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Biomedical subjects

R P Gregory

Publications and source records attributed to R P Gregory.

At least 19 recordsLinked to original sources
PubMed2003

Post-operative progress of dystonia patients following globus pallidus internus deep brain stimulation.

In the current era of functional surgery for movement disorders, deep brain stimulation (DBS) of the globus pallidus internus (GPi) is emerging as the favoured intervention for patients with dystonia. Here we report our results in 20 patients with medically intractable dystonia treated with GPi stimulation. The series comprised 14 patients with generalized dystonia and six with spasmodic torticollis. Although comparisons were limited by differences in their respective neurological rating scales, chronic DBS clearly benefited both patient groups. Data conveying the rate of change in neurological function following intervention are also presented, demonstrating the gradual but progressive and sustained nature of improvement following stimulation of the GPi in dystonic patients.

Adult↗
PubMed2000

Diabetes training for dietitians: needs assessment, program description, and effects on knowledge and problem solving.

Recent changes in management and medical nutrition therapy for diabetes mellitus have produced a need to retrain many practicing dietitians. To meet this need, a multidisciplinary group experienced in medical nutrition therapy and educational methods used a formal needs-assessment process to design a new training program. Sugar is Not a Poison (SNAP): The Dietitian's New Role in Diabetes Management is a 2 1/2-day program that uses written text, didactic presentation, and exercises that simulate patient encounters to accomplish 12 learning objectives. Program evaluations show high levels of participant satisfaction. Mean (+/- standard deviation) scores on pre- and postests of knowledge and problem solving were 69 +/- 13% and 86 +/- 9%, respectively (P < 0.01). The SNAP program needs assessment, training methods, and knowledge problem-solving test are relevant to all types of education programs in clinical dietetics.

Diabetes Mellitus↗
PubMed2000

Clinical, electrophysiological, and molecular genetic studies in a new family with paramyotonia congenita.

OBJECTIVES: To characterise the clinical and electrophysiological features and to determine the molecular genetic basis of pure paramyotonia congenita in a previously unreported large Irish kindred. METHODS: Clinical and neurophysiological examination was performed on three of the five affected family members. Five unaffected and three affected members of the family were available for genetic testing. Direct sequence analysis of the SCN4A gene on chromosome 17q, was performed on the proband's DNA. Restriction fragment length polymorphism (RFLP) analysis was used to screen other family members and control chromosomes for the SCN4A mutation identified. RESULTS: Each affected member had clinical and examination features consistent with pure paramyotonia congenita. Electrophysiological studies disclosed a 78% drop in compound muscle action potential (CMAP) amplitude on cooling to 20 degrees C. DNA sequence analysis identified a heterozygous point mutation G4367A in exon 24 of the SCN4A gene which segregated with paramyotonia and was absent in 200 control chromosomes. The mutation is predicted to result in a radical amino acid substitution at a highly conserved position within the voltage sensing fourth transmembrane segment of the fourth repeated domain of the sodium channel. CONCLUSIONS: The G4367A mutation is likely to be pathogenic and it associates with a pure paramyotonia phenotype. In keeping with other paramyotonia mutations in this region of the skeletal muscle sodium channel, it is predicted that this mutation will impair voltage sensing or sodium channel fast inactivation in a temperature dependent fashion. This study provides further evidence that exon 24 in SCN4A is a hot spot for paramyotonia mutations and this has implications for a DNA based diagnostic service.

Adult↗
PubMed2000

Utility of a brief self-efficacy scale in clinical training program evaluation.

Self-efficacy is often studied as a predictor of professional practice behaviors or as an outcome of clinical training, using brief scales with little validation. This study examines the utility of a brief self-efficacy scale in the evaluation of a clinical training program. Subjects were 119 registered dietitians who participated in diabetes training. Hypothesized relationships between self-efficacy ratings and indices of skill mastery, participation in training, and subsequent practice change were examined. Self-efficacy ratings after training correlated significantly with relevant prior experience (r = .4 and .29, p < .01) but not total experience and with knowledge post-test score (r = .21, p < .02). Self-efficacy for all 12 program objectives increased significantly after training. Post-training self-efficacy for two program objectives correlated significantly with self-reported successful practice changes related to those objectives (r = .4, p < .04 and r = .51, p < .01). The data suggest that brief self-efficacy assessments can contribute meaningfully to clinical training program evaluation.

Analysis of Variance↗
PubMed1999

The perception of visual images encoded in musical form: a study in cross-modality information transfer.

