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Biomedical subjects

Peter Bailey

Publications and source records attributed to Peter Bailey.

10 recordsLinked to original sources
PubMed2006

Differences between midazolam and propofol sedation on upper airway collapsibility using dynamic negative airway pressure.

BACKGROUND: Upper airway obstruction (UAO) during sedation can often cause clinically significant adverse events. Direct comparison of different drugs' propensities for UAO may improve selection of appropriate sedating agents. The authors used the application of negative airway pressure to determine the pressure that causes UAO in healthy subjects sedated with midazolam or propofol infusions. METHODS: Twenty subjects (12 male and 8 female) completed the study. After achieving equivalent levels of sedation, the subjects' ventilation, end-tidal gases, respiratory inductance plethysmographic signals, and Bispectral Index values were monitored for 5 min. Negative airway pressure was then applied via a facemask in steps of 3 cm H(2)O from -3 to -18 cm H(2)O. UAO was assessed by cessation of inspiratory airflow and asynchrony between abdomen and chest respiratory inductance plethysmographic signals. RESULTS: Equivalent levels of sedation were achieved with both drugs with average (+/- SD) Bispectral Index levels of 75 +/- 5. Resting ventilation was mildly reduced without any changes in end-tidal pressure of carbon dioxide. There was no difference between the drugs in the negative pressure resulting in UAO. Five female subjects and one male subject with midazolam and four female subjects and one male subject with propofol did not show any UAO even at -18 cm H(2)O. Compared with males, female subjects required more negative pressures to cause UAO with midazolam (P = 0.02) but not with propofol (P = 0.1). CONCLUSIONS: At the mild to moderate level of sedation studied, midazolam and propofol sedation resulted in the same propensity for UAO. In this homogeneous group of healthy subjects, there was a considerable range of negative pressures required to cause UAO. The specific factors responsible for the maintenance of the upper airway during sedation remain to be elucidated.

Adult↗
PubMed2005

Highlights of the 2002 Canadian Neurological Society (CNS) manpower survey.

BACKGROUND: The Canadian Neurological Society commissioned a manpower survey in 2002 to assess demographics, distribution, specialty interests, working conditions, job satisfaction and future plans of neurologists across the country. METHODS: A survey was mailed to all known Canadian neurologists (n = 694) on two separate occasions. Further encouragement by telephone contact was undertaken. The response rate was 54%. RESULTS: The mean age of neurologists who responded was 51 years, with 14% being women. Approximately 55% of neurologists were community-based. Seventy-six percent designated a sub-specialty interest. On average, neurologists worked 57 hours per week and the majority had significant "on-call" commitments. Job satisfaction was higher among academic neurologists when compared with community-based neurologists, and greater among men than women. A greater percentage of older neurologists were satisfied with their work than their younger colleagues. Significant attrition in the neurological work force is a major concern, since up to 20% of neurologists reported that they are likely to retire in the next five years and about 15% are likely to reduce their practice. CONCLUSIONS: This survey suggests that substantial concerns are facing Canadian neurology over the next five years. Major efforts to retain existing expertise and enhance residency training will be required to simply maintain the present quality of neurological care in Canada.

Attitude of Health Personnel↗
PubMed2005

The place of 360 degree appraisal within a team approach to professional development.

The role of appraisal within professional development has assumed a higher profile in response to national policies including those relating to clinical governance and workforce development. Under the guidance of a service development manager trained in human resource management, a new interprofessional Primary Care Practice Team near Cambridge defined and implemented a new appraisal system drawing on the principles of 360 degree appraisal. The appraisal system was designed to support the service function and the team culture, and took into account good management practice and the requirements of partner organizations and professional affiliations. This paper describes how the system was introduced, tailored to the particular needs of the interprofessional practice team, and evaluated. Early experience suggests that the approach enhances understanding of roles and responsibilities and is supportive to interprofessional team development. It is well received by team members involved and by some of the external partner organizations. However, it is demanding on resources and concerns were raised about the completeness of this approach to appraisal.

England↗
PubMed2004

Arrays of ultraconserved non-coding regions span the loci of key developmental genes in vertebrate genomes.

