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N Mills

Publications and source records attributed to N Mills.

At least 19 recordsLinked to original sources
PubMed2002

Capturing users' experiences of participating in cancer trials.

Randomized controlled trials are accepted to be the research design of choice to evaluate the effectiveness of health care interventions and are commonly used to evaluate cancer treatments. There are concerns, however, that levels of recruitment to trials are often much lower than anticipated, particularly in cancer trials. Several research methods have been used to collect aspects of users' experiences of participating in cancer trials. Perhaps the most common method has been through measures of outcome and the impact of treatments on quality of life (QoL), using standardized schedules to capture physical, social and psychological health. In some areas of cancer, individual patient testimonies illuminate particular issues or narratives. Another body of research has grown around issues of user involvement in trials, including surveys of recruitment and participation, as well as investigations of patient preferences and experiences of participation. We searched MEDLINE and the Cochrane Trials Library from 1995 to 2001 for relevant publications. In this article, we review the literature in these areas and examine whether users' experiences of participating in cancer trials can be used to assist in the design or conduct of trials.

Female↗
PubMed2001

Predator-induced stress makes the pesticide carbaryl more deadly to gray treefrog tadpoles (Hyla versicolor).

Global declines in amphibians likely have multiple causes, including widespread pesticide use. Our knowledge of pesticide effects on amphibians is largely limited to short-term (4-d) toxicity tests conducted under highly artificial conditions to determine lethal concentrations (LC50). We found that if we used slightly longer exposure times (10-16 d), low concentrations of the pesticide carbaryl (3-4% of LC50(4-d)) killed 10-60% of gray treefrog (Hyla versicolor) tadpoles. If predatory cues also were present, the pesticide became 2-4 times more lethal, killing 60-98% of tadpoles. Thus, under more realistic conditions of increased exposure times and predatory stress, current application rates for carbaryl can potentially devastate gray treefrog populations. Further, because predator-induced stress is ubiquitous in animals and carbaryl's mode of action is common to many pesticides, these negative impacts may be widespread in nature.

Animals↗
PubMed2000

Effects of thyroid hormone on Leydig cell regeneration in the adult rat following ethane dimethane sulphonate treatment.

We tested the effects of thyroid hormone on Leydig cell (LC) regeneration in the adult rat testis after ethane dimethyl sulphonate (EDS) treatment. Ninety-day-old, thyroid-intact (n = 96) and thyroidectomized (n = 5) male Sprague-Dawley rats were injected intraperitoneally (single injection) with EDS (75 mg/kg) to destroy LC. Thyroid-intact, EDS-treated rats were equally divided into three groups (n = 32 per group) and treated as follows: control (saline-injected), hypothyroid (provided 0.1% propyl thiouracil in drinking water), and hyperthyroid (received daily subcutaneous injections of tri-iodothyronine, 100 microg/kg). Testing was done at Days 2, 7, 14, and 21 for thyroid-intact rats and at Day 21 for thyroidectomized rats after the EDS treatment. Leydig cells were absent in control and hyperthyroid rats at Days 2, 7, and 14; in hypothyroid rats at all ages; and in thyroidectomized rats at Day 21. The LC number per testis in hyperthyroid rats was twice as those of controls at Day 21. 3beta-Hydroxysteroid dehydrogenase (LC marker) immunocytochemistry results agreed with these findings. Mesenchymal cell number per testis was similar in the three treatment groups of thyroid-intact rats on Days 2 and 7, but it was different on Days 14 and 21. The highest number was in the hypothyroid rats, and the lowest was in the hyperthyroid rats. Serum testosterone levels could be measured in control rats only on Day 21, were undetectable in hypothyroid rats at all stages, and were detected in hyperthyroid rats on Days 14 and 21. These levels in hyperthyroid rats were twofold greater than those of controls on Day 21. Serum androstenedione levels could be measured only in the hyperthyroid rats on Day 21. Testosterone and androstenedione levels in the incubation media showed similar patterns to those in serum, but with larger values. These findings indicate that hypothyroidism inhibits LC regeneration and hyperthyroidism results in accelerated differentiation of more mesenchymal cells into LC following the EDS treatment. The observations of the EDS-treated, thyroidectomized rats confirmed that the findings in hypothyroid rats were, indeed, due to the deficiency of thyroid hormone.

Androstenedione↗
PubMed1999

Effect of a primary-care-based epilepsy specialist nurse service on quality of care from the patients' perspective: quasi-experimental evaluation.

