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Biomedical subjects

R Bale

Publications and source records attributed to R Bale.

At least 37 records · Page 2Linked to original sources
PubMed1999

A comparison of the utility of dimensional and categorical representations of psychosis. UK700 Group.

BACKGROUND: The usefulness of any diagnostic scheme is directly related to its ability to provide clinically useful information on need for care. In this study, the clinical usefulness of dimensional and categorical representations of psychotic psychopathology were compared. METHOD: A total of 706 patients aged 16-65 years with chronic psychosis were recruited. Psychopathology was measured with the Comprehensive Psychopathological Rating Scale (CPRS). Lifetime RDC, DSM-III-R, and ICD-10 diagnoses and ratings of lifetime psychopathology were made using OPCRIT. Other clinical measures included: (i) need for care; (ii) quality of life; (iii) social disability; (iv) satisfaction with services; (v) abnormal movements; (vi) brief neuropsychological screen; and (vii) over the last 2 years--illness course, symptom severity, employment, medication use, self-harm, time in hospital and living independently. RESULTS: Principal component factor analysis of the 65 CPRS items on cross-sectional psychopathology yielded four dimensions of positive, negative, depressive and manic symptoms. Regression models comparing the relative contributions of dimensional and categorical representations of psychopathology with clinical measures consistently indicated strong and significant effects of psychopathological dimensions over and above any effect of their categorical counterparts, whereas the reverse did not hold. The effect of psychopathological dimensions was mostly cumulative: high ratings on more than one dimension increased the contribution to the clinical measures in a dose-response fashion. Similar results were obtained with psychopathological dimensions derived from lifetime psychopathology ratings using the OCCPI. CONCLUSIONS: A dimensional approach towards classification of psychotic illness offers important clinical advantages.

Adolescent↗
PubMed1999

To what extent does symptomatic improvement result in better outcome in psychotic illness? UK700 Group.

BACKGROUND: The effectiveness of therapeutic interventions in psychosis is increasingly reported in terms of reductions in different symptom dimensions. It remains unclear, however, to what degree such symptomatic changes are accompanied by improvement in other measures such as service use, quality of life, and needs for care. METHODS: A sample of 708 patients with chronic psychotic illness was assessed on three occasions over 2 years (baseline, year 1 and year 2). A multilevel analysis was conducted to examine to what degree reduction in psychopathological scores derived from factor analysis of the Comprehensive Psychopathological Rating Scale (CPRS), was associated with improvement in service use, disability, subjective outcomes and measures of self-harm. RESULTS: Reduction in positive, negative, depressive and manic symptoms over the study period were all independently associated with lessening of social disability. Reduction in negative symptoms, and to a lesser extent in positive and manic symptoms, was associated with less time in hospital and more time living independently, whereas changes in positive and manic symptoms resulted in fewer admissions. Subjective outcomes such as improvement in quality of life, perceived needs for care and dissatisfaction with services showed the strongest associations with reduction in depressive symptoms. Reduction in positive symptoms was associated with decreased likelihood of parasuicide. Results did not differ according to diagnostic category. CONCLUSION: The findings suggest that changes in distinct psychopathological dimensions independently and differentially influence outcome. Therapeutic interventions aimed at reducing symptoms of more than one dimension are likely to have more widespread effects.

Adolescent↗
PubMed1999

Tardive dyskinesia in psychosis: are women really more at risk? UK700 Group.

It is commonly held that women are more at risk of developing tardive dyskinesia (TD). However, recent evidence suggests that this may only be the case in samples of older patients, men being more at risk in the younger age groups. Abnormal movements were measured with the Abnormal Involuntary Movement Scale (AIMS) in a sample of 706 chronic psychotic patients aged not older than 65 years (median age 36 years). Female gender was associated with a lower risk of TD (OR, 0.5; 95% CI, 0.3-0.7). The effect of gender was independent of other risk factors such as older age, severity of negative symptoms and exposure to antipsychotic medication in the previous 2 years. There was no evidence that the effect of these risk factors differed between the sexes. In samples of relatively young patients with chronic psychotic illness, who typically represent the majority of patients in community programmes for the severely mentally ill, men are more at risk of TD than women.

Adult↗
PubMed1999

The quantity and quality of clinical practice guidelines for the management of depression in primary care in the UK.

