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Biomedical subjects

M Burns

Publications and source records attributed to M Burns.

At least 19 recordsLinked to original sources
PubMed2006

Prediction of urinary symptoms after 125iodine prostate brachytherapy.

AIMS: To evaluate the post-treatment urinary morbidity experienced by a cohort of men undergoing ultrasound-based transperineal prostate brachytherapy, as monotherapy for early stage carcinoma of the prostate. MATERIALS AND METHODS: One hundred and thirty-four consecutive patients received prostate brachytherapy between March 2000 and July 2002, and were asked to complete the International Prostate Symptom Score (IPSS) and Hospital Anxiety and Depression (HAD) questionnaires before treatment and at 1, 3, 6, 9, 12 and 18 months after implant. Data on catheterisation and surgical interventions were also recorded. Pre-treatment IPSS, dosimetry and other variables were analysed in relation to catheterisation rates and post-treatment IPSS scores at each time window. RESULTS: One hundred and eleven patients returned sufficient data for meaningful analysis. Of the patients who completed IPSS at 1 month, 85 (97%) reported deterioration in IPSS scores. This peak of symptoms, identified by a rise in median IPSS, started to improve by 3 months, and was approaching baseline by 18 months. The only significant determinants of early urinary toxicity were pre-treatment IPSS, pre-treatment prostate volume and the difficulty of implant. However, prostate volume was not significant beyond 1 month. Twenty-six patients required catheterisation at a median of 10 days after implant. Significant predictors of urinary retention were pre-treatment prostate volume and pre-treatment IPSS. Patients requiring catheterisation continued to have significantly higher IPSS at 18 months than patients who had never required a catheter. CONCLUSION: Brachytherapy was generally well tolerated, with urinary toxicity in most patients persisting for at least 3-6 months after prostate brachytherapy. Those whose pre-treatment prostate volume and IPSS were high experienced more severe urinary symptoms in the first few months.

Aged↗
PubMed2006

A qualitative analysis of the 'management of schizophrenia' within a medium-secure service for men with learning disabilities.

Within secure psychiatric services, nurses trained to work with people with learning disabilities are often called upon to deal with those experiencing psychosis; a role that they are not routinely prepared for in generic learning disability nurse training. Psycho-social interventions (PSI) are recommended as an adjunct to routine pharmacological treatment for people experiencing psychosis. There is a small literature that suggests that PSI has utility with people with learning disabilities. As part of a wider evaluation of the introduction of a PSI framework to a 10-bedded medium-secure unit for men with learning disabilities and mental health problems, 13 members of nursing staff completed the 'Management of Schizophrenic Patients Checklist'. The responses were analysed using a grounded theory approach. Principle themes identified are described. The therapy vs. security quandary frequently reported in forensic psychiatry was evident in responses. The findings are guiding a programme of training and ongoing supervision within the service and are discussed in the context of wider therapeutic issues and institutional environment.

Humans↗
PubMed2005

Radiation protection for your hands.

A prospective clinical trial was performed to assess the suitability of a new type of sterilisable, user-friendly radiation protection glove. In a preliminary trial, we showed that the dominant hand of the primary operating orthopaedic surgeon receives the highest dose of radiation. During a 4-month period, 98 procedures were done requiring the use of an image intensifier. The doses of radiation to the dominant hand of the operating surgeon were reduced to less than the doses of radiation to the non-dominant hand. The glove was sterilisable, user-friendly and accepted by the majority of surgeons. It offers greater than 90% attenuation of X-rays and is superior to all other scatter gloves on the market.

Gloves, Protective↗
PubMed2003

Anger management training: the effects of a structured programme on the self-reported anger experience of forensic inpatients with learning disability.

Within the current political climate, there is an increasing burden on mental health professionals to achieve accuracy in risk assessment and prediction. The accurate assessment and treatment of anger can make a valuable contribution towards alleviating this burden as part of a comprehensive treatment package. This study describes an anger management training programme provided to a group of three forensic inpatients with learning disability. An ABA single case study design was used, with anger levels assessed at weekly intervals before, during and after the programme. The results suggested that anger management training is useful with this client group, with established tools, such as the Novaco Anger Scale, the Spielberger State-Trait Anger Expression Inventory and the Modified Overt Aggression Scale, allowing the impact of the programme on anger levels to be evaluated. There is an indication that maintenance treatment is required to prevent anger levels increasing to pretest levels following treatment.

