopic and ultrastructural distribution of type VI collagen in human liver: alterations in chronic biliary disease.

We have investigated the distribution of type VI collagen in normal human liver obtained from cadaveric renal transplant donors, using a peroxidase-antiperoxidase method for light microscopic visualization, and an immunogold labelling method for ultrastructural localization. The distribution was compared with that of the more abundant interstitial collagen type III, using antibodies to amino terminal procollagen type III. Staining for type VI collagen was identified in Glisson's capsule, in portal tract stroma and within the space of Disse. Perisinusoidal staining showed intra-acinar heterogeneity with the intensity in acinar zones 2 and 3 being greater than in zone 1. Type III collagen was also found in the space of Disse although no significant intra-acinar variation in staining intensity was noted. Immuno-gold labelling for type VI collagen was demonstrated on amorphous or microfilamentous material lying between, and occasionally appearing to interconnect, cross-striated collagen fibrils, whereas labelling for amino terminal procollagen type III was exclusively on fibrils. Intracellular staining for type VI collagen was noted in perisinusoidal (lto) cells. These results confirm that type VI collagen is a ubiquitous constituent of the normal hepatic extracellular matrix and suggest that it may be synthesized by perisinusoidal (lto) cells. The distribution of type VI collagen was also studied in biopsy material from patients with different histological stages of primary biliary cirrhosis. Intense staining was noted around proliferating bile ductules within developing fibrous septa and in established septa of cirrhotic liver. These observations indicate that this 'minor' matrix component may play an important role in hepatic fibrogenesis.

Chronic Disease↗
PubMed1992

Comparing need with resource allocation.

In a study of health visitor caseloads in Bristol and Weston health authority, 16,000 families were assessed against 26 criteria known by health visitors to affect long term health. Considerable variations were found in the long term risk to the health of individual families. Families with high levels of health risk were concentrated in the caseloads of some health visitors and in a few geographical localities. The results suggest that there is a serious misallocation of health visiting resources and that steps should be taken to adjust resources to reflect more closely the patterns of need.

Community Health Nursing↗
PubMed1991

Interpartner reliability of reporting of recent sexual behaviors.

Epidemiologic studies exploring risks for sexually transmitted diseases, including human immunodeficiency virus infection, typically rely on self-report of sexual behaviors. Estimates of the incidence and prevalence of sexual practices are important measures for assessment of behavioral interventions as well as for examining disease transmission. This study examined the degree of agreement within heterosexual couples reporting frequency and type of sexual behaviors, including condom use. Self-reports were obtained from 71 couples attending Baltimore sexually transmitted disease clinics in 1989-1990 regarding the number of days and number of episodes of three specific sexual practices (any type of sexual activity, vaginal sex, and vaginal sex with condom use) over a 30-day period. Paired t test analysis revealed both sexes to be very consistent in their reporting of recent sexual experiences. Multivariate analysis showed that agreement did not vary by socioeconomic status, by whether the partners were married to each other, or by age. These findings suggest that reliable information regarding sexual behaviors may be obtained from men or women.

Adult↗
PubMed1991

Computer-based program for identifying medication orders requiring dosage modification based on renal function.

A computer-based program that enables staff pharmacists to quickly review medication orders written for renally impaired patients is described. Medication orders requiring dosage modification based on the renal function of the patients for whom they were written were being identified by a medical staff-approved pharmacist intervention program. However, staff pharmacists were unable to assess the orders easily and rapidly because of a lack of readily available patient data. In response, a computer-based intervention program was developed. Specific dosage guidelines for renally eliminated drugs in patients with renal dysfunction were entered into the pharmacy computer. An interface with the laboratory computer enables the pharmacy computer to access creatinine concentration or clearance values, perform calculations if necessary, and alert pharmacists to specific drug orders that may require modification. Such medication orders are flagged by the pharmacy computer during order entry. When a staff pharmacist judges that intervention is needed, he or she telephones the ordering physician or sends a note to the patient's nursing station. Over a two-month period, 1485 orders were identified as being potentially inappropriate. Physicians were contacted about 191 of the flagged orders, and they accepted the pharmacist's recommendation for 141 (74%) of these orders. The interventions resulted in a drug acquisition cost saving of $7082 over the two-month period. A computer-based program enabled staff pharmacists to easily and rapidly identify orders for renally eliminated agents that required modification, reduced the risk of adverse reactions, trimmed costs, and promoted the clinical dimension of pharmacy practice.

Clinical Pharmacy Information Systems↗
PubMed1991

Primary care psychiatry: the case for action.

Since the introduction of the National Health Service a number of epidemiological enquiries have established the importance of mental disorders in the field of primary care. Examples are provided from the work of the General Practice Research Unit at the Institute of Psychiatry in London. The results furnish a rational basis for collaborative action between research workers, general practitioners and policy makers.

Community Psychiatry↗
PubMed1990

Twenty years on.

Explore the source record for details and available documents.

Forecasting↗
PubMed1989

The natural history of schizophrenia: a five-year follow-up study of outcome and prediction in a representative sample of schizophrenics.

