Multi-centre clinical respiratory research: a new approach?

BACKGROUND: Recruitment to clinical trials organised by the research committee of the British Thoracic Society (BTS) has declined. We suspected that this was due to increasing workloads for consultant physicians in the National Health Service (NHS). We investigated possible causes in study 1 and a possible solution in study 2. METHODS: Study 1--a questionnaire was sent to BTS members listing possible factors that might deter them from entering patients into trials. These were scored on a 0-5 scale. Study 2--we set up 13 panels of experts to cover all major fields of respiratory medicine. They were asked to design projects that would address the most important research questions that could be answered by multi-centre clinical trials. We sent 11 projects for scoring to consultant members of the BTS who were asked to score them on scientific merit and on their ability to contribute patients to the study. RESULTS: Study 1--of the 59% of consultants who responded, 77% said that competition with increasing demands on their time was the major reason for not participating. Study 2--40% of consultants returned project scores. Three projects were subsequently selected for grant application. CONCLUSIONS: Clinical research in the UK is under threat from increasing workloads on consultants. One solution to this problem is a national approach to commission major projects. The most important clinical research questions might then still be answered in the limited time available to consultants.     

Factor analysis of rank-ordered data: An old approach revisited.

Responds to the J. B. Kruskal and R. N. Shepard (see record 1975-00098-001) work in which a solution to the problem of nonmetric factor analysis is offered. An investigation comparing this method and factor analysis of rank-ordered data suggests that the practicality of the Kruskal-Shepard method is limited by computational cost and sensitivity to random error. In situations in which linearity is questioned, an attractive practical alternative that is much less costly and substantially more robust to random error is linear principal-components analysis of the rank-ordered data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Benzodiazepines revisited

Glucagonoma is an endocrine tumor of almost exclusively pancreatic origin which is rarely associated with a clinical syndrome mainly characterized by migratory necrolytic erythema, hyperglycemia, weight loss, hypoaminoacidemia and anemia. Ten to 30% of the patients may present thromboembolic phenomenon, deep vein thrombosis and pulmonary embolism which often lead to the death of the patient. We report the case of a patient diagnosed with pancreatic glucagonoma the presentation of which consisted in episodes of repeated deep vein thrombosis without associated migratory necrolytic erythema.     

Sadism revisited

Sadism has been for a long time, among psychoanalytic and other writers, the subject of extensive theorizing and controversy. This paper takes a fresh look at the many dimensions (sexual, characterological, neurotic, psychotic, neurological) of this old aberrations.     

Theophylline revisited

For over 50 years, theophylline has been used regularly for the management of chronic asthma. However, because of its perceived narrow therapeutic index and the fact that it has been considered a weak bronchodilator, the use of theophylline therapy has diminished. Furthermore, with the introduction of newer pharmacologic agents and recommendations in widely accepted guidelines, both nationally and internationally, have further contributed to its decreased use. For years, theophylline has not only been considered a bronchodilator, but for many clinicians, an agent that could be used to enhance respiratory muscle function and mucociliary clearance and act at the level of the central nervous system to enhance ventilation. These properties were felt to be potentially useful for patients with severe exacerbated asthma. Recent studies have suggested that theophylline therapy can play a beneficial role in the management of both chronic stable asthma and exacerbated disease treated in the emergency department setting. Furthermore, a growing body of evidence suggests that theophylline has certain antiinflammatory and immunomodulating properties, even at plasma concentration levels below the accepted therapeutic range. If this is true, then theophylline may act best as a controller medication in the management of asthma. Because of its low cost and its ease of administration, theophylline therapy should be revisited and discussed as not only a reliever of bronchospasm, but a controller of chronic asthma.     

Cyclazocine revisited

Recently synthesized compounds which have long-term mu antagonist activity and short-term kappa agonist effects prevent self-administration of cocaine and morphine in rats. Cyclazocine, a compound synthesized in 1962 and studied in animals and man in the 1960's and in the early 1970's is a mu antagonist in rats and man and is a potent kappa agonist in both species. It also prevents self-administration of cocaine and morphine in rats. Although it produces unpleasant side effects in man, subjects become tolerant to these side effects but not to the antagonistic actions of the drug after prolonged administration.     

