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Biomedical subjects

D Berry

Publications and source records attributed to D Berry.

At least 19 recordsLinked to original sources
PubMed2004

Decreased lung capillary blood volume post-exercise is compensated by increased membrane diffusing capacity.

The diffusing capacity of the lung for carbon monoxide (DLCO) decreases to below the pre-exercise value in the hours following a bout of intense exercise. Two mechanisms have been proposed: (1) development of pulmonary oedema and (2) redistribution of central blood volume to peripheral muscles causing a reduction in pulmonary capillary blood volume ( V(c)). In the present study DLCO, V(c) and the membrane diffusing capacity ( D(m)) were measured in nine healthy females using a rebreathing method, in contrast to the single breath technique employed in previous studies. DLCO, V(c) and D(m) were measured before and at 1, 2, 3, 16 and 24 h following maximal treadmill exercise. Compared with pre-exercise values, DLCO was depressed by up to 8.9 (3.0)% ( P<0.05) for the first 3 h following exercise, but had returned to pre-exercise values by 16 h post-exercise. V(c) fell by 21.2 (4.1)% ( P<0.05) at 3 h post-exercise, but at the same time D(m) increased by 14.7 (9.1)%. It was concluded that: (1) the increase in D(m) made it unlikely that the fall in DLCO was due to interstitial oedema and injury to the blood gas barrier; (2) on the other hand, the reduction in DLCO following exercise was consistent with a redistribution of blood away from the lungs; and (3) the trend for D(m) and V(c) to reciprocate one another indicates a situation in which a fall in V(c) nevertheless promotes gas transfer at the respiratory membrane. It is suggested that this effect is brought about by the reorientation of red blood cells within the pulmonary capillaries following exercise.

Adaptation, Physiological↗
PubMed2004

Perceptions of the risks and benefits of medicines in patients with rheumatoid arthritis and other painful musculoskeletal conditions.

OBJECTIVES: To examine beliefs about medication risks and benefits in patients attending a specialist rheumatology clinic for pain-related conditions. METHODS: Eighty-one patients (37 first attendees and 44 existing clinic patients) completed a written questionnaire which asked about current treatments, perceived effectiveness, main risks and benefits, and compliance. RESULTS: Existing clinic patients perceived medications to be more effective and more risky than did the new patients, although both groups rated risks to be moderately low. The main perceived risks were adverse side-effects, although patients reported only moderately low levels of experiencing such effects. CONCLUSIONS: In contrast to some other studies, many of our patients were aware of medication risks and were prepared to accept them provided benefits were seen to be high. Existing clinic patients were more aware of risks and benefits, and reported higher compliance levels than new patients, possibly as a result of the hospital education programme. Future studies should evaluate the effects of the programme more systematically.

Adolescent↗
PubMed2003

Role of microbiological investigations in the management of non-perineal cutaneous abscesses.

BACKGROUND: Pus samples for microbiological examination are routinely sent after incision and drainage of abscesses. There is no evidence that microbiology reports influence treatment for non-perineal cutaneous abscesses. AIMS: This study assessed (1) how often the microbiology report is used to manage patients' treatment after incision and drainage of an abscess and (2) junior surgical trainees' opinions on sending pus for microbiological examination. METHOD: A retrospective analysis of the notes of all patients undergoing incision and drainage of abscesses from January 2001 to January 2002 was made. A telephone poll of junior surgical trainees was also undertaken. RESULTS: Most patients, 91%, had specimens referred for microbiology. Of these 43% yielded no growth. Staphylococcus aureus was the most common organism (55.9% of all positive cultures). Anaerobes were a frequent finding from axilla and groin abscesses. Mycobacterium tuberculosis was grown in two patients. Other less common organisms cultured were methicillin resistant S aureus (n=1) and Proteus sp (n=1). Follow up of microbiology reports was found to be inadequate. CONCLUSION: The bacteria present in non-perineal cutaneous abscesses are, for the most part, predictable. However, a significant number grow less common organisms. It is concluded that pus specimens should be sent routinely for culture and sensitivity and there should be further emphasis on following up microbiology reports by junior medical staff.

