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Biomedical subjects

P Schofield

Publications and source records attributed to P Schofield.

At least 19 recordsLinked to original sources
PubMed2006

Meeting the support and information needs of women with advanced breast cancer: a randomised controlled trial.

Addressing psychosocial and quality of life needs is central to provision of excellent care for people with advanced cancer. This study tested a brief nurse-delivered intervention to address the needs of urban women with advanced breast cancer. This study was conducted at four large urban hospitals in Australia. One hundred and five women with advanced breast cancer were recruited and randomised to receive the intervention or usual care, then asked to complete the European Organisation of Research and Treatment of Quality of life Q-C30 version (2.0) (EORTC Q-C30) (version 2) and Supportive Care Needs Survey (SCNS) at 1 month and 3 months postrecruitment. No significant differences were detected between intervention and usual care groups in the SCNS or the EORTC Q-C30 subscale scores. However, when the groups were divided into high needs (score of above 50) and low baseline needs (score of 50 or below) for each SCNS subscale, a significant difference between intervention and usual care groups was found in the psychological/emotional subscale among women with high baseline needs. In conclusions, this study demonstrated that a face-to-face session and follow-up phone call with a breast care nurse significantly reduced the psychological and emotional needs of those with high initial needs. There was no evidence of the intervention influencing the quality of life; or perceived needs of women with low initial psychological/emotional needs or perceived needs in other domains. Possibly, the intervention was not sufficiently intense to achieve an effect.

Adult↗
PubMed2006

Do oncologists discuss expensive anti-cancer drugs with their patients?

BACKGROUND: In Australia, some anti-cancer drugs are only available at significant financial cost to patients. We sought the views and practices of Australian medical oncologists regarding discussion of high cost drugs (HCDs). PARTICIPANTS AND METHODS: A postal survey was mailed to all 274 members of the Medical Oncology Group of Australia. Three clinical scenarios described HCDs associated with either improved overall survival, encouraging response rate in a treatment-refractory cancer, or a scenario with improved treatment tolerability. Participants were asked about their discussion and prescription of HCDs. RESULTS: There was a 78% response rate. Most respondents were male (71%), worked in a metropolitan practice (87%) and spent more than 50% of their working time in patient care (87%). Forty-eight percent had previously prescribed a HCD. In the three scenarios, respondents would generally prescribe the drug if it were subsidised, however, between 28% and 41% (depending on the scenario) would not mention the HCD if it were not subsidised. Major reasons for not mentioning the HCD were concerns that discussion would 'worry the patient' or that the doctor would 'feel bad'. CONCLUSIONS: Despite literature suggesting that patients wish to be well informed and active participants in decision making, the practice of a significant percentage of Australian medical oncologists may prevent this.

Antineoplastic Agents↗
PubMed2006

Patients' self-report and family caregivers' perception of quality of life in patients with advanced cancer: how do they compare?

This study describes the concordance between advanced cancer patients' self-report of quality of life and their caregivers' perception of the patients' quality of life at two time points. It is often necessary for health professionals to rely on information about the patients' quality of life that is provided by family caregivers (proxy), even though information from the patients is considered 'the gold standard'. Therefore, it is important to establish how reliable this proxy information is. Data were collected 4-6 weeks following diagnosis of recurrent or progressive disease, and again 12 weeks later. Fifty-one patients and their caregivers completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), version 2.0 at both time points. Descriptive statistics were used to calculate patient and caregiver scores and describe the sample. The level of agreement between the two scores, the patients' self-report and the family caregivers' score, was calculated on the mean scores of each scale. In general, most caregivers were able to accurately rate the global quality of life, the level of functioning and the degree of symptom distress experienced by the person they were caring for, when compared with the patients' self-rating. Caregiver ratings for physical domains tended to be more in agreement with those of patients as compared with ratings of the psychosocial domains. This study suggests information from proxy raters is reliable when the proxy is a family caregiver, and this remains true over time.

Adolescent↗
PubMed2005

How to recognize and manage psychological distress in cancer patients.