Adult↗
PubMed2001

Early clinical outcomes and routine management of patients with non-ST-segment elevation myocardial infarction: a nationwide perspective.

BACKGROUND: Myocardial infarction (MI) in the absence of electrocardiographic ST-segment elevation or new bundle branch block is the cause of hospitalization for a large and steadily increasing proportion of patients with acute ischemic chest pain. Despite its prevalence, the common demographic features, current hospital-based management, and short-term clinical outcome among patients with non-ST-segment elevation MI remain poorly defined. METHODS: A total of 183 113 patients with non-ST-segment elevation MI were identified in the National Registry of Myocardial Infarction database. Using a validated model, 43 928 patients (24.0%) were retrospectively placed in major, 34 917 (19.1%) in intermediate, and 104 268 (56.9%) in minor severity clinical event categories that included hospital death, recurrent myocardial ischemia, and nonfatal recurrent MI. RESULTS: The administration of widely available and universally recommended pharmacologic therapies, including aspirin and beta-adrenergic blocking agents, was suboptimal, particularly among patients with major severity clinical events. In contrast, coronary angiography and mechanical revascularization procedures were commonplace (>60% of all patients) and most frequently performed in patients within the minor (compared with the major) severity clinical event category (58.2% and 42.7%, respectively). CONCLUSIONS: Patients with non-ST-segment elevation MI are a heterogeneous population, with readily identifiable demographic characteristics and clinical features associated with important early outcomes, including death. Nationwide efforts directed toward maximizing pharmacologic therapy utilization and the performance of invasive procedures according to established guidelines must continue.

Aged↗
PubMed2001

BMP-12 gene transfer augmentation of lacerated tendon repair.

Bone morphogenetic protein (BMP) 12 is a recently discovered member of the human BMP family. It is the human homolog of mouse growth/differentiation factor (GDF)-7. Previously we reported that injection of mesenchymal progenitor cells transferred with the BMP-12 gene into the muscles of nude mice induced tendon-like tissue formation. In this study, we further investigated the effect of BMP-12 gene transfer on tendon cells. We observed that adenovirus mediated in vitro BMP-12 gene transfer into chicken tendon cells increased type I collagen synthesis. No change in alkaline phosphatase activity was observed following BMP-12 gene transfer. We also determined that BMP-12 gene transfer into a complete tendon laceration chicken model resulted in a two-fold increase of tensile strength and stiffness of repaired tendons, indicating improved tendon healing in vivo. We conclude that BMP-12 gene transfer is a promising procedure for improving the tendon repair process.

Alkaline Phosphatase↗
PubMed2001

Response surface modelling and kinetic studies for the experimental estimation of measurement uncertainty in derivatisation.

Response surface modelling is proposed as an approach to the estimation of uncertainties associated with derivatisation, and is compared with a kinetic study. Fatty acid methyl ester formation is used to illustrate the approach, and kinetic data for acid-catalysed methylation and base-catalysed transesterification are presented. Kinetic effects did not lead to significant uncertainty contributions under normal conditions for base-catalysed transesterification of triglycerides. Uncertainties for acid-catalysed methylation with BF3 approach significance, but could be reduced by extending reaction times from 3 to 5 min. Non-linearity is a common feature of response surface models for derivatisation and compromised first-order estimates of uncertainty; it was necessary to include higher order differential terms in the uncertainty estimate. Simulations were used to examine the general applicability of the approach and to study the effects of poor precision and of change of response surface model. It is concluded that reliable uncertainty estimates are available only when the model is statistically significant, robust, representative of the underlying behaviour of the system, and forms a good fit to the data; arbitrary models are not generally suitable for uncertainty estimation. Where statistically insignificant effects were included in models, they gave negligible uncertainty contributions.

Journal Article↗
PubMed2001

Thrombogenicity of radiofrequency ablation procedures: what factors influence thrombin generation?

