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Biomedical subjects

J M Bradley

Publications and source records attributed to J M Bradley.

At least 19 recordsLinked to original sources
PubMed2006

Self-management in bronchiectasis: the patients' perspective.

Self-management programmes for chronic disease are a high priority for healthcare providers. The content and method of delivery of self-management should give consideration to the specific requirements of the disease population. The aims of the present study were to assess the physical and psychosocial impact of bronchiectasis, to determine whether patients with bronchiectasis are receptive to self-management and to identify any obstacles or sources of support for a disease-specific self-management programme. A total of 32 patients with a diagnosis of bronchiectasis attended four focus groups. Each focus group was videotaped and subjected to qualitative analysis using the grounded theory approach. Bronchiectasis had an impact on patients' physical and psychosocial well-being. Patients demonstrated the potential to self-manage with strategies including self-regulation of medication and airway clearance. Perceived obstacles to self-management included lack of information and confidence. Patients suggested that self-management could be promoted through disease-specific information and appropriate healthcare procedures. In summary, patients with bronchiectasis have their lives disrupted by this chronic condition, but are receptive to self-management. The present study has provided information from the patients' perspective of elements which need to be included in a successful disease-specific self-management programme.

Activities of Daily Living↗
PubMed2006

Do patients prescribed short-burst oxygen therapy meet criteria for ambulatory oxygen?

The aim of this study was to determine whether patients (n = 40) with chronic obstructive pulmonary disease (COPD) currently receiving short-burst oxygen therapy meet existing criteria for ambulatory oxygen. A prospective randomised balanced double-blind crossover design was used. Criterion (i) for ambulatory oxygen (desaturation by 4% to below 90% on the practice walk) was met in 21 patients; 15 of these 21 patients also met criterion (ii) (10% improvement in distance and/or breathlessness score with oxygen). Despite no evidence of desaturation in 19/40 patients, 9/19 improved their distance and/or breathlessness score with oxygen. This study has shown that many patients on short-burst oxygen meet existing criteria for ambulatory oxygen and may have been receiving suboptimal therapy. It supports recent proposals for the development of comprehensive assessment services which incorporate assessment for all categories of oxygen.

Aged↗
PubMed2005

Short-term ambulatory oxygen for chronic obstructive pulmonary disease.

BACKGROUND: Ambulatory oxygen is defined as the use of supplemental oxygen during exercise and activities of daily living. Ambulatory oxygen therapy is often used for patients on long term oxygen therapy during exercise, or for non long term oxygen therapy users who achieve some subjective and/or objective benefit from oxygen during exercise. The evidence for the use of ambulatory oxygen therapy is extrapolated from two sources: longer term studies and single assessment studies. Longer term studies assess the impact of ambulatory oxygen therapy used at home during activities of daily living. Single assessment studies compare performance during an exercise test using oxygen with performance during an exercise test using placebo air. OBJECTIVES: To determine the efficacy of ambulatory oxygen in patients with COPD using single assessment studies. SEARCH STRATEGY: The Cochrane Airways Group COPD register was searched with predefined search terms. Searches were current as of March 2005. SELECTION CRITERIA: Only randomised controlled trials were included. Studies did not have to be blinded. Studies had to compare oxygen and placebo when administered to people with COPD who were undergoing an exercise test. DATA COLLECTION AND ANALYSIS: Two reviewers (JB, B'ON) extracted and entered data in to RevMan 4.2. MAIN RESULTS: Thirty one studies (contributing 33 data sets), randomising 534 participants met the inclusion criteria of the review. Oxygen improved all pooled outcomes relating to endurance exercise capacity (distance, time, number of steps) and maximal exercise capacity (exercise time and work rate). Data relating to VO2 max could not be pooled and results from the original studies were not consistent. For the secondary outcomes of breathlessness, SaO2 and VE, comparisons were made at isotime. In all studies except two the isotime is defined as the time at which the placebo test ended. Oxygen improved breathlessness, SaO2/PaO2 and VE at isotime with endurance exercise testing. There was no data on breathlessness at isotime with maximal exercise testing. Oxygen improved SaO2/PaO2 and reduced VE at Isotime. AUTHORS' CONCLUSIONS: This review provides some evidence from small, single assessment studies that ambulatory oxygen improves exercise performance in people with moderate to severe COPD. The results of the review may be affected by publication bias, and the small sample sizes in the studies. Although positive, the findings of the review require replication in larger trials with more distinct subgroups of participants. Maximal or endurance tests can be used in ambulatory oxygen assessment. Consideration should be given to the measurement of SaO2 and breathlessness at isotime as these provide important additional information. We recommend that these outcomes are included in the assessment for ambulatory oxygen. Future research needs to establish the level of benefit of ambulatory oxygen in specific subgroups of people with COPD.

