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Biomedical subjects

N Preston

Publications and source records attributed to N Preston.

8 recordsLinked to original sources
PubMed2001

HoNOS: is there any point in training clinicians?

This study examines the impact of training and clinical experience on the inter-rater reliability of the HoNOS. Following either standard or modified HoNOS training, two groups of registered mental health nurses (RMHNs) were tested for inter-rater reliability (IRR) using a standard case vignette. In addition, another group of nurses and two nonclinical comparison groups had their IRR tested using the same vignette but without receiving any HoNOS training. There was no significant difference between IRR scores post-training compared with the pre-training scores. This is the case whether the recommended or modified training programmes were used. In addition, there is no significant difference between nurses and the comparison group, characterized by nonclinical work experience in a mental health setting. All four groups achieved adequate IRR. Finally, the comparison group with no regular exposure to mental health patients but experience using rating scales are significantly less reliable than the other four groups. The results suggest two possible interpretations. The first is that the HoNOS scales are so well designed that only familiarity with psychiatric patients and no experience with rating scales is sufficient to achieve adequate IRR even without training. Alternatively, the use of written vignettes does not provide a valid measure of HoNOS IRR.

Clinical Competence↗
PubMed2000

Pathways and outcomes of psychiatric care: does it depend on who you are, or what you've got?

OBJECTIVES: To investigate predictors of outcome and cost for patients treated by Mental Health Services in the south metropolitan area of Perth using logistic regression to control for potential confounding factors. METHOD: Data were collected over a 3-month period on 2691 subjects (47% male, 53% female) as part of the Mental Health Classification and Services Cost Project. RESULTS: The average age of subjects was 44.3 years. Nearly 80% of care occurred in community settings and virtually all inpatient care was for acute emergencies. The most common diagnosis was schizophrenia (33%) followed by mood disorders (30%). Within the study period, 88% of patients had only one episode of care (n = 2361) and a further 8% two (n = 223). Patients with schizophrenia were one-third as likely to be discharged from care (95% CI = 0.2-0.4) and 30% as likely to have longer episodes of care (95% CI = 1.1-1.6). Patients with personality, substance or adjustment disorders spent less time in treatment, and those with personality or substance disorders were more likely to be discharged from psychiatric care. A past history of inpatient care was associated with a worse outcome in terms of length of care, or not being successfully discharged. Severity of illness as determined by involuntary treatment or elevated Health of the Nation Outcome Scales and Life Skills Profile (LSP) scores was associated with increased costs. Greater disability on the LSP was also associated with increased length of care. Sociodemographic factors were as least as important as diagnosis in predicting the cost and outcome of treatment. CONCLUSIONS: Demographic factors may better predict increased health service use than diagnostic casemix. Since sociodemographic variables contribute as much to outcome as diagnosis, comparing results between units is likely to be misleading unless adjusted for these factors.

Adult↗
PubMed2000

Monitoring skeletal response to treatment which site to measure in the femur?

In the past it was usual to interpret bone mineral density (BMD) scans of the femur using the femoral neck, trochanter, or Ward's triangle sites. Recently, a study by the International Committee for Standards in Bone Measurement recommended that the total hip should be the preferred site for the interpretation of femur BMD, and another study described a new central hip site that may offer improved precision. This article compares the longitudinal sensitivities of the different femur BMD sites for monitoring patient response to treatment. The study population was 152 postmenopausal women enrolled in a trial of a bisphosphonate therapy. Spine and hip BMD scans were performed at 0, 1, and 2 yr. The mean percentage change at 2 yr was calculated for six sites in the hip, and the spine was also included for comparison. Treatment effect was defined as the difference in the BMD change between the treated and placebo groups. Although the data analysis incorporated a term for a calibration change caused by a repair of the dual X-ray absorptiometry scanner, the effect of this event on the estimation of treatment effect was negligible. Longitudinal sensitivity was derived by dividing the treatment effect by the root mean square error (RMSE) of the statistical model. Results (and standard errors) normalized to the ratio of treatment effect: RMSE for femoral neck BMD were as follows: femoral neck: 1.00; trochanter: 1.33 (0.38); intertrochanteric: 0.84 (0.41); total hip: 1.20 (0.38); Ward's triangle: 1.03 (0.27); central hip: 1.09 (0.30); spine: 2.08 (0. 45). At none of the femur sites was the change in BMD large enough to allow monitoring of response to treatment in individual patients. However, for studies involving the follow-up of a group of subjects, the longitudinal sensitivities of the different femur sites were equal within the statistical errors of the study. In particular, total hip BMD appears to be as effective as femoral neck BMD for detecting response to treatment in the femur in the setting of a clinical trial or similar research study.

Absorptiometry, Photon↗
PubMed1995

Platinum-Taxol non-cross resistance in epithelial ovarian cancer.

The aim of this study was to assess the clinical evidence for platinum-Taxol non-cross-resistance in patients with epithelial ovarian cancer. Unlike other studies, only patients who had demonstrably progressive disease on platinum therapy were analysed. Patients received 135-200 mg m-2 of Taxol over 3 or 24 h and all patients were assessed for response by computerised axial tomography. The overall response rate was 22.2% (8/36 patients, 95% CI 10-39%). Only patients who received > or = 175 mg m-2 of Taxol responded (26.7%; 8/30 patients, 95% CI 12-46%). No complete responses were seen and the duration of response was short, median 7 months (range 5-9+). Response was associated with a short treatment-free interval (P = 0.02); only those who were treated immediately after they had progressed on their previous platinum therapy responded. Response duration was associated with a good performance status (P < 0.05). Platinum and Taxol are non-cross-resistant in a proportion of patients and therefore patients who are resistant to platinum compounds may benefit from Taxol although the duration of any response is short. These data support current strategies that involve combining Taxol with platinum compounds as first-line therapy in advanced epithelial ovarian cancer.

Adult↗
PubMed1995

New strategies for the management of malignant ascites.

Intractable malignant ascites accounts for 6% of all hospice admissions. The onset of malignant ascites indicates a poor prognosis, hence minimal supportive therapy is indicated. This paper examines the method of control for malignant ascites presently available to patients, examines their limitations and proposes new strategies for managing intractable malignant ascites. Ascites is discussed in terms of its pathology--that is, as a form of lymphoedema. With this in mind treatment is proposed based upon principles incorporated into lymphoedema management. Nurses have taken a dominant role in the care of patients with lymphoedema and there appears no reason why ascites management cannot become the remit of nurses offering appropriate, but predominantly palliative therapy.

Ascites↗
PubMed1990

Generalised protothecosis in a collie dog.

A case of generalised protothecosis in a Collie dog is discussed. A long-standing history of severe colitis was the major clinical sign. Dissemination to many organs was confirmed histologically. Possible pathogenesis is discussed along with a review of the literature. The possibility of a breed disposition in Collie dogs is discussed. The organisms are ubiquitous in the environment and generalised disease suggests the possibility of immune competence.

Animals↗