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O F W James

Publications and source records attributed to O F W James.

8 recordsLinked to original sources
PubMed2005

Development, validation, and evaluation of the PBC-40, a disease specific health related quality of life measure for primary biliary cirrhosis.

BACKGROUND AND AIMS: Study of health related quality of life (HRQOL) and the factors responsible for its impairment in primary biliary cirrhosis (PBC) has, to date, been limited. There is increasing need for a HRQOL questionnaire which is specific to PBC. The aim of this study was to develop, validate, and evaluate a patient based PBC specific HRQOL measure. SUBJECTS AND METHODS: A pool of potential questions was derived from thematic analysis of indepth interviews carried out with 30 PBC patients selected to represent demographically the PBC patient population as a whole. This pool was systematically reduced, pretested, and cross validated with other HRQOL measures in national surveys involving a total of 900 PBC patients, to produce a quality of life profile measure, the PBC-40, consisting of 40 questions distributed across six domains. The PBC-40 was then evaluated in a blinded comparison with other HRQOL measures in a further cohort of 40 PBC patients. RESULTS: The six domains of PBC-40 relate to fatigue, emotional, social, and cognitive function, general symptoms, and itch. The highest mean domain score was seen for fatigue and the lowest for itch. The measure has been fully validated for use in PBC and shown to be scientifically sound. PBC patient satisfaction, measured in terms of the extent to which a questionnaire addresses the problems that they experience, was significantly higher for the PBC-40 than for other HRQOL measures. CONCLUSION: The PBC-40 is a short easy to complete measure which is acceptable to PBC patients and has significantly greater relevance to their problems than other frequently used HRQOL measures. Its scientific soundness, shown in extensive testing, makes it a valuable instrument for future use in clinical and research settings.

Adult↗
PubMed2004

The diurnal profile of gastric pepsin activity is reduced with Helicobacter pylori infection.

Both Helicobacter pylori and pepsin are proven mucosal damaging agents and implicated in the aetiology of peptic ulcer disease. Historically studies of pepsin over time have proved methodologically difficult, and as a result little work has been done on the effect of H. pylori on luminal pepsin secretion. Our objectives were to determine pepsin activity over 24 hr in normal human subjects and to examine luminal pepsin activity in relation to H. pylori infection. Twenty-seven healthy volunteers had gastric juice samples aspirated every 2 hr for 24 hr. All subjects had H. pylori status determined by C13 urea breath test and serology. Meals were standardized throughout the study period. Gastric juice samples were measured for pH, diluted, and frozen in acetate buffer pH 4.1 for up to 1 month, conditions shown to cause no loss of activity. Individual samples were measured for pepsin activity by assaying for new N-terminal peptide formation. Mean pepsin activity (microg enzyme/ml) in 21 normal H. pylori-negative subjects ranged from 114 to 1030 microg/ml, with a characteristic diurnal profile of increasing activity to maximum after the evening meal. Mean pepsin activity in subjects with H. pylori was consistently below that for age-matched H. pylori-negative subjects at each time point. Overall mean pepsin activity was significantly lower in those with H. pylori compared to those without (P < 0.001). There is significant pepsin activity in the stomach throughout the 24-hr period, with a trend for the highest activity through the night. Subjects with H. pylori infection have lower luminal pepsin activity.

Adolescent↗
PubMed2004

Patterns of autoimmunity in primary biliary cirrhosis patients and their families: a population-based cohort study.

BACKGROUND: Primary biliary cirrhosis (PBC) is a chronic liver disease with autoimmune features but uncertain aetiology. Increased risk of PBC among relatives of patients may reflect common environmental factors, or inherited immunogenetic susceptibility. Associations between PBC and other autoimmune diseases have been reported, but their true extent and pattern is unknown. AIM: To examine the prevalence and association patterns of autoimmune disease in a representative group of PBC patients. DESIGN: Clinical cohort study. METHODS: We clinically assessed members of a geographically-based PBC patient cohort (n = 160) for the presence of additional autoimmune disease, using established specific diagnostic criteria. RESULTS: Some 53% of patients had at least one additional autoimmune condition, and 63% had serum autoantibodies other than AMA or ANA. AMA+ patients had a significantly lower prevalence of additional autoimmunity than AMA- patients (49% vs. 79%; p < 0.01). The greatest relative increase in disease prevalence was for scleroderma (8% of patients). Autoimmune disease was present in 14% of first-degree relatives. DISCUSSION: PBC patients and their families have a wide susceptibility to autoimmunity. This observation supports an autoimmune aetiology and suggests that the genetic basis of PBC is likely to be expressed, at least in part, through factors controlling immune tolerance in general.

Adult↗
PubMed2004

Asymptomatic primary biliary cirrhosis: clinical features, prognosis, and symptom progression in a large population based cohort.

