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Crothers IR, Linden MA, Kennedy N. Attitudes of children towards peers with acquired brain injury (ABI). Brain Inj 2007; 21:47-52. [PMID: 17364519 DOI: 10.1080/02699050601149054] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
RESEARCH OBJECTIVE Children with acquired brain injury (ABI) can experience severe problems in establishing peer relationships. The attitudes peers hold toward a child with an ABI can significantly impact on their willingness to befriend. The present work sought to investigate the attitudes peers hold toward a fictional child with ABI. METHODS AND PROCEDURES Fifty children from a primary school were compared against a similar number from a secondary school. Gender was evenly split across both groups. A vignette describing a young boy acquiring a brain injury, and his subsequent change in behaviour, was presented to the children. The Friendship Activity Scale (FAS) was then used to judge how likely the children were to befriend the fictional character. OUTCOMES AND RESULTS Results showed a statistically significant interaction between gender and age [F(1, 96) 6.285, p = 0.014] with older males expressing more positive attitudes than younger males. CONCLUSION The study suggests that children with ABI are more likely to experience negative attitudes in primary school, and concludes in calling for additional research to more fully explore the social experience of children with ABI.
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Walsh CAE, Minnock P, Slattery C, Kennedy N, Pang F, Veale DJ, Bresnihan B, FitzGerald O. Quality of life and economic impact of switching from established infliximab therapy to adalimumab in patients with rheumatoid arthritis. Rheumatology (Oxford) 2007; 46:1148-52. [PMID: 17478471 DOI: 10.1093/rheumatology/kem074] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate the quality of life and economic impact of switching therapy from infliximab to adalimumab in patients with rheumatoid arthritis (RA). METHODS In this open-label study, patients demonstrating a clinical response to infliximab were switched to treatment with adalimumab and followed for 16 weeks. Both generic (Health Assessment Questionnaire and Short Form 36 Physical Component Summary and Mental Component Summary) and specific (Rheumatoid Arthritis Quality of Life questionnaire) assessment instruments of physical function and of quality of life were employed. An economic analysis of treatment-related costs was also performed. Disease activity was assessed by the composite 28-joint count Disease Activity Score (DAS28). C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured as acute phase markers. RESULTS Nineteen patients were enrolled and completed the study. No changes in functional and quality-of-life measures were observed. One-year extrapolation data showed potential reductions in costs following switching to adalimumab that could be attributed primarily to reductions in patient- and staff-related costs. Safety and tolerability were similar for both treatments. Although there was a significant reduction in DAS28 (P < 0.005) and CRP (P < 0.001) after switching to adalimumab, there were no significant changes in individual DAS28 components, including swollen and tender joint counts and ESR. CONCLUSIONS A switch from infliximab to adalimumab in patients with RA who have responded to infliximab is a feasible, well-tolerated treatment option, with the potential for direct and indirect economic advantages.
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Suntharalingam M, Dipetrillo T, Wanebo H, Doyle L, Krasna M, Daly B, Kennedy N, Safran H. 40. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Butow PN, Solomon M, Young JM, Whelan T, Salkeld G, Wilson K, Harrison JD, Hruby G, Mansour O, Kennedy N, Tattersall MHN. Consumer impact of an interactive decision aid for rectal cancer patients offered adjuvant therapy. Colorectal Dis 2006; 8:676-82. [PMID: 16970578 DOI: 10.1111/j.1463-1318.2006.00975.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE There is increasing interest in the use of decision aids (DAs) to facilitate patient involvement in clinical decisions. This study explored the views of patients with colorectal cancer and participants in a community bowel screening service regarding an interactive DA concerning adjuvant treatment for rectal cancer, and the impact of the aid on knowledge, anxiety, attitudes and preferences for treatment options. METHOD Fourteen patients with colorectal cancer participated in four focus groups. Eighty-nine participants in a community bowel screening service completed a questionnaire before and 1 week after viewing the DA. Thirty were randomly selected to participate in a telephone interview to obtain qualitative feedback about the DA. RESULTS Focus group participants reported using information to evaluate their doctor's care and expertise, or to prepare themselves for future symptoms and side-effects. Most supported the use of a DA and preferred pie charts to convey risk information. Within the community sample, anxiety remained stable and knowledge increased after exposure to the DA. Almost all participants found the DA useful and easy to understand, and felt it would make the process of decision making easier. CONCLUSION A DA regarding adjuvant therapy for rectal cancer appears to be valued and to produce positive outcomes. A randomized controlled trial of this intervention is now required.
