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Biomedical subjects

R F Harvey

Publications and source records attributed to R F Harvey.

At least 19 recordsLinked to original sources
PubMed1992

Applying psychometric criteria to functional assessment in medical rehabilitation: III. Construct validity and predicting level of care.

A discriminant analysis was performed using Rasch ability estimates derived from four Patient Evaluation and Conference System (PECS) subscales, to distinguish among the functional independence and impairment profiles exhibited by patients admitted into any of three levels of medical rehabilitation delineated by the National Association of Rehabilitation Facilities (NARF): (1) inpatient hospital, (2) atypical nursing home (intermediate), or (3) day program. Two discriminant functions accounted for 91% and 9% of the between-group variance, respectively. Cross-validated classification of patients into one of the three levels of care, based on discriminant function scores, produced 75% correct classification; a 66% improvement over the percentage of correct classification likely by chance alone. Results support the construct validity of the PECS subscales and indicate they may be useful in validating clinically-based admission decisions among three of the levels of care promulgated by NARF.

Activities of Daily Living↗
PubMed1992

The MD thesis in the training of a consultant physician.

A postal survey was carried out among the 94 consultant physicians of the South Western region (83% response rate) to ascertain their attitudes to the tradition of obtaining an MD by thesis as part of a physician's training. Most felt that the practice was questionable, and only half felt that it made an important contribution. For some, doing an MD had been a painful experience, even a waste of time. Having an MD impressed selection committees, but did not appear to alter the length of training nor the probability of obtaining a consultant post in a teaching hospital. We suggest that the MD is of limited value in judging a junior doctor's suitability to be a consultant physician.

Attitude of Health Personnel↗
PubMed1992

The diagnosis of intra-abdominal abscesses in patients with severe Crohn's disease.

A series of 24 patients with severe relapses of Crohn's disease responding poorly to conventional treatment with corticosteroids was studied to determine the incidence of intra-abdominal abscesses and the best means to detect them. Ultrasound scans proved to be difficult to interpret and unreliable. Computed tomography demonstrated abnormal bowel thickening in most cases, and showed seven of the eight intraabdominal abscesses. 111In leucocyte scintigraphy always demonstrated inflamed areas of bowel, but underestimated the extent of disease in three patients and overestimated it in five. All eight abdominal abscesses were detected, and there were no false-positive results. It was always possible to distinguish the abscess from inflamed bowel wall. Intra-abdominal abscess is not uncommon in patients with severe relapses of Crohn's disease which are not responsive to corticosteroid therapy, being present in about one-third of patients. 111In leucocyte scintigraphy is a simple and helpful test for differentiating between active inflammatory bowel disease and complicating abscesses, contributing significantly to the management of patients with severe Crohn's disease.

Abscess↗
PubMed1992

Applying psychometric criteria to functional assessment in medical rehabilitation: II. Defining interval measures.

The use of functional assessment total scores in arithmetic operations has proliferated despite the lack of evidence supporting their use as interval measures of patient ability. Such evidence is minimally necessary to assure the validity of functional assessment total scores for clinical and management decision-making. Two requirements of interval measurement are explained and a set of Rasch analyses of 5,500 assessments using the Patient Evaluation and Conference System (PECS) are presented. The analyses were performed to determine the extent to which four item subsets identified in a previously reported factor analysis of the PECS comprise interval measures of functional independence status. Results indicate that the PECS scales meet these requirements to varying degrees. The analyses also identify areas in which measurement quality can be improved.

Activities of Daily Living↗
PubMed1991

Applying psychometric criteria to functional assessment in medical rehabilitation: I. Exploring unidimensionality.

While rehabilitation providers are facing increasing pressure to document treatment outcomes, critics have warned against the inappropriate use of ordinal functional assessment data in arithmetic operations. Two salient criticisms concern the combination of items representing multidimensional abilities into a single total score, and the indeterminate distances between hierarchical functional assessment scale categories. In this initial study, the factor structure of the Patient Evaluation and Conference System (PECS) was studied to assess the potential for unidimensional measurement. Factor analysis of a multidiagnostic dataset (n = 3,564) yielded eight factors accounting for 60% of the variance among 68 PECS items. The factors indicate that several unidimensional measures may underlie the PECS. These factors are delineated, and further studies of unidimensionality and additivity are recommended.

Activities of Daily Living↗
PubMed1990

99Tcm-nanocolloid imaging in inflammatory bowel disease.