AIMS: Thromboembolic complications have been reported after radiofrequency ablation but the low incidence of overt clinical events has been a limitation to the study of factors affecting thrombogenic risk. The aim of this study was to determine whether radiofrequency ablation has a procoagulant effect and to examine variables that affect thrombio generation. METHODS AND RESULTS: Thirty-seven consecutive patients who underwent radiofrequency ablation were studied prospectively. Blood samples were assayed for thrombin-antithrombin III (TAT) and d-dimer (DD) at five different time points: (1) baseline; (2) after sheath insertion; (3) after electrophysiological study but before radiofrequency ablation; (4) at completion of the procedure; and (5) 24 h post-procedure. TAT levels were within the normal range at baseline and increased significantly after sheath insertion from 2.1 +/- 1.2 microg l(-1) to 13.3 +/- 16.0 microg l(-1) (P<0.01). Levels increased further to 24.0 +/- 19.9 microg l(-1) (P<0.01) after electrophysiological study but did not increase after radiofrequency ablation. TAT normalized at 24 h. DD increased significantly from baseline values (230.2 +/- 176.8 ng ml(-1)) to 285.4 +/- 237.4 ng ml(-1) (P=0.019) after sheath insertion. There was a further significant increase after electrophysiological study to 423.4 +/- 324.3 ng ml(-1) (P<0.01), and a slight but non-significant increase to 464.4 +/- 307.4 ng ml(-1) after radiofrequency ablation (P=0.159). DD remained elevated at 24 h. Procedure duration was the only variable that correlated with the relative increase in TAT and DD. The patients with the longest procedure durations had more catheters inserted, more radiofrequency applications and largely consisted of accessory bypass tract-mediated tachycardias. Heparin administration significantly blunted the relative increase in TAT after radiofrequency ablation (P=0.005). CONCLUSION: Radiofrequency ablation procedures confer an increased risk of thrombosis. Catheterization and diagnostic study contribute largely to the thrombogenic stimulus. Thrombogenicity is increased in prolonged, complex procedures and is decreased in patients who have been administered heparin during the procedure.

Adult↗
PubMed2001

Topography of spatially directed conditioned responding: effects of context and trial duration.

Domesticated quail (Coturnix japonica) received a discrete conditioned stimulus (CS) at one end of the experimental chamber paired with the opportunity to copulate with a female quail (the unconditioned stimulus) in a goal box located 112 cm away. Approach to the CS (sign tracking) and approach to the goal area (goal tracking) were measured. The duration of exposure to the experimental context (C) was varied in Experiment 1, and the duration of the conditioning trials (T) was varied in Experiment 2 for independent groups, creating C/T ratios of 1.0, 1.5, 4.5, 45, and 180. Contrary to previous reports of a direct relation between the C/T ratio and conditioned responding, in the present experiments, a shift in the topography and stimulus control of conditioned behavior occurred. Low C/T ratios (1.0-4.5) produced goal tracking controlled by contextual cues, whereas high C/T ratios (45 and 180) produced sign tracking controlled by the discrete CS.

Animals↗
PubMed2000

Early and pre-discharge aspirin administration among patients with acute myocardial infarction: current clinical practice and trends in the United States.

OBJECTIVES: The purpose of our study was to determine the frequency of aspirin administration among patients with acute myocardial infarction (MI) as dictated by physicians practicing in the United States. BACKGROUND: Aspirin (ASA), a widely available, inexpensive and generally well-tolerated platelet inhibitor, is recommended for patients with acute coronary syndromes, including acute MI. However, there is concern that aspirin is underutilized in daily clinical practice. METHODS: Early (<24 hours) and predischarge ASA administration were determined among 220,171 patients with suspected acute MI enrolled in the Second National Registry of Myocardial Infarction (NRMI 2) between June, 1994 and April 30, 1996. RESULTS: Overall, 165,122 (74.9%) of patients received ASA within 24 hours of hospital admission, whereas 55,049 patients did not. Early ASA recipients were younger, more often male, arrived at the hospital earlier, and were more likely to be classified as Killip Class II or less compared to those who did not receive ASA. Patients who received aspirin were also more likely to have chest pain, electrocardiographic ST segment elevation, and tended to arrive at the hospital earlier than those who did not receive ASA. However, over 20% of patients with ST segment elevation did not receive early ASA therapy. From the total cohort of early ASA recipients, only 69% received ASA at the time of hospital discharge. Trends in early and pre-discharge aspirin administration over a 2 year time period in all patients (72.6 to 75.1% and 71.5 to 74.6%, respectively; p < 0. 001) and in specific patient subsets were encouraging with a gradual but steady increase; however, utilization remained comparatively low in women and the elderly. By multivariable analysis, in-hospital recurrent MI (OR 0.90, 95% CI;.78-1.0, p = 0.04), stroke (OR 0.65, 95% CI,.52-.80, p < 0.001) and death (OR 0.24, 95% CI,.22-.26, p < 0. 001) occurred less frequently when ASA was administered within 24 hours of hospitalization. CONCLUSION: Aspirin is currently underutilized in routine clinical practice as both primary and adjunctive forms of therapy in MI, especially among patients known to be at risk for recurrent cardiothrombotic events. The targeted and timely use of aspirin reduces early cardiovascular events and should remain a priority in national health care efforts.

