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Biomedical subjects

M J Harrison

Publications and source records attributed to M J Harrison.

At least 19 recordsLinked to original sources
PubMed2006

Developments in rheumatology consultant manpower provision: the BSR/arc Workforce Register 2003-05.

OBJECTIVES: To summarize the changes and continuing inequalities in rheumatology service provision in the UK between 2001 and 2005. METHODS: Questionnaires about demographics and workload were sent to all consultants on the BSR/arc Workforce Register in January 2003 and 2005. RESULTS: A total of 94% of 506 consultants responded in 2003 and 89% of 542 in 2005. About 19% of the consultants practice rheumatology with acute medicine. Levels of optimal provision exceed 60% in England and Wales, but are below 50% in Scotland and Northern Ireland. The levels of provision in London are substantially higher than anywhere else. The median number of hours worked per week has increased from 35.2 in 2003 to 41 in 2005. CONCLUSIONS: Rheumatology continues to expand. There is inequality with better provision in England (especially London) and Wales than Scotland and Northern Ireland. Patterns of nurse and Senior House Officer (SHO) provision correlate with consultant numbers. Thus, the catalyst for improved service is consultant expansion.

Consultants↗
PubMed2006

Orthogonal search-based rule extraction for modelling the decision to transfuse.

Data from an audit relating to transfusion decisions during intermediate or major surgery were analysed to determine the strengths of certain factors in the decision making process. The analysis, using orthogonal search-based rule extraction (OSRE) from a trained neural network, demonstrated that the risk of tissue hypoxia (ROTH) assessed using a 100-mm visual analogue scale, the haemoglobin value (Hb) and the presence or absence of on-going haemorrhage (OGH) were able to reproduce the transfusion decisions with a joint specificity of 0.96 and sensitivity of 0.93 and a positive predictive value of 0.9. The rules indicating transfusion were: 1. ROTH > 32 mm and Hb < 94 g x l(-1); 2. ROTH > 13 mm and Hb < 87 g x l(-1); 3. ROTH > 38 mm, Hb < 102 g x l(-1) and OGH; 4. Hb < 78 g x l(-1).

Blood Loss, Surgical↗
PubMed2006

Immigrant women family caregivers in Canada: implications for policies and programmes in health and social sectors.

Migration has become a profound global phenomenon in this century. In Canada, uncoordinated policies, including those related to immigration, resettlement, employment, and government funding for health and social services, present barriers to immigrant women caregivers. The purpose of this paper is to share relevant insights from individual and group interviews with immigrant women family caregivers, service providers and policy influencers, and discuss these in relation to immigration, health and social policy, and programme trends in Canada. The present authors conducted individual interviews with immigrant women family caregivers (n = 29) in phase 1, followed by two group interviews with women family caregivers (n = 7), and two group interviews with service providers and policy-makers (n = 15) in phase 2. Using an inductive approach, the authors employed thematic content data analysis. Immigrant women experienced barriers to health and social services similar to Canadian-born family caregivers, particularly those who have low incomes, jobs with limited flexibility and heavy caregiving demands. These immigrant women family caregivers avoided certain formal services for a variety of reasons, including lack of cultural sensitivity. However, their challenges were compounded by language, immigration and separation from family in the home country. The identified barriers to support reinforce the importance of modifying and expanding policies and programmes affecting immigrant women's ability to care for family members with illnesses or disabilities within the context of Canadian society. Participants recommended changes to policies and programmes to deal with information, transportation, language, attitudinal and network barriers. The various barriers to services and programmes which were experienced by immigrant women caregivers underscore the importance of reviewing policies affecting immigration, caregiving, and access to health and social services. Intersectoral collaboration among agencies is essential to reduce the barriers identified in the present study, and to establish services which are linguistically and culturally appropriate.

Asian People↗
PubMed2006

Variation in preoperative assessment of cardiac output reserve and likelihood of transfusion among anaesthetists: a pilot study.