BACKGROUND: Many patients with primary biliary cirrhosis (PBC) are asymptomatic at the time of diagnosis. However, because most studies of asymptomatic PBC have been small and from tertiary centres, asymptomatic PBC remains poorly characterised. AIMS: To describe the features and progression of initially asymptomatic PBC patients. METHODS: Follow up by interview and note review of a large geographically and temporally defined cohort of patients with PBC, collected by multiple methods. RESULTS: Of a total of 770 patients, 469 (61%) were asymptomatic at diagnosis. These patients had biochemically and histologically less advanced disease than initially symptomatic patients. Median survival was similar in both groups (9.6 v 8.0 years, respectively) possibly due to excess of non-liver related deaths in asymptomatic patients (31% v 57% of deaths related to liver disease). Survival in initially asymptomatic patients was not affected by subsequent symptom development. By the end of follow up, 20% of initially asymptomatic patients had died of liver disease or required liver transplantation. The majority of initially asymptomatic patients developed symptoms of liver disease if they were followed up for long enough (Kaplan-Meier estimate of proportion developing symptoms: 50% after five years, 95% after 20 years). However, 45% of patients remained asymptomatic at the time of death. CONCLUSIONS: Although asymptomatic PBC is less severe at diagnosis than symptomatic disease, it is not associated with a better prognosis, possibly due to an increase in non-hepatic deaths. The reasons for this are unclear but may reflect confounding by other risk factors or surveillance bias. These findings have important implications for future treatment strategies.

Aged↗
PubMed2003

Snoring, daytime sleepiness and stroke: a case-control study of first-ever stroke.

Previous reports have shown an association between snoring and stroke but it is not clear whether this reflects confounding factors nor whether the association is attributable to obstructive sleep apnoea (OSA). We performed a case-control study of 181 patients admitted to hospital with first-ever stroke and community control subjects matched individually for age, sex and general practitioner. Subjects were interviewed with a structured questionnaire to identify snoring, daytime sleepiness and stroke risk factors. The association between snoring alone and stroke was not statistically significant: odds ratio (95% CI) 1.44 (0.88, 2.41). Daytime sleepiness was, however, significantly associated with stroke: odds ratio 3.07 (1.65, 6.08). Multiple logistic regression showed that hypertension, current smoking, taking alcohol regularly (negatively) and a higher Epworth sleepiness score were independently associated with stroke. The results suggest that the previously reported association between 'simple' snoring and stroke might have been due to poor controlling for confounding variables. Our study suggests an association with greater sleepiness prestroke, the cause of which is unclear, although OSA is a possible candidate.

Adult↗
PubMed2003

Oral antioxidant supplementation for fatigue associated with primary biliary cirrhosis: results of a multicentre, randomized, placebo-controlled, cross-over trial.

BACKGROUND: We have previously reported, in an uncontrolled trial, an improvement in fatigue scores in patients with primary biliary cirrhosis given oral antioxidant supplementation. We now present data from a controlled trial. PATIENTS AND METHODS: Sixty-one patients with primary biliary cirrhosis-associated fatigue were randomized into a double-blind, placebo-controlled, cross-over trial. Participants received 12 weeks each of placebo and antioxidant supplementation (vitamins A, C and E, selenium, methionine and ubiquinone) in random order, separated by a 4-week washout period. The primary trial outcome (fatigue) was assessed using the Fisk scale. Other symptoms of primary biliary cirrhosis were measured using Likert and visual analogue scales. RESULTS: Forty-four patients completed both arms of the trial. No significant changes in fatigue were recorded in the active phase of treatment (median improvement in Fisk score, 1; P = 0.61). Small improvements in Fisk scores were recorded during placebo therapy (median improvement, 4; P = 0.03). Neither medication was associated with improvement in any other symptoms related to primary biliary cirrhosis. Adverse effects were more common during active therapy and were mild and self-limiting. One patient died from unrelated causes during active treatment. CONCLUSIONS: Although oral antioxidant supplementation appears to be safe, we could not find any evidence for a beneficial effect on fatigue or other liver-related symptoms.

Administration, Oral↗
PubMed2002

Sleep-disordered breathing following acute stroke.

BACKGROUND: The reported prevalence of sleep apnoea following stroke varies between 44% and 72%, but its course and relations are unclear. AIM: To determine the prevalence and course of sleep-disordered breathing in acute stroke in-patients, and its relation to age, stroke subtype, pre-stroke handicap and post-stroke outcome. DESIGN: Prospective uncontrolled observational study. METHODS: Paired respiratory sleep studies were performed at week 2 and week 6-9 following stroke. Pre- and post-stroke handicap (modified Rankin Score) and week 2 and week 6-9 disability (Barthel Score) and impairment (Scandinavian Neurological Stroke Score) were assessed. Pre-stroke sleepiness was determined by Epworth Score. RESULTS: There were 68 patients in the week 2 study, and 50 in the week 6-8 study. Mean week 2 Apnoea Hypopnoea Index (AHI) was 30; 64 patients (94%) had an AHI > or =10. Mean AHI was higher in subjects with lacunar vs. cortical strokes (44 vs. 28, p<0.05), in subjects aged > or =65 years (32 vs. 21, p<0.05) and in those with greater pre-stroke handicap (modified Rankin Score 2 vs. <2) (41 vs. 27, p<0.05). In 50 paired studies, mean AHI fell from 31 to 24 (p<0.01) and the proportion with AHI > or =10 fell from 96% to 72%. Pre-stroke sleepiness was associated with post-stroke neurological impairment (r=-0.325, p<0.05) and disability (r=-0.377, p<0.05). DISCUSSION: Sleep-disordered breathing improves in the first 6-9 weeks following stroke, but remains highly prevalent. Worse sleep-disordered breathing was observed following lacunar stroke, and in older subjects or those with pre-stroke handicap.

Acute Disease↗