Ambulatory Care↗
PubMed2005

Short term ambulatory oxygen for chronic obstructive pulmonary disease.

BACKGROUND: Ambulatory oxygen is defined as the use of supplemental oxygen during exercise and activities of daily living. Ambulatory oxygen therapy is often used for patients on long term oxygen therapy during exercise, or for non long term oxygen therapy users who achieve some subjective and/or objective benefit from oxygen during exercise. The evidence for the use of ambulatory oxygen therapy is extrapolated from two sources: longer term studies and single assessment studies. Longer term studies assess the impact of ambulatory oxygen therapy used at home during activities of daily living. Single assessment studies compare performance during an exercise test using oxygen with performance during an exercise test using placebo air. OBJECTIVES: To determine the efficacy of ambulatory oxygen in patients with COPD using single assessment studies. SEARCH STRATEGY: The Cochrane Airways Group COPD register was searched with predefined search terms. Searches were current as of March 2004. SELECTION CRITERIA: Only randomised controlled trials were included. Studies did not have to be blinded. Studies had to compare oxygen and placebo when administered to people with COPD who were undergoing an exercise test. DATA COLLECTION AND ANALYSIS: Two reviewers (JB, B'ON) extracted and entered data in to RevMan 4.2.7. MAIN RESULTS: Twenty-seven studies (contributing 29 data sets), randomising 469 participants met the inclusion criteria of the review. Oxygen improved all pooled outcomes relating to endurance exercise capacity (distance, time, number of steps) and maximal exercise capacity (exercise time and work rate). Data relating to VO2max could not be pooled and results from the original studies were not consistent. For the secondary outcomes of breathlessness, SaO2 and VE, comparisons were made at isotime. In all studies except two the isotime is defined as the time at which the placebo test ended. Oxygen improved breathlessness, SaO2/PaO2 and VE at isotime with endurance exercise testing. There was no data on breathlessness at isotime with maximal exercise testing. Oxygen improved SaO2/PaO2 at isotime; the reduction in VE did not reach statistical significance. AUTHORS' CONCLUSIONS: This review provides some evidence from small, single assessment studies that ambulatory oxygen improves exercise performance in people with moderate to severe COPD. The results of the review may be affected by publication bias, and the small sample sizes in the studies. Although positive, the findings of the review require replication in larger trials with more distinct subgroups of participants. Maximal or endurance tests can be used in ambulatory oxygen assessment, but endurance tests may be more appropriate as they are more related to activities of daily living. Consideration should be given to the measurement of SaO2 and breathlessness at isotime as these provide important additional information. We recommend that these outcomes are included in the assessment for ambulatory oxygen. Future research needs to establish the level of benefit of ambulatory oxygen in specific subgroups of people with COPD.

Ambulatory Care↗
PubMed2005

Escherichia coli heat stable (STa) enterotoxin and the upper small intestine: lack of evidence in vivo for net fluid secretion.

Heat stable (STa) enterotoxin from E. coli reduced fluid absorption in vivo in the perfused jejunum of the anaesthetized rat in Krebs-phosphate buffer containing lactate and glucose (nutrient buffer), in glucose saline and in glucose free saline. Bicarbonate ion enhanced fluid absorption of 98 +/- 7 (6) microl/cm/h was very significantly (P < 0.0001) reduced by STa to 19 +/- 4 (6) microl/cm/h, but net secretion was not found. When impermeant MES substituted for bicarbonate ion, net fluid absorption of 29 +/- 3 (6) microl/cm/h was less (P < 0.01) than the values for phosphate buffer and bicarbonate buffer. With STa in MES buffer, fluid absorption of 3 +/- 2 (6) microl/cm/h was less than (P < 0.001) that in the absence of STa and not significantly different from zero net fluid absorption. E. coli STa did not cause net fluid secretion in vivo under any of the above circumstances. Neither bumetanide nor NPPB when co-perfused with STa restored the rate of fluid absorption. In experiments with zero sodium ion-containing perfusates, STa further reduced fluid absorption modestly by 20 microl/cm/h. Perfusion of ethyl-isopropyl-amiloride (EIPA) with STa in zero sodium ion buffers prevented the small increment in fluid entry into the lumen caused by STa, indicating that the STa effect was attributable to residual sodium ion and fluid uptake that zero sodium-ion perfusates did not eradicate. These experiments, using a technique that directly measures mass transport of fluid into and out of the in vivo proximal jejunum, do not support the concept that E. coli STa acts by stimulating a secretory response.

