Representation of South Asian people in randomised trials: ethnic origin need not be a barrier to participation.
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Asia↗
Biomedical subjects
Sue Wilson
Publications and source records attributed to Sue Wilson.
Effects on sleep architecture of pindolol, paroxetine and their combination in healthy volunteers.
RATIONALE: The combination of pindolol with a serotonergic antidepressant has been used to speed up the antidepressant response and to augment in cases of resistant depression. Animal studies have suggested that this increased response occurs because of 5HT(1A) antagonist properties of pindolol, which in combination with a serotonergic antidepressant produces a synergistic increase in 5HT in the synapse. OBJECTIVES: To test whether the combination of pindolol with a serotonergic antidepressant produces a synergistic increase in synaptic 5HT by examining the effects on measures of sleep, psychomotor performance and ratings of anxiety. METHODS: Twelve healthy male volunteers took part in randomised crossover study in which they received paroxetine 20 mg/day (or its placebo) for 9 days with a washout period of 5 days between. On day 7 and 9 of each treatment they also received pindolol 2.5 mg (or its placebo) three times a day. Sleep EEG recordings were made on each of the nights on pindolol (or its placebo) and ratings of saccadic eye movement parameters, subjective sleep, anxiety and other adverse events recorded on the following days. Four drug conditions were therefore tested: placebo, pindolol alone, paroxetine alone and paroxetine+pindolol. RESULTS. The combination of paroxetine+pindolol produced an increase in REM suppression and a reduction in SWS compared with other drug combinations. There were no significant effects on the other measures of 5HT function recorded in this study. CONCLUSIONS: REM suppression by the combination was approximately equal to the sum of REM suppression by each drug individually and thus does not show a synergistic effect. However, there was a significant reduction in SWS produced by only the combination treatment, which may suggest a specific effect of the combination on non-REM sleep mechanisms.
Adult↗
A cluster randomised controlled trial of patient-held medical records for people with schizophrenia receiving shared care.
BACKGROUND: Patient-held records can improve communication across the primary-secondary interface. There has been no previous rigorous assessment of the utility of patient-held records for people with schizophrenia from a primary care perspective and their value for this population is unclear. AIM: To evaluate the effectiveness of a patient-held record for patients with schizophrenia receiving shared care. DESIGN OF STUDY: Cluster randomised controlled trial. SETTING: Seventy-four general practices and six community mental health localities in Birmingham, England between June 1998 and June 1999. METHOD: A sample of 201 patients with schizophrenia (ICD-10 classification F20) was recruited; of these, 100 were intervention and 101 were control. Patient-held records were given to the intervention patients. At 12-month follow-up, all patients were accounted for and 191 (95%) were revisited. Primary outcomes were the Verona Service Satisfaction Scale-54 (VSSS-54) and the Krawiecka and Goldberg (K & G) rating scale of psychopathology at 12-month follow-up. Secondary outcomes were use of primary and secondary care services. RESULTS: A total of 63/92 (68.5%) patients still had the patient-held record, 64/92 (69.6%) had used it, and 39 (60.9%) of the 64 who had used it said the patient-held record was regularly used by their keyworker. However the patient-held record had no significant effect on primary outcomes (VSSS-54: F1,116 = 0.06, P = 0.801, K & G: F1,116 = 0.6, P = 0.439) or on use of services. A higher symptom score was associated with not using the patient-held record. CONCLUSIONS: The trial provides no good evidence to suggest that patient-held records should be introduced as part of routine shared care for all patients with schizophrenia. However, the patient-held record was acceptable to patients with schizophrenia and acted as a communication tool, particularly between patients and keyworkers.
Adolescent↗
The effects of levetiracetam on objective and subjective sleep parameters in healthy volunteers and patients with partial epilepsy.
Levetiracetam is a novel antiepileptic drug which has recently been released as an adjunctive treatment for partial epilepsy. In the two studies reported here we examined the objective and subjective effects of levetiracetam on sleep in 12 healthy volunteers and 17 patients [16 who could be evaluated for electroencephalogram (EEG) recordings] with a history of partial epilepsy on stable carbamazepine monotherapy. The studies were of a similar double-blind crossover placebo-controlled design with subjects' sleep being recorded in their own homes. The results from the two studies showed considerable similarities. In both, levetiracetam produced an increase in the time spent in stage 2 sleep, which in the patient study was accompanied by a decrease in the time spent in stage 4 sleep and in the volunteer study an increase in rapid eye movement (REM) latency. The subjective changes included reports that sleep was of a better quality with fewer awakenings and patients also reported that their sleep was more restful. Volunteers and patients did, however, feel less alert on waking in the morning. Therefore, both groups reported a decrease in awakenings after levetiracetam despite the finding from the EEG of no change in the actual number of awakenings. It may be concluded from both studies that levetiracetam does affect some indicators of subjective sleep perception, but does not influence objective sleep measures of sleep continuity. The results from the patient study during placebo add-on treatment also showed that patients on carbamazepine had a marked increase in SWS, an increase in stage 2 sleep and an increase in REM latency compared with healthy volunteers. Interestingly, levetiracetam also reduced bilateral epileptiform EEG activity, particularly in patients with more discharges.
Adult↗
Effect of nurse colposcopists on a hospital-based service.
The number of colposcopies performed annually in the UK is increasing. Nurse colposcopists have been introduced by many units to cope with this workload. The small amount of evidence to support the introduction of nurse colposcopists suggests that nurses are viable alternative providers of colposcopy. This study compares the performance of nurse colposcopists with that of doctors.
Ambulatory Care↗
How can we develop a cost-effective quality cervical screening programme?
This article discusses the evidence base underpinning the United Kingdom cervical screening programme and proposes that there is now sufficient evidence to suggest that too many women are screened too frequently. The financial savings generated from increasing the screening interval to five years and restricting routine screening to women aged 25 to 50 years may, we suggest, be better spent on improving the quality of the cervical screening programme. Re-awakening this debate must not however deflect energy and effort from recruiting women who have never been screened or further developing quality control systems. Any debate must also fully engage women of all ages as the key stakeholders in the decision-making process.
Adult↗
A systematic review of the evidence supporting the use of priority dispatch of emergency ambulances.
OBJECTIVES: Systematic reviews of the literature assist in the location, appraisal, and synthesis of available evidence. This systematic review aimed to 1) assess the existing literature evaluating the effect of the priority dispatch of emergency ambulances on clinical outcome and ambulance utilization and 2) assess the relative effectiveness of sources of literature relevant to prehospital care. METHODS: Systematic review. The quality of each paper was assessed using a standardized seven-point scoring schedule. Sources used were: Medline, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), Bath Information & Data Services (BIDS), bibliographic searching, contacting researchers active in the field, and hand-searching relevant journals. Key words used were: "ambulance," "prioritisation," "dispatch," and "triage." RESULTS: Three hundred twenty-six papers were identified: 64 (19.6%) were related to the prioritization of emergency ambulances, and only 20 (6.1%) contained original data. The overall quality of publications was poor, seven (35%) papers having a quality score > or = 4. Only half were identified by electronic databases, 55% were identified by people working in the field, and two (10%) were identified by hand-searching (some papers were identified by more than one source). Two high-quality papers support the concept that criteria-based dispatch (CBD) improves clinical outcome; two other papers support CBD's role in improving ambulance utilization. CONCLUSIONS: There is very little evidence to support the effect of the prioritization of emergency ambulances on patient outcome. Electronic databases identify only approximately half of all relevant prehospital literature. Future systematic reviews in this area should use electronic databases, supplemented by contact with appropriate experts.
Ambulances↗