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Biomedical subjects

Michael P Jones

Publications and source records attributed to Michael P Jones.

At least 19 recordsLinked to original sources
PubMed2007

Impact of anal incontinence on psychosocial function and health-related quality of life.

The relationship among the frequency of anal incontinence (AI), psychosocial factors, and health-related quality of life (HRQOL) was evaluated. Consecutive patients (n=280) completed a bowel symptom questionnaire, the Symptom Checklist 90 -- Revised (SCL 90-R), and an assessment of HRQOL. Group 1 had no incontinence, Group 2 had AI less than once per week, and Group 3 experienced AI more than once per week. Multivariate analyses were used to evaluate the relationship among symptoms, the SCL-90-R subscales, and HRQOL. Group 3 reported more frequent stools than the other groups. Significant psychological distress was present in both incontinent groups compared to Group 1 (P=0.002). A reduction in overall HRQOL was also seen in the incontinent groups. Depression was inversely correlated with QOL-Satisfaction and QOL-Ratings and positively correlated with QOL-Interference. AI was associated with impaired psychosocial function and decreased HRQOL. The frequency of AI was associated with increased HRQOL-Interference, but minimally with the degree of psychosocial impairment.

Adult↗
PubMed2006

Comparison of case-deletion diagnostic methods for Cox regression.

Case-deletion diagnostics are a routine component of regression analysis since they identify unusual observations that substantially affect parameter estimates. The exact approach is to compute the change in each regression parameter by dropping that individual and refitting the model. Repeating a Cox regression for the removal of each individual is very time consuming and therefore not done in practice. The two methods commonly used to approximate the exact case-deletion change for Cox regression are the empirical influence function approach and the covariate-vector augmentation approach. This paper reports the results of a simulation study on how well these methods estimate the exact change in a parameter estimate when deleting a known outlier or a known non-outlier. Additionally, we investigate how well these methods correctly identify outliers and non-outliers. The covariate augmentation approach clearly outperformed the influence function approach in these simulations.

Adenocarcinoma↗
PubMed2006

Coping strategies and interpersonal support in patients with irritable bowel syndrome and inflammatory bowel disease.

BACKGROUND & AIMS: Coping strategies are used to manage conflict and illness and can have adaptive or maladaptive effects on health status. Perceived availability and quality of social support also influences health status. Coping strategies and social support have not been well studied in irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD). To understand their role better, coping strategies, social support, and psychiatric distress were assessed in patients with IBS and IBD and in controls. METHODS: Participants completed the Ways of Coping Questionnaire, the Interpersonal Support Evaluation, Symptom Checklist-90-revised, IBS-Quality of Life (QOL), and IBD-QOL. Participants also completed the Toronto Alexithymia Scale and Somatosensory Amplification Scale. RESULTS: The study population included 55 controls, 74 IBS patients, and 48 IBD patients. The IBS and IBD patients had higher scores on measures of psychiatric distress, alexithymia, and somatosensory amplification than controls, but did not differ from one another. QOL scores did not differ between patients with IBS and IBD. Patients with IBS and IBD reported significantly less interpersonal support than controls. Controls identified planful problem solving as the dominant coping strategy whereas patients with IBS and IBD relied significantly less on planful problem solving and positive reappraisal and more on escape-avoidance strategies. CONCLUSIONS: Compared with controls, IBS and IBD patients had increased levels of psychiatric distress, a poorer QOL, less interpersonal support, and greater reliance on passive coping strategies. These data suggest that psychosocial disturbances are common in IBD and IBS and suggest that the observed differences reflect illness behavior rather than a disorder-specific process.

Adaptation, Psychological↗
PubMed2006

The Optical Dilator: a clear, over-the-scope bougie with sequential dilating segments.