Initiatives to improve epilepsy care have emphasized the role of specialist nurses. Formal evaluation of these initiatives are scarce. Further evaluative studies are required to ascertain the optimal means of providing epilepsy care. This study aimed to assess the effect of a primary-care-based epilepsy specialist nurse service on patients' reported health status, perceived quality of life, health care use, attitudes to health care, and provision of information. A quasi-experimental follow-up questionnaire survey was sent to all 574 patients aged 16 years or over and receiving antiepileptic drugs for epilepsy, registered in 14 general practices in north-west Bristol. Patients in seven practices who received the new service (intervention patients) were compared with patients in seven practices who did not (control patients). Follow-up comparisons between intervention and control patients were adjusted for baseline differences. Response rates to the first, second and both surveys were 66.2%, 68.6% and 50.9%, respectively. Intervention patients were more likely than control patients to have discussed most epilepsy topics with general practitioners and/or hospital doctors. and were significantly more likely to have categorized general practitioner care as excellent (odds ratio (OR) 2.30, 95% confidence intervals (CI) 1.12-4.70). Intervention patients were significantly less likely than controls to have reported never missing taking their anti-epileptic drugs (OR 0.48, 95% CI0.24-0.94). There were no significant changes in measures of health status, use of other health care services, and perceived quality of life between intervention and control patients. This study provides evidence of an improvement, after 1 year, in communication and satisfaction but not health status resulting from the introduction of a primary-care-based epilepsy service.

Adult↗
PubMed1999

Effect of a primary care based epilepsy specialist nurse service on quality of care from the patients' perspective: results at two-years follow-up.

Epilepsy specialist nurses have the potential to improve the quality of care of community-based patients with epilepsy, although evidence of their effectiveness is limited by the lack of formal or long-term evaluation. Results of a controlled trial that assessed the effectiveness of a primary care based specialist nurse-led service suggested improvements in communication and satisfaction but not health status at one-year follow-up. A second follow-up was conducted to assess the effects after two years. Patients who reported having seen the nurse at least once in the two years ('users') were compared with those who had not ('non-users'). Comparisons between users and non-users were adjusted for baseline differences. Results were based on 40% of all 595 adult patients known to have epilepsy in 14 general practices and who answered questionnaires at baseline and two years later. The new epilepsy service was used more by those with greatest needs for care. Users of the new service were significantly more likely than non-users to have discussed 8 of 11 topics asked about epilepsy [odds ratios (ORs) ranging from 2.42 to 7.91] with their general practitioner (GP), and 2 of the 11 topics with the hospital doctor (ORs 5.59, 5. 74). Service users were significantly less likely than non-users to feel their GP knew enough about epilepsy [OR 0.27, 95% confidence intervals (CI) 0.74-0.98], and significantly more likely to report epilepsy as having an adverse impact on 3 of 10 areas of everyday life (ORs ranging from 2.09 to 2.50). Users were more likely than non-users to have seen their GP for any reason in the previous year and to change their medication from use of more than one antiepileptic drug to monotherapy, although findings were not significant. Results suggest that the epilepsy specialist nurse service is not a cost-reducing substitute, particularly for general practitioner care, but it appears to improve communication and prescribing of monotherapy, and increases access for the most needy. The service may, however, have an adverse impact on patients' perceptions of the effects of epilepsy on aspects of everyday life.

Adult↗
PubMed1997

Patients' experience of epilepsy and health care.

OBJECTIVE: The aim of this study was to assess the severity of epilepsy and its effect on patients lives, and to describe patients' use of and attitudes to health care. METHOD: A questionnaire was sent to 595 people with epilepsy identified from 14 general practices in north-west Bristol. All patients aged 16 years and over receiving anti-epileptic medication for their epilepsy were included in the study. Areas investigated included severity of epilepsy and its effect on quality of life, anti-epileptic medication and its perceived effect, health care utilization and preferences for health care. RESULTS: Seizure frequency was strongly associated with adverse effects of epilepsy. Attacks of epilepsy were experienced at least monthly by 20.4% (95% confidence intervals (Cl) 17.0-23.7%) of patients, 29.4% (25.4-33.4%) took more than one anti-epileptic drug, 56.1% (50.1-62.2%) reported drug side effects, 74.1% (70.3-77.8%) would prefer to receive all or most of their epilepsy care in a general practice setting, and 69.8% (63.5-76.2%) would like contact with a primary care-based epilepsy specialist nurse. During the previous year 42.4% (35.9-48.8%) of patients had not seen a doctor about their epilepsy. Of patients who had attended the general practice only 13.4% (9.6-17.2%) had regular arrangements to see their GP about epilepsy. Patients receiving both primary and secondary care had the greatest needs and wants for improved care. CONCLUSIONS: Structured care, including regular appointments, co-ordination of primary and secondary care, and increased monitoring and discussion, may improve the quality of life of people with epilepsy, but requires evaluation.

Adolescent↗
PubMed1989

Coronary artery bypass grafting in the presence of valvular disease.

