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Biomedical subjects

R Rosser

Publications and source records attributed to R Rosser.

At least 19 recordsLinked to original sources
PubMed2003

Clinical decision guidelines for NHS cosmetic surgery: analysis of current limitations and recommendations for future development.

Because of increasing demand for publicly funded elective cosmetic surgery, clinical decision guidelines have been developed to select those patients who should receive it. The aims of this study were to identify: the main characteristics of such guidelines; whether and how they influence clinical decision making; and ways in which they should be improved. UK health authorities were asked for their current guidelines for elective cosmetic surgery and, in a single plastic surgery unit, we examined the impact of its guidelines by observing consultations and interviewing surgeons and managers. Of 115 authorities approached, 32 reported using guidelines and provided sufficient information for analysis. Guidelines mostly concerned arbitrary sets of cosmetic procedures and lacked reference to an evidence base. They allowed surgery for specified anatomical, functional or symptomatic reasons, but these indications varied between guidelines. Most guidelines also permitted surgery 'exceptionally' for psychological reasons. The guidelines that were studied in detail did not appreciably influence surgeons' decisions, which reflected criteria that were not cited in the guidelines, including cost of the procedure and whether patients sought restoration or improvement of their appearance. Decision guidelines in this area have several limitations. Future guidelines should: include all cosmetic procedures; be informed by a broad range of evidence; and, arguably, include several nonclinical criteria that currently inform surgeons' decision-making.

Cosmetics↗
PubMed1997

A prospective study of changes in negative mood states of women undergoing surgical hysterectomy: the relationship to cognitive predisposition and familial support.

Levels of anxiety and depression were documented by questionnaire response from a sample of 89 women who were to undergo surgical hysterectomy 3 weeks later. Fifty-four per cent (n = 48) of the sample reported anxiety and 26% (n = 23) reported depression at clinical levels during the preoperative period, with an additional number (n = 16 anxiety; n = 19 depression) at borderline status. Despite an overall significant postoperative reduction of negative mood states, clinical levels of anxiety were found in a substantial minority of women both 2 (24%) and 6 months (31%) after surgery. Levels of depression at these times were respectively 13% and 11% of the sample which provided postoperative information. These data confirm previous reports of high levels of negative mood states in patients referred for surgical hysterectomy. However, analyses of individual profiles of change confirm that there was a beneficial outcome for the large majority of the women, with 83% of those with clinical levels of anxiety showing improved status. Regression analyses indicated that postoperative outcomes with respect to negative affect could be predicted from preoperative status, and the data provide some support for the hypothesis that for a minority of women, negative mood states co-presented with gynecological symptoms may not be attenuated by surgery. Both dispositional resilience and familial cohesiveness were entered as significant variables in regression models examining postoperative status, although they provided only a limited increase to the postoperative variance prediction from measure of preoperative levels of affect. Preoperative mood status was found to be inversely related to an intrapersonal dimension of 'dispositional resilience' and to 'family cohesiveness'. It is suggested that measurement of preoperative mood status to family cohesiveness and dispositional resilience may provide useful adjunctive measures in attempts to identify women at risk of reporting an unsatisfactory surgical outcome.

Adult↗
PubMed1995

Functional aspects of recollective experience in face recognition.

This article describes two experiments on awareness in recognition memory for novel faces. Two kinds of awareness, recollective experience and feelings of familiarity in the absence of recollective experience, were measured by "remember" and "know" responses. Experiment 1 showed that "remember" but not "know" responses were reduced by divided attention at study. Experiment 2 showed that massed versus spaced repetition of faces in the study list had opposite effects on "remember" and "know" responses. Massed repetition increased "know" responses and reduced "remember" responses. Spaced repetition increased "remember" responses and reduced "know" responses. The results of both experiments replicate previous findings from the verbal domain in the domain of face recognition, and hence they increase the ecological validity of this experimental approach to memory and awareness and the generality of its database. These findings are discussed from a rehearsal perspective on factors influencing the two states of awareness and in relation to the alternative "process dissociation" procedure.

Adult↗
PubMed1995

Eliciting EuroQol descriptive data and utility scale values from inpatients. A feasibility study.