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Boydell J, van Os J, Caspi A, Kennedy N, Giouroukou E, Fearon P, Farrell M, Murray RM. Trends in cannabis use prior to first presentation with schizophrenia, in South-East London between 1965 and 1999. Psychol Med 2006; 36:1441-1446. [PMID: 16854250 DOI: 10.1017/s0033291706008440] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is evidence that cannabis use might be relevant to the aetiology of schizophrenia. We aimed to measure any change in cannabis use over time in those first presenting with schizophrenia in South-East London from 1965 to 1999, and compare this with change in use in those presenting with non-psychotic psychiatric disorders. METHOD The rate of cannabis use in the year prior to first ever presentation was measured over seven time periods. Logistic regression modelling was used to determine (a) whether cannabis use changed over time, after controlling for age, sex and ethnicity, and (b) whether there was an interaction between diagnosis and time. RESULTS Cannabis use increased over time in both the schizophrenia group [odds ratio per time period (OR) 2.03, 95% confidence interval (CI) 1.74-2.38, p<0.0001] and the non-psychotic disorders group (OR 1.24, 95% CI 1.05-1.47, p=0.012), after controlling for age, sex and ethnicity. However, the effect of time was significantly greater in the schizophrenia group than in the non-schizophrenia group (chi2=17, p<0.0001). CONCLUSION Cannabis use in the year prior to presentation with schizophrenia increased markedly between 1965 and 1999, and disproportionately so compared to increase in cannabis use in other psychiatric disorders.
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Krishnadasan A, Kennedy N, Zhao Y, Ritz B. Nested Case-Control Study of Occupational Chemical Exposures and Prostate Cancer Among Workers Using a Job Exposure Matrix. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s158-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Goldstone AR, Kennedy N, Metcalfe M. Randomized clinical trial of mechanical bowel preparation versus no preparation before elective left-sided colorectal surgery (Br J Surg 2004; 92: 409-414). Br J Surg 2005; 92:1046. [PMID: 16034805 DOI: 10.1002/bjs.5127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses can be sent electronically via the BJS website (www.bjs.co.uk) or by post. All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length. Letters submitted by post should be typed on A4-sized paper in double spacing and should be accompanied by a disk.
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Krishnadasan A, Kennedy N, Zhao Y, Ritz B. 158: Nested Case-Control Study of Occupational Physical Activity and Prostate Cancer Using a Job Exposure Matrix. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s40a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kennedy N, Everitt B, Boydell J, Van Os J, Jones PB, Murray RM. Incidence and distribution of first-episode mania by age: results from a 35-year study. Psychol Med 2005; 35:855-863. [PMID: 15997605 DOI: 10.1017/s0033291704003307] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Few epidemiological studies have investigated incidence by age or age at onset distributions for mania or bipolar disorder. The current study aimed to determine these in a defined area in south-east London, over a 35-year period. METHOD All cases of first-episode mania presenting to psychiatric services in Camberwell, south-east London, between 1965 and 1999 were identified. Incidence rates by age, using 5-year age-at-onset bands, were estimated and the structure of the age-at-onset distribution for first-episode mania was investigated using finite mixture distributions (admixture analysis). RESULTS The incidence of DSM-IV bipolar I disorder (BP I), first manic episode peaked in early adult life (16.38/100,000 population per year in the 21-25 years band) with a much smaller peak in mid-life. A two-component normal mixture distribution fitted age at onset better than either a single normal distribution or a three-component mixture, implying the existence of early and later onset subgroups. The early onset group had a stronger family history of bipolar disorder, and showed more acute, severe and atypical symptoms during their first manic episode. CONCLUSIONS The incidence of mania peaks in early adult life but there is clear evidence of early and later onset subgroups which may represent different forms of disorder.
