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Biomedical subjects

T Mason

Publications and source records attributed to T Mason.

At least 55 records · Page 3Linked to original sources
PubMed1998

Clinical trials of antibacterial agents: a practical guide to design and analysis. Statisticians in the Pharmaceutical Industry Working Party.

Guidelines on the conduct of clinical trials of antibacterial agents produced by the US Food and Drug Administration, the British Society for Antimicrobial Chemotherapy, the Infectious Diseases Society of America and a European Working Party have been reviewed. Although very informative, these guidelines provide limited practical guidance on the design and statistical aspects of phase III studies of antimicrobial agents. This paper describes the differences between antibacterial trials and clinical studies in other therapeutic areas with regard to subjective endpoints, dual clinical and bacteriological endpoints, frequent protocol violations and difficulty of using placebo controls. The importance of a detailed protocol and planned analysis strategy is emphasized. The choice of comparator agents, practical issues with the blinding of trial materials and the documentation of patients excluded from study entry are discussed. The use of different patient groups and different endpoints in analyses are described. The principles of equivalence and their application to trials of antibacterial agents are discussed, together with an approach to calculating sample size. A variety of statistical analyses of results are compared for different situations indicating some of the problems that can arise. Different methods of presentation of study data are included with emphasis on regulatory submissions rather than scientific publications. Some graphical presentations are recommended and issues regarding data across different studies are discussed.

Anti-Infective Agents↗
PubMed1998

Gender differences in the use of seclusion.

This paper offers a contribution to the research on the use of seclusion by focusing specifically on gender. The study was carried out in a special hospital which provides care in conditions of high security. Data were collected on all seclusions over a one-year period which resulted in a database of 823 episodes of seclusion. The results indicate that female patients account for more seclusions than their male counterparts and that they are secluded more often but for shorter durations. Whereas the mentally ill category are subject to more seclusions it is the psychopathically disordered classification that is responsible for more female episodes. Further research is under way to examine the reasons for the disparities.

England↗
PubMed1997

Psychosocial outcomes and health status of adults who have had juvenile rheumatoid arthritis: a controlled, population-based study.

OBJECTIVE: The goal of this study was to evaluate the physical and psychosocial impact of juvenile rheumatoid arthritis (JRA) among a population-based cohort of adults who had the disease during childhood, compared with a control cohort of subjects with no history of JRA. METHODS: The Rochester Epidemiology Project database was used to identify all cases of JRA (based on the American College of Rheumatology [formerly, the American Rheumatism Association] 1977 criteria) among Rochester, Minnesota residents first diagnosed between January 1, 1960 and December 31, 1993. Controls were age- and sex-matched to the cases as of the date of diagnosis of JRA. A pretested postal survey was mailed to all adult cases (whose date of birth was before December 31, 1975) and matched controls from the same population, to obtain information on socioeconomic issues and functional status (using the Health Assessment Questionnaire and the Health Status Questionnaire). The complete medical records of all cases and controls were reviewed to obtain information on demographics and clinical manifestations of JRA. RESULTS: Of the 50 eligible cases, 44 (88%) responded to the survey. There were 102 age- and sex-matched controls (2-3 per case) who responded to the survey. Seventy-three percent of the cases had pauciarticular-onset JRA, 16% had polyarticular-onset JRA, and 11% had systemic-onset JRA. Average followup was 24.7 years and 24.5 years after the index date for cases and controls, respectively. Greater disability (P = 0.0002), more bodily pain (P = 0.0002), increased fatigue (P = 0.0112), poorer health perception (P = 0.0004), and decreased physical functioning (P = 0.0002) were reported by the cases compared with the controls. JRA cases reported significantly lower rates of employment (P = 0.015) and lower levels of exercise (P = 0.0002) than did controls. Level of educational achievement, annual income, health insurance status, and rate of pregnancy and childbirth were similar for both cases and controls. CONCLUSION: Adults who have had JRA during childhood experience long-term physical and psychosocial impairment.

Adolescent↗
PubMed1997

An ethnomethodological analysis of the use of seclusion.

The use of seclusion in psychiatric practice is a contentious issue. This paper reports on an ethnomethodological approach to understanding the decision-making process in the use of seclusion. Through first-level and second-level reasoning analysis, three themes emerged which underscored the subjects' rationalization process. These were: (a) mechanistic searching, (b) frame conflict, and (c) asylum status. This research suggests that the decision to use seclusion is based on a complex interplay of cultural and organizational factors rather than due to the presentation of symptoms by the patient.

Attitude of Health Personnel↗
PubMed1997

Transvaginal sacrospinous colpopexy--a new and easier way.

Sacrospinous colpopexy is an operation which is gaining wide acceptance for suspending the vaginal vault in a women with prolapse who wishes to retain the ability to maintain coitus. However, wider use may be prevented by the technical difficulty of the procedure. This article is a review of 63 cases where the operation was performed using a new 'ENDO STITCH' method which offers advantages both in ease (because it avoids the necessity of direct visualization of the ligament), and possibly safety, (because it avoids the need for retractors).