PURPOSE: The safety and efficacy of esophageal dilation is enhanced when direct visualization is possible, tactile sensation and feedback from resistance is maintained, and multiple dilations with a single passage of the dilating device is an option. The InScope Optical Dilator (InScope, a Division of Ethicon Endo-Surgery, Inc, Cincinnati, Ohio) is a flexible, transparent bougie fitted over a standard endoscope, with 3 dilating segments allowing sequential dilation under direct visualization. We report our experience with this device in treating benign esophageal strictures. METHODS: Patients with solid food dysphagia due to peptic strictures or Schatzki's ring were studied by using a 27F or 29F endoscope. Based on stricture appearance and estimated luminal diameter, 1 of 3 dilator sizes was chosen: IN0216 (14-, 15-, and 16-mm dilating segments), IN0218 (16-, 17-, and 18-mm dilating segments), or IN0220 (18-, 19-, and 20-mm dilating segments). RESULTS: Twenty-six patients were dilated and included 17 peptic strictures and 9 Schatzki's rings. Before dilation, most patients reported difficulties with solids at every meal. Median improvement 3 weeks after dilation was rated by patients as "substantial relief." Patients rated the dilation experience as largely "not at all unpleasant" immediately after endoscopy and had no recollection at 3 weeks' follow-up. There were no complications. Endoscopists rated dilator use as typical of experience with other bougies, and visualization was rated as high. CONCLUSION: The Optical Dilator maintains the value of tactile sensation and the convenience of 3 dilating sizes for each passage of the instrument with the added benefit of direct visualization.

Adolescent↗
PubMed2006

The role of psychosocial factors in peptic ulcer disease: beyond Helicobacter pylori and NSAIDs.

A variety of organic etiologies are associated with peptic ulcer disease, and the most relevant of these are infection with Helicobacter pylori and use of nonsteroidal anti-inflammatory drugs. Between 5% and 20% of patients with gastric or duodenal ulcer, however, lack an identifiable organic etiology. In these patients particularly and in all ulcer patients in general, psychosocial factors may play a significant role. At present, there is no definitive study proving a causal relationship between psychological stress and the development of ulcer disease. Studies to date suffer from significant methodological limitations and have not effectively addressed the poor correlation between ulcer craters and ulcer symptoms. A conservative application of available data would suggest that psychosocial factors play a significant role in symptom perception and reporting in patients with dyspeptic symptoms and may play a role in ulcer formation.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2006

Small intestinal motility.

PURPOSE OF REVIEW: To review recently published studies presenting novel and relevant information on small intestinal motility in humans and animals. RECENT FINDINGS: Mechanisms of intestinal dysmotility in patients with pseudoobstruction and colonic inertia are becoming better clarified. The role of enteric flora in health and disease is an important and rapidly evolving area that will no doubt yield significant advances in the evaluation and treatment of many digestive disorders. The role of bacterial overgrowth in irritable bowel syndrome requires further study. The mechanisms underlying postoperative ileus are becoming both better understood and increasingly complex. Peripheral opioid antagonists may represent an important therapeutic advance in the treatment of ileus. Cannabinoids also appear to play a role in ileus and this echoes our rapidly evolving understanding of these compounds in the regulation of motility. SUMMARY: Small intestinal motility remains an understudied area. Recent publications have shed additional light on myogenic, neural, and hormonal control mechanisms.

Gastrointestinal Motility↗
PubMed2006

The cost-effectiveness of large amalgam and crown restorations over a 10-year period.

OBJECTIVE: To assist clinical decision making for an individual patient or on a community level, this study was done to determine the differences in costs and effectiveness of large amalgams and crowns over 5 and 10 years when catastrophic subsequent treatment (root canal therapy or extraction) was the outcome. METHODS: Administrative data for patients seen at the University of Iowa, College of Dentistry for 1735 large amalgam and crown restorations in 1987 or 1988 were used. Annual costs and effectiveness values were calculated. Costs of initial treatment (large amalgam or crown), and future treatments were determined, averaged and discounted. The effectiveness measure was defined as the number of years a tooth remained in a state free of catastrophic subsequent treatment. Years free of catastrophic treatment were averaged, and discounted. The years free of catastrophic treatment accounted for individuals who dropped out or withdrew from the study. RESULTS: Teeth with crowns had higher effectiveness values at a much higher cost than teeth restored with large amalgams. The cost of an addition year free of catastrophic treatment for crowns was 1088.41 dollars at 5 years and 500.10 dollars at 10 years. Teeth in women had more favorable cost-effectiveness ratios than those in men, and teeth in the maxillary arch had more favorable cost-effectiveness ratios than teeth in the mandibular arch. CONCLUSIONS: Neither the large amalgam or crown restoration had both the lowest cost and the highest effectiveness. The higher incremental cost-effectiveness ratio for crowns should be considered when making treatment decisions between large amalgam and crown restorations.

