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Biomedical subjects

M Barnes

Publications and source records attributed to M Barnes.

At least 19 recordsLinked to original sources
PubMed2006

Continuous positive airway pressure reduces daytime sleepiness in mild to moderate obstructive sleep apnoea: a meta-analysis.

BACKGROUND: Obstructive sleep apnoea syndrome (OSAS) affects an estimated 2-4% of the middle aged population. Meta-analyses of randomised controlled trials have shown that the severe presentation of the syndrome (apnoea hypopnoea index (AHI) >30/hour) is effectively treated with continuous positive airway pressure (CPAP). Until recently there have been insufficient data to determine whether CPAP improves sleepiness in the larger subgroup with mild to moderate OSAS (AHI 5-30/hour). METHODS: A systematic search of Medline and a hand search identified seven randomised controlled trials where CPAP was compared with either a placebo or with conservative management in the treatment of mild to moderate OSAS (AHI 5-30/hour). All trials used the Epworth Sleepiness Scale (ESS), four used the Multiple Sleep Latency Test (MSLT), and three used the Maintenance of Wakefulness Test (MWT) to measure sleepiness. RESULTS: Meta-analyses indicated that CPAP significantly reduced subjective daytime sleepiness (ESS) by 1.2 points (95% CI 0.5 to 1.9, p = 0.001), improved objective daytime wakefulness (MWT) by 2.1 minutes (95% CI 0.5 to 3.7, p = 0.011), but did not affect objective daytime sleepiness (MSLT, mean benefit -0.2 minutes, 95% CI -1.0 to 0.6, p = 0.6). The two significant effects were small (effect size <0.30). CONCLUSIONS: CPAP elicits small improvements in subjective sleepiness and objective wakefulness in people with mild to moderate OSAS. However, the effects on sleepiness are of limited clinical significance.

Adult↗
PubMed2006

Spontaneously occurring fibroid tumors of the laying hen oviduct.

Spontaneously occurring benign uterine leiomyomas (fibroids) are the most common tumors of reproductive-age women. It is estimated that more than 70% of all women will develop uterine fibroids, and the presence of these tumors is a primary cause of hysterectomies. Research into the causes and treatment of uterine fibroids is hampered by a lack of reliable animal models for the disease. Leiomyomas that appear to be outwardly similar to human uterine fibroid tumors are known to occur on the oviducts of laying hens over 2 yr of age. The objective of this study was to characterize these tumors and compare them to human uterine fibroids to determine the suitability of the aging hen as a model system for the study of the disease. In this study, hens at 5 yr of age were examined for the presence of oviduct-associated fibroid tumors. Tumors were found attached to the internal surface of the oviduct, embedded in the oviduct wall, or attached to the exterior of the magnum and isthmus. Tumor and normal oviduct samples were frozen or fixed in formalin for histological analyses or immunohistochemistry for estrogen and progesterone receptors, proliferating cell nuclear antigen and Bcl-2 protein expression. Human uterine fibroid samples were acquired and evaluated compared with hen oviduct fibroids. The results indicate that laying hen fibroid tumors are similar to human fibroid tumors with respect to estrogen and progesterone receptors, localized cellular proliferation, and expression of the Bcl-2 protein.

Age Factors↗
PubMed2006

Hypothermia pediatric head injury trial: the value of a pretrial clinical evaluation phase.