Abscess↗
PubMed2003

From passive to active electronic healthcare records.

OBJECTIVES: The provision of patient data to clinicians as and when it becomes available is a general objective of information systems in healthcare. It is known that the timely receipt of patient data can have a significant bearing on healthcare outcomes. One of the on-going tasks is to provide this data in the form of an Electronic Healthcare Record according to some agreed standard. The aim in this paper is to provide patient data in electronic form by pushing the information to the end users as soon it becomes available, in advance of any explicit request from the users. METHODS: This paper describes how an existing record system, the Synapses Federated Healthcare Records Server, has been extended to incorporate active functionality to facilitate pushing the information to end-user applications. The user must specify the information of interest to him, so that the system pushes only information useful to the final user. The approach proposed here relies solely on the use of callbacks through the middleware layer being used, a mechanism available in all existing middleware implementations. RESULTS: The Synapses Federated Healthcare Records Server which has resulted from this research is a more flexible and scaleable system, capable of fulfilling the needs of a wider range of healthcare organisation than when a strictly passive approach is used. CONCLUSIONS: It is shown that healthcare organisation can incorporate a healthcare record system with active functionality without any large investment or significant risk to their existing information systems.

Humans↗
PubMed2002

Pathological evaluation, clinical chemistry and plasma cholecystokinin in neonatal and young miniature swine fed soy trypsin inhibitor from 1 to 39 weeks of age.

The potential toxicity of dietary soy trypsin inhibitor (TI) was evaluated in neonatal miniature swine. From 1 to 6 weeks of age, two groups of male piglets were artificially reared in an Autosow and automatically fed either TI or control liquid diet. From 6 to 39 weeks of age, these two groups were fed either TI or control chow diet. A third group, sow control (SC), suckled from birth to 6 weeks of age, were also weaned to control chow from 6 to 39 weeks of age. Clinical chemistry and plasma cholecystokinin (CCK) determined at 6, 18, 30 and 39 weeks of age, and serum amylase activity with gross and histopathological analyses of major organs at 6 and 39 weeks of age are reported. TI had no effect on plasma CCK, serum amylase activity, or numerous clinical chemistry values. TI-fed piglets had a larger relative liver weight at 6 weeks of age. Relative pancreas weight decreased with age but was not affected by TI. Gross and histopathological analyses of major organs, except the spleen, were within normal limits. Increased incidence of extramedullary hematopoiesis was noted in the spleen of the TI group at 6 but not at 39 weeks of age. There was no consistent pattern in immunohistochemical foci for secretin, gastrin releasing polypeptide or CCK, and no change in DNA, RNA, mitotic index or nuclear density of pancreatic cells. At 6 weeks of age, TI increased pancreatic protein and amylase activity but not trypsin or chymotrypsin activity. None of the effects suggested that this dose of TI was toxic to either the neonatal or sexually mature miniature male swine.

Administration, Oral↗
PubMed2002

A laboratory test request protocol system.

This paper describes the design, implementation and assessment of a computer-based protocol application to support requests by clinicians for laboratory investigations. As part of the motivation for the work a rigorous engineering software approach was adopted not just for purely technical reasons but also as a means of maximising the role of the user.

Clinical Laboratory Techniques↗
PubMed2001

Effect of induction chemotherapy and tandem cycles of high-dose chemotherapy on outcomes in autologous stem cell transplant for metastatic breast cancer.

