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Biomedical subjects

P Maguire

Publications and source records attributed to P Maguire.

At least 19 recordsLinked to original sources
PubMed1992

Pharmacological profiles of fentanyl analogs at mu, delta and kappa opiate receptors.

Receptor binding assays using [3H]DAGO ([D-Ala2,MePhe4-Gly5-ol]enkephalin) (mu), [3H]DPDPE ([D-Pen2,D-Pen5]enkephalin) (delta) and [3H]U-69593 (kappa) were done in guinea pig whole brain membranes. Agonist activity was determined in norbinaltorphimine or beta-funaltrexamine (beta-FNA) treated guinea pig ileum (mu and kappa, respectively) and beta-FNA-treated mouse vas deferens (delta). The compounds with highest affinity were the most potent at the mu-receptor. The selectivity observed in the binding affinities was also found in in vitro activity. No correlation was found between mu-affinity and selectivity; the highest affinity analog, lofentanil, was found to be among the least selective, while another high affinity analog, R30490, was the most mu-selective. The results show that not all fentanyls are highly mu-selective, and could produce actions through delta- and kappa-opiate receptors.

Analgesics, Opioid↗
PubMed1991

Psychiatric morbidity in patients with advanced cancer of the breast: prevalence measured by two self-rating questionnaires.

Two hundred and twenty-two women with advanced cancer of the breast were asked to complete two previously validated self-assessment questionnaires (Hospital Anxiety and Depression Scale (HADS) and the Rotterdam Symptom Checklist (RSCL) in order to determine the prevalence and persistence of affective disorders in this group of patients. Fifty-six (27%) of 211 women who completed the HADS and 33 (22%) of 204 who completed the RSCL rated as probable cases of an anxiety state and/or depressive illness. One hundred and fifty-five patients completed the questionnaires again 1-3 months later. Twenty-one (13%) were persistently anxious or depressed as judged by the HADS compared with 14 (10%) on the RSCL. When both questionnaires were considered together, approximately one third of patients had scores suggestive of an affective disorder and in one third of these it was persistent. Only 30 patients (43% of cases) were detected as 'cases' by both questionnaires and this finding warrants further investigation.

Anxiety Disorders↗
PubMed1991

Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires.

Eighty-one patients with advanced breast cancer completed the Hospital Anxiety and Depression Scale (HADS) and Rotterdam Symptom Checklist (RSCL) to determine how well these questionnaires identified patients suffering from an anxiety state or depressive illness, compared with an independent interview by a psychiatrist who used the Clinical Interview Schedule. A threshold score was defined for each questionnaire which gave the optimal sensitivity and specificity. Seventy-five per cent of patients were correctly identified as suffering from an affective disorder by both the Rotterdam Symptom Checklist and by the Hospital Anxiety and Depression Scale. Twenty-one per cent of 'normal' patients were misclassified by the Rotterdam Checklist and 26% by the Hospital Anxiety and Depression Scale. When the HADs anxiety and depression subscales were analysed separately, the performance of the anxiety items was superior to that of the depression items. Both questionnaires were found to have good predictive value and could be used in patients with advanced cancer to help screen out those with an affective disorder.

Anxiety Disorders↗
PubMed1990

A clinical review of cervicography.

A new investigative modality, cervicography, has been advocated for cervical screening. In the first 51 patients referred for colposcopy because of an abnormal cervicogram, none had invasive cancer and 75% had preinvasive cancer. The cervicogram appears superior to cytology but inferior to colposcopy in the detection of cervical pathology. Based on the available evidence, however, cervicography cannot be recommended for universal screening. It may have a role in the follow-up of patients with a mildly abnormal cervical smear, but the optimum management remains early referral for colposcopy.

Adult↗
PubMed1990

Can communication skills be taught?

Basic interviewing skills can be learned at undergraduate and postgraduate level, providing effective methods are used. These include demonstration of key skills, practice under controlled conditions, and audiotape or videotape feedback of performance by a tutor within small groups. More complex skills can also be learned but may not be used or maintained without ongoing training and supervision.

