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Biomedical subjects

Mark Jones

Publications and source records attributed to Mark Jones.

17 recordsLinked to original sources
PubMed2003

A systematic review of physicians' survival predictions in terminally ill cancer patients.

OBJECTIVE: To systematically review the accuracy of physicians' clinical predictions of survival in terminally ill cancer patients. DATA SOURCES: Cochrane Library, Medline (1996-2000), Embase, Current Contents, and Cancerlit databases as well as hand searching. STUDY SELECTION: Studies were included if a physician's temporal clinical prediction of survival (CPS) and the actual survival (AS) for terminally ill cancer patients were available for statistical analysis. Study quality was assessed by using a critical appraisal tool produced by the local health authority. DATA SYNTHESIS: Raw data were pooled and analysed with regression and other multivariate techniques. RESULTS: 17 published studies were identified; 12 met the inclusion criteria, and 8 were evaluable, providing 1563 individual prediction-survival dyads. CPS was generally overoptimistic (median CPS 42 days, median AS 29 days); it was correct to within one week in 25% of cases and overestimated survival by at least four weeks in 27%. The longer the CPS the greater the variability in AS. Although agreement between CPS and AS was poor (weighted kappa 0.36), the two were highly significantly associated after log transformation (Spearman rank correlation 0.60, P < 0.001). Consideration of performance status, symptoms, and use of steroids improved the accuracy of the CPS, although the additional value was small. Heterogeneity of the studies' results precluded a comprehensive meta-analysis. CONCLUSIONS: Although clinicians consistently overestimate survival, their predictions are highly correlated with actual survival; the predictions have discriminatory ability even if they are miscalibrated. Clinicians caring for patients with terminal cancer need to be aware of their tendency to overestimate survival, as it may affect patients' prospects for achieving a good death. Accurate prognostication models incorporating clinical prediction of survival are needed.

Analysis of Variance↗
PubMed2003

Surgeon specific mortality in adult cardiac surgery: comparison between crude and risk stratified data.

OBJECTIVE: As a result of recent failures in clinical governance the government has made a commitment to bring individual surgeons' mortality data into the public domain. We have analysed a database to compare crude mortality after coronary artery bypass surgery with outcomes that were stratified by risk. DESIGN: Retrospective analysis of prospectively collected data. SETTING: All NHS centres in the geographical north west of England that undertake cardiac surgery in adults. PARTICIPANTS: All patients undergoing isolated bypass graft surgery for the first time between April 1999 and March 2002. MAIN OUTCOME MEASURES: Surgeon specific postoperative mortality and predicted mortality by EuroSCORE. RESULTS: 8572 patients were operated on by 23 surgeons. Overall mortality was 1.7%. Observed mortality between surgeons ranged from 0% to 3.7%; predicted mortality ranged from 2% to 3.7%. Eighty five per cent (7286) of the patients had a EuroSCORE of 5 or less; 49% of the deaths were in this lower risk group. A large proportion of the variability in predicted mortality between surgeons was due to a small but differing number of high risk patients. CONCLUSIONS: It is possible to collect risk stratified data on all patients undergoing coronary bypass surgery. For most the predicted mortality is low. The small proportion of high risk patients is responsible for most of the differences in predicted mortality between surgeons. Crude comparisons of death rates can be misleading and may encourage surgeons to practise risk averse behaviour. We recommend a comparison of death rates that is stratified by risk and based on low risk cases as the national benchmark for assessing consultant specific performance.

Adult↗
PubMed2003

Computer-taught coping techniques for venepuncture: preliminary findings from usability testing with children, parents and staff.

Teaching cognitive and behavioural coping techniques can reduce children's pain and distress during medical procedures. However, these simple techniques are often not taught to children due to lack of staff time, training and teaching aids. We developed a computer-based self-administered programme (CTCT) to teach coping skills to school-aged children in the waiting room prior to venepuncture. All children had topical local anaesthetic and parents were present. Children reported only mild pain and distress from venepuncture and seven children used techniques learned from the CTCT programme. Previous pain coping influenced behavioural distress during venepuncture. Ten children reported that they would use CTCT again. Nine parents stated they would recommend their child use CTCT in future. All staff responded favourably to the use of CTCT for children prior to venepuncture. Our preliminary findings demonstrate that the coping techniques can be taught using a computer game format and that children, parents and staff found the method acceptable.

