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Biomedical subjects

P Griffiths

Publications and source records attributed to P Griffiths.

At least 19 recordsLinked to original sources
PubMed2006

Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children.

BACKGROUND: Faecal incontinence is a common and potentially distressing disorder of childhood. OBJECTIVES: To assess the effects of behavioural and/or cognitive interventions for the management of faecal incontinence in children. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 1 February 2006). SELECTION CRITERIA: Randomised and quasi-randomised trials of behavioural and/or cognitive interventions with or without other treatments for the management of faecal incontinence in children. DATA COLLECTION AND ANALYSIS: Reviewers selected studies from the literature, assessed study quality, and extracted data. Data were combined in a meta-analysis when appropriate. MAIN RESULTS: Eighteen randomised trials with a total of 1168 children met the inclusion criteria. Sample sizes were generally small. All studies but one investigated children with functional faecal incontinence. Interventions varied amongst trials and few outcomes were shared by trials addressing the same comparisons. Combined results of nine trials showed higher rather than lower rates of persisting symptoms of faecal incontinence up to 12 months when biofeedback was added to conventional treatment (OR 1.11 CI 95% 0.78 to 1.58). This result was consistent with that of two trials with longer follow-up (OR 1.31 CI 95% 0.80 to 2.15). In one trial the adjunct of anorectal manometry to conventional treatment did not result in higher success rates in chronically constipated children (OR 1.40 95% CI 0.72 to 2.73 at 24 months). In one small trial the adjunct of behaviour modification to laxative therapy was associated with a significant reduction in children's soiling episodes at both the three month (OR 0.14 CI 95% 0.04 to 0.51) and the 12 month assessment (OR 0.20 CI 95% 0.06 to 0.65). AUTHORS' CONCLUSIONS: There is no evidence that biofeedback training adds any benefit to conventional treatment in the management of functional faecal incontinence in children. There was not enough evidence on which to assess the effects of biofeedback for the management of organic faecal incontinence. There is some evidence that behavioural interventions plus laxative therapy, rather than laxative therapy alone, improves continence in children with functional faecal incontinence associated with constipation.

Behavior Therapy↗
PubMed2006

In utero magnetic resonance of non-isolated ventriculomegaly: Does ventricular size or morphology reflect pathology?

AIM: To confirm whether ventricular size or morphology reflects the underlying pathology in foetuses referred with a diagnosis of possible ventriculomegaly (Vm) and central nervous system (CNS) pathology. METHODS: Retrospective analysis of 40 in utero magnetic resonance (MR) examinations was undertaken. Ventricular size was measured on axial sections by two observers, and morphology was agreed by consensus. Results were analysed according to gestational age at referral, degree of Vm (mild 10-15 mm, moderate/severe >15 mm) and morphology. RESULTS: Nine cases had no Vm (mean gestational age 23.6 weeks, range 19-33), 17 had mild Vm (mean age 23.9 weeks, range 20-31), and 14 had moderate/severe Vm (mean age 25.9 weeks, range 20-35). All groups had a mix of morphology and pathology. Eighteen suspected cases of spina bifida were referred and 17 confirmed (mean age 22.6 weeks, range 19-30) using MR. The morphology was mixed, five cases (27.8%) had an angular appearance (this morphology was only seen in cases with spina bifida). Fourteen cases (77.8%) had Vm (eight mild, six severe). Of the thirteen cases of agenesis of the corpus callosum (ACC) suspected on ultrasound, seven were confirmed using MR (mean age 26.5 weeks, range 20-35). Of those seven cases with ACC confirmed on MR, and three additional cases only detected by in utero MR, five had colpocephaly, seven had Vm (four mild, three severe). CONCLUSION: Severity of Vm did not reflect the type, or presence, of underlying pathology. Morphology appears an indicator of pathology. Angular ventricles should initiate a search for spinal defects. Colpocephaly may indicate ACC.

Brain Diseases↗
PubMed2005

Quality of care for NSAID users: development of an assessment tool.