Asylums revisited

The authors revisited Erving Goffman's Asylum (Saint Elizabeths Hospital) and found both the "institutionalization" and "secondary adjustment" phenomena he described 20 years ago. However, they question whether secondary adjustments necessarily follows institutionalization. They also express doubt that institutionalization should be condemned automatically and suggest that it may in fact be the approach of choice for some patients.     

Vesicorectostomy revisited

Between 1948 and 1959 vesicorectostomy, a permanent anastomosis between the bladder and rectum, was constructed in 7 male patients. Scattered reports of this procedure exist but none since 1959 and long-term followup has never been reported. we present long-term followup, including renal function, excretory urography and voiding cystorectography, and review the quality of life in the 7 patients. The most frequent complication was stenosis of the anastomosis. None of the patients in this series with normal preoperative upper tracts showed radiographic or chemical deterioration postoperatively. Since this procedure maintains urinary continence, does not disturb the normal physiology of the ureterovesical junction and minimizes urinary reabsorption its use should be considered in certain patients as an alternative method of urinary diversion.     

Hedonic capacity and schizotypy revisited: A taxometric analysis of social anhedonia.

P. E. Meehl (1962) originally conjectured that hedonic capacity was an indicator of the latent class or taxon of schizotypy. However, P. E. Meehl (1989, 1990) subsequently diminished the role of hedonic capacity in his theory, indicating that hypohedonia is one of a dozen normal-range (nontaxonic) individual-differences factors that may potentiate the expression of schizophrenia. This dimensional-only view of hedonic capacity was tested by applying taxometric procedures to the Revised Social Anhedonia Scale (RSAS; M. L. Eckblad, L. J. Chapman, J. P. Chapman, & M. Mishlove, 1982) in a sample of college students (N?=?1,526). Analyses indicated that the construct measured by the RSAS is taxonic in nature with a base rate approximating .10. These data are interpreted in the context of other findings suggesting that social anhedonia is an indicator of schizotypy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hippocampal sclerosis revisited

Studies dating back more than 150 years reported a relationship between hippocampal sclerosis and epilepsy. Retrospective studies of patients who underwent temporal lobectomy for intractable partial epilepsy found a relationship between a history of early childhood convulsions, hippocampal sclerosis, and the development of temporal lobe epilepsy. Many believe that febrile seizures lead to hippocampal damage and this in turn predisposes the patient to the development of temporal lobe epilepsy. Studies in adult rats have shown that seizures can lead to hippocampal damage and unprovoked recurrent seizures. However, many questions remain as to the relevance of early childhood seizures to hippocampal sclerosis and temporal lobe epilepsy. Human prospective epidemiologic studies have not shown a relationship between early childhood seizures and temporal lobe epilepsy. Recent MRI studies in humans suggest that a preexisting hippocampal lesion may predispose infants to experience febrile seizures, later on hippocampal sclerosis, and possibly temporal lobe epilepsy may occur. Unlike the studies in adult rats, normal immature rats with seizures have not been shown to develop hippocampal damage or unprovoked seizures in adulthood. Furthermore, animal studies reveal that preexisting brain abnormalities can predispose to hippocampal damage following seizures early in life. This paper reviews evidence for and against the view that early childhood convulsions, hippocampal sclerosis, and temporal lobe epilepsy are related, while also exploring clinical and animal studies on how seizures can lead to hippocampal damage, and how this can result in temporal lobe epilepsy. By better understanding the cause and effect relationship between early childhood seizures and hippocampal injury in normal and abnormal brains specific treatments can be developed that target the pathogenesis of epilepsy.     

Torque misuse revisited

The larynx is an hormonal target. Tone of the voice depends on the fact that there is or there is not male hormones, or on the presence of female hormones? At menopause, estrogens and gestagens may fade, and androgens may appear. Both are in harmony. But does the fact that estro-progestative hormones disappear at menopause allow androgenic action? Often androgens can be converted in estrogen and estron-sulfate. The voice, then, may stay feminine. Otherwise, the androgenic effects will affect the striated muscles of the vocal fold, the thickness of the stratified epithelium and the strength of the larynx. Of 100 women, our study has shown that 17 had a menopausal voice syndrome with lack of intensity, a voice fatigue, a narrow register. The hormonal replacement treatment is the treatment for voice professional. The singing voice, the speaking voice recover. For each woman, the specific treatment has to be adapted with vitamins and hormonal therapy to preserve the harmony of the voice and the being.