Aged↗
PubMed1999

Police officers' detection of breath odors from alcohol ingestion.

Police officers frequently use the presence or absence of an alcohol breath odor for decisions on proceeding further into sobriety testing. Epidemiological studies report many false negative errors. The current study employed 20 experienced officers as observers to detect an alcohol odor from 14 subjects who were at blood alcohol concentrations (BACs) ranging from zero to 0.130 g/dl. Over a 4 h period, each officer had 24 opportunities to place his nose at the terminal end of a 6 in. tube through which subjects blew. Subjects were hidden behind screens with a slit for the tube to prevent any but odor cues. Under these optimum conditions, odor was detected only two-thirds of the time for BACs below 0.08 and 85% of the time for BACs at or above 0.08%. After food consumption, correct detections declined further. Officers were unable to recognize whether the alcohol beverage was beer, wine, bourbon or vodka. Odor strength estimates were unrelated to BAC levels. Estimates of BAC level failed to rise above random guesses. These results demonstrate that even under optimum laboratory conditions, breath odor detection is unreliable, which may account for the low detection rate found in roadside realistic conditions.

Adult↗
PubMed1999

Management of narrow therapeutic index drugs.

Summary. Narrow therapeutic index (NTI) drugs are agents for which small changes in systemic concentration can lead to significant changes in pharmacodynamic response. This may result in potentially subtherapeutic or toxic effects, particularly in patients with advanced age, comorbid illness, or those receiving multiple medications. Bioequivalence among generic and innovator drug products does not always ensure therapeutic equivalence, especially with regard to NTI drugs. Warfarin is a NTI drug for which substitution is now available and may occur routinely without the knowledge of the patient or practitioner. To avoid overanticoagulation or underanticoagulation, the additional cost of patient education and monitoring may actually exceed cost savings by using the less expensive generic drug product. When brand name drug is preferred by the practitioner, "no substition" must be specified on the prescription to avoid mandated generic interchange of warfarin and other NTI drugs.

Anticoagulants↗
PubMed1999

Repeatability of goniometer measurements of the knee in patients wearing an Ilizarov external fixator: a clinic-based study.

OBJECTIVE: To examine the intra-tester and inter-tester reliability of three different methods of measurement of knee range of motion in patients undergoing limb reconstruction with the Ilizarov external fixator. DESIGN: Twenty-five patients had the passive range of motion of their knee measured by 13 physiotherapists who were experienced in the use of goniometry. The testers were assigned into random pairs, each tester measured three or four patients who were allocated to them using the three different methods. These were: (1) a universal goniometer aligned against anatomical landmarks, (2) a universal goniometer aligned against the Ilizarov frame and (3) a modified universal goniometer. SETTING: Orthopaedic limb reconstruction outpatient clinics. SUBJECTS: Twenty-five patients undergoing limb reconstruction using an Ilizarov external fixator on both the femur and tibia. RESULTS: Comparison of the three different goniometry methods showed that using a modified goniometer there was enhanced reliability compared with other methods. This method demonstrated good repeatability for both intra-tester and inter-tester measurements. CONCLUSIONS: When serial measurements of knee range of motion are taken in patients wearing an Ilizarov external fixator the modified model of goniometer should be used.