The aim of this pilot study was to investigate anaesthetists' assessment of the ability of patients to increase cardiac output over a range of clinical scenarios and of their perceived 'likelihood of transfusion' in these scenarios. Specialist anaesthetists were given a questionnaire with clinical cues in the form of diagnoses about theoretical patients. They were asked to use 100 mm visual analogue scales (VAS) for their assessments of each patient's cardiac reserve and their 'likelihood of transfusion' of these patients; the endpoints of the VAS being 'Very low' (0 mm) to 'High' (100 mm), and 'Do not transfuse' (0 mm) to 'Transfuse' (100 mm) respectively. The assessment of patients' cardiac output reserve by anaesthetists (n = 54) showed great variation; for example, a patient with severe aortic stenosis was perceived overall to have a limited ability to increase cardiac output (mean VAS 16 mm) but there was considerable variation between anaesthetists (25-75 percentiles 10 mm to 21 mm). Assessment of 'likelihood of transfusion' (n = 42) also had great variation; as an example a patient with 'angina' with a haemoglobin of 95 g l(-1) was perceived overall to have an average likelihood of transfusion of 50 mm, but the 25-75 percentiles ranged from 33 mm to 71 mm. This study suggests that inter-anaesthetist variability in the assessment of a patient's 'cardiac output reserve' and his 'likelihood of transfusion' is large.

Anesthesia↗
PubMed2005

Results of intervention for lupus patients with self-perceived cognitive difficulties.

The authors developed an 8-week psychoeducational group intervention for patients with systemic lupus erythematosus (SLE) who reported cognitive dysfunction but were not globally impaired on neuropsychological testing. Results of a nonrandomized, uncontrolled pilot study of this program in 17 women with SLE suggest that metamemory and memory self-efficacy improve after participation. One hundred percent retention throughout the study further suggests that patients with SLE are willing and capable of successfully completing the program.

Adaptation, Psychological↗
PubMed2005

Relationship of quality of life and physical function measures with disease activity in children with systemic lupus erythematosus.

The objective of this study is to assess relationship of systemic lupus erythematosus (SLE) activity with quality of life (QOL) and physical function and determine which is more closely correlated with SLE activity in children; and identify factors critical to children's QOL. In this cross-sectional study, children with SLE and parents completed corresponding versions of physical function (Childhood Health Assessment Questionnaire CHAQ), and QOL (Pediatric Quality of Life Inventory-PedsQL Generic/Rheumatology modules) questionnaires. SLE Disease Activity Index (SLEDAI), Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI), severity, self-concept and socioeconomic status (SES) were measured. For 24 children, CHAQ scores significantly correlated with SLEDAI (rho = 0.4, p = 0.04), SDI (rho = 0.6, p = 0.004), and associated with severity (p = 0.03). PedsQL scores did not significantly correlate with above parameters. Higher self-concept/SES correlated (p < 0.05) with better physical function and QOL. For 19 parents, the only significant correlation was between SLEDAI and Worry domain-Rheumatology module (rho = 0.5, p = 0.01). Lack of strong correlation of disease activity with QOL and physical function suggests that they are different constructs with partial overlap, and should be considered collectively while evaluating the impact of SLE on children/families. Self-concept and SES should be assessed while measuring QOL in children. Larger sample is required to confirm results.

Adolescent↗
PubMed2004

Quality of life in paediatric lupus.

Paediatric systemic lupus erythematosus (SLE) is associated with significant morbidity and has biopsychosocial implications resulting from the disease and its treatment. The aim of this study was to identify domains of quality of life (QOL) impacted by SLE in children. Children with SLE and their parents were asked a single open-ended question related to lupus. Themes derived from children's responses focused primarily on coping and maintaining control of their life despite SLE. Themes from the parents' responses were twofold: a) efforts to cope with their child having SLE; and b) appreciation/sadness in connection with their children's coping process. Qualitative exploration of different facets of QOL in these children is critical for the understanding of specific factors that assist/ease the coping process and formulating interventions for improving children's/family's self-efficacy and disease management.

Adaptation, Psychological↗
PubMed2003

Unfulfilled expectations and negative interactions: nonsupport in the relationships of women caregivers.