BACKGROUND: Despite research evidence that guidelines can improve patient care, concerns remain over their cost-effectiveness. This is particularly so when there is a proliferation of guidelines for the same condition. Faced with differing recommendations, users will wish to make informed decisions on which guideline to follow. In creating a guideline appraisal instrument we have assessed guidelines developed in the United Kingdom (UK) for the management of a range of disorders including depression in primary care. AIM: To identify the number of UK clinical guidelines for the management of depression in primary care and to describe their quality and clinical content. METHOD: A survey was undertaken to identify all depression guidelines developed in the UK between January 1991 and January 1996. All guidelines produced by national organizations and a random sample of local guidelines were appraised using a validated instrument by six assessors: a national expert in the disease area, a general practitioner, a public health physician, a hospital consultant, a nurse specializing in the disease area, and a researcher on guideline methodology. The clinical content of each guideline was then assessed by one of the researchers (RB) according to a defined framework. RESULTS: Forty-five depression guidelines were identified. While there was a considerable range in the quality of the six national and three local guidelines appraised, at a group level their performance was similar to guidelines for other diseases. Clinical recommendations tended to reflect the joint consensus statement produced by the Royal College of General Practitioners and Royal College of Psychiatrists in 1992. The most obvious difference was in the style in which the guidelines were written and presented. CONCLUSION: A 'national template' was the starting place for most guidelines. Steps need to be taken to ensure that these templates are based on the best possible research evidence and professional opinion. Local clinicians should concentrate on effective dissemination and implementation strategies, rather than creating new guidelines.

Depressive Disorder↗
PubMed1998

Repositioning accuracy: comparison of a noninvasive head holder with thermoplastic mask for fractionated radiotherapy and a case report.

PURPOSE: To compare accuracy, clinical feasibility, and subjective patient impression between a noninvasive head holder (Vogele Bale Hohner [VBH]; Wellhoefer Dosimetry, Schwarzenbruck, Germany) developed at the University of Innsbruck and the thermoplastic mask fixation system for use in fractionated external radiotherapy. We present a case report of an actual patient fixated in the VBH head holder during radiation therapy. MATERIALS AND METHODS: The VBH head holder consists of an individualized vacuum dental cast connected to a head plate via two hydraulic arms allowing noninvasive, reproducible head fixation of even uncooperative patients. Accuracy was tested and compared with that of the thermoplastic mask using the Phillips EasyGuide navigation system on five volunteers. Specific external registration points served as landmarks and their positions were compared after each repositioning. System and operator inaccuracy were also taken into account. The times taken for production and repositioning of the respective fixation devices were compared, and subjective impressions were noted. RESULTS: Mean VBH head holder repositioning accuracy was 1.02 mm while that of the thermoplastic mask was 3.05 mm. 69% of mask repositionings showed a deviation > 2 mm and 41% > 3 mm (as opposed to 8% and 1% respectively for the VBH head holder) Those points located farthest away from the respective plane of fixation showed the largest deviations. Both production and repositioning times were similar between the systems; depending upon the patient, the VBH head holder was generally better tolerated than the mask system. CONCLUSION: Due to its significantly better repositioning accuracy compared to that of the thermoplastic mask, the VBH head holder is especially suited for external radiation requiring precise repositioning due to critical tissues in immediate surrounding of the area to be irradiated.

Adult↗
PubMed1998

[3D navigation for interstitial stereotaxic brachytherapy].

AIM: The aim of this paper is to describe the adaption of 3D-navigation for interstitial brachytherapy. The new method leads to prospective and therefore improved planning of the therapy (position of the needle and dose distribution) and to the possibility of a virtual simulation (control if vessels or nerves are on the pathway of the needle). MATERIAL AND METHODS: The EasyGuide Neuro navigation system (Philips) was adapted in the way, that needles for interstitial brachytherapy were made connectable to the pointer and correctly displayed on the screen. To determine the positioning accuracy, several attempts were performed to hit defined targets on phantoms. Two methods were used: "free navigation", where the needle was under control of the navigation system, and the "guided navigation" where an aligned template was used additionally to lead the needle to the target. In addition a mask system was tested, whether it met the requirements of stable and reproducible positioning. The potential of applying this method in clinical practice was tested with an anatomical specimen. RESULTS: About 91% of all attempts lied within 5 mm. There were even better results on the more rigid table (94% < 4 mm). No difference could be seen between both application methods ("free navigation" and "navigation with template"), they showed the same accuracy. CONCLUSIONS: The accuracy of the phantom experiments and the confirmation by the experiment with the anatomical specimen showed that excellent results can be expected in clinical practice using rigid tables and patient supporting systems.

Brachytherapy↗
PubMed1998

[Ruptures of the medial gastrocnemius muscle: diagnosis with high resolution ultrasound].

AIM: Evaluation of high resolution ultrasound to diagnose rupture of the medial head of gastrocnemius muscle in patients with uncharacteristic calf pain. METHOD: 66 patients with clinically unclear calf pain were examined in a prospective study. RESULTS: Out of 66 patients, 51 showed sonographic criteria of a partial rupture of the medial gastrocnemius head. 47 ruptures were located in musculotendineus transition zone. CONCLUSION: High resolution sonography detect minimal lesions of the medial gastrocnemius muscle in patients with clinically uncharacteristic calf pain.