BACKGROUND: The utility of a pretrial clinical evaluation or run-in phase prior to conducting trials of complex interventions such as hypothermia therapy following severe traumatic brain injury in children and adolescents has not been established. METHODS: The primary objective of this study was to prospectively evaluate the ability of investigators to adhere to the clinical protocols of care including the cooling and rewarming procedures as well as management guidelines in patients with severe traumatic brain injury (Glasgow Coma Scale<or=8) treated with 24 h of hypothermia therapy. A secondary objective was to evaluate the ability of study research assistants to complete the study case report form using a procedures manual. The study was conducted at 18 sites in Canada, the United Kingdom and France prior to proceeding to a randomized controlled trial (RCT). After 2 patients were enrolled at each center, an independent clinical evaluation committee examined the process of care and the completeness of data collection. Centers were permitted to enroll patients in the RCT once they met pre-established adherence criteria. RESULTS: Seventeen of the 18 centers completed the pretrial clinical evaluation phase demonstrating compliance with study procedures and proceeded to an RCT of hypothermia therapy. One center enrolled only 1 patient in the pretrial clinical evaluation phase due to small numbers of patients with traumatic brain injury, and therefore, did not proceed to the RCT. Three centers were required to enroll more than 2 patients in the pretrial clinical evaluation phase prior to proceeding to the RCT because of problems with adherence to the clinical protocols at two centers and the training of new study personnel at another center. Of the 39 patients enrolled during the pretrial clinical evaluation phase, 8 (20.5%) died and 22 (62.9%) had a good outcome defined as normal, mild or moderate disability assessed using the Pediatric Cerebral Performance Category score at 6 months following injury. DISCUSSION: The pretrial clinical evaluation phase was useful to ensure compliance with complex hypothermia therapy and consensus-based clinical management guidelines of care successfully implemented across 17 of 18 centers. This study maneuver allowed us to complete a subsequent RCT in 225 children following severe traumatic brain injury.

Algorithms↗
PubMed2005

Predictors of success following endovascular aneurysm repair: mid-term results.

OBJECTIVE: Australian cases of endovascular aneurysm repair (EVAR) performed between 1999 and 2001 have been evaluated to determine the mid-term (6 months to 5 years) safety and efficacy of the procedure. This study looks at predictors of success, based on mid-term follow-up data. DESIGN OF STUDY: This study uses results obtained from a prospective semi-voluntary register (audit) of Australian data obtained from surgeons in the private and public sector. RESULTS: Peri-operative mortality for patients enrolled in the audit was 1.8%. Ninety-three percent of procedures were technically successful (890/961). Nearly 13% of patients have had re-interventions (mostly endoluminal) at follow-up. Analysis of audit data shows that the likelihood of experiencing post-operative complications or requiring additional procedures increases with ASA rating, increasing age, large pre-operative aneurysm size, aneurysm angle >45 degrees and number of co-morbid conditions diagnosed. CONCLUSIONS: This study confirms satisfactory mid-term results in a, national rather than unit specific, setting. Predictors of clinical failure or need for re-intervention include large aneurysm size, neck angulation >or=45 degrees and short infrarenal neck.

Aged↗
PubMed2005

Functional outcome in young adults with spina bifida and hydrocephalus.

INTRODUCTION: Quality of life was studied in 31 adult survivors of spina bifida, each with Verbal or Performance IQ score over 70. METHODS: Instruments measured physical and occupational function, cognitive/psychological function, somatic sensation, and social interaction in the context of the ability to live independently. RESULTS: Domain group means except motor independence were in the average range (+/- 1 standard deviation). Variability within the group with respect to physical phenotype (high spinal lesions were associated with poorer motor independence) and medical history [a greater number of shunt revisions (> 4) were associated with poorer functional numeracy] was predictive of quality of life. Both spinal lesion level and number of shunt revisions influenced occupational status. DISCUSSION: There was a relation between everyday mathematics, reading skills, and quality of life. The consequences of the physical, medical, and cognitive effects of spina bifida extend into young adulthood and have an impact on quality of life.

Activities of Daily Living↗
PubMed2005

Long-term use of acid suppression started inappropriately during hospitalization.

BACKGROUND: Practitioners routinely misuse acid suppression medications on general medical floors and inappropriately continue the drug at discharge. AIMS: To: (i) retrospectively study the appropriateness of acid suppression use on the general medical floors; (ii) characterize the patient population discharged on unnecessary acid suppression and (iii) evaluate whether patients discharged on unnecessary acid suppression continue the medicine long term. METHODS: Retrospective chart review of general medical patients admitted to an in-patient teaching service over 6 consecutive months. RESULTS: About 60% of patients lacked an indication for initiation of acid suppression and 34% of these patients were discharged on the medicine. The only independent predictor of continuation of acid suppression at discharge was longer length of stay. Multivariate analysis did not identify a characteristic distinguishing those patients discharged inappropriately on acid suppression. At 3 and 6 months of follow-up, 80% and 50% of patients, respectively, remained on acid suppression therapy without an appropriate indication. CONCLUSIONS: Our data verifies that practitioners routinely start general medical in-patients on acid suppression without an appropriate indication. Many of these prescriptions are continued at discharge for no apparent reason, leading to their long-term misuse.