BACKGROUND: Most research has viewed social support as unconditionally positive, but negative interactions such as conflict and dissatisfaction with support are present in caregivers' relationships and have a negative impact on their health. PURPOSE: The purpose of this study was to describe women's experience of nonsupport and identify the types of nonsupport present in their relationships with family and friends while caring for a family member with dementia. ETHICS: The study received ethical clearance from the university ethics review committee. METHODS: The theoretical perspective of symbolic interaction guided this longitudinal qualitative research. Included in the study were 25 in-depth interviews with a group of eight women selected from a larger study of family caregiving because they described nonsupport in their relationships with family and friends. FINDINGS: The women experienced two types of problems in realizing support. Unmet expectations for support was the most pervasive difficulty and included unfulfilled or missing offers of assistance, unmet expectations for social interaction, mismatched aid, or incompetence on the part of the potential helper. Negative interactions, particularly with kin, took several forms: disparaging comments that belittled a caregiver's experience, conflict between the caregiver and others in their appraisal of the care recipient's health status, criticism of the caregiver's decisions in caring for the care recipient, and spillover from longstanding conflict and issues in the family history. LIMITATIONS: This study was limited to women caring for an adult relative with dementia and included a relatively homogeneous sample of English speaking, North American women of European descent. CONCLUSIONS: This study highlighted the utility of identity theory to explain the impact of unmet expectations for support and recognized disparaging comments as a form of nonsupportive interactions.

Aged↗
PubMed2002

Decreased flares of rheumatoid arthritis during the first year of etanercept treatment: further evidence of clinical effectiveness in the "real world".

OBJECTIVE: To determine the incidence of disease flare during the first year of etanercept treatment for 88 patients with rheumatoid arthritis (RA) and compare it with the incidence of flare in those same patients in the year before etanercept use. METHODS: The outpatient clinic charts of all patients with RA who were prescribed etanercept in or before September 1999, who also had at least one year's follow up in the same outpatient clinic, were surveyed. The primary outcome measure was the number of disease flares in one year before and after etanercept use. The secondary outcome measures included the number of patients who did and did not flare, how flares were treated, and the drug alterations that were necessary during the same two time intervals. RESULTS: The total number of flares for all patients in the year before etanercept treatment was 214 (mean (SD) 2.43 (1.75)). The number of flares in the first year of etanercept treatment decreased to 83 (mean 0.94 (1.07)) (p<0.0001). The total number of patients who had at least one flare in the year before etanercept use was 80; eight had no flares. In their first year of etanercept treatment, 50 patients had at least one flare; 38 had no flares (p<0.0001). Twenty one patients (24%) stopped using etanercept before completing one year's treatment. CONCLUSION: This study of patients with RA in the "real world" shows that etanercept is effective in reducing the number of RA flares.

Antirheumatic Agents↗
PubMed2002

Data standardisation in GlycoSuiteDB.

GlycoSuiteDB, a database of glycan structures, has been constructed with an emphasis on quality, consistency and data integrity. Importance has been placed on making the database a reliable and useful resource for all researchers. This database can help researchers to identify what glycan structures are known to be attached to certain glycoproteins, as well as more generally identifying what types of glycan structures are associated with different states, for example, different species, tissues and diseases. To achieve this, a major effort has gone into data standardisation. Many rules and standards have been adopted, especially for representing glycan structure and biological source information. This paper describes some of the challenges faced during the continuous development of GlycoSuiteDB.

Animals↗
PubMed2002

Reporting consistency in systemic lupus erythematosus patients: how reliable are patient histories?

Systemic lupus erythematosus (SLE) patients are frequently seen by multiple physicians and at multiple times. In each instance, most of the information important in clinical decision-making is gathered from the patient. There are no studies looking at reporting consistency of certain aspects of SLE patients' history. We studied this by administering the same nine-item questionnaire 4 months apart to the same cohort of SLE patients. In addition, a retrospective chart review was done to correlate the information obtained by prospective questioning and with that on the charts. Our results showed overall good consistency in the areas of general medical history, SLE-specific history and social history. The information gathered by the chart review, in general, went in parallel with that obtained by prospective questioning. This was also true for the poor correlation observed in the family history questions. Many studies and databases depend rather heavily on patient reporting and the quality of this information is usually not substantiated. Our study suggests that, even though SLE patients are generally consistent reporters of certain aspects of their histories, family history information provided is frequently not consistent with previous reporting.