We assessed the effect standard-dose induction chemotherapy and tandem cycles of high-dose chemotherapy (HDC) have on outcomes in metastatic breast cancer. One hundred and one women with metastatic breast cancer were enrolled in two non-randomized phase II studies. The first group of 64 patients (induction group) received four cycles of docetaxel 75 mg/m2 and doxorubicin 50 mg/m2. The next 37 patients did not receive induction (no induction group). Both groups received two (tandem) cycles of HDC. Blood-derived stem cells were collected after the first HDC cycle, processed using CD34+ cell selection and then reinfused after the second HDC cycle. Outcomes were compared between the two groups and also to patients participating in the Philadelphia (inter-group) randomized metastatic breast cancer transplant trial (PBT-01). Intent-to-treat analysis revealed no significant differences in complete response rates (37.5% vs 27%; P = 0.20), overall response (75% vs 71%), median progression free survival (PFS) (11.9 vs 8 months; P = 0.24) and overall survival (OS) (>36 vs 25 months; P = 0.16), in the induction vs no induction groups, respectively. Adjusting for differences in known baseline characteristics, induction group patients were found to have significantly longer PFS (P = 0.002), OS (P = 0.01) and more frequent conversion from a partial to complete response (58% vs < or = 13%, P < or = 0.0002) when compared with PBT-01 patients. Induction chemotherapy administered prior to tandem cycles of HDC does not appear to adversely affect outcomes in metastatic breast cancer patients. Outcomes in our induction group also compare favorably with those observed in PBT-01 and warrant further clinical investigation.

Adult↗
PubMed2001

Activities of the APN to enhance unpartnered elders self-efficacy after myocardial infarction.

Unpartnered elders recovering from a myocardial infarction find themselves with limited support to contend with their physical and emotional recovery. The advanced practice nurse (APN) can play an instrumental role in improving the health outcomes of these elders. Detailed description of the activities of the APN that affect patient outcomes in current randomized clinical trials have been inadequate in published reports. Therefore, the purpose of this article is to describe the activities of an APN in a nurse-coached intervention study for unpartnered elders post-myocardial infarction. Thematic analysis from the subject logs and narratives from the APN identified the four themes of patient education, validation/feedback, encouragement/support, and problem solving as the unique activities of the APN. These activities enhanced the recovery of these vulnerable unpartnered elders after a myocardial infarction.

Aged↗
PubMed2000

In vivo measurement of colonic butyrate metabolism in patients with quiescent ulcerative colitis.

BACKGROUND: Butyrate, a short chain fatty acid produced by bacterial fermentation, is a major fuel source for the colonocyte. In vitro work has shown that ulcerative colitis may be characterised by a metabolic defect in colonocyte butyrate oxidation. AIMS: To investigate the rate of metabolism of rectally administered butyrate in patients with quiescent colitis. METHODS: [1-(13)C]-butyrate enemas were administered to 11 patients with long standing quiescent ulcerative colitis and to 10 control patients. The rate of production of (13)CO(2) in exhaled breath over four hours was measured by isotope ratio mass spectrometry combined with indirect calorimetry in order to measure CO(2) production. This allowed calculation of the patients' resting energy expenditure and respiratory quotient. RESULTS: Over a four hour period, 325 (SEM 21) micromol (13)CO(2) was recovered in breath samples from the colitis group compared with 322 (17) micromol from the control group (NS). The respiratory quotient of the colitic group was significantly lower than that of the control group. CONCLUSION: There was no difference in the rate of metabolism of butyrate between the two groups. It is unlikely that there is a primary metabolic defect of butyrate metabolism in patients with quiescent ulcerative colitis.

Adult↗
PubMed2000

Plasma D-dimer levels in operable breast cancer patients correlate with clinical stage and axillary lymph node status.