We conducted a microstudy to elicit health state descriptions and utility values, using the EuroQol instrument, from a sample of acutely ill inpatients on 5 wards at University College London Medical School. Most current work to date has elicited such descriptive and valuation data from random surveys of the general population. One problem with this is that most responders from the general population have not actually experienced the states being valued. Our goal was to ascertain whether there were any differences between the values given by inpatients and those of the general population. However, the small sample size of patients included in our feasibility study means our conclusions must remain tentative. Nevertheless, the results suggest that patients give higher values than the general population. We suggest that more research needs to be done eliciting values from patients.

Adolescent↗
PubMed1994

The Marchioness disaster: preliminary report on psychological effects.

The psychological after-effects on 27 survivors of the Marchioness riverboat disaster of 20 August 1989 are described. On measures of intrusive memories and psychological difficulties these subjects are significantly higher than population norms, and somewhat higher than psychiatric in-patient populations. Personality measures taken after the disaster show that neuroticism scores are very much higher than population norms, but personality measures were not correlated with distress.

Adult↗
PubMed1991

The King's Cross fire. Part 2: The psychological injuries.

This paper describes the experiences of six people who received severe burns in the King's Cross Underground Station fire of 1987. They all developed post-traumatic stress disorder to varying levels of intensity and the problems of psychological intervention as they related to the patients' different mental defence mechanisms are outlined.

Adult↗
PubMed1991

Psychological aftermath of the King's Cross fire.

The King's Cross fire occurred at the end of the evening rush hour, on 18 November 1987. King's Cross station is within the department's health district and we felt a responsibility to respond to the psychological aftermath. The unique features of our intervention were the degree of inter agency coordination, the use of a systematic outreach and screening programme, the collection of psychotherapy outcome measures and the development of an ongoing clinic. The work represents a sustained attempt to assess the nature and prevalence of post-traumatic reactions and the most medically and economically effective form of intervention. In this paper we describe the way our team responded to the high level of psychological distress that we found, we present some preliminary results, outline two therapeutic trials, and refer to the longterm consequences for the work of our department.

Disaster Planning↗
PubMed1991

Psychiatric screening of admissions to an accident and emergency ward.

One hundred medical and surgical patients admitted to an accident and emergency ward were screened for psychiatric disorder. A psychiatric diagnosis was made in 37 patients, 32 of whom were correctly identified by the GHQ. Psychiatric morbidity was associated with being single, lower social class, unemployment, homelessness and living in Bloomsbury Health District or north-east London. It was also associated with not being registered with a GP. The 14 overdose patients were no more likely to receive a psychiatric diagnosis than other patients, yet constituted most of the psychiatric referrals. Few patients were asked by medical staff about emotional worries or problems. A desire to be asked such questions and a past psychiatric history were associated with a psychiatric diagnosis. Routine screening of psychiatric morbidity in both medical and surgical patients and appropriate psychiatric referral of identified patients is recommended. A system of facilitating GP registration is necessary, as much of the morbidity identified could be contained within primary care.

Adolescent↗
PubMed1990

Screening for psychiatric morbidity in an accident and emergency department.

One hundred and twenty A&E Department daytime attenders were screened for psychiatric disorder in a two stage procedure. Thirty-three patients were identified as General Health Questionnaire (GHQ) 'cases' of whom 28 agreed to a psychiatric interview using the Clinical Interview Schedule. Twenty-eight GHQ 'non-cases' were also interviewed. A psychiatric diagnosis was made in 24 patients, 21 of whom were GHQ cases. Patients were more likely to suffer from psychiatric morbidity if the presenting complaint was other than minor trauma. There were trends for psychiatric morbidity to be associated with not being married and living in Bloomsbury Health District (No Fixed Abode or resident) or Northeast London. Sixty-nine percent of cases had a positive past psychiatric history. Ten of 12 cases (83%) requiring primary care intervention were not registered with a GP. It is suggested that appropriate intervention would be for A&E Departments to routinely facilitate such registration. In addition, resources need to be released to make 9am to 5pm walk-in psychiatric services commonplace.

Adult↗
PubMed1984

Psychometric and cranial CT study in myotonic dystrophy.