OBJECTIVE: Assessments of NSAID use based on authoritative guidelines typically overlook patients' views and nuances of medical history. Our objective was to develop an assessment tool that incorporates these aspects, and technical items, for quality of care assessments in NSAID users. METHODS: Patients newly referred to a university hospital were interviewed by a nurse using an agreed template. A multidisciplinary group of rheumatologists, nurse specialists, primary care physicians and a pharmacist reviewed current guidance and systematic reviews on NSAID use, and a series of interview transcripts. The group agreed, by informal consensus, important determinants of effective and safe NSAID use. Technical aspects of medical care and items that reflected interpersonal care were included in an index for assessing quality of care for individual patients. Interview transcripts of 100 patients were scored by panel members and reliability of scores was tested by calculating weighted percentage agreement and the kappa statistic. RESULTS: Our final index had five domains: medical risk factors; steps taken to reduce risk; knowledge of adverse effects; NSAID dose; and cost efficiency. Each item was scored 0, 1 or 2. Scores were summed, giving a maximum of 10 (low scores indicating low quality). Intra-rater agreement was >90%; kappa was 0.47-0.87 for individual domains and 0.59 for overall score. Inter-rater agreement for overall score was 95%; kappa was 0.25-0.78 for domains and 0.48 for overall score. Patients with especially low scores were identified using the mode of scores for five assessors; obvious clinical concerns were identified, supporting index face validity. CONCLUSIONS: A simple index to evaluate quality of care for NSAID users based on a patient interview is described. This may be used by one or more assessors to examine care standards and highlight deficiencies in relation to NSAID use in practice.

Adolescent↗
PubMed2005

Women of higher socio-economic status are more likely to be overweight in Karnataka, India.

This study explores differences in body mass index (BMI), diet, and lifestyle between women of varying socio-economic status in Karnataka, India, using data from the National Family Health Survey 2 (n = 4374), in-depth interviews (n = 20) and six focus group discussions (n = 40) completed in Bangalore. Predictors of overweight (BMI > or = 25 kg/m2 were modelled using logistic regression. A content analysis of the qualitative data was undertaken to understand behavioural factors affecting overweight. Prevalence of undernutrition was high for rural women (48%) and for overweight, prevalence was high in large urban areas (44%). In Bangalore knowledge of unhealthy foods was higher for richer women, although their diet and activity levels were less healthy than poorer women, who did not have the resources to purchase less healthy diets. Although some knowledge of the need for activity and healthy diets exists for wealthier Bangalore women, this does not translate into healthy behaviour, suggesting a need for obesity prevention programmes.

Adolescent↗
PubMed2005

Ocular motility findings in chronic progressive external ophthalmoplegia.

AIMS: To characterise the ocular motility features of chronic progressive external opthalmoplegia by quantitative and semiquantitative means. To assess the prevalence of diplopia and the binocular adaptations to nonaligned visual axes. METHOD: We studied 25 patients with chronic progressive external ophthalmoplegia. In each case muscle biopsies were consistent with mitochondrial myopathy. All patients underwent cover test in the primary position, assessment of binocular status, and measurement of uniocular fields of fixation using the Goldmann perimeter. RESULTS: A total of 23 (92%) patients had an exo-deviation, with six (26%) of those having an associated vertical deviation: 12 patients were binocular. Of the 13 patients with a manifest deviation seven had diplopia and six had suppression. Of all paired extra-ocular muscles (EOM), 68% had symmetry of movement within 5 degrees of each other. CONCLUSION: Almost all patients had an exo-deviation. Diplopia was more common than expected. The majority of patients had symmetry of EOM limitation.

Adult↗
PubMed2005

Do split-side rails present an increased risk to patient safety?