Adult↗
PubMed2006

New directions in the assessment of gastric function: clinical applications of physiologic measurements.

A variety of methods exist to assess gastric motor and sensory function. Specific techniques allow for the measurement of emptying, contractility, accommodation and sensation. Several of these techniques are suitable for in-office use rather than in a hospital or gastroenterology laboratory. While gastric function tests continue to proliferate and become more clinically accessible, their relevance to specific digestive symptoms or syndromes remains poorly studied. Additionally, the ability of gastric function testing to guide therapy or predict responses to interventions also remains poorly studied. Gastric function testing should be employed cautiously in clinical practice with an awareness that test results represent observations rather than diagnosis.

Breath Tests↗
PubMed2005

Linear signed-rank tests for paired survival data subject to a common censoring time.

In this paper we consider rank-based tests for paired survival data, in which pair members are subject to the same right censoring time. Linear signed-rank tests have already been developed for the two-treatment problem in which pair members receive the opposite treatments. Assuming a bivariate accelerated failure time model, we extend this class of linear signed-rank tests to the case of multiple covariates, making this methodology applicable to more complicated experimental designs. These tests can be reformulated as weighted sums of contigency table measures, giving an alternative method of computation and intuitive view of how these tests work. A simulation study of their small-sample performance relative to other tests demonstrates that the linear signed-rank tests have greater power in cases of moderately to highly correlated data.

Humans↗
PubMed2005

New insights into the pathophysiology of irritable bowel syndrome: implications for future treatments.

Irritable bowel syndrome (IBS) is a multifactorial disorder characterized by abdominal pain and altered bowel habits. Chronic symptoms may occur due to changes in gastrointestinal motor function, enhanced perception of gut stimuli, and psychosocial factors. Recent data suggest that abnormal processing of afferent signals occurs in IBS patients. A newly recognized causative factor in a subset of IBS patients is post-infectious IBS. Altered transport of intestinal gas and bowel distention may contribute to abdominal discomfort, pain, and bloating. Changes in gut microflora have also been reported, but data remain scant. Advances have been made in our understanding of serotonin signaling and metabolism in IBS patients, in part due to the introduction of specific receptor agonists and antagonists. Finally, exciting data are emerging on genetic alterations that may contribute to the pathophysiology and treatment of IBS. Increasingly novel mechanisms are being identified that should aid in better understanding of the complex pathophysiology of IBS and developing new therapies.

Brain↗
PubMed2005

Bloating and intestinal gas.

The most common symptoms associated with intestinal gas are eructation, flatulence, abdominal bloating, and distention. Aerophagia is an uncommon cause of eructation in which repetitive air swallowing results in belching, abdominal distention, and increased flatus. Few therapies have been shown to be effective in treating these symptoms. Eructation can be treated by decreasing excessive air swallowing. Occasionally, behavioral therapy and psychotherapy are employed. Bloating, distention, and other gas-related symptoms are common in functional gastrointestinal disorders; however, their pathophysiology is poorly understood. Additionally, evidence supporting the use of various available therapies in treating gas-related symptoms is either absent or poor. Dietary therapy may be effective in patients with excessive gas production. Excessive gas production, identified by increased flatus, may benefit from a low-carbohydrate diet. Many patients with gas-related symptoms have normal gas production but may have either impaired gas transport or transit through the gut or visceral hypersensitivity. Few studies have addressed the treatment of impaired gas transport.

Journal Article↗
PubMed2005

Clinical predictors of Barrett's esophagus length.

BACKGROUND: Assessment of clinical factors associated with Barrett's esophagus (BE) length remained within the realm of anecdotal reports or one center's experience. The aim of this multicenter study was to determine which clinical factors are highly correlated with the length of BE. METHODS: Patients diagnosed with BE were recruited into the study from 5 academic centers in the United States. All patients had an upper endoscopy that documented BE by the presence of intestinal metaplasia in biopsy specimens. All patients were evaluated by a validated demographic questionnaire and the GERD Symptom Checklist. RESULTS: A total of 263 patients with BE were recruited into the study. Mean BE length length for the entire sample was 4 +/- 3.3 cm. A longer hiatal hernia (r = 0.22, p < 0.01), any dysplasia (t = -2.3, p < 0.05), H2 receptor antagonist (H2-RA) consumption (t = 1.98, p < 0.05), and nonsmoking (t = -2.5, p < 0.05) were correlated with a longer segment of BE. Proton pump inhibitors (PPI) (t = 1.96, p < 0.05) were correlated with a shorter segment of BE. CONCLUSIONS: PPIs were correlated with shorter lengths of BE. In contrast, a longer hiatal hernia, any dysplasia, nonsmoking, or use of H2-RAs were correlated with a longer BE segment.