Psychological distress is common in cancer patients, however, it is often unrecognized and untreated. We aimed to identify barriers to cancer patients expressing their psychological concerns, and to recommend strategies to assist oncologists to elicit, recognize, and manage psychological distress in their patients. Medline, Psychlit, and the Cochrane databases were searched for articles relating to the detection of emotional distress in patients. Patients can provide verbal and non-verbal information about their emotional state. However, many patients may not reveal emotional issues as they believe it is not a doctor's role to help with their emotional concerns. Moreover, patients may normalize or somatize their feelings. Anxiety and depression can mimic physical symptoms of cancer or treatments, and consequently emotional distress may not be detected. Techniques such as active listening, using open questions and emotional words, responding appropriately to patients' emotional cues, and a patient-centred consulting style can assist in detection. Screening tools for psychological distress and patient question prompt sheets administered prior to the consultation can also be useful. In conclusion, the application of basic communication techniques enhances detection of patients' emotional concerns. Training oncologists in these techniques should improve the psychosocial care of cancer patients.

Anxiety↗
PubMed2005

Mapping the quality of life and unmet needs of urban women with metastatic breast cancer.

Enhancing quality of life and reducing the unmet needs of women are central to the successful management of advanced breast cancer. The objective of this study was to investigate the quality of life and support and information needs of urban women with advanced breast cancer. This study was conducted at four large urban hospitals in Melbourne, Australia. A consecutive sample of 105 women with advanced breast cancer completed a questionnaire that contained the European Organization of Research and Treatment of Cancer Quality of Life Q-C30 and the Supportive Care Needs Survey. Between one quarter and a third of the women reported difficulties with their physical, role and social functioning, and a little over a quarter of the women reported poor global health status. Fatigue was a problem for most women. The highest unmet needs were in the psychological and health information domains. Almost no differences in unmet needs were detected when comparing different demographic and disease characteristics of women. Health care providers should routinely monitor the quality of life and needs of women with advanced breast cancer to ensure that appropriate treatment, information or supportive services are made available.

Adaptation, Psychological↗
PubMed2005

Percutaneous coronary intervention: recommendations for good practice and training.

Cardiologists undertaking percutaneous coronary intervention (PCI) are excited by the combination of patient and physician satisfaction and technological advance occurring on the background of the necessary manual dexterity. Progress and applicability of percutaneous techniques since their inception in 1977 have been remarkable; a sound evidence base coupled with the enthusiasm and ingenuity of the medical device industry has resulted in a sea change in the treatment of coronary heart disease (CHD), which continues to evolve at breakneck speed. This is the third set of guidelines produced by the British Cardiovascular Intervention Society and the British Cardiac Society. Following the last set of guidelines published in 2000, we have seen PCI activity in the UK increase from 33,652 to 62,780 (87% in four years) such that the PCI to coronary artery bypass grafting ratio has increased to 2.5:1. The impact of drug eluting stents has been profound, and the Department of Health is investigating the feasibility of primary PCI for acute myocardial infarction. Nevertheless, the changes in the structure of National Health Service funding are likely to focus our attention on cost effective treatments and will require physician engagement and sensitive handling if we are to continue the rapid and appropriate growth in our chosen field. It is important with this burgeoning development now occurring on a broad front (in both regional centres and district general hospitals) that we maintain our vigilance on audit and outcome measures so that standards are maintained for both operators and institutions alike. This set of guidelines includes new sections on training, informed consent, and a core evidence base, which we hope you will find useful and informative.

Angioplasty, Balloon, Coronary↗
PubMed2004

Validation of the cancer needs questionnaire (CNQ) short-form version in an ambulatory cancer setting.

The short-form Cancer Needs Questionnaire (CNQ) is a self-administered cancer-specific questionnaire designed to assess patients' needs across several domains. The purpose of this study is to further evaluate its internal consistency and construct validity, in a group of ambulatory patients with cancer. Four hundred and fifty patients with a variety of cancer types participated. Factor analysis reproduced five domains: psychological; health information; physical and daily living; patient care and support; and interpersonal communication needs. Cronbach's alpha coefficients ranged from 0.94 to 0.77, indicating substantial consistency across items grouped in the five domains. A priori predictions regarding convergent and contrasting groups construct validity were explored using bivariate relationships between domains of the short-form CNQ, the EORTC QLQC-30 and Beck Depression Inventory (short-form), with support provided for most of the predictions. The current study provides supportive evidence that the short-form CNQ is a reliable and valid instrument for assessing the needs of patients with cancer in an ambulatory care setting.