Animals↗
PubMed2005

Physiotherapy involvement in non-invasive ventilation hospital services: a British Isles survey.

The aim of this study was to assess the involvement of physiotherapists in the delivery of non-invasive ventilation (NIV) services in the British Isles. A postal questionnaire was sent to all senior physiotherapists in hospitals providing specialist respiratory medicine. The response rate was 88% (269/305). Physiotherapists were involved in managing patients using NIV in 212/233 hospitals that used NIV. The majority of physiotherapists, 97% (206/212), were involved in treating patients on NIV. Physiotherapists assessed patients for NIV in 68% (145/212) of hospitals and were involved in setting up patients on NIV in 46% (97/212) of hospitals. There were no major differences between countries, within the British Isles, in the level of involvement of Physiotherapists in the management of patients on NIV. Physiotherapists need to develop specialist skills with regard to assessment and setting up patients on NIV if they want to expand their role in the management of patients on NIV.

Delivery of Health Care↗
PubMed2005

Short burst oxygen therapy in chronic obstructive pulmonary disease: a patient survey and cost analysis.

The prescription of home oxygen cylinders is substantial. This study aimed to establish patient's current use of short burst oxygen therapy in chronic obstructive pulmonary disease (COPD) and to examine potential cost savings if cylinder use had been replaced by a concentrator. An interviewer-administered questionnaire was completed by 100 patients currently receiving short burst oxygen therapy. Patients reported that they used their oxygen before exercise/activity (26%), during exercise (19%), after exercise/activity (87%) and at rest (46%) and mostly for the relief of symptomatic breathlessness. The length of time [mean (SD)] patients had oxygen at home was 27.42 (29.31) months. Of those patients using cylinders, savings could have been made by transferring from cylinders to concentrators. While withdrawal of oxygen may be difficult, an oxygen assessment service could ensure that future prescription is aimed at those who benefit and is delivered by the most cost-effective method.

Aged↗
PubMed2004

Subjective benefit of inhaled therapies in patients with bronchiectasis: a questionnaire study.

The objectives of this study were to obtain information about the use and subjective benefits of inhaled therapies in patients with bronchiectasis and to determine if these benefits were related to the presence of airflow obstruction. One hundred and twenty patients completed a questionnaire on inhaled therapies and performed spirometry. Inhalers were used daily by 85/120 patients with bronchiectasis and 42/120 patients had a nebuliser. Inhaled therapies were used extensively in patients with (FEV1 < 80%) and without (FEV1 > 80%) evidence of airflow obstruction. The majority of patients reported subjective benefits from their inhaled therapies. Chi2 analysis showed that there was no association between perceived benefits of short acting bronchodilators (SAB), long acting bronchodilators (LAB), corticosteroids or nebulisers and degree of airflow obstruction. This study provides information about the subjective benefits of inhaled therapies which could facilitate a more comprehensive assessment of the net benefit of inhaled therapies in patients with bronchiectasis with and without airflow obstruction.

Administration, Inhalation↗
PubMed2004

Surviving out of hospital cardiac arrest at home: a postcode lottery?