We have used 99Tcm-labelled nanocolloid in an attempt to locate areas of inflamed bowel wall or abscesses in five patients with ulcerative colitis and nine with Crohn's disease. The scintigraphic findings were evaluated by comparison with those of recent barium studies and, in three patients, with surgical findings at laparotomy. It proved difficult to localize segments of inflamed bowel accurately with 99Tcm-nanocolloid because of the accumulation of radioactivity in the gut lumen, especially 2 or more hours after injection. However, there was little uptake of the labelled nanocolloid by areas of inflamed gut wall in the period before 2 h. When 99Tcm-nanocolloid scans were compared with 111In-WBC scans in eight patients who had both investigations, 99Tcm-nanocolloid scintigraphy was considerably less sensitive than 111In-WBC scintigraphy. One abscess was located correctly; the other was obscured by nearby bladder and bone marrow radioactivity. We conclude that 99Tcm-nanocolloid scanning is neither sensitive nor reliable enough for assessing the location of inflamed bowel wall or the presence of abscess in patients with inflammatory bowel disease.

Adult↗
PubMed1990

Comparison of omeprazole and cimetidine in reflux oesophagitis: symptomatic, endoscopic, and histological evaluations.

Symptomatic patients with endoscopically verified reflux oesophagitis were randomised to a double blind trial in which they received either omeprazole (20 mg once daily) or cimetidine (400 mg four times daily) for four, and if necessary, eight weeks. In an 'intention to treat' analysis, oesophagitis was found to have healed after four weeks in 77 of 137 (56%) in the omeprazole group and in 34 of 133 (26%) in the cimetidine group (p less than 0.001). By eight weeks these values were 71% and 35% respectively; p less than 0.001. Histological assessments were available for 73% of the patients. At entry, 63% (66 of 104) in the omeprazole group and 60% (56 of 94) in the cimetidine group (ns) had abnormal histology. After the study, the proportions of patients who initially had had abnormal histology but who then progressed to normal were 67% (44 of 66: omeprazole) and 48% (27 of 56: cimetidine) respectively (p less than 0.001). All patients had reflux symptoms at entry. After four weeks, 46% in the omeprazole group and 22% (p less than 0.001) in the cimetidine group were asymptomatic. Diary cards completed for the first two weeks showed that patients treated with omeprazole experienced fewer reflux symptoms by day and night and used fewer antacids. Omeprazole, 20 mg once a day for four to eight weeks, healed a greater proportion of patients with reflux oesophagitis than cimetidine, 1.6 g per day, assessed endoscopically and histologically, and relieved more patients' symptoms.

Cimetidine↗
PubMed1990

Serum trypsin in hepatosplenic schistosomiasis in the Sudan.

Serum trypsin was measured by radioimmunoassay in 30 patients with hepatosplenic schistosomiasis and 30 healthy controls. Patients with hepatosplenic schistosomiasis had a significantly lower serum trypsin 164.3 +/- 43.3 ng/ml than controls 241.3 +/- 74.0 ng/ml (P less than 0.001). It is concluded that the exocrine pancreatic function is impaired with regard to serum trypsin in hepatosplenic schistosomiasis.

Adolescent↗
PubMed1989

Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome.

33 patients with refractory irritable bowel syndrome were treated with four 40-minute sessions of hypnotherapy over 7 weeks. 20 improved, 11 of whom lost almost all their symptoms. Short-term improvement was maintained for 3 months without further formal treatment. Hypnotherapy in groups of up to 8 patients was as effective as individual therapy.

Adult↗
PubMed1988

Computerized tomography head scans as predictors of functional outcome of stroke patients.

Preadmission computerized tomography (CT) scans of the head were used to help develop a clinical method for the prediction of outcome of stroke patients. The functional gains and discharge outcomes of 100 stroke patients after inpatient rehabilitation were considered. Reports of preadmission (acute care hospital) CT scans of the head were analyzed and placed into six groups representing progressive anatomic involvement. Functional status was measured at admission and discharge using the patient evaluation and conference system (PECS) and placed into four functional groups. The groups ranged from normal to totally dependent in self-care activities, ambulation, and bladder and bowel functioning. Admission CT head scans reported in two categories--"normal" or "small superficial infarct"--were associated with return to independent functioning. Bihemispheric infarcts were associated with discharge to nursing home (71%), rather than to independent living. Of all patients with functional gain as measured with PECS, 79% returned home.

Adolescent↗
PubMed1987

Effects of sleeping with the bed-head raised and of ranitidine in patients with severe peptic oesophagitis.

