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Publication History View all

  • The Clinical Teacher 08/2012; 9(4):267-8.
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    ABSTRACT: Trigeminal neuralgia (TN) is a rare form of neuropathic facial pain characterised by severe, paroxysmal pains in the face. Little is known about the decision process in treatment of TN, and management with anti-epileptic drugs or surgical procedures carries risks of side effects, recurrence and complications. One hundred fifty-six previously diagnosed TN patients completed an adapted time-trade-off utility measurement questionnaire to ascertain how they valued the potential outcomes from various surgical and medical treatments. The decision analysis revealed that microvascular decompression surgery (MVD) offered the best chance of improved quality of life or highest maximum expected utility (MEU). MVD (MEU=16.08 out of a possible 20) was closely followed by balloon compression (MEU=15.97), percutaneous glycerol rhizolysis (MEU=15.61) and then radiofrequency thermocoagulation (MEU=14.93). Medication offered the least optimal chance of improved quality of life (MEU=14.61). The difference between the highest (MVD) and lowest scoring treatments (medication) was 7.3% (1.46/20). These results were sensitive to some utility values, meaning the preferred treatment is changed by the values patients assign to outcomes. As surgical techniques narrowly offer the highest chance of maximising patient quality of life, all patients with TN should consider surgery. However, surgery is not right for everyone, and patients should be informed about their full range of choices. Treatment decisions must take place after careful consideration of the values patients place on benefits and risks of treatment.
    Pain 11/2007; 131(3):302-10.
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    ABSTRACT: This project aimed to prepare a self complete patient satisfaction survey for patients who have undergone surgery for trigeminal neuralgia and then assess its reproducibility, validity and acceptability in one centre. The questionnaire, for initial use in patients who had undergone posterior fossa surgery for trigeminal neuralgia, was designed after a systematic review of the surgical literature had been performed and discussions held at the US and UK Trigeminal Neuralgia Support group meetings. It underwent several changes after input from neurosurgeons, patients, copywriter and statistician and finally contained 44 questions, the SF12, Hospital Anxiety and Depression Scale (HAD), Brief Pain Inventory (BPI) and McGill Pain questionnaire (MPQ). From the total number of 413 patients in the database of one centre the questionnaire was sent with a covering letter to 305 patients, the rest had died (25), were lost to follow up (26) or did not meet the inclusion criteria (56). One patient had bilateral PSR. The completed questionnaires were evaluated by an independent physician, neurosurgeon and patient. A repeat questionnaire was sent to 10% of the patients to check reproducibility. The questionnaires were well completed with a final response rate of 92%. It appeared to be highly acceptable and reproducible but needed adjustment to improve its validity before being used in other centres and for all surgical procedures. A new questionnaire is proposed which could be used on an annual basis. A questionnaire has been developed for use in patients who have undergone surgical management for trigeminal neuralgia and which is acceptable to patients.
    Acta Neurochirurgica 10/2005; 147(9):925-32.
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    ABSTRACT: Oral lichen planus (OLP) is one of the commoner conditions seen in oral medicine clinics. Current treatments are palliative rather than curative. Numerous treatments have been tried but many have not been evaluated in randomized controlled trials (RCTs). To review the effectiveness and safety of any therapy compared with placebo for the treatment of symptomatic OLP. A systematic review of 11 RCTs, totalling 223 patients was done. The main outcome measures used were improvement of signs (erythema, reticulation, ulceration) and symptoms (pain, discomfort) usually after 8 weeks of therapy. Eleven interventions were grouped into four therapeutic classes (topical ciclosporins, topical or systemic retinoids, topical steroids and phototherapy) for comparison. No therapy was replicated exactly. Trials recording the same outcomes in each therapeutic class were pooled. The largest number of pooled trials was four. Small odds ratios with very wide confidence intervals indicating statistically significant but imprecisely known treatment benefits were seen in all but one trial. Only systemic agents were associated with treatment toxicities; all other side-effects were mild and mainly local. The results are tempered by the small study sizes, lack of replication, lack of standardized outcome measures and the very high likelihood of publication bias. Therefore this review provides only circumstantial evidence for the superiority of the assessed interventions over placebo for the palliation of symptomatic OLP. There is a need for larger placebo-controlled RCTs with carefully selected and standardized outcome measures.