OBJECTIVE: To find out if the response time, distance travelled to scene, and geographical location affect survival from out of hospital cardiac arrest (OHCA). METHODS: Retrospective cohort study over 10 years, 1 December 1991 to 1 August 2001. Outcome and demographic data were obtained for 1956 OHCAs occurring at home, in the Lothians region, from the Heartstart Scotland database. Survival rates to hospital admission and discharge were examined by postcode district. RESULTS: Certain postcode areas were served by quicker response times and shorter journeys. The survival to admission rate was greater in those areas where the median response time was <10 minutes (13.5% versus 8.1%, p<0.05). There was greater survival to discharge in these areas but not significantly so (4.1% versus 3.2%, p = 0.42). Survival to admission was more likely in areas where the median distance travelled was <four miles (13.3% versus 9.7%, p<0.05) but not survival to discharge (4.0% versus 3.7%, p = 0.72). A close correlation between distance travelled and response time was shown (Pearson = 0.93, p<0.01), likewise between distance travelled and survival to admission (Spearman = -0.87, p<0.01). Certain areas, particularly those at greater geographical distance from ambulance dispatch points, were found to be associated with significantly lower survival to admission rates. CONCLUSIONS: Survival to admission from OHCA is strongly influenced by response time and distance travelled to the scene. The geographical location of an arrest can potentially influence survival to admission. Measures should be taken to strategically position ambulance dispatch points and to task the nearest geographically available vehicle to attend an OHCA.

Aged↗
PubMed2004

Airway clearance in bronchiectasis: a randomized crossover trial of active cycle of breathing techniques (incorporating postural drainage and vibration) versus test of incremental respiratory endurance.

OBJECTIVES: The purpose of this study was to compare the efficacy of the test of incremental respiratory endurance (TIRE) with active cycle of breathing techniques (ACBT) [incorporating postural drainage (PD) and vibration] as methods of airway clearance in adults with bronchiectasis. DESIGN: A randomized crossover study in which a single session of ACBT (incorporating PD and vibration) was compared to a single session of TIRE was carried out in 20 patients (14 female) with stable, productive bronchiectasis. MEASUREMENTS: Weight of sputum (treatment plus 30 min) was the primary outcome measure recorded. Pre- and post-treatment measures of lung function and SpO2 were also recorded. RESULTS: All 20 patients were stable during the study period. Sputum weight expectorated during and 30 min post-ACBT (incorporating PD and vibration) treatment was significantly greater than the sputum weight expectorated during and 30 min post-TIRE treatment [mean difference 2.44 g (95% CI 0.43-4.45)]. CONCLUSION: ACBT (incorporating PD and vibration) is a more effective method of airway clearance in bronchiectasis than TIRE during single treatment sessions.

Bronchiectasis↗
PubMed2004

Prescribing practice for intermittent oxygen therapy: a GP survey.

INTRODUCTION: UK figures show that the prescription of home oxygen cylinders for intermittent use is substantial. AIM: To examine GP assessment criteria and prescribing practice for intermittent oxygen therapy in patients with a diagnosis of chronic obstructive pulmonary disease (COPD) in Northern Ireland. METHODS: A postal questionnaire was sent to all GPs (n = 534) in two health boards who had prescribed cylinder oxygen in a six month period prior to the study. The questionnaire was piloted to establish reliability and validity. RESULTS: Completed questionnaires were returned by 52% (280/534) of GPs. GPs 'most frequently' used advice from hospital specialists [82% (230/280)] to determine the need for intermittent oxygen. Criteria such as breathlessness score on exercise (e.g., BORG), oximetry on exercise, local guidelines or national guidelines were used less frequently or never. CONCLUSIONS: Most patients are likely to have been prescribed intermittent oxygen without any objective assessment. Implementation of evidence-based guidelines and a formal oxygen assessment service, would rationalize the use of intermittent oxygen therapy and enable better targeting of this expensive resource.

Follow-Up Studies↗
PubMed2003

Incontinence in adult females with cystic fibrosis: a Northern Ireland survey.

The objectives of this survey were to establish the prevalence, onset, severity and impact of incontinence and attitudes towards the availability of advice and treatment in female adults with cystic fibrosis (CF) in Northern Ireland. All female patients (n=59) at the Northern Ireland Regional Adult CF Centre were posted a questionnaire on incontinence. Leakage of urine occurred in 14/46 respondents. Leakage of urine occurred when chest was bad in 8/14 patients and when chest was good or bad in 3/14 patients. Patients reported that their bladder problem affected their ability to perform airway clearance or cough (13/14), and exercise (4/14). The main reason given for the patients who did not seek help for their incontinence (10/14) was that they were too embarrassed. This study highlights that patients with CF are reluctant to seek treatment for incontinence despite the impact this condition can have.