Adolescent↗
PubMed2004

Primary pericardial mesothelioma presenting as pericardial constriction: a case report.

A 19 year old man presented with a six month history of chest pain, dyspnoea, and lethargy and was found on an echocardiogram to have a dilated left ventricle with a small pericardial effusion. Ramipril and a course of steroids were tried but serial echocardiograms showed a persistently thickened pericardium and slowly developing features of constriction. On computed tomography, a large mediastinal mass encasing the heart, along with para-aortic and paratracheal lymphadenopathy, was found. Right heart catheter studies showed equal pressures in all four chambers. His deteriorating clinical condition led to a pericardiectomy. Histology confirmed primary pericardial mesothelioma. The patient died soon after surgery.

Adult↗
PubMed2004

Social position and minor psychiatric morbidity over time in the British Household Panel Survey 1991-1998.

STUDY OBJECTIVE: To examine social inequalities in minor psychiatric morbidity as measured by the GHQ-12 using lagged models of psychiatric morbidity and changing job status. DESIGN: GHQ scores were modelled using two level hierarchical regression models with measurement occasions nested within individuals. The paper compares and contrasts three different ways of describing social position: income, social advantage and lifestyle (the Cambridge scale), and social class (the new National Statistics Socio-Economic Classification), and adjusts for attrition. SETTING: Survey interviews for a nationally representative sample of adults of working age living in Britain. PARTICIPANTS: 8091 original adult respondents in 1991 who remain of working age during 1991-1998 from the British Household Panel Survey (BHPS). MAIN RESULTS: There was a relation of GHQ-12 to social position when social position was combined with employment status. This relation itself varied according to a person's psychological health in the previous year. CONCLUSIONS: The relation between social position and minor psychiatric morbidity depended on whether or not a person was employed, unemployed, or economically inactive. It was stronger in those with previously less good psychological health. Among employed men and women in good health, GHQ-12 varied little according to social class, status, or income. There was a "classic" social gradient in psychiatric morbidity, with worse health in less advantaged groups, among the economically inactive. Among the unemployed, a "reverse" gradient was found: the impact of unemployment on minor psychiatric morbidity was higher for those who were previously in a more advantaged social class position.

Adult↗
PubMed2003

Social inequalities in health by individual and household measures of social position in a cohort of healthy people.

STUDY OBJECTIVE: It is increasingly recognised that different dimensions of social inequality may be linked to health by different pathways. Furthermore, factors operating at the individual level such as employment conditions may affect health in a different way from household level factors. The paper examines the associations between self rated health and four measures of social position- occupational class, household social advantage, personal and household income. DESIGN: Multilevel logistic regression models were used to predict self rated health using longitudinal data from the British Household panel survey (BHPS) with respondents nested within households. Separate analyses were carried out for economically active and inactive respondents. SETTING: Interview based surveys of adults living within households that are representative of British households. PARTICIPANTS: Adult respondents from the BHPS. MAIN RESULTS: Occupational class has relatively strong effects on the self rated health of the economically active, although household level factors also seem to influence their health. Household social advantage has relatively strong effects on the self rated health of the economically inactive. CONCLUSIONS: The paper found evidence in support of the view that different dimensions of social inequality have different pathways to self rated health. There are unexplained similarities in health between household members, which require further investigation.

Adolescent↗
PubMed2001

A study of uranium speciation in acetate solutions at temperatures from 25 to 250 degrees C.

We report U L3-edge XAS analysis results from a study of the speciation of U(VI) in acetate solutions between 25 and 250 degrees C, at pH's between 1.82 and 2.57 and [acetate]:[U] ratios of 0.5 to 50. At 25 degrees C in excess acetate there are at least two acetate ligands in the equatorial plane with a U-O bond distance of 2.44 A. At elevated temperatures with excess acetate, acetate is still coordinated but the speciation mixture appears more complicated. Less evidence exists for acetate coordination when [acetate]:[U] ratio is unity or below. pH within this limited range appears to have little effect on the uranyl speciation.

Journal Article↗
PubMed2001

Distribution and activation of eosinophils in inflammatory bowel disease using an improved immunohistochemical technique.

