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Biomedical subjects

P Dawes

Publications and source records attributed to P Dawes.

At least 19 recordsLinked to original sources
PubMed2003

Control perceptions in patients with rheumatoid arthritis: the impact of the medical consultation.

OBJECTIVE: To identify factors that patients perceive as influencing control in living with the symptoms of rheumatoid arthritis (RA). METHOD: A sample of 40 patients with RA were recruited randomly from an out-patient population. The participants of the sample were interviewed in depth by one researcher to identify perceptions of control. They also completed two self-administered questionnaires, the Health Assessment Questionnaire and the Rheumatology Attitude Index. RESULTS: Four major categories were identified that positively influenced perceptions of control in patients living with the consequences of RA. These included: (i) the reduction of physical symptoms; (ii) social support matching perceived need; (iii) the provision of information; and (iv) the medical consultation. Components of the consultation included patient involvement, provision of information, feedback and reassurance, empathy and access to an expert. CONCLUSION: The categories identified can be influenced by health-care professionals in the management of the patient, and if the medical consultation is utilized to its full potential it can play a major role in enabling patients with RA to manage the daily symptoms of their condition.

Adult↗
PubMed1998

Absence of an association between mannose-binding lectin polymorphism and rheumatoid arthritis.

It has been proposed that mannose-binding lectin (MBL) interactions with agalactosyl forms of IgG immunoglobulins found in rheumatoid synovial fluid might lead to enhanced complement activation, an important mediator of the joint damage in rheumatoid arthritis (RA). In order to investigate this possible link between increased MBL-mediated activation of complement and perpetuation of rheumatoid synovitis, we have compared the frequency of an allelic form of MBL, known to be incapable of activating complement, in a group of hospital patients with severe RA and control subjects. No evidence was found to support an association between the presence of this MBL allele and protection from rheumatoid disease; genotype frequencies were similar in both groups. This suggests that complement activation via MBL-agalactosyl IgG complexes is unlikely to play a major role in the pathophysiology of RA.

Adult↗
PubMed1997

Nutritional support for patients with intellectual disability and nutrition/dysphagia disorders in community care.

Patients with intellectual disability and neurological handicaps associated with swallowing difficulties are vulnerable to dehydration and undernutrition. Some patients are severely undernourished, a condition which is usually associated with recurrent food aspiration and respiratory infections. Underweight patients are usually provided with adequate dietary protein by carers: their low energy intakes reflect inadequate intakes of fat and carbohydrate. Many patients gain weight following the provision of easily assimilated energy-dense fat- and sugar-containing foods. Where these measures fail, the provision of a percutaneous endoscopic gastrostomy (PEG) tube may be life-saving. Optimal supervision of patients with severe nutrition/dysphagia problems requires a support network linking carers at home or in community care facilities with the primary health care team and the local district general hospital.

Anthropometry↗
PubMed1997

Tumor necrosis factor microsatellite haplotypes are different in male and female patients with RA.

We investigated whether tumor necrosis factor (TNF) microsatellite polymorphisms are associated with sex and age at disease onset in rheumatoid arthritis (RA). A case-control study was used to compare the frequencies of TNF microsatellite alleles in 181 Caucasian RA cases and 251 controls. TNF microsatellite genotyping was performed using fluorescent based polymerase chain reaction (PCR) techniques and HLA-DR typing using PCR based sequence specific oligonucleotide probing. The association of TNF microsatellite alleles a6, b5, and d4 with RA was confirmed. These polymorphisms were more frequent in female patients. Male patients with RA with young age at onset had a different TNF microsatellite profile, TNFa2, b1, and c2 being the most frequent. TNF microsatellite polymorphisms are different in male and female patients with RA. This difference was more obvious in patients stratified according to age at onset. Sex and age at onset should be considered in studies of genetic factors in RA.

Adult↗
PubMed1995

Inflammatory back pain in primary care.

Three-hundred-and-thirteen back pain sufferers completed a screening questionnaire for inflammatory back pain. This was positive in 46 (15%), who were invited for a further examination. Only two of these patients had definite ankylosing spondylitis. Eighteen of them (39%) had other features associated with spondyloarthropathy. It is suggested that up to 5% of back pain sufferers may have a mild form of ankylosing spondylitis that may never progress to definite ankylosis, but for whom treatment as if they had ankylosing spondylitis may be of benefit.