Clinical Competence↗
PubMed1989

Breast conservation versus mastectomy: psychological considerations.

From the available evidence it is clear that mastectomy is associated with a substantial psychological and psychiatric morbidity. To date there is no convincing evidence that counseling can prevent this morbidity, but monitoring of women's psychological adjustment can lead to early detection and effective treatment of their problem. The use of immediate or delayed implantation or reconstruction appears to reduce the psychiatric morbidity in those women who are particularly concerned about their appearance at the time of surgery. Psychiatric morbidity is further increased when adjuvant chemotherapy is used and when treatment results in persistent arm pain and swelling. A shorter course of adjuvant chemotherapy and reduction of surgery within the axilla could reduce psychiatric morbidity. The role of radiotherapy is still unclear, but in some studies a link has been found between the amount of radiotherapy given, adverse effects, and psychiatric morbidity. In women undergoing breast conservation the reduction in body image problems is offset by greater anxiety about recurrence and depression caused by radiotherapy. Exploring and allowing choice when a patient has a strong preference for breast conservation or mastectomy appears to reduce morbidity. But attention still needs to be paid to the early recognition and treatment of psychological problems in patients with breast cancer, and guidelines are provided.

Aftercare↗
PubMed1989

The recognition of psychiatric morbidity on a medical oncology ward.

The Generalised Health Questionnaire and Standardised Psychiatric Interview were used to determine psychiatric morbidity among 126 patients consecutively admitted to a medical oncology unit. Senior house officers and nurses also rated anxiety and depression. 36 (29%) patients were psychiatrically ill and affective disorders (29, 23%) predominated. Psychiatric morbidity was associated with feeling moderately or severely physically ill, and previous psychiatric illness, but not with awareness of having cancer or lack of a confiding tie. The General Health Questionnaire identified 79% of affective disorders at the cost of a 34% false positive rate. Doctors and nurses recognised only 49% of the depressed group; more of those with morbid anxiety (79%) were identified but only because they assumed most patients were anxious. Training in interviewing skills could substantially improve the identification and referral rates of patients with psychiatric morbidity.

Anxiety Disorders↗
PubMed1989

Psychiatric morbidity associated with screening for breast cancer.

The 28-item GHQ was used to assess psychiatric morbidity in 302 women attending for routine breast cancer screening, 300 women attending for further investigation of a positive screening result and 150 women referred for investigation of breast symptoms. The GHQ-28 was administered on arrival at the relevant clinic and three months later. Medical records were used to determine the outcome of the clinic attendance. Women were classified into routinely screened women, women with false positive screening results, symptomatic women with a benign diagnosis, newly diagnosed cancer patients and previously treated cancer patients. When tested on arrival at the clinic, 25% of routinely screened, 30% of women with false positive results and 35% of symptomatic women with benign conditions were probable cases of psychiatric morbidity. The only statistically significant difference was between the routinely screened and symptomatic benign groups. Levels of anxiety were significantly higher in those with false positive results and in the symptomatic benign group than in the routinely screened. Three months later the prevalence of probable psychiatric morbidity had fallen to 19% in both the routinely screened and those with false positive results but remained significantly higher in the symptomatic benign group (31%). Probable cases of psychiatric morbidity among newly detected cancer patients rose from 34 to 46% over the 3-month period. Among women who had had breast cancer diagnosed in the past prevalence remained at 21%. The prevalence of probable psychiatric morbidity in screened women is similar to that in the general population. Among women referred for further investigation because of a false positive screening result prevalence was only slightly increased and there was no evidence of a sustained increase in anxiety. Provided that delays are kept to a minimum and that women are kept informed, a breast cancer screening programme does not increase psychiatric morbidity. Further research is required in cancer patients to determine whether those diagnosed in asymptomatic women have a higher and more sustained degree of psychiatric morbidity than those diagnosed in women who are aware of symptoms.

Aged↗