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Kennedy N, Flanagan N. Is nasogastric fluid therapy a safe alternative to the intravenous route in infants with bronchiolitis? Arch Dis Child 2005; 90:320-1. [PMID: 15723931 PMCID: PMC1720323 DOI: 10.1136/adc.2004.068916] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kennedy N, Boydell J, van Os J, Murray RM. Ethnic differences in first clinical presentation of bipolar disorder: results from an epidemiological study. J Affect Disord 2004; 83:161-8. [PMID: 15555709 DOI: 10.1016/j.jad.2004.06.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Revised: 06/28/2004] [Accepted: 06/28/2004] [Indexed: 01/30/2023]
Abstract
BACKGROUND Although high incidence rates of mania have been described in some ethnic minority populations, little is known about any ethnic differences in the early clinical presentation of bipolar disorder. METHODS All cases of operationalised DSM-IV bipolar I disorder (BPI), first manic episode, within a defined epidemiological catchment area over a 35-year period, were identified; sociodemographic data, including ethnicity, and clinical information were then extracted. The proportion of African-Caribbean (n=52), African (n=33) and white European (n=149) cases who experienced a depressive episode before onset of mania and psychotic symptoms at first mania were compared. RESULTS African-Caribbean and African groups were significantly less likely to have experienced a depressive episode before onset of first mania, at 13.5% and 6.1%, respectively, compared with 28.1% in the white European group. African-Caribbean and African groups also experienced more severe psychotic symptoms at first mania, but there were no differences in mood incongruent or first rank symptoms between ethnic groups. LIMITATIONS Data pertaining to diagnosis and clinical symptoms were extracted by retrospective case note review. CONCLUSIONS Ethnic differences in clinical presentation of bipolar disorder may have implications for assessment and treatment of ethnic minority patients.
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Macdonald JE, Kennedy N, Struthers AD. Effects of spironolactone on endothelial function, vascular angiotensin converting enzyme activity, and other prognostic markers in patients with mild heart failure already taking optimal treatment. BRITISH HEART JOURNAL 2004; 90:765-70. [PMID: 15201246 PMCID: PMC1768327 DOI: 10.1136/hrt.2003.017368] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine whether the favourable effects on endothelial function, vascular angiotensin converting enzyme (ACE) activity, cardiac remodelling, autonomic function, and QT intervals of spironolactone in combination with ACE inhibitor also occur in patients with New York Heart Association class I-II congestive heart failure (CHF) taking optimal treatment (including beta blockers). METHODS Double blind, crossover study comparing 12.5-50 mg/24 hours spironolactone (three months) with placebo in 43 patients with class I-II CHF taking ACE inhibitors and beta blockers. RESULTS Acetylcholine induced vasodilatation improved with spironolactone (p = 0.044). Vascular ACE activity fell (p = 0.006). QTc and QTd fell (mean (SD) QTc 473 (43.1) ms with placebo, 455 (35.4) ms with spironolactone, p = 0.002; QTd 84.5 (41.3) ms with placebo, 72.1 (32.3) ms with spironolactone, p = 0.037). beta-Type natriuretic peptide (BNP) and procollagen III N-terminal peptide (PIIINP) concentrations were also reduced by spironolactone (mean (SD) BNP 48.5 (29.6) pg/ml with placebo, 36.8 (28.5) pg/ml with spironolactone, p = 0.039; PIIINP 3.767 (1.157) microg/ml with placebo, 3.156 (1.123) microg/ml with spironolactone, p = 0.000). CONCLUSIONS Spironolactone improves vascular function (endothelial function, vascular ACE activity) and other markers of prognosis (BNP, collagen markers, and QT interval length) in asymptomatic or mild CHF when added to optimal treatment including beta blockade. This gives support to the hypothesis that the prognostic benefit seen in RALES (randomised aldactone evaluation study) and EPHESUS (eplerenone postacute myocardial infarction heart failure efficacy and survival study) may also occur in patients with milder CHF already taking standard optimal treatment.
