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Biomedical subjects

N Barnett

Publications and source records attributed to N Barnett.

At least 19 recordsLinked to original sources
PubMed2005

Improving medication management for patients: the effect of a pharmacist on post-admission ward rounds.

PROBLEM: Medication management in the NHS has been highlighted by the UK Department of Health as an area for improvement. Pharmacist participation on post-take (post-admission) ward rounds was shown to reduce medication errors and reduced prescribing costs in the USA and in UK teaching hospitals, which can contribute to improved medication management. We sought to demonstrate the problem in our hospital by collecting data on prescribing practice from three consecutive general medical post-take ward rounds. SETTING: Northwick Park Hospital, a district general hospital in north-west London, which provides acute medical services to a population of 300,000. STRATEGY FOR CHANGE: A pharmacist was invited to become a member of the post-take ward round team that reviewed medical patients admitted within the preceding 24 hours. Patients also continued to receive care from a ward based pharmacist. Patient notes were analysed for cost of drugs on admission and discharge, discrepancies between admission drug history and pharmacist history, number of admission drugs stopped before discharge, and pharmacist recommendations. Pharmacist recommendations and actions were classified using a National Patient Safety Agency risk matrix. EFFECTS OF CHANGE: Discrepancies between the admission and the pharmacist derived drug history were noted in 26 of 50 in the pre-intervention group and 52 of 53 in the intervention group. The annual drug cost per patient following discharge increased by pounds 181 in the pre-intervention group and by pounds 122 in the intervention group. Five pre-admission drugs were stopped in three pre-intervention patients saving pounds 276 per annum, while the 42 drugs stopped in 19 intervention patients saved pounds 4699 per annum. No ward based pharmacist recommendations were recorded in the pre-intervention group. Recommendations regarding drug choice, dose, and need for drug treatment were most common; 58 minor, 48 moderate and four major risks to patients were potentially avoided. LESSONS LEARNT: The presence of a pharmacist on a post-take ward round improved the accuracy of drug history documentation, reduced prescribing costs, and decreased the potential risk to patients in our hospital. As a result of this work a full time pharmacist has now been funded to attend daily post-take ward rounds on a permanent basis.

Drug Costs↗
PubMed2001

Partnership in nursing care (PINC): the Blackburn model.

Concerns that partnership in care was not really working brought about the need to establish new documentation. A written management plan of care which actively involves the child and family to identify the partnership in care component is essential. Integration of medical and nursing history forms the basic assessment for a jointly managed plan of care. A major culture change needed to be managed to ensure more purposeful and effective communication within the nursing team. The balance of power for nursing care delivery has shifted away from the children's nurse towards the child/parent/carer. The Blackburn PINC model has provided the structures to ensure partnership in care is a reality. Ongoing development and evaluation in response to nursing and parent comments ensures that the process is responsive to current needs.

Documentation↗
PubMed1999

Mechanisms of photoreceptor death and survival in mammalian retina.

The mammalian retina, like the rest of the central nervous system, is highly stable and can maintain its structure and function for the full life of the individual, in humans for many decades. Photoreceptor dystrophies are instances of retinal instability. Many are precipitated by genetic mutations and scores of photoreceptor-lethal mutations have now been identified at the codon level. This review explores the factors which make the photoreceptor more vulnerable to small mutations of its proteins than any other cell of the body, and more vulnerable to environmental factors than any other retinal neurone. These factors include the highly specialised structure and function of the photoreceptors, their high appetite for energy, their self-protective mechanisms and the architecture of their energy supply from the choroidal circulation. Particularly important are the properties of the choroidal circulation, especially its fast flow of near-arterial blood and its inability to autoregulate. Mechanisms which make the retina stable and unstable are then reviewed in three different models of retinal degeneration, retinal detachment, photoreceptor dystrophy and light damage. A two stage model of the genesis of photoreceptor dystrophies is proposed, comprising an initial "depletion" stage caused by genetic or environmental insult and a second "late" stage during which oxygen toxicity damages and eventually destroys any photoreceptors which survive the initial depletion. It is a feature of the model that the second "late" stage of retinal dystrophies is driven by oxygen toxicity. The implications of these ideas for therapy of retinal dystrophies are discussed.