BACKGROUND: Evolutionarily conserved sequences within or adjoining orthologous genes often serve as critical cis-regulatory regions. Recent studies have identified long, non-coding genomic regions that are perfectly conserved between human and mouse, termed ultra-conserved regions (UCRs). Here, we focus on UCRs that cluster around genes involved in early vertebrate development; genes conserved over 450 million years of vertebrate evolution. RESULTS: Based on a high resolution detection procedure, our UCR set enables novel insights into vertebrate genome organization and regulation of developmentally important genes. We find that the genomic positions of deeply conserved UCRs are strongly associated with the locations of genes encoding key regulators of development, with particularly strong positional correlation to transcription factor-encoding genes. Of particular importance is the observation that most UCRs are clustered into arrays that span hundreds of kilobases around their presumptive target genes. Such a hallmark signature is present around several uncharacterized human genes predicted to encode developmentally important DNA-binding proteins. CONCLUSION: The genomic organization of UCRs, combined with previous findings, suggests that UCRs act as essential long-range modulators of gene expression. The exceptional sequence conservation and clustered structure suggests that UCR-mediated molecular events involve greater complexity than traditional DNA binding by transcription factors. The high-resolution UCR collection presented here provides a wealth of target sequences for future experimental studies to determine the nature of the biochemical mechanisms involved in the preservation of arrays of nearly identical non-coding sequences over the course of vertebrate evolution.

Animals↗
PubMed2003

Of rocks and safe channels: learning to navigate as an interprofessional team.

A new interprofessional primary care team was established in a greenfield site. Using anethnographic approach, significant experiences in the formation of the team were documented and specific problem areas were defined and addressed using action research principles. The nature of the problems experienced and the processes used in their resolution are described and related to current policy recommendations and to existing literature on the theory and practice of team development. Problems include: the potentially varied expectations and managerial requirements of collaborating partners, the lack of clarity over professional roles and associated essential competencies, and the appropriate management and development of specialist professional roles. Conclusions drawn concern the complexity of the issues raised by interprofessional team working, and the value of existing techniques and models in this setting, such as the viable systems model, 360 degree appraisal and action research.

Health Services Research↗
PubMed2003

Handedness, measures of hemispheric asymmetry, and lateralised lexical decision.

The goals of the present study were to evaluate the differences between measures of lateralisation in the human brain derived from a dichotic listening (DL) task and from a task involving identification of visually presented consonant-vowel-consonant (CVC) nonwords, and to correlate these lateralisation indices with performance on a lexical decision task involving visually presented words and nonwords. Visual stimuli were presented either in a central position, or to the left or right of fixation. Left-handed and right-handed participants completed each of the three tasks. Lateralisation indices were derived from performance on the DL and CVC tasks, and latency and accuracy measures of lexical decision performance were obtained for targets presented centrally and parafoveally. Lateralisation indices for left-handed and right-handed participants differed significantly for both tasks, and the two lateralisation indices had different pattern of correlation with lexical decision performance for left- and right-handers. For left-handers, lateralisation indices derived from the (visual) CVC task were correlated with lexical decision response latency for targets in central and left visual field. For right-handers, lateralisation indices derived from the (auditory) DL task were correlated with lexical decision response latency for targets in central and right visual field. A possible explanation for this finding is that the two laterality measures reflect specialisation for different types of linguistic processing in the human brain.

Journal Article↗
PubMedDate not supplied

A clinical study of migraine evolution.

BACKGROUND: The buildup time of migraine headaches has not been well delineated in publications to date and we are aware of patients whose migraines last well over 72 hours. More concentration on these factors in the assessment of patients might lead to more appropriate therapeutic choices. METHOD: Prospective ascertainment of such data through a questionnaire completed by 253 informed and willing patients with IHS migraine with or without aura consulting Canadian headache specialists. Data were electronically sent to a central computer from each center, tabulated and analyzed using standard statistical parameters. RESULTS: In 253 patients with migraine ascertained using applied IHS criteria, nausea was a feature in over 90% of cases, especially in those with aura. This inhibited the ingestion of oral medications in about a quarter of all subjects. The time to build from no pain to moderate/severe pain was shorter in subjects with auras and was less than 2 hours in 97% of those with and 86% of those without auras. However, we also identified a group of subjects with migraine (over 10% of all) in whom the build time to maximum pain is delayed for over 2 hours. Nausea was experienced by 91.7% of subjects, slightly but significantly later in those without auras. While most headaches in each group lasted from 4 to 72 hours, 24.3% of those with and 20.6% of those without aura expected to experience pain for more than 72 hours, while in untreated cases disability due to pain, nausea, or malaise usually persisted for over 3 days in 24.3% and 16.7% of those with and without aura, respectively. One-fifth of migraineurs may be in pain and/or disabled by accompanying symptoms for over 3 days in a typical migraine attack. Over half of our subjects reported that their medications worked well or excellently. CONCLUSIONS: Attacks of migraine in real-life clinical situations vary somewhat from the IHS criteria in that they are more often associated with nausea that interferes with oral therapy; can persist for over 72 hours; may have slow (>2 hours) buildup to maximum pain in 10% of cases; and may cause disability for over 3 days. Nevertheless, current therapeutic regimens (including prescribed medications) work well for a substantial majority.

Adult↗