PURPOSE: To investigate the relationship between preoperative plasma D-dimer levels and extent of tumor involvement in operable breast cancer patients. PATIENTS AND METHODS: A total of 140 preoperative plasma specimens were obtained from women scheduled to undergo diagnostic breast biopsies. Ninety-five patients in the initial group went on to undergo axillary lymph node dissection. Of the 140 patients from whom plasma samples were obtained, 102 were subsequently diagnosed with invasive breast carcinoma, nine were subsequently diagnosed with ductal carcinoma-in-situ, and 20 were subsequently diagnosed with benign breast disease. Plasma D-dimer levels were quantitated using a commercially available immunoassay kit (DIMERTEST; American Diagnostica, Greenwich, CT). The relationships between plasma D-dimer and other prognostic variables (tumor size, estrogen receptor, progesterone receptor, nuclear grade, histologic grade, lymphovascular invasion, and clinical stage grouping) were then examined using univariate and multivariate linear and logistic regression analyses. RESULTS: Median plasma D-dimer levels were significantly higher in patients with invasive carcinoma than those patients with either benign breast disease or carcinoma-in-situ (P =.0001). A significant relationship existed between the presence of elevated D-dimer (> 100 ng/mL) and involved axillary lymph nodes (chi(2) test; P =.001). Elevated D-dimer levels predicted positive lymph node involvement in both univariate regression (P =.0035) and multivariate linear regression (P =.012) models. In addition, elevated D-dimer levels predicted the presence of lymphovascular invasion in univariate logistic regression (P =. 0025) and multivariate logistic regression analysis (P =.0053). Quantitative D-dimer levels were highly correlated with clinical stage grouping (analysis of variance test; P =.002). CONCLUSION: Plasma D-dimer levels were markers of lymphovascular invasion, clinical stage, and lymph node involvement in operable breast cancer. This correlation suggests that detectable fibrin degradation, as measured by plasma D-dimer, is a clinically important marker for lymphovascular invasion and early tumor metastasis in operable breast cancer.

Adult↗
PubMed2000

The bearing surface in total hip arthroplasty: evolution or revolution.

Highly cross-linked polyethylenes represent a new class of polyethylenes that demonstrate dramatic improvements of wear characteristics in laboratory tests. Cross-linked polyethylenes can be manufactured by a number of methods, all of which lead to some changes in the physical properties of the polyethylene. The very limited clinical information about cross-linked polyethylenes available has been favorable. Cross-linked polyethylenes appear to hold promise as an alternative to conventional polyethylene and to hard-on-hard bearing surfaces, but much more clinical information will be required before they can be recommended for routine clinical use.

Biomechanical Phenomena↗
PubMed1999

Dispelling urban myths in healthcare risk management.

Applied research to explore and challenge myths in healthcare risk management is pivotal to the growth of the profession. The authors demonstrate this process through exploring patient safety and malpractice issues on weekdays compared with on weekends and holidays. Analysis suggests that claim volume is driven by service volume.

Delivery, Obstetric↗
PubMed1999

Downsizing, reengineering and patient safety: numbers, newness and resultant risk.

Downsizing and reengineering are facts of life in contemporary healthcare organizations. In most instances, these organizational changes are undertaken in an attempt to increase productivity or cut operational costs with results measured in these terms. Less often considered are potential detrimental effects on patient safety or strategies, which might be used to minimize these risks.

Hospital Restructuring↗
PubMed1999

Cost-effectiveness of treatment of early stage endometrial cancer.

OBJECTIVE: The purpose of this study was to determine the average life-years gained and cost per life-year gained in treatment of early endometrial cancer. METHODS: We performed a decision analysis using statistical models for survival after treatment for Stage I endometrial cancer. Estimates for survival probabilities without treatment, with surgery alone, and with surgery and radiation were derived from the literature. Charges and costs of treatment were estimated based on data from our institution. We calculated the average number of life-years gained and the cost per life-year gained of various treatment options based on these estimates. Sensitivity analyses were performed to determine the effect of uncertainty about parameter estimates on the results derived from our model. RESULTS: Based on the assumptions of our model, most of the life-years gained in treatment of early endometrial cancer are attributable to hysterectomy, with a very low associated cost. For the "average" woman with endometrial cancer, about 10 life-years are gained from hysterectomy at a cost of $1000 per life-year gained, whereas adjuvant radiation yields on average 1 year of life gained at $4000 per life-year gained. Both life-years gained and cost are dramatically affected by age at diagnosis and to a lesser extent by histologic grade and comorbid medical conditions. CONCLUSIONS: This analysis suggests that the use of hysterectomy and adjuvant radiation in treatment of early endometrial cancer is a worthwhile use of health care resources. More sophisticated models may help determine the cost-effectiveness of various treatment strategies in specific subgroups of patients.

