Rhiannon Tudor Edwards

CLINICAL USE OF NUCLEAR MAGNETIC RESONANCE IN THE INVESTIGATION OF MYOPATHY

Abstract Topical nuclear magnetic resonance allows non-invasive investigation of the metabolism of skeletal muscle and other tissues. Energy exchange can be followed by measurement of 31 P NMR spectra which characterise changes in muscle content of inorganic phosphorus (Pi) and phosphorylcreatine. Muscle pH is determined from the chemical shift of Pi with respect to phosphorylcreatine. Topical NMR can be used to study changes in intermediary metabolites during exercise, and the clinical value is illustrated in a patient with phosphofructokinase deficiency who would otherwise have required multiple biopsies of muscle. In diseases such as Duchenne muscular dystrophy, where muscle may be partly replaced by fat or other tissue, the findings with 31 P NMR can be related to independent estimates of tissue composition obtained from 1 H and 13 C NMR spectra and from X-ray computerised tomography.

Parenting programme for parents of children at risk of developing conduct disorder: cost effectiveness analysis

Objective To investigate the cost effectiveness of a parenting programme. Design An incremental cost effectiveness analysis alongside a pragmatic randomised controlled trial of the effectiveness of a group parenting programme delivered through Sure Start in the community. Setting Sure Start areas in north and mid Wales. Participants Parents of 116 children aged 36-59 months (87% of the clinical sample) at risk of developing conduct disorders defined by scoring over the clinical cut off on the Eyberg child behaviour inventory). Children were identified by health visitors and recruited by the research team. Intervention The Webster-Stratton Incredible Years basic parenting programme or a six month waiting list control. Main outcome measure Incremental cost per unit of improvement on the intensity score of the Eyberg child behaviour inventory. Results The bootstrapped incremental cost effectiveness ratio point estimate was �73 (€109,

Exercise performance and fatiguability in patients with chronic fatigue syndrome.

142) per one point improvement on the intensity score (95% confidence interval �42 to �140). It would cost �5486 (€8190,

Diabetic retinopathy screening: a systematic review of the economic evidence.

10 666) to bring the child with the highest intensity score to below the clinical cut-off point and �1344 (€2006,

REMCARE: reminiscence groups for people with dementia and their family caregivers – effectiveness and cost-effectiveness pragmatic multicentre randomised trial

2618) to bring the average child in the intervention group within the non-clinical limits on the intensity score (below 127). For a ceiling ratio of �100 (€149,

An evaluation of the effectiveness and cost effectiveness of the National Exercise Referral Scheme in Wales, UK: a randomised controlled trial of a public health policy initiative.

194) per point increase in intensity score, there is an 83.9% chance of the intervention being cost effective. The mean cost per child attending the parenting group was �1934 (€2887,

Long-term effectiveness of a parenting intervention for children at risk of developing conduct disorder

3760) for eight children and �1289 (€1924,

Skeletal muscle damage: a study of isotope uptake, enzyme efflux and pain after stepping.

2506) for 12 children, including initial costs and materials for training group leaders. When we categorised the sample into relatively mild, moderate, and severe behaviour groups based on intensity scores at baseline the intervention seemed more cost effective in those with the highest risk of developing conduct disorder. Conclusion This parenting programme improves child behaviour as measured by the intensity score of the Eyberg child behaviour inventory at a relatively low cost and was cost effective compared with the waiting list control. This parenting programme involves modest costs and demonstrates strong clinical effect, suggesting it would represent good value for money for public spending.

FIRE (Facilitating Implementation of Research Evidence): a study protocol.

To examine the role of delay in recovery of peripheral muscle function following exercise in the fatigue experienced by patients with the chronic fatigue syndrome (CFS) and to examine the influence of effort perception in limiting exercise performance in these patients, a study was carried out on a group of twelve patients with chronic fatigue syndrome and 12 sex and age-matched sedentary control subjects. Symptom limited incremental cycle exercise tests including measurements of perceived exertion were performed followed by examination of the contractile properties of the quadriceps muscle group for up to 48 hours. Muscle function was assessed by percutaneous electrical stimulation and maximum voluntary contractions. Muscle function at rest and during recovery was normal in CFS patients as assessed by maximum isometric voluntary contraction, 20:50 Hz tetanic force ratio and maximum relaxation rate. Exercise duration and the relationship between heart rate and work rate during exercise were similar in both groups. CFS patients had higher perceived exertion scores in relation to heart rate during exercise representing a reduced effort sensation threshold of 3.2 units on an unmodified Borg scale in CFS patients. Patients with chronic fatigue syndrome show normal muscle physiology before and after exercise. Raised perceived exertion scores during exercise suggest that central factors are limiting exercise capacity in these patients.

Clinical and lay preferences for the explicit prioritisation of elective waiting lists: survey evidence from Wales

Diabet. Med. 27, 249–256 (2010)