Adaptation, Psychological↗
PubMed2002

MDMA alters the response of the circadian clock to a photic and non-photic stimulus.

3,4-Methylenedioxymethamphetamine (MDMA or 'Ecstasy') is a widely used recreational drug that damages serotonin 5-HT neurons in animals and possibly humans. Published literature has shown that the serotonergic system is involved in photic and non-photic phase shifting of the circadian clock, which is located in the suprachiasmatic nuclei. Despite the dense innervation of the circadian system by 5-HT and the known selective neurotoxicity of MDMA, little is known about the effects of MDMA on the circadian oscillator. This study investigated whether repeated exposure to the serotonin neurotoxin MDMA alters the behavioural response of the Syrian hamster to phase shift to the serotonin 5-HT1A/7 receptor agonist 8-hydroxy-2-(di-n-propylamino) tetralin hydrobromide (8-OH-DPAT). This agonist was administered under an Aschoff Type I (CT8) and Aschoff Type II (ZT8) paradigm (5 mg/kg) and was given before and after treatment with MDMA (10, 15 and 20 mg/kg administered on successive days). Pre-treatment with MDMA significantly attenuated phase shifts to 8-OH-DPAT. We also tested the ability of the clock to phase shift to a photic stimulus after treatment with MDMA. A 15-min light pulse (mean lux 125 at CT14 or ZT14) was administered before and after treatment with MDMA. Phase shifts to a photic stimulus were significantly attenuated by pre-treatment with MDMA. Our study demonstrates that repeated exposure to MDMA may alter the ability of the circadian clock to phase shift to a photic and non-photic stimulus in the hamster. Disruption of circadian function has been linked with a variety of clinical conditions such as sleep disorders, mood, concentration difficulties and depression, consequently outlining the potential dangers of long-term ecstasy use.

8-Hydroxy-2-(di-n-propylamino)tetralin↗
PubMed2002

The Chinese herbal formulation biminne in management of perennial allergic rhinitis: a randomized, double-blind, placebo-controlled, 12-week clinical trial.

BACKGROUND: Herbal therapies have been widely used in allergic rhinitis (AR), but none have been shown to be effective in controlled scientific clinical trials. OBJECTIVE: The aim of this study was to test the effects of the Chinese herbal formulation Biminne in patients with moderate to severe perennial AR. METHODS: In a randomized, double-blind, placebo-controlled clinical trial, 58 patients were randomized to receive either Biminne capsules (n = 26) or placebo (n = 32) in doses of five capsules twice a day for 12 weeks. Main outcomes were measured by changes in symptom diaries, quality of life scores, patients' evaluations of improvement on visual analog scores, and physicians' overall evaluation. Total serum immunoglobulin E was measured in all patients without knowledge of which group they were in. After 1 year we performed a randomized, double-blind, dose-response study in 22 patients who had previously received placebo. RESULTS: The trial outcomes evaluated by four instruments showed a statistically significant improvement in some of the symptoms of AR, whereas others exhibited a positive trend that did not reach statistical significance. Followup 1 year after completion of the trial suggested that benefit of the treatment persisted. A pilot dose-response study showed both half and full strengths were effective. Total serum immunoglobulin E was reduced after the herbal treatment. CONCLUSIONS: Our results suggest the Biminne formulation is effective in treatment of perennial AR. Its mode of action is unknown.

Administration, Oral↗
PubMed2002

Statistical power in stuttering research: a tutorial.

The capacity to make reliable inductive statements about populations is critical for the advancement of scientific knowledge. An important contribution to that advancement of knowledge is determining that effects are either present or not present in populations. Statistical power is an important methodological qualification for any research that presents statistical results, and particularly so for research that presents null results. In this paper we describe the statistical concept of power, outline parameters of research that influence it, and demonstrate how it is calculated. With reference to selected published research, attention is drawn to the problems associated with a body of underpowered research, one being that population effects may go undetected. One way to prevent this problem is to calculate power a priori in planning research and include confidence intervals when presenting the results of research. However, it is difficult, if not impossible in many cases, to obtain high participant numbers for communication disorders of low prevalence such as stuttering. With this in mind, the paper concludes with an attempt to open discussion about ways to redress the problems associated with statistical power.

Humans↗
PubMed2002

Leak testing. Getting down to the fundamentals of leak detection and measurement.