Adolescent↗
PubMed1993

Effect of naloxone on the habituation of novelty-induced hypoalgesia: the collateral inhibition hypothesis revisited.

Repeated daily administration of the opiate receptor antagonist naloxone prior to hotplate tests provokes longer paw-lick latencies by attenuating the habituation of novelty-induced hypoalgesia. This hypoalgesia has been found to persist when pain tests are subsequently conducted following saline administration. The present experiments were conducted to determine whether the substrates mediating the hypoalgesia observed during naloxone and saline tests are similar or distinct. Neither the hypoalgesia observed during naloxone nor saline tests were affected by the induction of tolerance to the hypoalgesic effect of morphine, suggesting that both effects are mediated by nonopioid antinociceptive mechanisms. Previous work from our laboratory demonstrated that the hypoalgesia observed during naloxone tests is inhibited by clonidine, enhanced by yohimbine, and unaffected by prazosin and phentolamine. In the present article, we report a similar pattern of results for the hypoalgesia observed during saline tests. It is concluded that the substrates mediating both effects are similar. The results are discussed in relation to the possibility that an opioid substrate involved in habituative learning may be inhibitory on a nonopioid antinociceptive substrate.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1993

Naloxone potentiation of novelty-induced hypoalgesia: characterization of the alpha-noradrenergic receptor subtype.

Repeated daily administration of the opiate receptor antagonist naloxone (10 mg/kg) attenuates the habituation of novelty-induced hypoalgesia. This effect can be reversed by the alpha 2-noradrenergic receptor agonist clonidine and enhanced by the alpha 2-antagonist yohimbine. The present experiments were conducted to provide further support for the importance of the alpha 2-receptor and determine the possible influence of the alpha 1-receptor. Naloxone's effect on novelty-induced hypoalgesia was not affected by pretreatment with the specific alpha 1-receptor antagonist prazosin (0.2-1.0 mg/kg, SC) or the nonselective alpha antagonist phentolamine (2.0-10.0 mg/kg). In a second series of experiments, it was found that the potentiation of naloxone's effect by yohimbine (2 mg/kg) was reversed by clonidine (0.1 mg/kg) but was not influenced by prazosin or phentolamine. These results suggest that the alpha 1-noradrenergic receptor subtype does not mediate the effect of naloxone on novelty-induced hypoalgesia. They also reinforce the importance of the alpha 2-receptor subtype in the mediation of this effect.

Animals↗
PubMed1992

Clonidine and yohimbine modulate the effects of naloxone on novelty-induced hypoalgesia.

Previous research has shown that repeated daily pretreatment with the opiate receptor blocker naloxone retards the development of habituation to novelty-induced hypoalgesia. The present experiments were conducted in order to determine whether noradrenergic substrates mediates this effect. Animals in the NAL condition were administered 10 mg/kg naloxone prior to assessment of pain sensitivity on a 48.5 degrees C hot plate. Control animals (SAL condition) were administered saline prior to pain assessment, and naloxone 2-4 h later. Paw lick latencies declined over repeated tests in SAL animals, suggesting the habituation of novelty hypoalgesia. Naloxone pretreatment attenuated this decline. The longer paw lick latencies observed in NAL condition animals were reduced by administration of 2 microgram/kg clonidine, a specific noradrenergic alpha-2 receptor agonist, and enhanced in a dose dependent (0.5-4.0 mg/kg) fashion by the alpha-2 antagonist yohimbine. Clonidine and yohimbine either failed to alter pain reactivity in control animals, or produced less marked effects than those observed in naloxone-exposed animals. These results suggest that noradrenergic substrates mediate naloxone's effects on novelty hypoalgesia.

Animals↗
PubMed1992

Spinal cord alpha-2 noradrenergic receptors mediate conditioned analgesia.