Adult↗
PubMed1997

The Mental Health Act and professional hostage taking.

Compulsory detention of psychiatric patients is seen as a necessary response to a perceived threat, against themselves or against others, and such detention is rationalized as humane, compassionate and benevolent. However, seen from the recipient's perspective such detention and enforced treatment may be viewed as malevolent. This paper is concerned with examining the role of compulsory detention of the mentally abnormal offender in respect of the 1983 Mental Health Act by analysis of the resultant ideas which underpin it. First, in terms of its role as a sanction against transgressors of a particular value system, who are spotlighted by the increased 'surveillance' in our society. Second, the issues of treatability and consent are discussed in relation to the neo-legalism that permeates our social world. In addition, the role of the 1983 Mental Health Act as a means of social control will be examined using the notion of a covert political 'policing' in the form of compulsory detention, resulting from the medico-legal confrontation of power bases which defines the patient as a 'professional hostage'. Quite clearly there is an overlap of themes which creates a difficulty in interpretation. However, with increasing legal facilities for detention and the increasing number of 'conditions' being drawn under the medical umbrella it is important to attempt to review the results of this legislation within those areas identified above and to understand how this may be interpreted for those held against their wishes.

Commitment of Persons with Psychiatric Disorders↗
PubMed1997

Seclusion and the lunar cycles.

1. The lunar cycle's influence over psychological disturbances in the human being is known as the Transylvanian effect. 2. Seclusion is used predominantly for the control and management of violence and aggression in patients. 3. If the Transylvanian effect is supported, a relationship between lunar cycles and the use of seclusion should exist; no such correlation, however, was found in this study.

Hospitals, Psychiatric↗
PubMed1997

The epidemiology of morphea (localized scleroderma) in Olmsted County 1960-1993.

OBJECTIVE: To determine the incidence, prevalence, survival rates, clinical manifestations, and longterm outcome of patients with morphea (localized scleroderma) and its subtypes over a 33 year period in Olmsted County, Minnesota. METHODS: We used the unique data resources of the Rochester Epidemiology Project to review all Olmsted County medical records with any potential diagnosis consistent with morphea (including plaque, generalized, bullous, linear, and deep entities) from 1960 through 1993. RESULTS: We screened 1030 medical records and identified 82 (59 female; 23 male) cases of morphea first diagnosed between 1960 and 1993. All cases were followed until death or migration from Olmsted County, a total of 754 person-years of observation. The annual age and sex adjusted incidence rate per 100,000 population was 2.7 (95% confidence interval 2.1, 3.3). The incidence rate increased significantly over the 33 years (p = 0.0037) on an average of 3.6% per year. The prevalence (estimated using cumulative incidence) at 80 years of age was about 2/1000. 50% of the patients had a cutaneous softening or evidence of disease resolution by 3.8 years' duration. The shortest active disease duration was found in the plaque group (50% resolution or skin softening by 2.7 years) compared to 5.5 years in the deep group. Arthralgias, synovitis, uveitis, and joint contractures were more frequent in the linear and deep categories. Although 9 patients (11%) developed some disease related disability over the followup period, this was common (44%) in the deep group. No case of morphea developed severe internal organ involvement and none progressed to systemic sclerosis. The survival rate was not significantly different from the general population (p = 0.409). CONCLUSION: Morphea, and its subtypes, are more common than previously recognized, and can lead to important disability.

Adolescent↗
PubMed1996

p53 mutations in bladder tumors from arylamine-exposed workers.

In this study we compared the frequency and pattern of p53 mutations in 34 bladder tumors from people with high-level occupational exposure to arylamines to those in 30 bladder tumors from people without such exposure. No differences were observed for p53 mutations between the two groups. The frequency of mutation was similar at 47% for arylamine-exposed individuals and 53% for unexposed individuals and showed a similar pattern of mutation, with GC to AT transitions accounting for the majority of the mutations in both groups. This finding suggests that arylamine exposure does not leave a mutational "footprint" in the p53 gene. However, compared to other tumors, bladder tumors from both exposed and unexposed individuals had a high frequency of multiple mutations and it is interesting that these mutations were highly concordant. We suggest that one explanation of this pattern of mutations could be from decreased DNA repair fidelity within tumor cells. The frequency of mutation in p53 is closely linked to tumor grade and stage and so may be a late event in the development of bladder tumors.

Aged↗
PubMed1996

Juvenile rheumatoid arthritis in Rochester, Minnesota 1960-1993. Is the epidemiology changing?