Sleeping with the bed-head raised is commonly recommended as treatment for patients with troublesome oesophagitis, but its effect has not been objectively tested. Ranitidine therapy is useful in oesophagitis, but it does not often produce complete relief of symptoms. The effects of each of these treatments alone and in combination have been studied in 71 patients with severe (grade III) peptic oesophagitis. Each treatment improved both symptoms and endoscopic appearances significantly more than placebo did. However, the combination of the two treatments was much better than either alone; the reduction in pain score and the area of ulceration healed were about twice those with either treatment alone. Smoking more than five cigarettes per day or drinking more than 30 g alcohol per day significantly reduced the effectiveness of ranitidine therapy, but age, sex, body weight, or the presence of a hiatus hernia had no detectable effect.

Adult↗
PubMed1987

Prognosis in the irritable bowel syndrome: a 5-year prospective study.

To establish the short-term and long-term results of current treatment of irritable bowel syndrome (IBS), 104 patients were studied prospectively. All patients were treated similarly and the results were assessed after a few weeks and then after at least 5 years. IBS can be diagnosed more easily than has been suggested--72% of this series were correctly diagnosed by their referring doctor, and only 12% required radiological studies to exclude organic disease. The response to treatment was considerably better than expected, possibly because of the more aggressive use of high-fibre diets and bulking agents. Thus, 85% of patients were rendered virtually symptom-free in the short term, and 68% were still virtually symptom-free 5 years later. The response to treatment was better in men than in women, in those with constipation than with diarrhoea, when the symptoms had initially been triggered by an episode of acute diarrhoea, and in patients with a relatively short history. With a few simple investigations, sympathetic explanation, and appropriate treatment, most patients with IBS have a good prognosis.

Adolescent↗
PubMed1987

Pathogenesis of the impaired gall bladder contraction of coeliac disease.

We have investigated the possibility that the abnormally decreased gall bladder contraction after meals in patients with coeliac disease might result in part from an abnormality in the gall bladder response to endogenous cholecystokinetic hormones--for example, cholecystokinin and motilin--rather than solely from decreased secretion of such hormones. Eight patients with untreated coeliac disease and nine controls received intravenous infusions of the pure synthetic cholecystokinin analogue caerulein, 2-16 ng/kg/hour. Gall bladder emptying was measured on a minute-by-minute basis using 99mTc-HIDA scans. In the patients with coeliac disease, gall bladder emptying was greatly decreased (34.6 +/- 9.9 v 61.5 +/- 7.5% at 60 minutes, p less than 0.02), and a much greater dose of caerulein was needed to initiate gall bladder contraction (3.80 +/- 1.08 v 1.49 +/- 0.56 ng/kg, p less than 0.02). These results suggest that the abnormal gall bladder contraction in coeliac disease is not simply because of impaired release of cholecystokinin. Although mechanical factors secondary to the increased gall bladder size in patients with coeliac disease might to some extent account for the findings, the alternative explanation is that the gall bladder muscle is for some reason resistant to the action of cholecystokinetic agents. A similar phenomenon affecting the pancreas might contribute to the abnormally decreased pancreatic secretion found in coeliac disease.

Adult↗
PubMed1987

Computerized data bases: an integrated approach to monitoring quality of patient care.

Common information is shared by rehabilitation program evaluation, utilization review, and quality assurance. These administrative functions sometimes operate in isolation, not taking advantage of information sharing. This approach fails to recognize the potential for increased efficiency of integrating pertinent information to produce timely and useful reports. We report on a system design which addresses this concern by encouraging information sharing, reducing data duplication and creating a data base to produce needed statistical and management reports. Our discussion highlights the key elements of program evaluation, utilization review, and quality assurance. These elements are described as an integrated approach to meet the Commission on Accreditation of Rehabilitation Facilities and revised Joint Commission on Accreditation of Hospitals standards.

Database Management Systems↗
PubMed1986

Rehabilitation team and family assessment of the initial home pass.

Brain-injured individuals may have neurologic damage resulting in physical, cognitive and personality sequelae. Rehabilitation promotes recovery for these patients by restoring cognitive and social functions and focusing attention on medical-physical and cognitive-social intervention. A major component in rehabilitation is to teach family members to understand the process of recovery and their role in teaching and reinforcing desired behaviors at home. To investigate the utility of the family's role, we studied the effects of allowing patients to return to the home/family environment for short stays (therapeutic pass). By comparing functional ratings obtained from family and rehabilitation team members, we found families rated brain-injured patients higher in medical-physical areas and more equally in cognitive-social areas. Although we do not control for the family's frame of reference regarding the patient's premorbid status, we conclude that impaired cognitive functioning has a profound impact on family members who, like the patient, must make adjustments because of the disability. We recommend therapeutic passes as a meaningful tool in the process of educating families about the disability, its scope and impact, as well as its accompanying effects on cognitive and social functioning.

Brain Injuries↗