Twenty-two adults with myotonic dystrophy were assessed for evidence of intellectual impairment and cranial CT abnormalities. Psychometric evaluation demonstrated significantly lower verbal and performance IQs in the MD subjects than in matched normal controls. The reduced performance IQ was not simply related to loss of fine motor skills. No significant differences were found in memory and personality assessments between the MD and control groups. Lateral ventricular surface area was measured on CT scans using a semiautomated image analysis technique and was found to have a positive correlation with age in a control group of 45 normal scans (r = 0.833, P less than 0.001). This correlation was lacking in the MD group of subjects (r = 0.345, P greater than 0.05), in eight of whom the ventricular surface area was above the upper limit for age found in the control group. Asymptomatic areas of focal atrophy were found in two subjects. There was no correlation between ventricular size and severity or duration of the disease or verbal or performance IQ.

Adolescent↗
PubMed1983

Breathlessness and psychiatric morbidity in chronic bronchitis and emphysema: a study of psychotherapeutic management.

This paper describes a study of the outcome of psychotherapy with patients disabled by chronic obstructive airways disease giving rise to dyspnoea. Forty-three men and 22 women with severe COAD were randomly allocated for 8 weeks to one of three types of psychotherapy or to an untreated control group, and were followed up six months later. The group treated by a medical nurse without training in psychotherapy experienced sustained relief of dyspnoea but tended to undergo less psychodynamic change; psychiatric symptoms were reduced in those receiving supportive, but not analytical, psychotherapy. The psychosomatic mechanisms involved and the implications for medical and nursing practice and for liaison psychotherapy are discussed.

Aged↗
PubMed1983

Selection and outcome in in-patient psychotherapy.

In a retrospective study of 28 successive admissions for in-patient psychotherapy, the following characteristics have been identified as predictors of favourable outcome: a diagnosis of neurotic psychopathology; superior intelligence; considerable depression; and minimal previous out-patient treatment. Two alternative sets of decision rules are presented which might be used as a guide in deciding whether to admit patients. More rigorous selection criteria are suggested in the common situation where the demand for treatment greatly exceeds the supply of facilities, but such criteria would result in the exclusion of a small proportion of borderline patients who might respond to in-patient psychotherapy and might otherwise prove untreatable.

Adult↗
PubMed1983

Values in dynamic psychotherapy: measurement and social choice.

This review advocates more attention to the properties of measures of change in psychotherapy research. It anticipates the development of cardinal measures of different attributes, which can be combined by methods of proven validity, and placed on scales of value or utility.

Conflict, Psychological↗
PubMed1982

Nortriptyline metabolism in chronic renal failure: metabolite elimination.

Single oral dose kinetics of nortriptyline and of tis two major metabolites, conjugated and unconjugated 20-hydroxynortriptyline, were studied in eight healthy subjects and 15 patients with chronic renal failure, five of whom were being treated with hemodialysis. Nortriptyline kinetics were unaltered, but the elimination of the metabolites was reduced in both groups of patients. In chronic renal failure the excretion of nortriptyline metabolites appeared to be the rate-limiting step in nortriptyline elimination. Three depressed hemodialysis patients were treated with nortriptyline (75 mg at night) for 6 wk. The ratios of the steady-state plasma concentrations of unconjugated 10-hydroxynortriptyline to nortriptyline (0.74 to 2.30) were in the same range as those in a control group of depressed patients with adequate renal function (0.53 to 4.08) who were also receiving nortriptyline. Conjugated 10-hydroxynortriptyline in renal failure patients was slow to reach steady-state concentrations and these were 10 to 20 times as high as those of the control depressed patients. Conjugated 10-hydroxynortriptyline in dialysis fluid during treatment showed that a mean 43 +/- 7% (SD) of the dose was removed by a 10-hr dialysis. Dialysis clearance of conjugated 10-hydroxynortriptyline was 58 +/- 8 (SD) ml min-1, but nortriptyline and unconjugated 10-hydroxynortriptyline were not appreciably removed by dialysis. Hemodialysis is not likely to be of value in the management of acute nortriptyline poisoning.

Adolescent↗