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Kennedy N, Paykel ES. Treatment and response in refractory depression: results from a specialist affective disorders service. J Affect Disord 2004; 81:49-53. [PMID: 15183599 DOI: 10.1016/s0165-0327(03)00192-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2003] [Revised: 07/07/2003] [Accepted: 07/07/2003] [Indexed: 11/30/2022]
Abstract
BACKGROUND The best treatment approaches for chronic severe refractory depression remain uncertain. This study aimed to identify short-term outcome and most successful somatic treatments of severe refractory depressives referred to an affective disorders service. METHODS Patients with chronic refractory depression referred to a specialist affective disorders service over a 10-year period were studied. Using detailed case records of the index episode, courses of treatment and outcome were examined. RESULTS Patients were predominantly middle-aged females with few prior episodes but long index episodes. Patients received higher antidepressant doses and more combinations on the specialist service. Very-high-dose antidepressants (tricyclics, velafaxine or tricyclic--MAOI combinations), usually augmented with lithium and often combined with ECT, were the most effective somatic treatments. Most subjects improved substantially, but few reached premorbid levels. LIMITATIONS The study was retrospective. Treatment courses were sequential rather than random. CONCLUSIONS Refractory depression is responsive to vigorous somatic therapy, although most patients continue with some symptoms.
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Kennedy N, Paykel ES. Residual symptoms at remission from depression: impact on long-term outcome. J Affect Disord 2004; 80:135-44. [PMID: 15207926 DOI: 10.1016/s0165-0327(03)00054-5] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2002] [Revised: 02/05/2003] [Accepted: 02/06/2003] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although residual symptoms after remission from depression are common and predict early relapse, little is known about the impact of residual symptoms on longer-term clinical course of depression or social functioning. METHODS Sixty severe recurrent depressives, who remitted from an index episode of depression with residual symptoms or below residual symptomatology, were followed-up at 8-10 years. Subjects underwent detailed longitudinal interviewing on course of depression, treatment and socioecomonic functioning over follow-up. RESULTS Long-term follow-up data was obtained on all living subjects and 55 (95%) were interviewed. The residual symptoms group spent more time with depressive symptoms over follow-up but not at full criteria for major depression and showed greater impairment in longitudinal and follow-up social adjustment. No significant differences were found between the two groups in percentage recurring long-term, mean number of recurrences, readmissions, chronic episodes or clinical global outcome criteria. LIMITATIONS Long-term clinical and social outcomes were assessed by a single retrospective longitudinal interview. CONCLUSIONS Patients who remit from depression with residual symptomatology continue to have more depressive symptoms and impaired social functioning long-term and may need more aggressive treatment.