Cohort Studies↗
PubMed2001

The Medicago Genome Initiative: a model legume database.

The Medicago Genome Initiative (MGI) is a database of EST sequences of the model legume MEDICAGO: truncatula. The database is available to the public and has resulted from a collaborative research effort between the Samuel Roberts Noble Foundation and the National Center for Genome Resources to investigate the genome of M.truncatula. MGI is part of the greater integrated MEDICAGO: functional genomics program at the Noble Foundation (http://www.noble.org ), which is taking a global approach in studying the genetic and biochemical events associated with the growth, development and environmental interactions of this model legume. Our approach will include: large-scale EST sequencing, gene expression profiling, the generation of M.truncatula activation-tagged and promoter trap insertion mutants, high-throughput metabolic profiling, and proteome studies. These multidisciplinary information pools will be interfaced with one another to provide scientists with an integrated, holistic set of tools to address fundamental questions pertaining to legume biology. The public interface to the MGI database can be accessed at http://www.ncgr.org/research/mgi.

Computational Biology↗
PubMed2001

GlycoSuiteDB: a new curated relational database of glycoprotein glycan structures and their biological sources.

GlycoSuiteDB is a relational database that curates information from the scientific literature on glyco-protein derived glycan structures, their biological sources, the references in which the glycan was described and the methods used to determine the glycan structure. To date, the database includes most published O:-linked oligosaccharides from the last 50 years and most N:-linked oligosaccharides that were published in the 1990s. For each structure, information is available concerning the glycan type, linkage and anomeric configuration, mass and composition. Detailed information is also provided on native and recombinant sources, including tissue and/or cell type, cell line, strain and disease state. Where known, the proteins to which the glycan structures are attached are reported, and cross-references to the SWISS-PROT/TrEMBL protein sequence databases are given if applicable. The GlycoSuiteDB annotations include literature references which are linked to PubMed, and detailed information on the methods used to determine each glycan structure are noted to help the user assess the quality of the structural assignment. GlycoSuiteDB has a user-friendly web interface which allows the researcher to query the database using mono-isotopic or average mass, monosaccharide composition, glycosylation linkages (e.g. N:- or O:-linked), reducing terminal sugar, attached protein, taxonomy, tissue or cell type and GlycoSuiteDB accession number. Advanced queries using combinations of these parameters are also possible. GlycoSuiteDB can be accessed on the web at http://www.glycosuite.com.

Animals↗
PubMed2001

Microtubule organization in root cells of Medicago truncatula during development of an arbuscular mycorrhizal symbiosis with Glomus versiforme.

The colonization of plants by arbuscular mycorrhizal fungi has been shown to induce changes in cytoplasmic organization and morphology of root cells. Because of their role in a variety of cellular functions in plants, it is likely that microtubules are involved either in the signaling events leading to the establishment of the symbiosis or in changes in host cell morphology and cytoplasmic architecture. Recent studies of the arbuscular mycorrhizal symbiosis have shown that root cortical cells reorganize their microtubules upon colonization. These studies, however, have focused primarily on the cells containing hyphal coils or arbuscules and did not include descriptions of microtubule changes in adjacent cells. To probe further into the potential role of the microtubule cytoskeleton in the establishment of arbuscular mycorrhizal symbiosis, we examined the three-dimensional arrangement of microtubules in roots of the model legume Medicago truncatula colonized by the arbuscular mycorrhizal fungus Glomus versiforme by indirect immunofluorescence and confocal microscopy. Our data show extensive remodeling of the microtubule cytoskeleton from the early stages of arbuscule development until arbuscule collapse and senescence. While confirming some of the microtubule patterns shown in other mycorrhizal systems, our results also reveal that cortical cells adjacent to those containing arbuscules or adjacent to intercellular hyphae reorganize their microtubules. This indicates that the cortical cells initiate the modification of their cytoskeleton prior to entry of the fungus and is consistent with signal exchange between the symbionts prior to fungal penetration of the cells.