BACKGROUND: Concerns have been raised about the safety of split-side bed rails for patients in the UK. OBJECTIVES: To investigate whether split-side rails were more likely to be associated with entrapment and injury of patients than other bed rail types. To establish whether there was a difference in the site of injury caused by different bed rail types and whether the outcome of the injury (death versus survival) varied by bedrail type. METHODS: A search of the USA Food and Drug Administration MAUDE database was carried out. The reports were screened using rigorous inclusion/exclusion criteria and then coded for rail type, incident outcome, and area of body involved. RESULTS: Split-side rail incidents only accounted for 5% of the reports and were more likely to involve the chest or pelvis. Although the biggest overall risk by rail type cannot be determined from these data, the severity of the outcome changed with the equipment type. Incidents involving half rails were more likely to be associated with head, neck, or face entrapments and were also more likely than other bed rail types to result in death. DISCUSSION: Split-side rail entrapments were not a common occurrence. However, our findings suggest that bed rails are associated with some level of risk of entrapment that potentially could result in death. Healthcare providers should therefore ensure that they follow the guidelines for risk assessment and rail use from the MHRA and other professional bodies so that the cultural norm in the UK continues to be "opt in", where no bed rails are used unless indicated by a documented clinical assessment.

Accidental Falls↗
PubMed2004

Good practices that address continuity during transition from child to adult care: synthesis of the evidence.

BACKGROUND: Effective transition to adult services is required by an increasing number of children with ongoing needs. AIM: To identify practices that promote continuity at transition between child and adult services. METHODS: Systematic examination of the evidence from two search strategies yielding 5319 items. RESULTS: Only three of the 126 appraised items had strong external validity. A large range of different practices, which focused on the service, the young person and the family, were identified. Practices within the service addressed structural, process and outcome components. CONCLUSION: Four transition models are proposed for testing.

Adolescent↗
PubMed2004

The distributions of mitochondria and sodium channels reflect the specific energy requirements and conduction properties of the human optic nerve head.

AIM: To study the normal distributions of mitochondria and voltage gated Na+ channels in the human optic nerve head in order to gain insight into the potential mechanisms of optic nerve dysfunction seen in the inherited optic neuropathies. METHODS: Five fresh frozen human optic nerves were studied. Longitudinally orientated, serial cryosections of optic nerve head were cut for mitochondrial enzyme histochemistry and immunolabelling for cytochrome c oxidase (COX) subunits and voltage gated Na+ channel subtypes (Na(v) 1.1, 1.2, 1.3, and 1.6). RESULTS: A high density of voltage gated Na+ channels (subtypes Na(v) 1.1, 1.3, and 1.6) in the unmyelinated, prelaminar, and laminar optic nerve was found. This distribution co-localised both with areas of high COX activity and strong immunolabelling for COX subunits I and IV. CONCLUSIONS: Increased numbers of mitochondria in the prelaminar optic nerve have previously been interpreted as indicating a mechanical hold up of axoplasmic flow at the lamina cribrosa. These results suggest that this increased mitochondrial density serves the higher energy requirements for electrical conduction in unmyelinated axons in the prelaminar and laminar optic nerve and is not a reflection of any mechanical restriction. This could explain why optic neuropathies typically occur in primary inherited mitochondrial diseases such as Leber's hereditary optic neuropathy, myoclonic epilepsy with ragged red fibres (MERRF), and Leigh's syndrome. Secondary mitochondrial dysfunction has also been reported in dominant optic atrophy, Friedreich's ataxia, tobacco alcohol amblyopia, Cuban epidemic optic neuropathy, and chloramphenicol optic neuropathy. These diseases are rare but these findings challenge the traditional theories of optic nerve structure and function and may suggest an alternative approach to the study of commoner optic neuropathies such as glaucoma.

Adult↗
PubMed2003

Fine needle aspiration in plastic surgery outpatients: a retrospective study.

A survey suggested that fine needle aspiration cytology of masses in plastic surgery outpatient clinics was suboptimal. A cytopathologist gave training in the technique and the effectiveness of this intervention was audited. A total of 236 aspirates were taken from 147 patients in the earlier time period and 215 from 149 in the later period. The overall inadequate aspirate rate remained constant at 43%. The most common reasons for poor aspirates were excess blood, unrepresentative adipose tissue and insufficient cellular material. When the specimen was adequate after training, the sensitivity and specificity of the investigation were 96% and 100%, respectively. We present methods for sample optimization. Alternative strategies may be to limit aspiration to one clinician or to refer the patient to a cytopathologist experienced in the technique.