The present experiment investigated the effects of direct spinal administration of the monoaminergic receptor blockers yohimbine, phentolamine and methysergide on the expression of conditioned analgesia. Animals in the Paired group received classical conditioning trials in which one context was paired with footshock administration (1 mA shock for 15 s). Animals in the Unpaired control group were administered shock in a second, different, context. On the test day animals within each condition were administered saline (20 microliters), yohimbine (30 micrograms), phentolamine (30 micrograms), or methysergide (30 micrograms) prior to receiving a hot plate test (50 degrees C) in the context previously used to shock the Paired group. These ligands were administered into the spinal fluid through a chronic, indwelling spinal catheter. Animals in the Paired group which received saline displayed longer paw lick latencies than saline-treated animals in the Unpaired group. Yohimbine, but not phentolamine or methysergide, attenuated this conditioned analgesia. These results suggest that spinal cord noradrenergic substrates mediate conditioned analgesia, and that this mediation occurs specifically through the alpha-2 noradrenergic receptor.

Analgesia↗
PubMed1992

Guidelines on undergraduate curriculum in the UK. Education Committees of Arthritis and Rheumatism Council and British Society for Rheumatology.

Symptomatic locomotor abnormalities are common in medical in-patients, form a significant part of a general practitioner's workload, and are the single most important factor influencing disability in later life. That any qualifying doctor should have basic competencies with respect to the locomotor system thus seems appropriate. A survey of medical schools undertaken jointly by the Arthritis and Rheumatism Council (ARC) and British Society for Rheumatology (BSR) in 1990, however, suggests that the locomotor system still has a relatively low priority in undergraduate medical training. In 1990 therefore, the Education Committees of ARC and BSR established a joint working party to define guidelines on an undergraduate curriculum for rheumatology. These guidelines were discussed and developed at a Workshop in Oxford, and circulated to the Deans and Chairmen of Curriculum Committees at all UK Medical Schools in October 1991. It is hoped these guidelines will encourage inclusion of basic rheumatological competencies within the 'core' curriculum for all medical undergraduates.

Curriculum↗
PubMed1990

Comparison of short-term and continuous chemotherapy (mitozantrone) for advanced breast cancer.

132 patients with advanced recurrent breast cancer were treated with four courses of mitozantrone 14 mg/m2 intravenously every 3 weeks (9 weeks). Patients showing disease stabilisation or objective response were randomised to stop chemotherapy or to continue until disease progression. At that stage 27% showed partial responses, 3% complete responses, and 10% disease stabilisation. 22 patients were randomised to continue chemotherapy and 21 to stop. There was no difference in time to disease progression, response duration, or survival between the two groups. Toxicity was mild during the first four courses of therapy. Thus, short courses of single-agent chemotherapy can produce similar therapeutic results to long-term chemotherapy, which has major implications for cost, resource allocation, and toxicity of therapy. Stopping chemotherapy early in responders did not cause rapid relapse. Since drug resistance apparently develops early during therapy, new approaches to modify resistance should be more useful than continuous chemotherapy.

Adult↗
PubMed1989

Phase II study of low dose aminoglutethimide 250 mg/day plus hydrocortisone in advanced postmenopausal breast cancer.

Low dose aminoglutethimide 125 mg twice daily plus hydrocortisone 20 mg twice daily was shown to produce oestrogen and androgen suppression in postmenopausal women. A phase II study was carried out in 101 patients with advanced postmenopausal breast cancer. Objective response rates were 4% CR and 21% PR. Fourteen per cent had disease stabilization for more than 6 months (SD). Soft tissue sites showed the best response. Responses occurred in previous tamoxifen failures (28%) including SD. Toxicity was less than reported for higher dose regimens or low dose aminoglutethimide without hydrocortisone, particularly nausea and drowsiness. Survival from first relapse and start of therapy was not significantly different between PR and SD. This dosage regimen appears of comparable efficacy to previously reported higher dosage regimens with reduced toxicity compared to low dose regimens without hydrocortisone.

Aged↗
PubMed1989

The role of bacterial infection of the maxillary sinus in nasal polyps.

Fifty-two adult patients with nasal polyps were studied. All patients had preoperative sinus radiographs which were coded on the degree of mucosal thickening and these were compared with the results of irrigation of the maxillary sinuses. All irrigations were sent for culture and microscopy for pus cells. Pus cells and bacteria were found in only 16 of 104 wash-outs. It was concluded that the disease results in stasis of secretions and secondary maxillary sinusitis.

Bacterial Infections↗