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Kennedy N, Abbott R, Paykel ES. Remission and recurrence of depression in the maintenance era: long-term outcome in a Cambridge cohort. Psychol Med 2003; 33:827-838. [PMID: 12877397 DOI: 10.1017/s003329170300744x] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Long-term studies of severe depression have described high rates of non-recovery, recurrence, chronic incapacity and mortality. A more recent cohort was followed-up to ascertain whether the course had improved given developments in pharmacological and psychological treatments in the last 15 years. METHOD Subjects from a cohort of 70 mainly severe recurrent depressives originally recruited to a shorter follow-up study from 1990-1992 were followed-up after 8-11 years. Data included longitudinal information on course of depression and other psychiatric disorders, pharmacological and psychological treatment and social functioning during follow-up. RESULTS Sixty-nine (99%) subjects were successfully followed-up, with 61 of 66 living subjects interviewed and detailed follow-up data obtained in total on 65. Sixty (92%) of 65 subjects recovered during follow-up, with two-thirds subsequently suffering a recurrence. Eleven (17%) suffered from an episode of chronic depression of at least 2 years duration during follow-up. Social function at follow-up was good and there were high levels of pharmacological and psychological treatment. Greater severity of illness was the most consistent predictor of poor outcome. Times to recovery and recurrence and recovery and recurrence rates were very similar to older studies. CONCLUSIONS The long-term outcome of depression still shows high recurrence rates and does not appear to have changed in the last 20 years.
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Abstract
Four historical convergences are identified in the history of erotomania. According to the first, which lasted from Classical times to the early eighteenth century, erotomania was a 'general disease caused by unrequited love'. According to the second, erotomania was a disease of 'excessive physical love (nymphomania)'; this view remained active well into the nineteenth century. The third convergence focuses on the view that erotomania is a form of 'mental disorder', and this was held throughout the twentieth century. The fourth and current definition (a development of the third stage) sees erotomania as a 'the delusional belief of being loved by someone else'. Differences between Anglo-Saxon and French views cast doubt on the meaning or coherence of the much-abused English eponym 'de Clérambault syndrome'. Erotomania is a construct, a mirror reflecting Western views on spiritual and physical love, sex, and gender inequality and abuse. On account of this, it is unlikely that there will ever be a final, 'scientific' definition rendering erotomania into a 'natural kind' and making it susceptible to brain localization and biological treatment.
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McDonough M, Kennedy N. Pharmacological management of obsessive-compulsive disorder: a review for clinicians. Harv Rev Psychiatry 2002; 10:127-37. [PMID: 12023928 DOI: 10.1080/10673220216215] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Obsessive-compulsive disorder (OCD) has been treated pharmacologically with drugs that enhance availability of the neurotransmitter serotonin. This review summarizes the available literature on the pharmacological treatments of OCD. Numerous randomized controlled trials have attested to the efficacy of serotonin-reuptake inhibitors (SRIs) in treating this disorder, although a coherent model of serotonin dysfunction in OCD has not been established. Meta-analyses of randomized controlled trials have found better results with clomipramine than with other SRIs, but comparative studies have so far not replicated this finding. Aspects of the methodology in these studies that might explain this discrepancy are considered. Tolerability, side effects, dosing, and safety during pregnancy of the SRIs are discussed. Treatment of OCD with poor insight and of OCD comorbid with a tic disorder, augmentation strategies, and management of partial response to SRIs are reviewed. Finally, the available interventions for refractory OCD are considered.
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Abstract
Erotomania is a rare disorder in which an individual has a delusional belief that a person of higher social status falls in love and makes amorous advances towards him/her. Little is known about the background, classification, treatment, or outcome of individuals with this disorder. The purpose of this study was to evaluate current criteria for diagnosing and classifying primary and secondary erotomania in addition to examining course, outcome, and impact on victims of erotomania. Semistructured interviews covering personal and family details in addition to treatment and outcome to date were performed on a series of erotomanic patients identified in a defined area. Evaluation of diagnosis used DSM-IV and other criteria. Fifteen erotomanic subjects (11 female, four male) were identified. Most were isolated, without a partner or full-time occupation. Forty percent had a first-degree relative with a psychiatric history and of those half had a first-degree relative with a mono-delusional disorder. Less than half of the objects of their affection, mainly noncelebrities, were subject to harassment. Subjects with primary erotomania and erotomania secondary to other psychiatric diagnoses were identified using DSM-IV criteria. Ellis and Mellsop's criteria were found to be useful in assessing erotomania but we could not replicate Seeman's fixed and recurrent groups. Treatment and outcome was better than expected particularly for those with primary erotomania and erotomanics with a diagnosis of bipolar affective disorder. In this series, erotomanic symptoms largely occurred in the context of other psychiatric disorders, although subjects with pure erotomanic symptoms were seen. Subjects were less dangerous and engaged in less harassment of victims than the literature suggests. Subjects were often isolated, unemployed, and with few social contacts. Strong family psychiatric histories were seen particularly with regard to mono-delusional disorders raising the possibility of genetic inheritance. An adaptation of Ellis and Mellsop's criteria was suggested for the diagnosis of primary and secondary erotomania. Response to treatment and prognosis was good, particularly for primary erotomania and erotomania secondary to bipolar affective disorder.