Biopsy, Fine-Needle↗
PubMed2003

The effectiveness of current approaches to workplace stress management in the nursing profession: an evidence based literature review.

The effectiveness of current approaches to workplace stress management for nurses was assessed through a systematic review. Seven randomised controlled trials and three prospective cohort studies assessing the effectiveness of a stress management programmes were identified and reviewed. The quality of research identified was weak. There is more evidence for the effectiveness of programmes based on providing personal support than environmental management to reduce stressors. However, since the number and quality of studies is low, the question as to which, if any, approach is more effective cannot be answered definitively. Further research is required before clear recommendations for the use of particular interventions for nursing work related stress can be made.

Humans↗
PubMed2001

Inpatient diagnostic assessments: 1. Accuracy of structured vs. unstructured interviews.

This study compared structured vs. unstructured interviews for making psychiatric diagnoses. Three clinicians independently diagnosed 56 inpatient-subjects, each using a different method: (1) the unstructured Traditional Diagnostic Assessment (TDA), the standard method of clinical practice; (2) the Structured Clinical Interview for DSM-Clinical Version (SCID-CV), a widely used structured method; and (3) the Computer Assisted Diagnostic Interview (CADI), a structured computer-based method. Once finished, the three clinicians developed a Consensus diagnosis, using Spitzer's LEAD Standard (L=Longitudinal evaluation of symptomatology, E=Evaluation by expert consensus, AD=All Data from multiple sources). Diagnoses were assigned to one of 10 groups (cognitive impairment, general medical condition-induced, alcohol-induced, drug-induced, mania, depression, schizophrenia, schizoaffective, psychosis NOS, and anxiety). Diagnostic accuracy for each method, measured against Consensus, was as follows: TDA-agreement=53.8%, kappa=0.4325 ('fair'); SCID-CV-agreement=85.7%, kappa=0.8189 ('excellent'); CADI -agreement=85.7%, kappa=0.8147 ('excellent'). All three methods reached acceptable levels of diagnostic accuracy. Structured methods (SCID-CV, CADI) were significantly better than the unstructured TDA.

Adult↗
PubMed2001

Drugs and the dance music scene: a survey of current drug use patterns among a sample of dance music enthusiasts in the UK.

This study explores the utility of a self-completion survey method to quickly and cheaply generate information on patterns and trends among regular "recreational" drug consumers. Data is reported here from 1151 subjects accessed through a dance music publication. In keeping with previous studies of drug use within the dance scene polysubstance use was the norm. Many of those reporting use of "ecstasy" were regularly using multiple tablets often consumed in combination with other substances thus exposing themselves to serious health risks, in particular the risk of dose related neurotoxic effects. Seventy percent were drinking alcohol at hazardous levels. Subjects' patterns of drug purchasing also put them at risk of severe criminal sanction. Data supported evidence that cocaine use had become increasing popular in the UK, but contrasted with some commentators' views that ecstasy use was in decline. The utility of this method and how the results should be interpreted is discussed, as are the data's implications for harm and risk reduction activities.

Adult↗
PubMed2001

Fever pitch.

Explore the source record for details and available documents.

Cooperative Behavior↗
PubMed2001

Behavioural and cognitive interventions with or without other treatments for defaecation disorders in children.