Eosinophils are a recognized feature of inflammatory bowel disease (IBD), but their tissue distribution and functional importance in Crohn's disease (CD) and ulcerative colitis (UC) remain obscure. This study describes an improved immunohistochemical protocol to identify eosinophils in full thickness bowel wall specimens of IBD (n=40) and their in situ relationships with the chemoattractants eotaxin and RANTES. Eosinophils were identified using immunohistochemistry with a combination of monoclonal antibodies (EG1+EG2+MBP), an ultrasensitive technique superior to other methodologies, and their tissue distributions were related to those for eotaxin, RANTES, mast cells and neutrophils. Increased numbers of eosinophils (up to 400 cells/mm(2)) were observed in active, fulminant inflammation in both CD and UC, this being related to the severity of inflammation and not the diagnosis of the two disorders. The chemoattractants eotaxin (CCL11) and RANTES (CCL5) were upregulated in IBD tissues showing eosinophilia. Neutrophils and mast cells were commonly associated with eosinophil accumulations. Eosinophil numbers and their in situ activation are increased in active rather than chronic IBD. The observations strongly suggest a pivotal role for the eosinophil and its potent mediators in many pathophysiological symptoms of CD and UC, where it represents the major proportion of all granulocytic cells in active inflammatory bowel disease.

Adult↗
PubMed2001

Adenosine A2B receptors behave as an alternative anchoring protein for cell surface adenosine deaminase in lymphocytes and cultured cells.

Adenosine deaminase (ADA) is an enzyme of the purine metabolism that has been largely considered to be cytosolic. Recently, it has been demonstrated that the enzyme appears on the surface of lymphocytes where it interacts with the T-cell activation antigen CD26. ADA also appears on the surface of nonlymphoid cells anchored to adenosine A1 receptors. Here it is demonstrated that cell surface ADA in ADA+/CD26- T lymphocytes anchors to adenosine receptors of the A2B subtype (A2BR). An interaction between A2BR and cell surface ADA has been demonstrated in transfected Chinese hamster ovary cells and Jurkat J32 T lymphocytes. This has been proved by coimmunoprecipitation, binding of exogenous ADA to A2BR+ cells, and coimmunolocalization. The specificity of the interaction has also been demonstrated by the lack of interaction with other members of the G protein-coupled receptor superfamily. Binding of ADA to A2BR increases the affinity of the agonist 5'-N-ethylcarboxamidoadenosine and cAMP production. This effect occurs even when ADA devoid of enzyme activity is used. Therefore, in lymphocytes, cell surface ADA, apart from degrading extracellular adenosine, regulates those actions of adenosine that are mediated via adenosine receptors of the A2B subtype.

Adenosine Deaminase↗
PubMed2000

Percutaneous transmyocardial laser revascularisation for severe angina: the PACIFIC randomised trial. Potential Class Improvement From Intramyocardial Channels.

BACKGROUND: Percutaneous transmyocardial laser revascularisation (PTMR) is a proposed catheter-based therapy for refractory angina pectoris when bypass surgery or angioplasty is not possible. We undertook a randomised trial to assess the safety and efficacy of this technique. METHODS: 221 patients with reversible ischaemia of Canadian Cardiovascular Society angina class III (61%) or IV (39%) and incomplete response to other therapies were recruited from 13 centres. Patients were randomly assigned PTMR with a holmium:YAG laser plus continued medical treatment (n=110) or continued medical treatment only (n=111). The primary endpoint was the exercise tolerance at 12 months. Analyses were by intention to treat. FINDINGS: 11 patients died and 19 withdrew; 92 PTMR-group and 99 medical-treatment-group patients completed the study. Exercise tolerance at 12 months had increased by a median of 89.0 s (IQR -15 to 183) with PTMR compared with 12.5 s (-67 to 125) with medical treatment only (p=0.008). On masked assessment, angina class was II or lower in 34.1% of PTMR patients compared with 13.0% of those medically treated. All indices of the Seattle angina questionnaire improved more with PTMR than with medical care only. By 12 months there had been eight deaths in the PTMR group and three in the medical treatment group, with similar survival in the two groups. INTERPRETATION: PTMR was associated with increased exercise tolerance time, low morbidity, lower angina scores assessed by masked reviewers, and improved quality of life. Although there is controversy about the mechanism of action, and the contribution of the placebo effect cannot be quantified, this unmasked study suggests that this palliative procedure provides some clinical benefits in the defined population of patients.

