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Biomedical subjects

N Gillespie

Publications and source records attributed to N Gillespie.

11 recordsLinked to original sources
PubMed1999

Somatic distress as a distinct psychological dimension.

BACKGROUND: Somatoform disorders such as neurasthenia and chronic fatigue are characterized by a combination of prolonged fatigue and disabling neuropsychological and neuromuscular symptoms. However, the debate concerning the theoretical underpinnings of somatic disorders resembles the perennial dispute over the taxonomy of anxiety and depression. The objective of this study is to analyse the dimensional structure of items measuring anxiety, depression, phobic anxiety, somatic distress, and insomnia. It is anticipated that somatic distress should emerge as empirically distinct from measures of anxiety and depression, thereby lending support to proponents of the construct as independent of both anxiety and depression symptomatology. METHODS: A 33-item self-report symptom inventory derived from the SCL-90 and DSSI/sAD scales was used to measure recently experienced psychiatric distress in the form of depression, anxiety, phobic anxiety, somatic distress, and insomnia. SCL and DSSI/sAD items were measured on a four-point distress scale from 1 'not-at-all' to 4 'unbearably'. The inventory was administered to a community-based sample of 3468 Australian twins between the ages of 18 and 28. RESULTS: Factor analysis using Polychoric correlations and a Promax rotation criterion produced four factors: depression, phobic anxiety, somatic distress, and sleep disturbance. CONCLUSION: Results from the current factor analysis, together with the documented prevalence of somatic disorders, including evidence regarding the genetic and biological independence of somatic symptomatology, lend support to the argument that somatic symptoms, although correlated, are independent of anxiety and depression.

Adult↗
PubMed1999

Use of tissue glue in field situations.

Tissue glues are in widespread use in Accident & Emergency departments, and are simple to use. Results of closure of uncomplicated wounds using glue are comparable to traditional methods such as suture, 'sterile strips'. There are certain times in the field situation where evacuation of a casualty with a simple laceration could be impossible. These circumstances could be suitable for an individual suitably trained to effect wound closure using a tissue glue. This study simply set out to establish whether it was possible to train an infantry soldier how and when to close a wound using a tissue glue. A short period of instruction was followed by a practical session using wound simulators. It was found that the theoretical concepts and practical skills required to successfully glue a simulated wound were readily acquired by infantry soldiers, irrespective of their previous level of first aid training. The authors suggest that this concept should be pursued with the aim of field trials of cyanoacrylate tissue adhesives being carried out.

Cyanoacrylates↗
PubMed1998

Cross-modal links in exogenous covert spatial orienting between touch, audition, and vision.

Three experiments investigated cross-modal links between touch, audition, and vision in the control of covert exogenous orienting. In the first two experiments, participants made speeded discrimination responses (continuous vs. pulsed) for tactile targets presented randomly to the index finger of either hand. Targets were preceded at a variable stimulus onset asynchrony (150, 200, or 300 msec) by a spatially uninformative cue that was either auditory (Experiment 1) or visual (Experiment 2) on the same or opposite side as the tactile target. Tactile discriminations were more rapid and accurate when cue and target occurred on the same side, revealing cross-modal covert orienting. In Experiment 3, spatially uninformative tactile cues were presented prior to randomly intermingled auditory and visual targets requiring an elevation discrimination response (up vs. down). Responses were significantly faster for targets in both modalities when presented ipsilateral to the tactile cue. These findings demonstrate that the peripheral presentation of spatially uninformative auditory and visual cues produces cross-modal orienting that affects touch, and that tactile cues can also produce cross-modal covert orienting that affects audition and vision.

Adolescent↗
PubMed1997

Diagnosing left ventricular dysfunction after myocardial infarction: the Dundee algorithm.

Large-scale trials of angiotensin converting enzyme (ACE) inhibitors after acute myocardial infarction (AMI) suggest that the benefits are greatest in patients with left ventricular (LV) dysfunction. However, early evaluation of LV function in all patients after AMI by current methods can be difficult due to a lack of resources and skilled personnel. Thus a clinical algorithm that could be used at the bedside to reliably identify patients with a left ventricular ejection fraction (LVEF) < or = 40% would be helpful as an occasional alternative to echocardiography. We have devised such an algorithm based on the presence of one of: (i) clinical signs of heart failure; (ii) an index Q-wave anterior myocardial infarction; (iii) lack of thrombolytic therapy when there is a history of two or more previous myocardial infarctions and a CK rise > 1000 U/l. We tested this new algorithm prospectively in the coronary care units of two hospitals (one UK and one USA). In the UK centre, the sensitivity and specificity of the algorithm at identifying patients with a LVEF < or = 40% were 82% and 72%, respectively. In the US centre, the sensitivity of the algorithm was 91% and the specificity 78% at identifying patients with LV dysfunction. We have validated a simple clinical algorithm which can be used at the bedside for identifying patients who would benefit from an ACE inhibitor after AMI.