Cell Wall↗
PubMed2001

The role of apolipoprotein E in cognitive decline after cardiac operation.

BACKGROUND: Recently, Tardiff and colleagues have suggested that the presence of the apolipoprotein E, epsilon4 allele was associated with increased likelihood of cognitive decline after coronary artery bypass grafting. The objective of the current study was to replicate this earlier work using an increased sample size. The increased sample also enabled an analysis by individual genotype in cognitive decline after coronary artery bypass grafting. METHODS: Apolipoprotein E genotyping was performed on 111 individuals undergoing coronary artery bypass grafting. Each participant underwent a battery of nine neuropsychological tests before operation and 4 to 7 weeks after operation. RESULTS: Cognitive decline, assessed by both continuous Z change scores and two categoric measures of cognitive deficit, was not significantly associated with either individual apolipoprotein E genotypes or categorization by the presence or absence of the epsilon4 allele. The examination of potential moderating factors did not alter this finding. CONCLUSIONS: This study suggests that the epsilon4 allele is not associated with cognitive decline in the weeks after coronary artery bypass grafting.

Apolipoproteins E↗
PubMed2001

In-home nursing care for women with high-risk pregnancies: outcomes and cost.

OBJECTIVE: To evaluate a program that provides in-home care to women with pregnancies threatened by preterm delivery (including preterm labor, preterm premature rupture of membranes, and multiple gestation) and women with pregnancy-related hypertension. METHODS: Data from hospital discharge summaries were used to compare birth outcomes and cost of care for women in the in-home program and a cohort of women who received in-hospital antenatal care before the new program. Birth outcomes included data for mothers and infants. The sample included 437 women with threatened preterm delivery (n = 228 in-home, n = 209 in-hospital) and 308 with hypertension (n = 155 in-home, n = 153 in-hospital). The cost per woman included all costs of services for mothers and infants. RESULTS: Women at risk of preterm delivery who received in-home care were half as likely to have their infants in the neonatal intensive care unit more than 48 hours (odds ratio 0.53, 95% confidence interval 0.36, 0.78). On average, their infants weighed more (2732 +/- 716 g versus 2330 +/- 749 g, P <.001) and were 2 weeks older at birth (36.1 +/- 3.1 weeks versus 34.0 +/- 4.0 weeks, P <.001). There was a wide range in the total cost per woman and no significant difference between cohorts. For women with hypertension, there were no significant differences between in-home and in-hospital cohorts in birth outcomes or costs of care per woman. CONCLUSION: The program with current admission criteria, staffing, and guidelines for antenatal hospital admission provides safe care to women at similar cost to that of hospitalization.

Adult↗
PubMed2001

The graphical presentation of decision support information in an intelligent anaesthesia monitor.

This contribution examines the graphical presentation of decision support information generated by an intelligent monitor, named SENTINEL, developed for use during anaesthesia. Clinicians make diagnoses in real-time during operations by examining clinically significant trends in multiple signals. SENTINEL attempts to mimic this decision process by using a system of fuzzy trend templates. SENTINEL's implementation of fuzzy trend templates is capable of providing the dual fuzzy measures of belief and plausibility, which are derived from the theory of evidence. It is thus capable of generating fairly rich diagnostic decision support information. However, for SENTINEL to be effective, the visual presentation of this information must be intuitive to the anaesthetist, who may not be familiar with the theory of evidence. This paper discusses techniques that are being evaluated to meet the requirements of the SENTINEL anaesthesia monitor. Specifically, the paper presents methods for highlighting clinically significant trends in physiological (or derived) signals by superimposing a coloured band on the signal that reflects fuzzy output from the intelligent monitor. This paper also discusses the intuitive graphical presentation of binary diagnostic fuzzy measures, including their further interpretation and presentation as crisp "alarm" and "warning" conditions.

Anesthesia, General↗