Compared with isolated coronary artery bypass grafting (CABG), the combination of valve replacement or repair with coronary revascularization generally increases operative risk. However, complete revascularization is superior to no revascularization in patients with valvular and coronary artery disease (CAD). Patients who undergo aortic valve replacement and CABG have two unrelated disease processes; these patients only infrequently have ischemic cardiomyopathy, and the operative mortality is slightly increased to 4-7% for the combined procedure versus isolated aortic valve replacement. Patients who are operated on for mitral valve disease and CAD fall into two groups: 1) where CAD and mitral valve disease are not etiologically related, and 2) where mitral valve dysfunction is the result of ischemic changes. In the latter group, operative mortality significantly exceeds that for isolated mitral valve surgery, and surgical priority increases that difference (operative mortality 7-20%). Thus, the operative risk for a mitral valve procedure plus CABG exceeds that for isolated coronary revascularization or isolated valve replacement. In the combined procedure, risk increases if valve dysfunction is caused by CAD, if severe left ventricular function is present, if the patient has been assigned to Class IV, or if emergency operation is required.

Aortic Valve↗
PubMed1986

Depression and food intolerance: a single case study.

The detection and treatment of psychological dysfunction related to food intolerance with particular reference to the problem of objective evaluation is discussed. The case is described of a woman with chronic depression who exhibited classic signs of food intolerance and yet had remained untreated for over 10 years. A non-invasive procedure involving systematic monitoring of diet and symptoms, systematic eliminations and a double-blind, placebo-controlled re-introduction is described. Long-term follow-up revealed maintenance of marked improvements in psychological and physical functioning.

Depression↗
PubMed1985

Insulin-related genes expressed in human placenta from normal and diabetic pregnancies.

Rapid growth of human fetal tissues requires insulin or insulin-like growth factors. A high rate of human fetal growth occurs between implantation and about 14 weeks of gestation. Fetal pancreatic insulin secretion begins much later. Since maternal insulin does not cross the blood/placental barrier, other sources of insulin or insulin-like growth factors may be provided for fetal development. We report here that placental polyadenylylated RNAs from the first and third trimester of normal pregnancy as well as from term pregnancies of diabetic mothers hybridize to a 32P-labeled cloned cDNA of an insulin-related sequence expressed in fetal pancreas. Moreover, placentas from diabetic women express much more of these sequences. These results suggest that insulin-related genes are expressed in placental tissue during fetal development and may be a source of growth-promoting hormones for the human fetus. Fetuses developing in diabetic women receive a large influx of glucose. This in turn may stimulate the expression of insulin-related sequences, which may result in higher utilization of glucose, thus bringing about the macrosomia and high incidence of malformation and still-births known to result from pregnancies in diabetics.

DNA↗
PubMedDate not supplied

Transient changes in cortical alpha 1 adrenoceptors and seizure threshold following electroconvulsive seizures in rats.

Alpha 1 adrenoceptor density (Bmax) is consistently decreased in actively spiking human cortical epileptic foci. Interpretation of these unique human data is limited because all surgical excisions are completed shortly after a period of active seizure discharge. To determine the temporal profile of seizure-induced changes in cortical alpha 1 adrenoceptors we examined rats primed by 15 daily electroconvulsive seizures (ECS). Since the noradrenergic system has an inhibitory effect on epileptic activity, we also measured the postictal rise in minimal ECS seizure threshold. Animals were sacrificed immediately before or at intervals after the last scheduled seizure. Cortical membranes were assayed using [3H]prazosin as specific radioligand. Repeated ECS produced an increase in the number of cortical alpha 1 sites from 4 to 24 h postictally, but following the last seizure there was a transient 'normalization' of alpha 1 receptor density which persisted for 3 h. The postictal ECS seizure threshold also remained elevated for a 2 h period. Both these transient postictal changes may in part result from activation of the central NA system. Decreased alpha 1 adrenoceptors in surgical specimens of spiking cerebral cortex may also be a secondary response to focal seizure activity.

Animals↗
PubMedDate not supplied

Mindfulness of movement as a coping strategy in multiple sclerosis. A pilot study.

This study investigated the effectiveness of a short course of mindfulness of movement to help with symptom management in eight people with multiple sclerosis. Progress was compared to a control group who were asked to continue with their current care. Each participant received six individual one-to-one sessions of instruction. They were also provided with audio and videotape aides. Each participant was assessed on a test of balance, pre- and post-intervention, and at 3-month follow-up. All participants completed a rating of change of 22 symptoms relevant to multiple sclerosis. A close relative or friend was also asked to assess independently the degree of change. The mindfulness group reported improvement over a broad range of symptoms. This was verified by the relatives' independent rating and maintained at 3 month follow-up. The control group showed no improvement but instead tended towards a deterioration on many of the items. The physical assessment of balance also showed a significant improvement for the mindfulness group. This improvement was maintained at 3 month follow-up. In conclusion, training in mindfulness of movement appeared to result in improved symptom management for this group of people with multiple sclerosis. This was a pilot study, using small numbers, so the results need to be treated with caution. Several improvements to the experimental design are suggested. The role of individual therapeutic ingredients is discussed.

Activities of Daily Living↗