Aged↗
PubMed1996

Prediction of late cardiac events by dipyridamole thallium scintigraphy in patients with intermittent claudication and occult coronary artery disease.

Concomitant coronary artery disease often occurs in patients with peripheral vascular disease, but it may be asymptomatic. Despite being asymptomatic, cardiovascular events are the main source of morbidity and mortality in this group of patients. Dipyridamole thallium scintigraphy has been shown to be of prognostic value in patients with peripheral vascular disease and symptomatic coronary artery disease, but its effect on the long-term outcome in the asymptomatic group of patients is less defined. Eighty-four consecutive patients with peripheral vascular disease and no symptoms of coronary artery disease were therefore evaluated by clinical assessment, dipyridamole thallium imaging, radionuclide ventriculography, and cardiac catheterization and followed for a mean of 66 months. Abnormal perfusion patterns were found on thallium scintigraphy in 48 patients (57%); fixed, mixed, and reversible defects were present in 14 (17%), 11 (13%), and 23 (27%) patients, respectively. Significant coronary artery disease was present in 52 patients (69%) and mean left ventricular ejection fraction was 44%. During the follow-up period, 23 patients had a cardiac event (nonfatal myocardial infarction or cardiac death). Univariate analysis of 15 clinical, scintigraphic, radionuclide, and angiographic variables revealed that age, angiographic extent of coronary artery disease, and an abnormal thallium scan were significant predictors of subsequent cardiac events. Multivariate stepwise logistic regression analyses selected fixed and mixed thallium defects and diffuse coronary artery disease as the only significant independent predictors of outcome. Thus, the present study shows the value of dipyridamole thallium scintigraphy as a valuable prognostic indicator for long-term event-free survival in a cohort of patients with peripheral vascular disease and no history or symptoms of coronary artery disease.

Aged↗
PubMed1996

Diagnostic value of B-type natriuretic peptide concentrations in patients with acute myocardial infarction.

Although elevations of plasma atrial natriuretic peptide (ANP) concentrations have been shown to have prognostic significance in patients after acute myocardial infarction (AMI), the relation between plasma levels of B-type natriuretic peptide (BNP) and cardiovascular mortality remains unknown. To test the prognostic value of plasma ANP and BNP after AMI, plasma concentrations were measured a mean of 3 days after infarction in 75 patients. During a median follow-up of 19.7 months, 14 patients (18.4%) died of cardiovascular causes. On univariate analysis, plasma ANP and BNP, Killip class, modified Peel index, left ventricular ejection fraction, and presence of left ventricular failure were all associated with cardiovascular mortality. In contrast, plasma ANP was the only variable that correlated with the development of symptomatic heart failure and hospitalization. For the combined end point of cardiovascular mortality, symptomatic heart failure, and hospitalization, plasma neurohormones were the only variables of predictive value. By stepwise regression analysis, plasma BNP was the only significant independent predictor of cardiovascular mortality (p = 0.001), whereas plasma ANP identified patients at risk of symptomatic heart failure and hospitalization (p = 0.002 and 0.019, respectively). This study indicates that plasma BNP measured after AMI is a powerful neurohormonal predictor of subsequent cardiovascular mortality, whereas plasma ANP correlates better with the development of symptomatic heart failure and hospitalization. Routine measurement of both of these peptides in the period immediately after an AMI may provide a simple means of risk stratification with different information gained from each peptide.

Adult↗
PubMed1987

A putative mediator of insulin action which inhibits adenylate cyclase and adenosine 3',5'-monophosphate-dependent protein kinase: partial purification from rat liver: site and kinetic mechanism of action.

A novel putative mediator of insulin action which acts to inhibit adenylate cyclase and cAMP-dependent protein kinase has been purified from livers of insulin-treated streptozotocin-diabetic rats. It was increased by short term (5-min) insulin injections in vivo and purified several thousand-fold by Sephadex and HPLC. Its mol wt was somewhat larger (2500) than previous mediators identified, and it was more hydrophobic in character. Its mechanism of action or adenylate cyclase was determined and found to be chiefly directed against the catalytic subunit. Its action on the cAMP-dependent protein kinase was found to be competitive with regard to protein substrate, but noncompetitive with regard to ATP and cAMP. Its relationship to other putative insulin mediators and the mechanism of insulin action is discussed.

Adenosine Triphosphate↗