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Kennedy N. Delayed puberty and parotitis: an unusual presentation of HIV 15 years after infection in an untreated 17-year-old Malawian. Trop Doct 2001; 31:233. [PMID: 11676069 DOI: 10.1177/004947550103100425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Davies L, Hadcroft J, Mutton K, Earis JE, Kennedy N. Antimicrobial management of acute exacerbation of chronic airflow limitation. QJM 2001; 94:373-8. [PMID: 11435633 DOI: 10.1093/qjmed/94.7.373] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Antibiotics are frequently administered for exacerbations of chronic obstructive pulmonary disease and asthma, yet their role remains unclear. We prospectively audited the antimicrobial management of 167 patients aged >50 years hospitalized for exacerbations of chronic airflow limitation. Antibiotics were commenced on admission for 151 (90%) patients (oral 52%, intravenous 38%), including 17/23 (74%) with no evidence of fever, purulent sputum, leucocytosis or inflammatory chest X-ray changes. The mean number of different antibiotics prescribed was 1.8 (range 0-6); a wide range of antibiotics and antibiotic combinations were used. Sputum samples were sent for microbiological examination in 101 (61%) patients. Sputum culture was positive in 34, but only 11 (7% of the total) had amoxycillin-resistant organisms in their sputum. Seventeen patients (10%) developed diarrhoea while in hospital. Under logistic regression analysis, total number of antibiotics prescribed (p<0.0001) and age (p=0.0062) were the two factors associated with hospital-acquired diarrhoea. Only 34% of patients had received an influenza vaccination in the winter of the study, and 10% a pneumococcal vaccination within the last 5 years. In routine clinical practice, aggressive antibiotic therapy was frequently administered to patients admitted with chronic airflow limitation, despite limited clinical, radiological and microbial indications. Excessive use of antibiotics has important implications, including morbidity (antibiotic-associated diarrhoea), cost and the potential for increased microbial antibiotic resistance. A minority of patients with chronic airflow limitation are being vaccinated against influenza and Pneumococcus.
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Korniewicz DM, Garzon L, Seltzer J, Kennedy N, Feinleib M. Implementing a nonlatex surgical glove study in the OR. AORN J 2001; 73:435-40, 442, 445. [PMID: 11218930 DOI: 10.1016/s0001-2092(06)61982-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sterile surgical gloves are used to protect patients and health care workers (HCWs) from infection during surgery and to shield HCWs from exposure to bloodborne pathogens. Based on increased reports of latex allergy, many HCWs now use nonlatex surgical gloves as a substitute for natural rubber gloves. Little is known, however, about the performance of nonlatex gloves in surgery. This article describes a study that currently is being performed to test the barrier performance of nonlatex surgical gloves after they have been used in surgery and to determine HCW satisfaction. To date, 12,703 latex and nonlatex gloves from all surgical services have been collected and tested for barrier quality. This article describes the project and challenges encountered by the collaborative team of perioperative staff members and nurse researchers as they collect data.