Adult↗
PubMed1998

[ACOnet (Austrian Academic Computer Network) as data carrier for teleradiologic consultations].

PURPOSE: To assess the feasibility of image transfer for teleradiologic consultations using the Austrian Academic Computer Network (ACOnet). The ACOnet corresponds between the main universities to a MAN (Metropolitan Area Network) with a transfer rate of 4 Mbps. Its use is free of charge for university institutions. MATERIALS AND METHODS: 1740 test image data sets and 620 image data sets for teleradiological consultations were exchanged without annotations between the Departments of Diagnostic Radiology of the universities of Innsbruck and Graz, using the ACOnet. RESULTS: Data transmission was reliable and fast with an average transfer capacity of 170.2 kBytes/s (94-341 kBytes/s). There were no major problems with image transfer during the test phase. CONCLUSION: Due to its high transfer capacity, the ACOnet is considered a reasonable alternative to the ISDN service.

Austria↗
PubMed1998

Three-dimensional navigation in otorhinolaryngological surgery with the viewing wand.

We report our experiences with the ISG Viewing Wand intraoperative 3-dimensional navigation device in endonasal endoscopic procedures of the paranasal sinuses, anterior skull base, and petrous bone. In the last 12 months we have routinely used the wand in 90 patients for treatment of polyposis nasi, for biopsies and removal of tumors in the nasal cavity and at the frontal skull base, for endocrine ophthalmopathy, and in 1 case for cholesteatoma. We present our computed tomography, magnetic resonance imaging, and clinical protocols that allow a precise routine use of the Viewing Wand. In all cases, the system was extremely helpful for intraoperative localization and helped to optimize surgery.

Equipment Design↗
PubMed1998

The Austrian Academic Computer Network and its usefulness for teleradiology.

To study the value of the Austrian Academic Computer Network (ACOnet) for teleradiology, 1740 test image data-sets and 620 image data-sets were exchanged between the departments of diagnostic radiology of the Universities of Innsbruck and Graz using the ACOnet service. Data transmission was reliable and fast with an average transfer capacity of 170 kByte/s (range 94-341). During the test phase, no major problems with image transfer occurred. Assuming that problems like security of patient data-sets, data compression and data verification can be solved, the ACOnet service would be a useful additional tool for telemedicine applications throughout Austria and eastern Europe.

Austria↗
PubMed1997

[Use of the ISG viewing wand on the temporal bone. A model study].

Surgical interventions in the petrous bone have to be performed in close relationship to vital and delicate anatomical structures. In cases of revision surgery or with massive pathological changes 3D computer-assisted navigation provides an essential tool for preoperative planning, definition of target structures and intraoperative orientation. This technology can help to diminish intraoperative risks for the patient and may help to optimize any microsurgery. In this report we present our first experiences in using the ISG Viewing Wand in the petrous bone through a specially designed model. By recording more than 4000 single measurements we found that the ISG Viewing Wand can be used with sufficient precision. We have now outlined the most important conditions necessary for possible application to a patient.

Computer Systems↗
PubMed1996

Religion, ethnicity and obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is seen in many contrasting cultures but it is not known if the form of the disorder varies between these cultures. There have been anecdotal case reports where religion appeared to play a significant aetiological role in the disorder but the relationship between religion and OCD has not previously been systematically studied. This study was a retrospective, casenote study comparing the country of birth and religious affiliation of three groups of 50 patients. Its aim was to investigate the aetiological role played by religion in the development of OCD. The groups were patients with OCD from a specialist behavioural-cognitive unit, patients assessed in a specialist psycho-dynamic psychotherapy department and patients attending a general adult psychiatry outpatient department. More patients with OCD affiliated themselves with a religion as opposed to either of the other two groups. This difference disappeared when the type of religion was taken into account so that no conclusive relationship between OCD and religion could be identified. The findings do not diminish the importance of religion in the development of OCD in some individuals and suggest that future research in this area should include examination of the rigidity of upbringing and personal perception of the experience of strict rules or imposed religious practices.

Adolescent↗
PubMed1994

Case report: F23.

In this paper, we draw attention to the advantage of the International Classification of Diseases 10th Edition in the classification of short lived, reactive, psychotic illnesses over other systems of classification in widespread use, and illustrate this with some case histories.

Adult↗
PubMed1982

I.V. glyceryl trinitrate: haemodynamic effects and clinical use in cardiac surgery.

A commercial preparation of glyceryl trinitrate for i.v. administration was assessed under both experimental and clinical conditions. The overall haemodynamic effects were beneficial during coronary artery grafting and aortic valve replacement, when the drug was given at a rate of 0.8 microgram kg-1 min-1 at which dose there was no appreciable effect on resistance vessels. No adverse side-effects occurred. There was no change in the activity of the preparation, whether diluted or not, over a 6-h period.

Aortic Valve Stenosis↗