Adult↗
PubMed1999

FGF-2/fibroblast growth factor receptor/heparin-like glycosaminoglycan interactions: a compensation model for FGF-2 signaling.

Heparin-like glycosaminoglycans (HLGAGs) play a central role in the biological activity and signaling behavior of basic fibroblast growth factor (FGF-2). Recent studies, however, indicate that FGF-2 may be able to signal in the absence of HLGAG, raising the question of the nature of the role of HLGAG in FGF-2 signaling. In this study, we present a conceptual framework for FGF-2 signaling and derive a simple model from it that describes signaling via both HLGAG-independent and HLGAG-dependent pathways. The model is validated with F32 cell proliferation data using wild-type FGF-2, heparin binding mutants (K26A, K119A/R120A, K125A), and receptor binding mutants (Y103A, Y111A/W114A). In addition, this model can predict the cellular response of FGF-2 and its mutants as a function of FGF-2 and HLGAG concentration based on experimentally determined thermodynamic parameters. We show that FGF-2-mediated cellular response is a function of both FGF-2 and HLGAG concentrations and that a reduction of one of the components can be compensated for by an increase in the other to achieve the same measure of cellular response. Analysis of the mutant FGF-2 molecules show that reduction in heparin binding interactions and primary receptor site binding interactions can also be compensated for in the same manner. These results suggest a molecular mechanism that could be used by cells in physiological systems to modulate the FGF-2-mediated cellular response by controlling HLGAG expression.

Binding Sites↗
PubMed1999

Prognostic and predictive factors for patients with metastatic breast cancer undergoing aggressive induction therapy followed by high-dose chemotherapy with autologous stem-cell support.

PURPOSE: We performed a retrospective review to determine predictive and prognostic factors in patients with metastatic breast cancer who received induction therapy, and, if they responded to treatment, high-dose chemotherapy. PATIENTS AND METHODS: Patients with metastatic breast cancer received induction therapy with doxorubicin, fluorouracil, and methotrexate (AFM). Partial responders then received immediate high-dose chemotherapy, whereas those who achieved complete remission were randomized to immediate or delayed high-dose chemotherapy with hematopoietic stem-cell support. We performed a retrospective review of data from these patients and used Cox proportional hazards regression models for analyses. RESULTS: The overall response rate for the 425 patients enrolled was 74% (95% confidence interval, 70% to 78%). Multivariate analysis of data from all 425 patients revealed that positive estrogen receptor status (P =.0041), smaller metastatic foci (</= 2 v > 2 cm) (P =. 0165), a longer disease-free interval from initial diagnosis to diagnosis of metastases (</= 2 v > 2 years) (P =.0051), and prior treatment with tamoxifen (P =.0152) were good prognostic signs for overall survival. Patients who had received prior adjuvant therapy (P =.0001) and those who developed liver metastases (P =.0001) had decreased long-term survival. In the subgroup of responders to AFM induction, multivariate analysis showed that those with visceral metastases did less well (P =.0006), as did patients who had received prior adjuvant therapy (P =.0023). However, those who had received tamoxifen therapy in the adjuvant setting did better (P =. 0143). CONCLUSION: The chance for long-term remission with induction therapy with AFM and high-dose chemotherapy is increased for hormone receptor positive-patients with nonvisceral metastases who have not received prior adjuvant chemotherapy and have long disease-free intervals.

Adult↗