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McDonough M, Hillery J, Kennedy N. Olanzapine for chronic, stereotypic self-injurious behaviour: a pilot study in seven adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2000; 44 ( Pt 6):677-684. [PMID: 11115022 DOI: 10.1046/j.1365-2788.2000.00306.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Dopamine one (D1) receptor supersensitvity in the corpus striatum is said to be the primary mechanism within the dopamine model proposed for chronic, refractory self-injurious behaviour (SIB), which may explain why conventional neuroleptics have proven largely ineffective. In common with other atypical antipsychotic agents, olanzapine has more affinity for the D1 receptor. The present study explored whether olanzapine could reduce rates of the stereotypic form of chronic SIB, a subtype where dopamine dysfunction is the most likely underlying mechanism. A clinical sample of seven patients with various levels of learning disability who displayed features of stereotypic SIB were assessed over a 6-week period of baseline measurement and a 15-week treatment phase during which olanzapine was added to existing medication. Both SIB and other aberrant behaviours were measured by daily nurse rating and the Self-Injury Trauma Scale (SITS). All measurements were unblind. Doses ranged from 5 to 15 mg. Out of the seven subjects, three showed a clear improvement, one showed a marginal improvement, one deteriorated, and the data was equivocal for the remaining two individuals. The means of the SITS Number and Severity Indices (NI and SI, respectively) reduced significantly from baseline during both the 5- and 10-mg treatment phases, and taking treatment as a whole, by 53% and 48%, respectively (NI: mean = 0.7 units reduction, P = 0.02; SI: mean = 0.9 units reduction, P = 0.04). The risk index also reduced, but did not reach significance. A modest reduction in mean nurse-rated SIB was not significant for either phase or for treatment as a whole. At doses above 5mg, mean scores deteriorated on balance, although two responders showed a marginal additional improvement. Olanzapine was well tolerated with one adverse event reported (somnolence) which was mild and transient. The present pilot study suggests that olanzapine can reduce stereotypic SIB. A larger trial is indicated.
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Abstract
OBJECTIVE This paper examines the phenomonology in a case of erotomania and reviews classical and contemporary treatment options. METHOD A case of primary erotomania is described. RESULTS Treatment with hospitalization and risperidone produced rapid clinical improvement. CONCLUSION Atypical antipsychotic drugs may be useful in the treatment of this interesting syndrome.
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Kataoka T, Budd RC, Holler N, Thome M, Martinon F, Irmler M, Burns K, Hahne M, Kennedy N, Kovacsovics M, Tschopp J. The caspase-8 inhibitor FLIP promotes activation of NF-kappaB and Erk signaling pathways. Curr Biol 2000; 10:640-8. [PMID: 10837247 DOI: 10.1016/s0960-9822(00)00512-1] [Citation(s) in RCA: 461] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Activation of Fas (CD95) by its ligand (FasL) rapidly induces cell death through recruitment and activation of caspase-8 via the adaptor protein Fas-associated death domain protein (FADD). However, Fas signals do not always result in apoptosis but can also trigger a pathway that leads to proliferation. We investigated the level at which the two conflicting Fas signals diverge and the protein(s) that are implicated in switching the response. RESULTS Under conditions in which proliferation of CD3-activated human T lymphocytes is increased by recombinant FasL, there was activation of the transcription factors NF-kappaB and AP-1 and recruitment of the caspase-8 inhibitor and FADD-interacting protein FLIP (FLICE-like inhibitory protein). Fas-recruited FLIP interacts with TNF-receptor associated factors 1 and 2, as well as with the kinases RIP and Raf-1, resulting in the activation of the NF-kappaB and extracellular signal regulated kinase (Erk) signaling pathways. In T cells these two signal pathways are critical for interleukin-2 production. Increased expression of FLIP in T cells resulted in increased production of interleukin-2. CONCLUSIONS We provide evidence that FLIP is not simply an inhibitor of death-receptor-induced apoptosis but that it also mediates the activation of NF-kappaB and Erk by virtue of its capacity to recruit adaptor proteins involved in these signaling pathways.
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