Adult↗
PubMed1998

Early assessment and in-hospital management of patients with acute myocardial infarction at increased risk for adverse outcomes: a nationwide perspective of current clinical practice. The National Registry of Myocardial Infarction (NRMI-2) Participants.

BACKGROUND: Therapeutic decision making in critically ill patients requires both prompt and comprehensive analysis of available information. Data derived from randomized clinical trials provide a powerful tool for risk assessment in the setting of acute myocardial infarction (MI); however, timely and appropriate use of existing therapies and resources are the key determinants of outcome among high-risk patients. METHODS: Demographic, procedural, and outcome data from patients with MI were collected at 1073 U.S. hospitals collaborating in the National Registry of MI (NRMI 2). Patients were classified on hospital arrival as either "low risk" or "high risk" according to a modified Thrombolysis in Myocardial Infarction II Risk Scale based on predetermined demographic, electrocardiographic, and clinical features. RESULTS: Among the 170,143 patients enrolled, 115,222 (67.5%) were classified as low risk and 55,521 (32.5%) as high risk for in-hospital death, recurrent ischemia, recurrent MI, congestive heart failure, and stroke. Using a composite unsatisfactory outcome measure, in-hospital adverse events were had by a greater proportion of patients initially classified as high risk compared with those classified as low risk. By multivariate analysis, age >70 years, prior MI, Killip class >1, anterior site of infarction, and the combination of hypotension and tachycardia were independent predictions of poor outcome in patients with or without ST-segment elevation on the presenting electrocardiogram. High-risk patients with ST-segment elevation were treated with thrombolytics (47.5%) or alternative forms of reperfusion therapy (9.3%) within 62 minutes and 226 minutes of hospital arrival, respectively. High-risk patients offered reperfusion therapy were also more likely to receive aspirin, beta-blockers (intravenous, oral) and angiotensin-converting enzyme inhibitors within 24 hours of infarction (all p < 0.0001), survive their event (8.4% versus 21.4% p < 0.0001), and leave the hospital sooner than those not reperfused. CONCLUSIONS: This large registry experience included more than 150,000 nonselected patients with MI and suggests that high-risk patients can be identified on initial hospital presentation. The current use of reperfusion and adjunctive therapies among high-risk patients is suboptimal and may directly influence outcome. Randomized trials designed to test the impact of specific management strategies on outcome according to initial risk classification are warranted.

Angioplasty, Balloon, Coronary↗
PubMed1998

Intraretinal oxygen distribution in urethan-induced retinopathy in rats.

This study was performed to explore the interaction between chronic neural degeneration and the subsequent vascular remodeling. Weekly urethan administration in rats from birth produces a retinopathy model characterized by photoreceptor degeneration, retinal vascular regression, and retinal pigment epithelium (RPE) neovascularization. We investigated the hypothesis that altered oxygen distribution across the retina and choroid could be involved in the vascular changes seen in this retinopathy. We compared measurements of vitreal, intraretinal, and choroidal oxygen tension (PO2) distribution in anesthetized and ventilated control and urethan-treated rats at 8 and 16 wk of age with the use of oxygen-sensitive microelectrodes. Striking differences were observed in both choroidal and intraretinal PO2 distribution in urethan-treated rats compared with controls. At both ages, intrachoroidal PO2 was much lower in the urethan-treated rats. In addition, the intraretinal PO2 distribution across the inner retinal layers was more uniform than normal. A small elevation in PO2 was present at 8 wk in the inner nuclear layer where subsequent vascular regression occurred, and a small reduction in PO2 was present at the RPE, which recovered to normal values by 16 wk in regions where RPE vessel networks were first evident. Although the retinal arteries were considerably thinner at both ages in the urethan-treated rats, the vitreal PO2 profiles and superficial retinal PO2 remained normal. The unexpected and large reduction in the oxygen delivery from the choroid found in the urethan-treated rats may account for the lack of major hyperoxia within the pathological retina and the lower oxygen tension in the RPE before the vascular proliferation in this region. We propose that tissue PO2 is an important determinant of the vascular remodeling, which is seen in this model of neural degeneration and that the PO2 distribution changes described in this study help provide a new view of the pathogenesis of this model.

Animals↗