Longitudinal studies of schizophrenia based on at least 70 subjects and a minimum five-year follow-up period are reviewed in respect of the requirements of adequate method. A cohort of 121, PSE-diagnosed, schizophrenic admissions from a defined population was identified. The sex-distribution of the subjects was almost equal. Forty per cent were first admissions; 65% of the men and 24% women were unmarried; the mean age of onset for men was 28.6 years, for women 33.2 years. Almost half (48%) were continuously employed (including house and child care) for 2 years prior to admissions. First rank symptoms of schizophrenia were present in 79% of the men and 86% of the women. Comprehensive, standardized assessments of clinical state and social function were made on discharge from hospital and at follow-up by home interview of patient and relative(s). Outcome was also assessed by duration and frequency of readmission and by duration of employment. First admissions were analysed separately from the whole cohort. There were 49 first admissions generating an incidence of 7.4 per 100,000 general population per annum. Sixty-nine per cent of men and 13% of women were unmarried. The mean age of admission for men was 30.8 years, women 40.3 years and the mean age of onset 30.7 and 38.6 respectively. After 5 years first rank symptoms were present in 46% of the males and 35% of the females. The proportion showing depressive symptoms fell from 39% at intake to 22% at five years. In terms of a combination of symptoms and readmissions there was a good outcome in 50% of men and 65% of women, a trend comparable to that found in the whole cohort. For the whole cohort a combination of the number of symptoms and admissions disclosed a good outcome for 48%. The mean total duration of readmissions during the five years for men was 76 weeks and for women 27 weeks. Depressive symptoms were present in 38% at intake and 21% after 5 years. An overall rating of social functioning at 5 years showed no more than mild impairment for 47% of men and 74% of women, although individual items were more impaired. However, 38% of the group showed no more than mild impairment in any aspect of social functioning rated. Clinical and social outcome were, in general, closely correlated. The difference in outcome between men and women and the relations between clinical and social outcome are discussed. By means of an application of measures of association between independent and dependent variables to the onset data the clinical and social categories of pathology and impairment at 5 years were forecast.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

Movement versus focusing of visual attention.

In two experiments, we investigated the idea that attention moves through visual space in an analog fashion. The spatial distribution of attention was determined by presenting a spatially informative cue and comparing reaction times to targets at cued and uncued locations as a function of the interval from cue onset to target onset (SOA). Facilitation and inhibition were measured by reference to a neutral condition in which the cue provided no spatial information. In the first experiment, we used a central cue (an arrow), and in the second experiment, we used a peripheral cue (a 50-msec flash). With central cue, the facilitatory effects of the cuing were initially equal for all locations on the indicated side of the display, and then decreased for all locations except the one that had been specifically cued. These results are interpreted as being more consistent with "focusing" of an initially broad "beam" of attention than with "movement" of a narrow beam from fixation to the cued location. With peripheral cues, strong facilitation specific to the cued location was manifest as early as 50 msec after cue onset, but this effect decreased with increasing SOA. Inhibition for uncued locations increased with increasing SOA at a rate that generally reflected their distance from the cued location. Taken together, these results reveal important differences between peripheral and central cues in the generation of attentional selectivity, not just in the time-course of events, but also in the nature of the processes involved.

Attention↗
PubMed1988

The development of a computerized assessment for minor psychiatric disorder.

This paper describes the development, validation and use of a computerized assessment for minor psychiatric disorder based on the Clinical Interview Schedule (CIS; Goldberg et al. 1970). There was good agreement between the computerized assessment and the CIS administered by psychiatrists, both in assessing overall severity and in defining 'cases' of psychiatric disorder. Individual symptoms elicited by the computer and the CIS were compared, and the levels of agreement found were similar to those from inter-observer studies of standardized interviews. Subjects from a variety of non-psychiatric settings regarded the assessment as acceptable, accurate and easy to use. It is concluded that this computerized assessment of neurotic symptoms is valid and reliable. It eliminates observer bias, it is an efficient use of research resources and it may have clinical applications in primary care.

Adolescent↗
PubMed1988

Classification of mental disorder in primary care.

This monograph describes a study designed to test how far the two major international systems of disease classification, International Classification of Diseases (ICD) and International Classification of Health Problems in Primary Care (ICHPPC), can be consistently applied by General Practitioners (GPs) to mental disorder presenting in primary care, and to identify sources of observer variation occurring at different stages of clinical judgement. A group of 27 senior GPs was exposed to a series of real life general practice consultations, either in the form of videotape or written case-vignette material, chosen to reflect a wide range of minor psychiatric problems, differing not only in respect of phenomenology but also of their associations with social stresses and supports, physical illness and personality features. The findings clearly indicate that neither ICD nor ICHPPC can be applied consistently by GPs. However, while the overall diagnostic concordance using ICD and ICHPPC proved to be disappointingly low, agreement on individual observations relating to psychological, physical, personality and social features was moderately good. It was also noted that participants, when given the opportunity, tended to incorporate several domains into their diagnostic conclusions, aiming for a multidimensional formulation, to which neither ICD nor ICHPPC lend themselves. It is, therefore, not surprising that if the principal diagnostic schemata are neither adequate in themselves nor readily applicable to primary care, then GPs are more likely to resort to symptomatic treatment and evade diagnosis when confronted with minor psychiatric morbidity. The consequence of this approach for National Morbidity Surveys and drug trials are discussed. The historical development of multiaxial schemata of classification is briefly traced, the problems associated with DSM-III are discussed, and a comprehensive model of classification is proposed which incorporates the notions of severity and duration as well as of category on the four dimensions of psychological illness, social stresses and supports, personality and physical illness.

Adjustment Disorders↗