Aged↗
PubMed2005

Limits on gravitational-wave emission from selected pulsars using LIGO data.

We place direct upper limits on the amplitude of gravitational waves from 28 isolated radio pulsars by a coherent multidetector analysis of the data collected during the second science run of the LIGO interferometric detectors. These are the first direct upper limits for 26 of the 28 pulsars. We use coordinated radio observations for the first time to build radio-guided phase templates for the expected gravitational-wave signals. The unprecedented sensitivity of the detectors allows us to set strain upper limits as low as a few times 10(-24). These strain limits translate into limits on the equatorial ellipticities of the pulsars, which are smaller than 10(-5) for the four closest pulsars.

Journal Article↗
PubMed2004

Multimedia presentations in the age of the Health Insurance and Accountability Act.

The privacy rule of the Health Insurance Portability and Accountability Act (HIPAA) has made all physicians think more about their patients' privacy. In addition to safeguarding health information in routine office practice, doctors now are starting to consider the effects of the regulations on other professional activities including professional clinical multimedia presentations. This article explains specifically where and how multimedia (e.g., images, video) patient information may be used and shared. Although HIPAA itself is a lengthy and detailed document, a few simple rules can be extracted, which when followed, ensure that neither presentations nor patient privacy need to be sacrificed.

Confidentiality↗
PubMed2004

School based youth health nurses' role in assisting young people access health services in provincial, rural and remote areas of Queensland, Australia.

INTRODUCTION: People living in rural and remote areas have poorer health and more limited access to health services than those in urban areas. Adolescence, generally a period of optimum health, is fraught with risky health behaviours, increasing morbidity and mortality. Increasingly, mental health problems including depression, alcohol and drug use, suicide, self-harm, sexual health, inappropriate nutrition and physical activity are key areas of adolescent health concern in Queensland, Australia. To address the health and well being needs of young people the School Based Youth Health Nurse (SBYHN) Program was introduced into State high schools in Queensland in 1998. SBYHN responsibilities include individual consultations and health promotion within the high school environment. This study was undertaken to explore the referral role of SBYHN in provincial, rural and remote Queensland and to ascertain the availability of referral services. METHOD: A self-report survey was posted to all SBYHN in Queensland. Forty-four (62%) nurses participated; 27 from provincial, 11 from rural and 6 from remote areas. RESULTS: SBYHN consult with young people in provincial, rural and remote State high schools in the areas of psychological concerns, drug and alcohol concerns and/or abuse, family conflict and/or abuse, sexual and reproductive health, social and isolation concerns and nutritional advice. However, the frequency with which SBYHN reported themselves as an appropriate source for young people to seek assistance from varied from over 90% for areas such as sexual and nutritional advice to approximately 30% for areas such as physical abuse and drug and alcohol abuse. When required by the SBYHN, referral services were locally accessible to young people less than 50% of the time. Access to some referral services was reduced because some young people do not want parental involvement in their health and the service requires parental consent. When referral services were unavailable SBYHN used phone counselling, available generalists, supported and monitored the young people until a service was available, or they accepted this as an aspect of residing outside the metropolitan areas and did the best they could. Sometimes, when a young person was reluctant to attend a recommended service or there was a long wait for an appointment, SBYHN provided ongoing support while endeavouring to persuade attendance at the recommended service. Situations like these, experienced by at least half those studied, place SBYHN in the precarious position of practicing beyond their scope of practice. CONCLUSIONS: Health problems during adolescence can be reduced by ensuring assistance and support are available for young people when and if they require it. Thorough confidential individual consultations are provided by SBYHN and young people are availing themselves of this service. SBYHN are practicing at an advanced level and need to be recognised as such. Additionally, the availability of services in rural and remote regions needs consideration. As rural youth are more vulnerable to a number of health concerns, it is imperative that services are available for them. The issue of parental consent remains a barrier to young people seeking health services and it may be timely for community debate on this issue.

Journal Article↗
PubMed2004

What drives quality of life in multiple sclerosis?