Age Factors↗
PubMed1998

Effects of synthetic speech output and orthographic feedback on spelling in a student with autism: a preliminary study.

The effects of speech output and orthographic feedback on spelling performance were evaluated in this preliminary study. A nonspeaking student with autism was taught to spell words under three feedback conditions using a voice output communication aid. In the auditoryvisual condition, the participant received speech output and orthographic feedback. In the visual condition, the participant received only the orthographic feedback. In the auditory condition, the student received only speech output. An adapted alternating treatments design was used to evaluate the effects of the three feedback conditions. Although the participant reached criterion and maintained performance in each of the conditions, the provision of speech output alone and in combination with orthographic feedback resulted in more efficient spelling than the provision of orthographic feedback alone. Although replications with other subjects are necessary, findings suggest that speech output contributes to efficient spelling.

Achievement↗
PubMed1997

A hypothesis to explain the role of the suppressor and helper T cells in the immunologic selection of highly related human immunodeficiency virus isolates found in infected patients.

It is proposed that specific human immunodeficiency virus determinants in seropositive individuals are capable of evoking very strong suppressor T cell responses which inactivate certain helper T cells. This helper T cell suppression may be sufficient to inhibit the cytotoxic T cell recognition of these specific retroviral antigens and significantly reduce neutralizing antibody titers. As a consequence of the poor T helper cell responses to these different antigens, a number of related human immunodeficiency virus isolates are able to escape immune surveillance over the entire course of the infection. The selection and persistence of these distinct but related viral isolates may allow the human immunodeficiency virus infection to progress to other tissues and contribute to the gradual destruction of the remaining helper T cell population. Thus, the development of an effective antiviral therapy and possibly even a cure for the acquired immune deficiency syndrome may depend on the management of the suppressor and helper T cell activity in the infected individual.

HIV↗
PubMed1995

Artefacts in electron microscopy: ultrastructural features of chrysiasis.

Eleven cases of chrysiasis have been studied ultrastructurally and by electron probe microanalysis. Tissue samples were examined both with and without osmium and uranyl acetate staining. There was a significant morphological difference in the appearance of the gold deposits within aurosomes between the two groups. The untreated group showed finely granular deposits, often arranged in a linear fashion. Aurosomes from samples treated with osmium and uranyl acetate showed more electron-dense deposits and star-like formations. We propose that treatment of the tissue with osmium and uranyl acetate causes a change in the electron microscopic appearance of aurosomes, including the formation of the characteristic star-like aurosomes.

Antirheumatic Agents↗
PubMed1992

Epidermal nevus: surgical treatment by partial-thickness skin excision.

A child with epidermal nevus, systematized, is reported in which diffuse areas of pruritic and bleeding tissue were treated by partial-thickness skin excision, a technique reported to have been successful in other forms of benign dyskeratosis, such as psoriasis. At age 5 years, a test region of the anterior thigh was treated and remained disease free with an acceptable scar. At age 8 years, this technique was applied to the back, buttock, calf, and thigh. While the areas remain disease free, they have, unfortunately, healed with hypertrophic and keloid scars.

Child↗
PubMed1986

Genital tract papillomavirus infection in children.

Genital tract papillomas in five children were examined for the presence of human papillomavirus (HPV) DNA by molecular hybridization. Papillomavirus DNA was detected in each sample and was identified as HPV-6 (three cases), HPV-6 or HPV-11 (one case), or HPV-16 (one case). These viruses are the same as are responsible for genital papillomas (condylomata) of adults. The transmission of adult genital tract viruses to children occurs primarily by a venereal route but may occur by a nonvenereal route.

Child↗
PubMed1984

Lithium-induced increases in red blood cell choline and memory performance in Alzheimer-type dementia.

To investigate the relationship between RBC choline and memory in Alzheimer-type senile dementia (SDAT), lithium carbonate was administered to 14 SDAT patients in doses of 400-600 mg/day for 5 weeks. A battery of memory tests was administered at baseline and at weekly intervals. Five patients with serum concentrations below 0.6 meq/liter developed neurotoxicity and were dropped from further analysis. For the remaining patients, Li+ with mean serum concentrations up to 0.6 meq/liter did not alter memory scores significantly. The dramatic increases in RBC choline during the study, however, suggest that RBC choline is not correlated with memory functioning in SDAT.

Aged↗