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Biomedical subjects

S Rumble

Publications and source records attributed to S Rumble.

6 recordsLinked to original sources
PubMed1996

Prevalence of psychiatric morbidity in the adult population of a rural South African village.

We report on the first South African two-stage community prevalence study of psychiatric morbidity, conducted in Mamre, a rural "coloured' village, 50 km from Cape Town. Randomly selected adults (N = 481) were assessed using the Self-Reporting Questionnaire (SRQ) as a first-stage screen and the Present State Examination (PSE-9) was administered to a proportion of the sample (N = 121) as the second-stage criterion. Demographic, health care utilization, and substance abuse data were also collected. Using the PSE-9 CATEGO Index of Definition of 5, the weighted prevalence of psychiatric morbidity was 27.1% (confidence interval of 19.5-34.7%), the majority of cases being given a tentative diagnosis of depressive or anxiety disorder. The CATEGO algorithm may not be fully appropriate in this cultural context as there was an apparent over-diagnosis of paranoid states. The SRQ's weighted sensitivity and specificity were 0.49 and 0.82 respectively. Overall, the SRQ correctly identified 67% of cases and non-cases. No demographic variables predicted psychiatric morbidity, but there was an indirect link between morbidity and primary care utilization. Further South African studies of the validity of both the SRQ and of criterion instruments are needed. These may contribute to knowledge regarding cultural factors affecting psychiatric diagnosis.

Adolescent↗
PubMed1993

A comparison of conventional dialytic therapy and acute continuous hemodiafiltration in the management of acute renal failure in the critically ill.

OBJECTIVE: To compare and contrast the clinical outcomes in critically ill patients with acute renal failure managed with either acute continuous hemodiafiltration or conventional dialytic therapies. DESIGN: Retrospective review of the medical records of 167 consecutive cases of acute renal failure treated at a single center (July 1982-July 1991). Scoring for illness severity (APACHE II, number of failing organs) and assessment of outcome in terms of biochemical control of azotemia, ARF therapy-related morbidity, and overall morbidity and mortality. SETTING: Tertiary institution. PATIENTS: 167 consecutive critically ill patients with multiorgan failure and acute renal failure. MEASUREMENTS AND MAIN RESULTS: 84 patients received conventional dialytic therapy (CDT) (1982-1988) and 83 acute continuous hemodiafiltration (ACHD) (1988-1991). The etiology of ARF and illness severity indices were similar in both groups (organ failure scores: CDT 3.9 vs. ACHD 4.1; NS). All patients were critically ill, with more severely ill patients within the ACHD groups (mean APACHE II score: CDT 25.8 vs. ACHD 28.1; p < .01). There were no significant differences in pretreatment serum creatinine, glucose, bicarbonate and phosphate, white cell and platelet counts, incidence of disseminated intravascular coagulation, prevalence of sepsis, or evidence of pulmonary and/or peripheral edema. Overall survival was 29.8% for the CDT groups and 41% for the ACHD group (NS). When patients were stratified by severity of illness, survival in those with 2 to 4 failing organs was significantly greater in the ACHD group (CDT 31.1% vs. ACHD 53.8%; p < .025). Similarly, overall survival in patients with intermediate APACHE II scores (24 to 29) was significantly better in those treated with ACHD (CDT 12.5% vs. ACHD 46.4%; p < .025). During the course of ARF, in comparison to CDT, ACHD was associated with greater overall reductions in serum creatinine, and in phosphate and plasma urea, and an increased net nutritional intake. CONCLUSIONS: ACHD provided biochemical and outcome indicator advantages over conventional dialytic therapy. In patients with 2 to 4 failing organs or an intermediate APACHE II score (24 to 29) a significant survival advantage was demonstrated for ACHD over CDT. Although this study is a retrospective analysis, with all the inherent limitations of such studies, it suggests that ACHD is the treatment of choice for ARF in the critically ill, with maximum benefits seen in those with 2 to 4 failing organs and/or intermediate APACHE II scores.

Acute Kidney Injury↗
PubMed1990

The development of a framework for assessing developing conversational skills.

A framework for investigating the development of conversational skills in children, comprising the areas of topic control, repair of communication breakdown and linguistic cohesion, was devised. This was undertaken by a process of collating information from some existing pragmatic profiles and the developmental literature. The framework was then modified inductively to accommodate features of the data obtained from 12 normally developing English-speaking children in the age groups three, four and five years. A number of age-related trends emerged that were supported by the developmental literature. This study emphasizes the need for the development of more refined pragmatic assessment procedures which will aid the collection of normative data presently lacking.

Child, Preschool↗
PubMedDate not supplied

Acute renal failure in critical illness. Conventional dialysis versus acute continuous hemodiafiltration.

The dialytic therapy of choice in critically ill patients with acute renal failure (ARF) is a matter of controversy. The clinical outcome of such patients managed with either conventional dialytic therapy (CDT) or acute continuous hemodiafiltration (ACHD) was compared through retrospective review of medical records from the intensive care unit of a tertiary institution. Records from 167 critically ill patients with ARF consecutively treated in the same intensive care unit were reviewed. Eighty-four patients with ARF treated by CDT were compared to 83 treated with ACHD. The etiology of ARF and the degree of illness severity were similar in both groups (failing organs: CDT 3.9 vs. ACHD 4.1; mean APACHE II score: CDT 25.8 vs. ACHD 28.1). Overall survival was 29.8% for the CDT patients and 41% for the ACHD group (NS). In those with two to four failing organs, survival was greater in the ACHD group (53.8% vs. 31.1%; p < 0.025). This was also true for patients with an intermediate APACHE II score (24-29) who demonstrated better survival when treated by ACHD (46.4% vs. 12.5%; p < 0.025). Acute continuous hemodiafiltration was associated with better control of azotemia and hyperphosphatemia and increased nutritional intake. This retrospective study suggests that ACHD may offer clinically significant advantages over CDT, particularly in patients with an intermediate degree of critical illness severity.

Acute Kidney Injury↗