Adult↗
PubMed2001

Attachment among older adults: current issues and directions for future research.

Although John Bowlby conceptualized attachment theory as applicable across the life span, researchers have been relatively slow to examine attachment phenomena specifically among older adults. The present article reviews the extant research applying attachment theory to older populations; preliminary findings suggest that attachment issues hold particular relevance for older adults, given the increased potential for separation, loss and vulnerability associated with aging. Although many of the studies reviewed are somewhat limited methodologically, the overall pattern of results suggests that attachment patterns are associated with a variety of outcomes in later life (such as adaptation to chronic illness and caregiver burden among family members, reactions to the death of a loved one, and general well-being) in a theoretically consistent manner. The implications of and questions raised by current findings are reviewed, and directions for future research are discussed.

Aged↗
PubMed2001

Infection with Bartonella weissii and detection of Nanobacterium antigens in a North Carolina beef herd.

Very recently, Bartonella organisms have been isolated from large ruminants (deer, elk, and dairy and beef cattle) located in the United States and in France. In this study, we report the serologic, microbiologic, and molecular findings related to the isolation of a Bartonella species in North Carolina beef cattle and the detection of nanobacterial antigen using a commercially available enzyme-linked immunosorbent assay. Between August 1998 and September 1999, blood was collected from 38 cattle ranging in age from 1 month to 6.5 years. After a 1-month incubation period, a Bartonella sp. was isolated on a 5% rabbit blood agar plate from three of six EDTA blood samples. PCR amplification of the 16S rRNA gene from all three isolates resulted in a DNA sequence that was 100% identical to that of B. weissii 16S rRNA (GenBank no. AF199502). By IFA testing, 36 of 38 cattle had antibodies (> or =1:64) to Bartonella weissii (bovine origin) antigens. Nanobacterial antigen was detected in 22 of 22 serum samples. We conclude that infection with an organism similar or closely related to B. weissii can occur in North Carolina cattle and that although their actual existence is still controversial Nanobacterium antigens were detected with a commercially available test kit. The epidemiology, vector biology, and potential pathogenicity of these organisms in cattle deserve future consideration.

Alphaproteobacteria↗
PubMed2001

Effects of mechanical stretching on trabecular matrix metalloproteinases.

PURPOSE: The homeostatic mechanisms responsible for intraocular pressure (IOP) regulation are not understood. Studies were conducted to evaluate the hypothesis that trabecular meshwork (TM) cells sense increases in IOP as stretching or distortion of their extracellular matrix (ECM) and respond by increasing ECM turnover enzymes. METHODS: Flow rates were increased in perfused human anterior segment organ cultures and the matrix metalloproteinase (MMP) levels and IOP were evaluated. Human TMs in stationary anterior segment organ culture were mechanically stretched, and MMP levels were analyzed. TM cells were grown on membranes, which were then stretched, and MMP levels were evaluated. Western immunoblots, zymography, and confocal immunohistochemistry were used to evaluate changes in MMPs and their tissue inhibitors, the TIMPS: RESULTS: Doubling the flow rate in perfused human organ cultures increased gelatinase A levels in the perfusate by 30% to 50% without affecting gelatinase B or stromelysin levels. Immediately after doubling the flow rate, the measured IOP doubled. However, over the next few days the IOP gradually returned to the initial level, although the flow rate was maintained at double the initial value. Stretching stationary organ cultures or stretching TM cells grown on membranes resulted in similar increases in gelatinase A without changes in gelatinase B or stromelysin levels. The gelatinase A increases occurred between 24 and 72 hours and were approximately proportional to the degree of stretching. Although coating the membranes with different ECM molecule affected the gelatinase A response, the optimum response occurred when the cells had been grown long enough to produce their own ECM. By Western immunoblot and confocal immunohistochemistry, the stretch-induced increases in gelatinase A were accompanied by strong decreases in TIMP-2 levels and moderate increases in one membrane type MMP, MT1-MMP. After mechanical stretching of the membrane, gelatinase A, MT1-MMP and TIMP-2 all exhibited a similar punctate immunostaining pattern over the TM cell surface. CONCLUSIONS: These results are compatible with the hypothesis that elevations in IOP are sensed by TM cells as ECM stretch/distortion. TM cells respond by increasing gelatinase A and MT1-MMP, while decreasing TIMP-2 levels. This will increase ECM turnover rates, reduce the trabecular resistance to aqueous humor outflow, and restore normal IOP levels. This hypothesis provides a regulatory feedback mechanism for IOP homeostasis.