There are a variety of leak testing techniques in use today. When considering an item requiring leak testing it is important to ascertain first whether detection of the leak or measurement of the leakage rate is more important. Quantifying the leakage rate will dictate the leak measurement technique that is required.

Equipment Failure Analysis↗
PubMed2002

Childhood coughs and colds.

Causes, incidence and management of coughs and colds in children are discussed. In most cases consultation with a doctor and antibiotic therapy are unnecessary but health visitors and nurses have an important role in reassuring parents and advising them on management and relief of symptoms. When symptoms are frequent and persistent, the possibility of an underlying cause such as asthma should be considered. Parents should be advised to consult their doctor if a young baby with a cough or cold seems ill and is reluctant to feed, even if the baby does not have a raised temperature.

Child↗
PubMed2002

Teething in children and the alleviation of symptoms.

Teething is a normal process by which an infant begins to cut the first teeth (primary dentition). On average, infants begin teething at six months and by the age of three years all the first teeth have erupted. A variety of symptoms can accompany teething including sensitive and painful gums, mouth ulceration, drooling, feeding difficulties, lack of sleep and crying, all of which result in a distressed child and anxious parent. Some teething symptoms can be alleviated effectively at home with teething aids such as cold teething rings. In addition, over-the-counter treatments are available which provide pain relief and are mainly in the form of analgesic and anaesthetic gels, some of which also possess antiseptic properties. Gels such as those containing choline salicylate can be applied direct to the gums specifically to relieve pain and inflammation.

Analgesics↗
PubMed1997

The response to the slump test in a group of female whiplash patients.

This study was undertaken to assess the difference between the response to the slump test in 40 asymptomatic and 20 symptomatic female subjects with cervical pain after whiplash injury. Areas and alterations of pain responses during the test, and ranges of movement of knee extension, were analysed. The results demonstrated that the addition of knee extension and left ankle dorsiflexion during the slump test produced a significant increase in the intensity of comparable cervical symptoms in the whiplash group. The whiplash group also showed a greater limitation in knee extension range of movement during the test than did the control group. These differences suggest that pathological changes of the neural system itself or adjacent tissues, affecting the mechanics of the neural system, may be a contributing factor to these patients' cervical symptoms.

Journal Article↗
PubMedDate not supplied

Predicting treatment time with the Lidcombe Program: replication and meta-analysis.

BACKGROUND: The benefits of treating stuttering close to onset have become obvious in recent years, and the Lidcombe Program has emerged as an effective and safe treatment method for children in their preschool years. The benefits of implementing the programme with young children, however, need to be weighed against the knowledge that many children recover from stuttering without treatment. In light of this, speech-language therapists need to know how long treatment is likely to take and whether treatment time can be predicted. In particular, they need to know if adopting a 'watchful waiting' approach--to see if natural recovery occurs--jeopardizes responsiveness to treatment. A recent Australian study of 250 preschool-age children found that stuttering rate was the only significant predictor of treatment time with the Lidcombe Program. In other words, children whose stuttering was more severe took longer to pass through the programme. There were other trends in the data but they did not reach significance. AIMS: The present study, conducted independently in the UK, was designed to replicate the Australian study. Direct replication enabled pooling of the data from the two studies in a meta-analysis. METHODS & PROCEDURES: The study included 66 children who began treatment before 6 years of age. They were treated with the Lidcombe Program at a specialist stuttering clinic in Norwich. Logistic regression analyses were conducted on the data. The data from both the British and Australian cohorts were pooled in a meta-analysis. OUTCOMES & RESULTS: Results indicated that Stage 1 of the Lidcombe Program was completed in a median of 11 clinic visits, which is in line with the findings of the Australian study. Stuttering rate at first clinic visit was again found to be a significant predictor of treatment time. The remaining data trends were similar to those in the Australian data. In the meta-analysis, stuttering rate was once more found to be a predictor of treatment time. Of particular interest, however, was that the increased power provided by the meta-analysis identified an additional predictor, namely onset-to-treatment interval. Contrary to what is known about the responsiveness of children to the Starkweather and Gottwald treatment, and contrary to what might be expected given what we know about natural recovery, children who had been stuttering for more than 12 months took less time to progress through the programme than children who had been stuttering for less than 12 months. CONCLUSIONS: These findings indicate that delaying intervention with the Lidcombe Program for 1 year after onset, within the preschool years, is unlikely to jeopardize responsiveness to treatment. The clinical implications of these findings are discussed.

Age Factors↗