Adult↗
PubMed2000

Sensory stimulation (snoezelen) versus relaxation: a potential strategy for the management of chronic pain.

PURPOSE: The sensory environment (Snoezelen) has been advocated by those working in the field of learning disabilities and mental health as a strategy to induce relaxation. The purpose of the current study was to explore this potential within the field of pain management where the use of relaxation techniques is often employed as a strategy for the management of chronic pain. Thus the current study was designed in order to determine the use of the sensory environment compared against a traditional relaxation programme used within a District General hospital pain clinic. METHOD: Seventy three patients were randomly allocated into either a control or experimental group. Data collection involved the administration of questionnaires, which were selected in order to reflect the multidimensional nature of the chronic pain experience. Hence measures included: pain intensity, pain quality, anxiety, depression, self-efficacy, coping and sickness impact. Analysis was performed using SPSS and included Friedman two-way analysis and repeated measures analysis of variance. RESULTS: The results indicated that the experimental group experienced a significant increase in pain (p = 0.03), but they improved significantly in disability associated with sleep (p = 0.01), psychosocial (p = 0.03) and sickness impact total (p = 0.004). The experimental group experienced a significant decrease in pain (sensory - p = 0.002), (number of words chosen - p = 0.008), (pain rating index - p = 0.002). Furthermore a reduction in disability associated with physical (p = 0.009), psychosocial (p = 0.009), sleep (p = 0.001), recreation (p = 0.001) and SIP total (p = 0.001). Repeated measures analysis of variance revealed a significant improvement with the experimental group in terms of pain (p = 0.04) and self-efficacy (p = 0.02). CONCLUSIONS: The patients who attended the sensory environment did slightly better that those who attended the traditional relaxation programme in terms of self-efficacy. Thus the current study indicates the potential for future research into chronic pain management.

Adaptation, Psychological↗
PubMed1999

Psychological disturbance and service provision in parentally bereaved children: prospective case-control study.

OBJECTIVES: To identify whether psychiatric disturbance in parentally bereaved children and surviving parents is related to service provision. DESIGN: Prospective case-control study. SETTING: Two adjacent outer London health authorities. PARTICIPANTS: 45 bereaved families with children aged 2 to 16 years. MAIN OUTCOME MEASURES: Psychological disturbance in parentally bereaved children and surviving parents, and statistical associations between sample characteristics and service provision. RESULTS: Parentally bereaved children and surviving parents showed higher than expected levels of psychiatric difficulties. Boys were more affected than girls, and bereaved mothers had more mental health difficulties than bereaved fathers. Levels of psychiatric disturbance in children were higher when parents showed probable psychiatric disorder. Service provision related to the age of the children and the manner of parental death. Children under 5 years of age were less likely to be offered services than older children even though their parents desired it. Children were significantly more likely to be offered services when the parent had committed suicide or when the death was expected. Children least likely to receive service support were those who were not in touch with services before parental death. CONCLUSIONS: Service provision was not significantly related to parental wishes or to level of psychiatric disturbance in parents or children. There is a role for general practitioners and primary care workers in identifying psychologically distressed surviving parents whose children may be psychiatrically disturbed, and referring them to appropriate services.

Adolescent↗
PubMed1999

Use of in vitro gas production models in ruminal kinetics.

Physiological systems models for ruminant animals are used to predict the extent of ruminal carbohydrate digestion, based on rates of intake, digestion, and passage to the lower tract. Digestion of feed carbohydrates is described in these models by a first-order rate constant. Recently, an in vitro gas production technique has been developed to determine the digestion kinetics in batch fermentation, and nonlinear mathematical models have been fitted to the cumulative gas production data from these experiments. In this paper, we present an analysis that converts these gas production models to an effective first-order rate constant that can be used directly in rumen systems models. The analysis considers the digestion of an incremental mass of substrate entering the rumen. The occurrence of passage is represented probabilistically, and integration through time gives the total mass of substrate and total rate of digestion in the rumen. To demonstrate the analysis, several gas production models are fitted to a sample data set for corn silage, and the effective first-order rate constants are calculated. The rate constants for digestion depend on ruminal passage rate, an interaction that arises from the nonlinearity of the gas production models.

Animals↗