BACKGROUND: Faecal soiling is a common and potentially distressing disorder of childhood. OBJECTIVES: To assess the effects of behavioural and/or cognitive interventions for the management of defaecation disorders in children. SEARCH STRATEGY: The following databases were searched: the Cochrane Incontinence Group Trials Register (March 2001), the Cochrane Controlled Trials Register (Issue 4, 2000), The Enuresis Resource and Information Centre Register of studies of encopresis and soiling, AMED (1985 to April 2000), PsycINFO (1887 to June 2000), Index to Theses - Great Britain and Ireland (October 2000), Dissertation Abstracts (November 2000), EMBASE (January 1998 to October 1999), SIGLE (January 1980 to December 1996), BIOSIS (January 1998 to March 1999), Science Citation Index (January 1998 to March 1999), ISTP (January 1982 to March 1999). Date of the most recent searches: March 2001. Bibliographies of trials retrieved were also searched and colleagues and experts in the field were contacted for information. SELECTION CRITERIA: Randomised and quasi-randomised trials of behavioural and/or cognitive interventions with or without other treatments for the management of defaecation disorders in children. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected studies from the literature. One reviewer assessed the methodological quality of eligible trials and extracted data. Data were combined in a meta-analysis when appropriate. MAIN RESULTS: Sixteen randomised trials with a total of 843 children met the inclusion criteria. Sample sizes were generally small. Interventions varied among trials and few outcomes were shared by trials addressing the same comparisons. The synthesis of data from eight trials showed higher rather than lower rates of persisting problem up to 12 months when biofeedback was added to conventional treatment (OR 1.34 CI 95% 0.92 to 1.94). In two trials significantly more encopretic children receiving behavioural intervention plus laxative therapy improved compared with those receiving behavioural intervention alone at both the 6-month (OR 0.51 CI 95% 0.29 to 0.89) and the 12-month follow-up (OR 0.52 CI 95% 0.30 to 0.93). Similarly in another trial the addition of behaviour modifications to laxative therapy was associated with a marked reduction in children's soiling episodes (OR 0.14 CI 95% 0.04 to 0.51). REVIEWER'S CONCLUSIONS: There is no evidence that biofeedback training adds any benefit to conventional treatment in the management of encopresis and constipation in children. There is some evidence that behavioural intervention plus laxative therapy, rather than behavioural intervention or laxative therapy alone, improves continence in children with primary and secondary encopresis.

Behavior Therapy↗
PubMed2001

Understanding users' perspectives of barriers to maternal health care use in Maharashtra, India.

This paper uses data collected using in-depth, semi-structured interviews to examine utilization of maternal health care services among two rural and urban populations of Pune and Mumbai in Maharashtra, India. The study aims to identify key social, economic and cultural factors influencing women's decisions to use maternal health care and the places used for child delivery, whilst considering the accessibility of facilities available in the local area. Socioeconomic status was not found to be a barrier to service use when women perceived the benefits of the service to outweigh the cost, and when the service was within reasonable distance of the respondent's place of residence. A large number of women perceived private services to be superior to those provided by the government, although cost often meant they were unable to use them. The provision of services did not ensure that women used them; they had to first perceive them to be beneficial to their health and that of their unborn child. Respondents identified the poor quality of services offered at government institutions to be a motivating factor for delivering at home. Thus further investigation is needed into the quality of services provided by government facilities in the area. A number of respondents who had received antenatal care went on to deliver in the home environment without a trained birth attendant. Further research is needed to establish the types of care provided during an antenatal consultation to establish the feasibility of using these visits to encourage women, particularly those with high-risk pregnancies, to be linked to a trained attendant for delivery.

Attitude to Health↗
PubMed2001

Infant and child mortality in three culturally contrasting states of India.

Using cross-sectional, individual-level survey data from Maharashtra, Tamil Nadu and Uttar Pradesh collected under the Indian National Family Health Survey programme of 1992-93, statistical modelling was used to analyse the impact of a range of variables on the survival status of children during their first 2 years of life. Attention was focused on the potential impact of the mother's autonomy. The strongest predictors of mortality were demographic and biological factors, breast-feeding behaviour, and use and knowledge of health services. Variables that can be interpreted as being related to maternal autonomy, such as the presence of a mother-in-law in the household, did not have a significant direct effect on child survival at the individual level, and their indirect effects were very limited.

Age Distribution↗