    British Journal of Dermatology 09/2005; 153(2):336-41.
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    ABSTRACT: There are no reports of patient satisfaction surveys after either a microvascular decompression (MVD) or a partial sensory rhizotomy (PSR) for trigeminal neuralgia. This study compares patient satisfaction after these two types of posterior fossa surgery for trigeminal neuralgia, because it is postulated that recurrences, complications, and previous surgical experience reduce satisfaction. All patients who had undergone their first posterior fossa surgery at one center were sent a self-complete questionnaire by an independent physician. Among the 44 questions on four standardized questionnaires were 5 questions that related to patient satisfaction and experience of obtaining care. Patients were divided into those having their first surgical procedure (primary) and those who had had previous ablative surgery (nonprimary). Response rates were 90% (220 of 245) of MVD and 88% (53 of 60) of PSR patients. Groups were comparable with respect to age, sex, duration of symptoms, mean duration of follow-up, and recurrence rates. Overall satisfaction with their current situation was 89% in MVD and 72% in PSR patients. Unsatisfied with the outcome were 4% of MVD and 20% of PSR patients, and this is a significant difference (P < 0.01). Satisfaction with outcome was higher in those undergoing this as a primary procedure. In the primary group, satisfaction was dependent on recurrence and complication/side effects status (each P < 0.01), but this was not the case in the nonprimary group. Patients expressed a desire for earlier posterior fossa surgery in 73% of MVD and 58% of PSR patients, and this was highest in the primary group. The final outcome was considered to be better than expected in 80% of MVD and 54% of PSR patients, but 22% of the PSR group (P < 0.01) thought they were worse off. Patients undergoing posterior fossa surgery as a primary procedure are most satisfied and PSR patients are least satisfied, partly because of a higher rate of side effects.
    Neurosurgery 07/2005; 56(6):1304-11; discussion 1311-2.
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    ABSTRACT: We have recently identified two resistance-associated point mutations of organophosphate (OP)-insensitive acetylcholinesterase in the olive fruit fly Bactrocera oleae, the most important olive orchard pest world-wide. We have developed simple PCR-restriction fragment length polymorphism assays for each mutation, utilising an AccI restriction site created by Ile214Val, and a BssHII restriction site destroyed by a neutral change always accompanying the second mutation Gly488Ser. Samples from Greece homozygous for both mutations proved the most insensitive to dimethoate. The frequencies of these mutations in field-collected samples from several countries were investigated. Ninety-three percent of samples from Greece and Albania, where OPs have been extensively used in B. oleae control, were homozygous for both mutations. Resistance-associated alleles were detected at lower frequencies, but still with both mutations in conjunction in the majority of cases, in western Mediterranean countries with limited use of OPs. Samples from South Africa, however, did not have either of the resistance-associated mutations. The double mutation haplotype clearly confers a strong selective advantage in field populations of B. oleae exposed to OPs.