OBJECTIVE: To examine trends in the incidence and prevalence of juvenile rheumatoid arthritis (JRA) in Rochester, Minnesota, over 33 years. METHODS: The diagnostic retrieval system of the Rochester Epidemiology Project was utilized to screen medical records of all Rochester residents with any potential diagnoses of JRA from 1978 to 1993 (based on the American College of Rheumatology 1977 revised criteria). In addition, all cases of JRA from our previously identified cohort from 1960-1979 were verified, and the 2 data sets were combined, resulting in an incidence cohort spanning 33 years (1960-1993). RESULTS: Of the 1,240 medical records screened, we identified 65 cases of JRA diagnosed between 1960 and 1993 (48 females, 17 males). The average followup for cases was 12.7 years (range 0-34 years) for a total of 833 person-years of observation. A bimodal distribution of age at diagnosis was observed, with peaks between 0 and 4 years and 9 and 15 years. Seventy-two percent of patients had pauciarticular-onset, 17% had polyarticular-onset, and 11% had systemic-onset disease. Progression of pauciarticular to polyarticular disease occurred in 11% of the cases. The overall age- and sex-adjusted incidence rate was 11.7 per 100,000 population (95% confidence intervals 8.7, 14.8). The incidence rate per 100,000 population was 15.0, 14.1, and 7.8 for the time periods 1960-1969, 1970-1979, and 1980-1993, respectively (P = 0.024). A 3-year, centered, moving average, which was used to display time trends in incidence, suggested a cyclical pattern, with incidence peaks in 1967, 1975, and 1987. CONCLUSION: An overall decrease in the incidence rate over the last decade was observed, most marked in the pauciarticular- and systemic-onset subtypes. This decrease, along with the observed cyclical pattern, suggest that environmental factors may influence disease frequency.

Arthritis, Juvenile↗
PubMed1996

Revisiting the nursing management of the psychopath.

There has been a growing concern regarding the treatability of those patients labelled as psychopathically disordered. Notwithstanding this important debate, and the ultimate outcome of it, the nursing management of this categorized legal group continues on a daily basis. This paper contributes a theoretical foundation to the practicalities of nursing this particularly difficult patient group, based upon clinical experience, and offers a nursing perspective to the complexities of the debate.

Antisocial Personality Disorder↗
PubMed1996

Scatolia: psychosis to protest.

This paper presents the case of a female patient in a special hospital who engaged in faecal smearing whilst in seclusion. A management investigation followed a complaint by a Nurse Manager regarding the reluctance of staff to clean the room whilst the patients remained disturbed. The investigation team adopted a triangulated method of interviews, literature review, survey and case presentations to study the issues involved. The results presented here suggest the emergence of similar issues from both the interview commentary and the tabulated data from the survey. There appears an intricate and complex dilemma facing those managing situations involving scatolic behaviour. There are issues of concern from diverse organizational settings that overlap between those persons who engage in scatolia who may be deemed mentally impaired, psychiatrically disordered, or protest behaviour.

Adult↗
PubMed1996

Forensic psychiatric nursing: visions of social control.

Forensic nursing is a relatively recent, and fast developing, specialization within the wider field of psychiatry. The construction of professional practice at the interface of medical and legal services reflects larger ideological shifts in the management of human difference. Central to this trend is the posited relationship between mental disorder and criminality. The expanding loci of forensic expertise, beyond traditional institutional and health service settings, calls for a critical appraisal of present and proposed provision. Focusing on the British experience, in particular, this paper outlines the historical development of treatment for disordered offenders and explores contemporary initiatives. Deployment of nursing staff in the community, police stations, law courts and prisons, as an adjunct of medicalized crime, confuses further professional care with political control. The main conclusions presented are that the encroachment of psychiatry can be understood in terms of surveillance and social control. It is essential that nurses working in this field are aware of the power/knowledge equation that frames their practice, research and education. The penetration of forensic nursing into realms of society otherwise bereft of psychiatric intervention can be seen to have a darker dimension.

Attitude to Health↗
PubMed1995

Breast feeding and the development of juvenile rheumatoid arthritis.

OBJECTIVE: To determine if children with juvenile rheumatoid arthritis (JRA) are less likely to have been breast fed than controls. METHODS: Case-control study of data obtained from a survey of mothers 54 children with JRA and 79 playmates regarding breast feeding. Duration of breast feeding was tabulated and odds ratios (OR) with 95% confidence intervals (CI) were determined. RESULTS: OR for breast feeding in children with JRA was 0.40 (0.20-0.81, 95% CI) compared to playmates. For pauciarticular JRA (N = 28) OR was 0.31 (0.10-0.93); in polyarticular JRA (N = 24) OR was 0.60 (0.21-1.70). Lower OR for increased durations of breast feeding were noted in children with JRA. CONCLUSION: Children who have had JRA, especially pauciarticular JRA, are less likely to have been breast fed than controls, suggesting that breast feeding may have a protective effect on the development of JRA.

Adolescent↗
PubMed1995

A collaborative effort for rural health.

Collaboration between the W.K. Kellogg Foundation and a school of nursing helped to meet health care and environmental needs of the residents in two rural counties burdened with poverty and illiteracy. This endeavor also affords the faculty and students in the school of nursing opportunities to work with underserved populations in rural areas. The project continues its community service through evolving programs.

Educational Status↗