BACKGROUND: Extensive use of the EDSS measure of disease severity by clinicians, and the EQ-5D measure of quality of life by healthcare decision-makers, may not adequately reflect patient perceptions of the range and impact of their symptoms. AIM: To investigate the perceptions of MS patients in relation to specific symptoms and their general health-related quality of life. DESIGN: Questionnaire-based surveys. METHODS: Two consecutive postal surveys were sent to people whose contact details were on the database of the MS Trust. The first was sent to all 8,614. Of 3,403 respondents, 1992 agreed to participate in a second survey. RESULTS: In the first survey (response rate 40%), 1993 respondents (88%) reported moderate or severe fatigue; of 266 receiving disease-modifying therapy, 109 (41%) felt it improved their fatigue. In the second (response rate 78%), mean EQ-5D Index and z scores on the related quality of life deficit were significantly lower for respondents with relapsing or progressive disease than for those with benign disease. In the former groups (total n=1178), over 90% reported problems with mobility and usual activities, and over 80% reported problems with pain. The lowest mean SF-36 scores were for role-physical, physical functioning and vitality, vitality being higher in respondents receiving beta interferon vs. those who were not (p <0.0001). Vitality was highly correlated with social functioning (0.58), general health (0.51) and mental health (0.50). DISCUSSION: Fatigue can profoundly disrupt the occupational and social functioning of MS patients, but is not directly captured in either the EDSS or the EQ-5D. Further investigation of the patient-perceived benefits of disease-modifying therapy, particularly in relation to symptoms of fatigue, may be valuable.

Activities of Daily Living↗
PubMed2004

Guidance for the preparation of neurological management guidelines by EFNS scientific task forces--revised recommendations 2004.

Since the publication of the first EFNS task force reports in 1997, a total of 20 evidence-based guidelines for the treatment and management of neurological diseases have been published by the EFNS (http://www.efns.org/guidelines). In 2001, recommendations for the preparation of neurological guidelines were issued by the EFNS Scientific Committee (Eur J Neurol 2001; 8: 549-550). These have now been updated and revised. More unified criteria for standards of reporting are set up which include classes of scientific evidence and predefined levels of recommendation. These criteria as well as others listed below should be used for all working groups that aim at recommending treatment, diagnostic procedures or other interventions within the framework of the EFNS.

Consensus↗
PubMed2001

Increased muscle glycogen content is associated with increased capacity to respond to T-system depolarisation in mechanically skinned skeletal muscle fibres from the rat.

The ability of mechanically skinned muscle fibres from the rat to respond to T-system depolarisation was studied in relation to muscle glycogen content. Muscle glycogen was altered by incubating extensor digitorum longus (EDL) muscles in Krebs solution without glucose or in Krebs solution with glucose (10 mM) and insulin (20 U.l-1). The glycogen content of muscles stored without glucose was rather stable between 30 and 480 min (11.27 +/- 0.39 mumol.g-1), while the muscles stored with glucose and insulin maintained an elevated and stable level of glycogen (23.48 +/- 1.67 mumol.g-1) between 100 and 360 min. Single mechanically skinned fibres from paired muscles, incubated in either glucose-free Krebs or in Krebs with glucose and insulin, were subjected to cycles of T-system depolarisation-repolarisation in a controlled environment (8 mM ATP, 10 mM creatine phosphate, 1 mM Mg2+, pH 7.10) and the force response was monitored until the force had declined to 50% of the maximum response (50% rundown). Fibres from muscles with a higher glycogen content reached 50% rundown after a larger number of depolarisations and displayed consistently larger average response capacity values, calculated as the sum of the force responses to 50% rundown divided by the maximum Ca(2+)-activated force response in that fibre. Thus skinned fibres originating from muscles with a higher glycogen content have an increased ability to respond to T-system depolarisation when the effect of metabolite accumulation is minimised and the function of glycogen acting as an energy source is by-passed. This provides direct support to the hypothesis that glycogen has a protective role in maintaining fibre excitability.

Adenosine Triphosphate↗
PubMed2001

Experience-based educational strategies to promote woman-centred midwifery practice.

This paper discusses the evaluation of educational activities developed and implemented in a tertiary based, pre-endorsement midwifery program in Brisbane, Australia. The development of the experience-based activities outlined was driven by the feminist philosophy of the curriculum and a commitment to helping students develop as woman-centred practitioners. The activities focused on enabling students to hear women's stories of childbearing firsthand and understand these stories from the women's perspective, thus validating personal experience.