Adult↗
PubMed2005

Psychosocial correlates of symptoms in functional dyspepsia.

BACKGROUND & AIMS: Psychosocial factors may influence both symptom generation and reporting in functional dyspepsia. We determined the presence and severity of these factors as well as their relationship to dyspeptic symptoms in patients with functional dyspepsia and healthy subjects. METHODS: A total of 151 consecutive patients with functional dyspepsia referred chiefly from primary care clinics and 90 healthy subjects rated 15 dyspeptic symptoms. Participants completed the Medical Outcomes Study SF-36 and Symptom Checklist-90-revised. RESULTS: Functional dyspepsia patients reported significantly higher symptom scores, poorer quality of life, and greater psychiatric distress than healthy subjects. For both patients and healthy subjects, increasing symptom scores were associated with significant decreases in the Physical but not the Mental Components Summary of the Medical Outcomes Study SF-36. Although functional dyspepsia patients showed significantly greater psychiatric distress than healthy subjects, symptoms were correlated only modestly with scores on the Symptom Checklist-90-revised. A number of symptoms showed significant but modest correlations ( r s < .30) with the somatization scale with chest burning correlating most strongly ( r s = .48). Chest burning also was correlated significantly with depression, anxiety, and phobic anxiety. Functional dyspepsia patients at a secondary level of care have greater symptom severity, poorer quality of life, and greater psychiatric distress than healthy subjects. Increasing symptom severity is associated with poorer quality of life primarily in the areas of physical and social functioning. With the exception of chest burning, symptoms are not correlated highly with psychiatric distress. CONCLUSIONS: These data suggest that although functional dyspepsia patients experience increased psychiatric distress, symptom severity and psychiatric distress are not associated strongly.

Adult↗
PubMed2005

Small intestinal motility.

PURPOSE OF REVIEW: To review recently published studies presenting novel and relevant information on small intestinal motility in humans and animals. RECENT FINDINGS: The reviewed studies covered a variety of topics with several themes emerging. The relation between bacterial overgrowth and altered intestinal motility gathers support in a variety of conditions including portal hypertension and senescence. The mechanisms of postoperative ileus are becoming better understood. Cannabinoids play an important role in ileus and this further highlights the importance of these compounds in intestinal motility. Luminal impedance appears to be an important tool for investigation of intestinal flow. SUMMARY: Small intestinal motility remains an understudied area. Recent publications have shed additional light on myogenic, neural, and hormonal control mechanisms. Novel investigative techniques will likely further improve our understanding.

Animals↗
PubMed2005

Symptom reporting by functional dyspeptics during the water load test.

INTRODUCTION: Reporting of symptoms and visceral sensations in functional dyspepsia is subjective and influenced by such factors as somatization and depression. To better understand the role of these factors in symptom reporting, somatization, somatosensory amplification, alexithymia, and depression were evaluated in patients with functional dyspepsia undergoing a water load test. METHODS: Sixty-seven controls and 103 patients with functional dyspepsia underwent a 5-min water load. Participants both recalled dyspeptic symptoms from the previous 2 wk and rated symptoms of nausea, fullness, and bloating during water load. Participants also completed the symptom checklist-90-R, somatosensory amplification scale, and the Toronto alexithymia scale. RESULTS: Compared with controls, patients with dyspepsia had greater psychiatric distress and higher scores for somatosensory amplification and alexithymia. Patients with dyspepsia also reported fullness at significantly lower volumes of water and experienced greater symptoms during water load than controls. Receiver operator characteristics of water load volume and provoked symptoms suggested that water load (WL) volume was a better discriminator of patients with dyspepsia from controls. Patients with dyspepsia recalled significantly more symptoms in the 2 wk prior to study. Symptoms provoked during WL were not associated with measured psychiatric constructs in either controls or patients with dyspepsia whereas recalled symptoms in patients with functional dyspepsia were significantly associated with several measured psychiatric constructs. CONCLUSIONS: Patients with functional dyspepsia report fullness at lower volumes of ingested water and develop more symptoms than do controls. Water load volume better discriminates patients with dyspepsia from controls than does symptoms provoked during water load. Provoked symptoms in dyspepsia are not associated with measured psychiatric constructs but recalled symptoms are.