Animals↗
PubMed2000

Mediation of laser trabeculoplasty-induced matrix metalloproteinase expression by IL-1beta and TNFalpha.

PURPOSE: Laser trabeculoplasty of the anterior uveal region of the trabecular meshwork induces sustained matrix metafloproteinase expression within the juxtacanalicular region of the meshwork. Studies were conducted to test the hypothesis that a factor mediates this response and to identify the factor. METHODS: Human anterior segment organ cultures were subjected to laser treatment using standard clinical parameters and were returned to culture for 8 hours. The resultant 8-hour-conditioned culture medium was then tested for factor activity by evaluating its ability to produce two typical trabecular responses to laser treatment, that is, to induce stromelysin expression or to trigger cell division, when applied to fresh organ cultures or to cell cultures. Confocal immunohistochemistry of the laser-treated organ cultures and western immunoblot analysis of the conditioned medium were used to evaluate changes in potential candidates for the factor activity. The ability of the interleukin (IL)-1 receptor antagonist (IL-1ra)- and of tumor necrosis factor alpha (TNFalpha)- blocking antibodies to eliminate the stromelysin induction was evaluated. RESULTS: Medium conditioned for 8 hours induced typical trabecular cell division in anterior segment organ cultures. Medium conditioned for 8 hours, but not for 30 minutes, induced typical increases in stromelysin expression in these organ cultures and in cell cultures. After 8 hours, both trabecular cells in laser-treated organ cultures and in the conditioned medium contained elevated levels of IL-1beta and TNFalpha. The laser-treated organ cultures contained elevated levels of IL-1alpha, but it was not secreted into the medium. The ability of conditioned media to induce stromelysin expression was partially blocked by either the IL-1ra- or the TNFalpha-blocking antibody. CONCLUSIONS: Laser trabeculoplasty induces the expression and secretion of both IL-1beta and TNFalpha within the first 8 hours after treatment. These cytokines then mediate increased trabecular stromelysin expression. Putatively, this initiates remodeling of the juxtacanalicular extracellular matrix, a likely site for the aqueous outflow resistance, and thus restores normal outflow facility.

Animals↗
PubMed1999

Coinfection with multiple tick-borne pathogens in a Walker Hound kennel in North Carolina.

Both dogs and humans can be coinfected with various Ehrlichia, Bartonella, Rickettsia, and Babesia species. We investigated a kennel of sick Walker Hounds and their owners in southeastern North Carolina for evidence of tick-borne infections and associated risk factors. A high degree of coinfection was documented in the dog population. Of the 27 dogs, 26 were seroreactive to an Ehrlichia sp., 16 to Babesia canis, and 25 to Bartonella vinsonii, and 22 seroconverted to Rickettsia rickettsii antigens. According to PCR results, 15 dogs were infected with Ehrlichia canis, 9 with Ehrlichia chaffeensis, 8 with Ehrlichia ewingii, 3 with Ehrlichia equi, 9 with Ehrlichia platys, 20 with a Rickettsia species, 16 with a Bartonella species, and 7 with B. canis. The detection of DNA from any Ehrlichia species was associated with clinical illness and with concurrent B. canis infection (by PCR). Both E. canis and an uncharacterized Rickettsia species appeared to result in chronic or recurrent infection. Death in the dog population was associated with living in a dirt lot rather than the concrete kennel. Of 23 people on whom serologic testing was conducted, eight were seroreactive to Bartonella henselae, one to E. chaffeensis, and one to R. rickettsii antigen; however, none had clinical or hematologic abnormalities consistent with illness caused by these organisms. We conclude that kennel dogs with heavy tick exposure can be infected at a high rate with multiple, potentially zoonotic, tick-borne pathogens. In addition, our findings further illustrate the utility of PCR for documenting coinfection with tick-transmitted pathogens.

Animals↗