Adult↗
PubMed2001

Attentional-inhibitory control and social-behavioral regulation after childhood closed head injury: do biological, developmental, and recovery variables predict outcome?

Attentional-inhibitory control and social-behavioral regulation are two outcome domains commonly impaired after childhood closed head injury (CHI). We compared neuropsychological tests of attentional-inhibitory control (vigilance, selective attention, response modulation) and social discourse and intentionality (inferencing, figurative language, and speech acts) with parent ratings of attention and behavioral regulation in relation to four injury-related variables: age at CHI, time since CHI, CHI injury severity, and frontal lobe injury moderated by CHI severity. Participants were 105 school-aged children in the chronic stage of CHI, divided into mild, moderate, and severe injury severity groups, and further subdivided according to frontal lobe injury. Outcome indices were imperfectly correlated in the group as a whole, although several relations between neurocognitive tests and parent ratings were observed within CHI subgroups. Different domains of cognitive function had different predictors. For attentional-inhibitory control, age at injury and time since injury were most predictive of outcome; for social discourse, predictors were injury severity and frontal lobe injury moderated by injury severity. Variability in cognitive outcome after childhood CHI is not random, but appears related to age, time, and biological features of the injury.

Adolescent↗
PubMed2001

Crete: does farming explain urban and rural differences in atopy?

BACKGROUND: Urban-rural differences in the prevalence of atopy and associated allergic diseases have been reported in several non-European countries. Within Europe, where such variations are less striking, a farm childhood has been postulated to be protective. OBJECTIVE: We aimed to compare the prevalence of atopy in urban and rural children living in Crete and to examine the role of early exposure to a farming environment in explaining any measured differences. METHODS: A cross-sectional survey of children attending secondary schools in Iraklion, the capital city, and five villages 100 km to the south. Atopy was determined by the responses to skin prick tests with seven common aeroallergens. RESULTS: Nine-hundred and ninety-seven children participated in the survey. 19.6% of those living in Iraklion, but only 9.6% of those from the villages, had a positive response to one or more skin prick tests. Among urban children there were significant gradients in the prevalence of atopy across several categories of animal contact and consumption of farm (unpasteurized) milk products--before the age of 5 years. These differences, however, were not apparent among the rural children.

Adolescent↗
PubMed2001

Integration of radiographic images with an electronic medical record.

Radiographic images are important and expensive diagnostic tests. However, the provider caring for the patient often does not review the images directly due to time constraints. Institutions can use picture archiving and communications systems to make images more available to the provider, but this may not be the best solution. We integrated radiographic image review into the Regenstrief Medical Record System in order to address this problem. To achieve adequate performance, we store JPEG compressed images directly in the RMRS. Currently, physicians review about 5% of all radiographic studies using the RMRS image review function.

Computer Graphics↗
PubMed2000

Fyn and Lyn phosphorylate the Fc receptor gamma chain downstream of glycoprotein VI in murine platelets, and Lyn regulates a novel feedback pathway.

Activation of platelets by collagen is mediated by the complex glycoprotein VI (GPVI)/Fc receptor gamma (FcR gamma chain). In the current study, the role of 2 Src family kinases, Fyn and Lyn, in GPVI signaling has been examined using murine platelets deficient in one or both kinases. In the fyn(-/-) platelets, tyrosine phosphorylation of FcR gamma chain, phopholipase C (PLC) activity, aggregation, and secretion are reduced, though the time of onset of response is unchanged. In the lyn(-/-) platelets, there is a delay of up to 30 seconds in the onset of tyrosine phosphorylation and functional responses, followed by recovery of phosphorylation and potentiation of aggregation and alpha-granule secretion. Tyrosine phosphorylation and aggregation in response to stimulation by collagen-related peptide is further attenuated and delayed in fyn(-/-)lyn(-/-) double-mutant platelets, and potentiation is not seen. This study provides the first genetic evidence that Fyn and Lyn mediate FcR immune receptor tyrosine-based activation motif phosphorylation and PLC gamma 2 activation after the ligation of GPVI. Lyn plays an additional role in inhibiting platelet activation through an uncharacterized inhibitory pathway. (Blood. 2000;96:4246-4253)

Animals↗