Adult↗
PubMed2005

Teeth with large amalgam restorations and crowns: factors affecting the receipt of subsequent treatment after 10 years.

BACKGROUND: The authors evaluated the factors associated with the receipt of subsequent treatment by teeth restored with a large amalgam restoration or a large amalgam restoration and crown restoration after 10 years. METHODS: The authors used retrospective data from the University of Iowa College of Dentistry (Iowa City, Iowa) administrative database and patient records to evaluate patient and tooth factors for their association with the two primary outcomes: receipt of any subsequent treatment and receipt of catastrophic treatment (extraction, endodontic therapy). RESULTS: The authors followed 518 teeth over a 10-year period (49 percent with large amalgam restorations and 51 percent with crowns). Sixty-four percent of the large amalgam restorations and 32 percent of the crowns received subsequent treatment during the 10 years. In addition to restoration type, the patient's sex, history of grinding teeth and having a broken tooth were related to the tooth's receiving subsequent treatment. Twenty-two percent of large amalgam restorations and 12 percent of crowns received catastrophic treatment with the odds of teeth with large amalgam restorations receiving a catastrophic treatment being 2.1 times the odds of teeth with crowns receiving catastrophic treatment. CONCLUSIONS: Teeth with crowns were less likely to receive any treatment or catastrophic treatment over 10 years than were teeth with large amalgam restorations. Patient and tooth factors also were related to a tooth experiencing subsequent treatment. CLINICAL IMPLICATIONS: Teeth with crowns received less subsequent treatment than teeth with large amalgam restorations. This could be related to both the difference in longevity between the two restorations, as well as how appropriately treatment was planned for each procedure. Cost differences between the two restorations need to be factored into the decision-making process.

Adult↗
PubMed2004

Achalasia treatment: improved outcome of laparoscopic myotomy with operative manometry.

HYPOTHESIS: Operative manometry detects residual esophagogastric junction (EGJ) high pressure, ensuring complete myotomy. DESIGN: Consecutive patients undergoing laparoscopic myotomy. SETTING: Tertiary care academic medical center. PATIENTS: From 1997 to 2003, 139 patients with achalasia underwent laparoscopic myotomy. INTERVENTIONS: We assessed myotomy completeness by operative endoscopy and performed operative manometry to measure pressure across the EGJ myotomy. Residual high pressure was isolated and intact muscle divided. MAIN OUTCOME MEASURES: Esophageal manometry, quality of life, and dysphagia severity score. RESULTS: Median lower esophageal sphincter pressure was 27 mm Hg preoperatively; 10 patients had sigmoid esophagus and 57 had previous dilation and/or toxin injection. There were 136 laparoscopic myotomies and 3 conversions to open procedures (2%). Operative endoscopy was performed in all patients. Operative manometry, completed in 132 patients (95%), identified residual EGJ high pressure leading to myotomy revision in 45 patients (31 in the first 70 treated). Small perforations occurred in 19 patients, associated with previous dilation and/or toxin injection in 12 patients. One-month follow-up was available in 136 patients (98%); 126 patients had minimal symptoms (93%), whereas 1 had recurrent EGJ high pressure, 5 esophagitis, 3 sigmoid esophagus, and 1 paraesophageal hernia. In 60 patients with complete 1-year follow-up, quality of life and dysphagia improved (P <.05); mean lower esophageal sphincter pressure decreased to 7.6 mm Hg (P <.05). CONCLUSIONS: Operative manometry identifies residual EGJ high pressure and reduces the incidence of incomplete myotomy. Laparoscopic myotomy improves quality of life and dysphagia symptoms and may be the treatment of choice in most patients with achalasia.

Adult↗