This study demonstrates the ability of blind (previously sighted) and blindfolded (sighted) subjects in reconstructing and identifying a number of visual targets transformed into equivalent musical representations. Visual images are deconstructed through a process which selectively segregates different features of the image into separate packages. These are then encoded in sound and presented as a polyphonic musical melody which resembles a Baroque fugue with many voices, allowing subjects to analyse the component voices selectively in combination, or separately in sequence, in a manner which allows a subject to patch together and bind the different features of the object mentally into a mental percept of a single recognizable entity. The visual targets used in this study included a variety of geometrical figures, simple high-contrast line drawings of man-made objects, natural and urban scenes, etc., translated into sound and presented to the subject in polyphonic musical form.

Humans↗
PubMed1998

A decision analytic approach to commissioning ambulance cardiac services.

The paper discusses how a decision analytic framework has been used by an English health authority in relation to the commissioning of ambulance cardiac services. Strategies for the management by ambulance personnel of victims of cardiac arrest and persons with acute chest pain of cardiac origin were modelled in a decision-event tree, and a bibliographic database established. The international research literature prior to 1997 was searched in order to derive probability values for the tree. However, after checking whether the subgroupings of results in the papers were in accordance with the variables in the tree, the number of useful papers on acute chest pain was found to be only two. In the almost complete absence of information--even from small observational studies--on the management of the great majority of patients with cardiac symptoms transported by ambulance, the local ambulance service and the main providers of hospital services in the district are now collaborating in field studies of cardiac care in order to improve the inputs into the model.

Algorithms↗
PubMed1993

Electroencephalogram epileptiform abnormalities in candidates for aircrew training.

For 30 years the Royal Air Force has used the EEG as part of the medical screening of candidates for aircrew training. A total of 13,658 males aged 17-25 years have been examined. None had a previous history of significant illness. Sixty-nine (0.5%) of these showed unequivocal epileptiform discharges, 44 (58%) occurring only on photic stimulation. Those with EEG discharges of uncertain significance such as 6 and 14 Hz positive spikes, 6 Hz spike and wave, and non-specific paroxysmal activity were not included. A group of 43 with a follow-up period of 5-29 years have been reviewed. Only one person developed unequivocal epilepsy. If this rate is combined with results from similar studies, the chance of healthy individuals with EEG abnormalities of this type subsequently developing epilepsy is 2-3%.

Adolescent↗
PubMed1993

Lyme disease in military personnel.

The tick responsible for Lyme disease is common in areas inhabited by deer. This should theoretically put military personnel at increased risk. A history of tick bite is uncommon and the characteristic skin rash often absent. Two examples of servicemen with neurological Lyme disease without cutaneous manifestations are discussed, and six other cases referred to the RAF Institute of Pathology and Tropical Medicine since 1987 briefly reviewed. Five of the cases contracted the disease in Germany and four were dependents. Lyme disease is under-recognised and under-reported, so that the scale of the problem cannot be determined. It is recommended that wooded areas inhabited by deer should not be frequented without adequate clothing, particularly in the early summer months when tick activity is at its greatest.

Adult↗
PubMed1992

Tardive dyskinesia presenting as severe dysphagia.

A case of tardive dyskinesia presenting with severe dysphagia as the predominant feature is described. Diagnosis was delayed because clinically apparent orofacial dyskinetic movements were minimal. The symptoms resolved following the cessation of neuroleptic medication.

Bipolar Disorder↗
PubMed1989

Neuroleptic malignant syndrome in a case of post-partum psychosis.

A 27-year-old woman with a post-partum psychosis developed NMS which proved difficult to diagnose because of the organic features of the presenting illness. Possible contributory factors to the development of NMS included exhaustion, a non-specific viral illness, and rapid loading with haloperidol.

Adult↗
PubMed1986

Is 2% hydroxypropylmethylcellulose a safe solution for intraoperative clinical applications?

We examined 2% hydroxypropylmethylcellulose prepared for clinical intraocular surgical procedures in various laboratories. Each sample contained a variety of particulate debris of botanical origin, although in varying amounts. The identified material was also seen in a sample of the raw material from which all the clinical material had been prepared. Our conclusion is that filtration methods, which are the physical methods used to purify the product, are at worst ineffective and at best inadequate. Until proper laboratory and clinical studies confirm an acceptable level of adverse reactions, we recommend that this material not be used clinically.

Anterior Eye Segment↗