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Biomedical subjects

R R MacDonald

Publications and source records attributed to R R MacDonald.

11 recordsLinked to original sources
PubMed2003

Does cognitive-behavioural therapy influence the long-term outcome of generalized anxiety disorder? An 8-14 year follow-up of two clinical trials.

BACKGROUND: Generalized anxiety disorder is a common condition of excessive worry and tension which tends to run a chronic course associated with significant psychiatric and medical problems. Cognitive behaviour therapy (CBT) has been shown to be of clinical value in about 50% of cases with treatment gains maintained over follow-up periods ranging from 6 to 12 months. The potential value of CBT over the longer term has not been subject to rigorous investigation. METHOD: Results are reported of 8-14 year follow-up of two randomized controlled trials of cognitive-behaviour therapy for generalized anxiety disorder employing structured interview with an assessor blind to initial treatment condition. Comparison groups included medication and placebo in one study based in primary care, and analytical psychotherapy in the other based in secondary care. Follow-up samples (30% and 55% of trial entrants) were broadly representative of the original cohorts. RESULTS: Overall, 50% of participants were markedly improved of whom 30-40% were recovered (i.e. free of symptoms). Outcome was significantly worse for the study based in secondary care in which the clinical presentation of participants was more complex and severe. For a minority (30-40%), mainly from the secondary care study, outcome was poor. Treatment with CBT was associated with significantly lower overall severity of symptomatology and less interim treatment, in comparison with non-CBT conditions, but there was no evidence that CBT influenced diagnostic status, probability of recovery or patient perceptions of overall improvement. CONCLUSIONS: Both CBT and the complexity and severity of presenting problems appear to influence the long-term outcome of GAD.

Adult↗
PubMed1994

Fasciaform myringoplasty in children.

OBJECTIVE: To evaluate the efficacy of fasciaform myringoplasty as a means to repair large tympanic membrane perforations in children. DESIGN: Retrospective review of the records of 26 patients who underwent 29 consecutive fasciaform myringoplasty surgeries over a 47-month period. Patients were followed up from 2 to 47 months postoperatively. SETTING: Academic tertiary care children's hospital. PARTICIPANTS: Twenty-six patients (5 to 16 years old), with tympanic membrane perforations (25% to 95%) underwent a fasciaform myringoplasty procedure. The perforations were caused by extrusion of ventilation tubes (83%), deep retraction pockets, trauma, or repair after resection of cholesteatoma. INTERVENTION: The surgery involves resection of the native tympanic membrane and annulus. A new tympanic membrane is formed from formaldehyde-fixed autogenous temporalis fascia and positioned. OUTCOME MEASURE: Successful repairs, complications, and audiometric evaluations were analyzed. Fisher's Exact Test was used to compare complication rates by age. RESULTS: Successful closure was accomplished in 69% of cases. Otitis media recurred in 52%. Ventilation tubes were reinserted in 24%; 28% resolved with antibiotics alone. When tubes were placed through the graft, small residual graft perforations resulted. Audiometric evaluation revealed improvement in pure tone average to less than a 20-dB hearing level in 77% and reduction of the air-bone gap to within a 20-dB hearing level in 90% of those cases (10/29) with complete audiometric data. CONCLUSIONS: Fasciaform myringoplasty has proven to be a successful procedure for closing large tympanic defects and improving hearing acuity in the pediatric population. However, recurrent otitis media and eustachian tube dysfunction may continue. Rates of reperforation were statistically significantly higher in children 7 years old and younger. Conservative management of children in this younger age group is warranted.

Adolescent↗
PubMed1993

Flow cytometric studies of ploidy and proliferative indices in the Yorkshire trial of adjuvant progestogen treatment of endometrial cancer.

OBJECTIVE: To estimate whether flow cytometric indices provide independent measures of prognosis or predict response to prophylactic progestogens in endometrial cancer. DESIGN: Endometrial tumour specimens were retrieved and analysed by flow cytometry from 257 women who had been randomly allocated in a previous trial to receive prophylactic progestogen in addition to conventional therapy for endometrial carcinoma. SETTING: Fourteen district and two teaching hospitals in West Yorkshire. SUBJECTS: Women developing primary endometrial cancer between 1975 and 1983. MAIN OUTCOME MEASURES: Tumour ploidy status and proliferative indices and the relation of these to tumour stage and grade, to prognosis and to response to progestogens. RESULTS: Ploidy status and proliferative indices were related to tumour stage, grade and patient survival but were not independent predictors of survival. They did not predict patients who would respond to progestogens although there was a nonsignificant trend towards patients with diploid tumours surviving longer after progestogen treatment. CONCLUSIONS: Flow cytometry adds little to established prognostic indicators for endometrial cancer.

Aged↗
PubMed1980

Effect of distance on heterochromatic matching.

The brightness of colors in a number of paintings by Francis Pratt appeared to vary as a function of the viewing distance. These pictures were composed of narrow strips of different colors varying in brightness and saturation. Five experiments were undertaken to replicate and study this effect under controlled conditions using heterochromatic brightness matching of various pairs of colored stimuli. The subjects were first-year students in psychology, participating as a course requirement. The number of subjects varied in the different experiments, between 6 and 9. The relative brightness of blue as compared to red, orange, and yellow-green varied as a function of viewing distance. The relative brightness of the blue decreased as distance increased. By varying the physical size of the stimuli it was possible to keep the angle subtended at the retina constant for two distances and the effect remained. Any explanation must therefore account for the finding that the effect is not due to the apparent size of th stimuli.

Color Perception↗
PubMed1975

Management of tracheal rupture involving both bronchi.

A patient with a rupture of the lower trachea and both bronchi is presented. A review of the significant clinical findings is presented, and the anaesthetic management is discussed. The necessity of early bronchoscopy in these patients and the ready availability of experienced medical staff in assessing all severe trauma is emphasized.

Adolescent↗