    Pesticide Biochemistry and Physiology. 03/2005;
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    ABSTRACT: The complaint of a burning sensation in the mouth can be said to be a symptom of other disease or a syndrome in its own right of unknown aetiology. In patients where no underlying dental or medical causes are identified and no oral signs are found, the term burning mouth syndrome (BMS) should be used. The prominent feature is the symptom of burning pain which can be localised just to the tongue and/or lips but can be more widespread and involve the whole of the oral cavity. Reported prevalence rates in general populations vary from 0.7% to 15%. Many of these patients show evidence of anxiety, depression and personality disorders. The objectives of this review are to determine the effectiveness and safety of any intervention versus placebo for relief of symptoms and improvement in quality of life and to assess the quality of the studies. We searched the Cochrane Oral Health Group Trials Register (20 October 2004), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2004), MEDLINE (January 1966 to October 2004), EMBASE (January 1980 to October). Clinical Evidence Issue No. 10 2004, conference proceedings and bibliographies of identified publications were searched to identify the relevant literature, irrespective of language of publication. Studies were selected if they met the following criteria: study design - randomised controlled trials (RCTs) and controlled clinical trials (CCTs) which compared a placebo against one or more treatments; participants - patients with burning mouth syndrome, that is, oral mucosal pain with no dental or medical cause for such symptoms; interventions - all treatments that were evaluated in placebo-controlled trials; primary outcome - relief of burning/discomfort. Articles were screened independently by two reviewers to confirm eligibility and extract data. The reviewers were not blinded to the identity of the studies. The quality of the included trials was assessed independently by two reviewers, with particular attention given to allocation concealment, blinding and the handling of withdrawals and drop outs. Due to both clinical and statistical heterogeneity statistical pooling of the data was inappropriate. Nine trials were included in the review. The interventions examined were antidepressants (two trials), cognitive behavioural therapy (one trial), analgesics (one trial), hormone replacement therapy (one trial), alpha-lipoic acid (three trials) and anticonvulsants (one trial). Diagnostic criteria were not always clearly reported. Out of the nine trials included in the review, only three interventions demonstrated a reduction in BMS symptoms: alpha-lipoic acid (three trials), the anticonvulsant clonazepam (one trial) and cognitive behavioural therapy (one trial). Only two of these studies reported using blind outcome assessment. Although none of the other treatments examined in the included studies demonstrated a significant reduction in BMS symptoms, this may be due to methodological flaws in the trial design, or small sample size, rather than a true lack of effect. Given the chronic nature of BMS, the need to identify an effective mode of treatment for sufferers is vital. However, there is little research evidence that provides clear guidance for those treating patients with BMS. Further trials, of high methodological quality, need to be undertaken in order to establish effective forms of treatment for patients suffering from BMS.
    Cochrane database of systematic reviews (Online) 02/2005;
  • Nestlé Nutrition workshop series. Clinical & performance programme 02/2004; 9:77-88; discussion 88-92.
  • Medical Education 01/2004; 37(12):1125-6.
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    ABSTRACT: This paper describes a method for microinjection of proteins (Rho GTPases) into neutrophils and observations on the responses of the cells to these injections. Neutrophils are extremely difficult to inject because of their small size, complex morphology and fragility. To allow microinjections they must be cultured on a substrate that enables them to settle, adhere and spread. We determined that fibronectin- and/or collagen-coated coverslips are the best substrates and we used very fine needles and short microinjection times to minimize cell damage. These methods permitted us to inject up to 100 cells in a single preparation over a period of 30 min. Effects of microinjection were assessed by using tetramethylrhodamine isothiocyanate (TRITC)-phalloidin to label F-actin filaments, and observation by fluorescence and confocal scanning microscopy. Microinjection alone resulted in cell rounding and some changes in the F-actin cytoskeleton but injected cells remained adherent at the substrate, were able to respond to microinjected GTPases (V12Rac, V14RhoA, V12Cdc42) and continued to be responsive to activation by exposure to fMet-Leu-Phe (fMLP) or O-tetradecanoylphorbal 13-acetate (TPA). V12Rac caused an increase in neutrophil membrane ruffling and short protrusions from the cell membrane, whereas V14RhoA induced a large increase in punctate F-actin structures. V12Cdc42 produced focal condensation of F-actin and induced the formation of small microspikes. The differences between these responses of neutrophils and those of other similarly treated cell types are discussed. Our findings demonstrate that microinjection is a valuable technique for studying the role of individual proteins in neutrophils.
    Journal of Anatomy 11/2003; 203(4):379-89.
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