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Biomedical subjects

A Barrett

Publications and source records attributed to A Barrett.

At least 19 recordsLinked to original sources
PubMed2006

Effect of different forms of information produced for cancer patients on their use of the information, social support, and anxiety: randomised trial.

OBJECTIVE: To explore the hypothesis that different methods of selecting and printing information for cancer patients could improve emotional support by affecting interaction with others, and so lead to improved psychological wellbeing. DESIGN: Randomised trial with eight groups (three factors, 2x2x2). Data collected at recruitment and three month follow-up. PARTICIPANTS: 400 patients starting radiotherapy, of whom 325 with breast or prostate cancer and complete anxiety and depression data were included in the analysis. INTERVENTIONS: Printed booklets: half had only general information from CancerBACUP about each patient's cancer and half had personalised information from the patient's medical record plus selected general information; half were composed of information chosen interactively by the patient and half were produced automatically with a larger volume of material; and half had additional advice on anxiety management and half did not. MAIN OUTCOME MEASURES: Patients' views of the information, use of their booklets with others; change in reported social support; change in anxiety and depression. RESULTS: The larger booklets produced automatically were more likely to be found useful and to tell patients something new and less likely to be seen as too limited than the booklets produced interactively, but they were also more likely to overwhelm some patients. Personalised booklets were more likely than general booklets to tell patients something new. There was no difference in patients' perceived understanding of their cancer by any of the intervention factors. Patients with personalised information were more likely to show their booklets to others and to think it helped in discussing their cancer or its treatment. There were no major differences in social support, anxiety, or depression by any intervention factors. CONCLUSIONS: Patients were more likely to show personalised information to their confidants than general information. Further research is needed into the effects of sharing information on patients' social support and anxiety. Trial registration US Government Clinical Trials Database NCT00127465.

Adult↗
PubMed2006

National survey of radiotherapy fractionation practice in 2003.

AIMS: To document UK practice in radiotherapy fractionation. METHODS: All radiotherapy centres in the UK participated in a 1-week audit from 29 September 2003. Fractionation data were collected for all patients starting external beam radiotherapy. This included 2498 patients who were prescribed 32 547 fractions. RESULTS: For the radical treatment of non-skin malignancy (n = 708), the prescribed dose ranged from a single fraction of 8 Gy for total-body irradiation to 75 Gy in 43 fractions for prostate cancer. Postoperative treatment for breast cancer was dominated by three regimens: 40 Gy in 15 fractions; 45 Gy in 20 fractions; and 50 Gy in 25 fractions. Palliative treatment was given in a single fraction to 393 patients (36%) with doses of up to 15 Gy. Three hundred and ninety patients (36%) received four to seven fractions delivering 20-25 Gy. Only 89 patients (8%) received more than 10 fractions with palliative intent but used 29% of such fractions. In the treatment of bone metastases, the most common prescriptions were 8-10 Gy in a single fraction and 20 Gy in five fractions. CONCLUSION: UK radiotherapy practice has become more uniform and moved closer to practice in North America and Europe over the past 15 years. For radical radiotherapy, 54% of prescriptions were for a fraction size of 1.8-2.0 Gy but the distribution was bi-modal and 20% of patients were prescribed fraction sizes of 2.7-3.0 Gy. Evidence-based practice now supports hypo-fractionated palliative treatment favouring single fractions for bone metastases and one or two fractions for many patients with advanced lung cancer. Two fractions are advised for some patients with brain metastasis. If these guidelines had been applied uniformly, then the number of treatments prescribed for palliation could have fallen by 36% from 5197 to 3313. This would have represented a 6% reduction in the overall radiotherapy workload. Not all patients are suitable for such hypo-fractionated treatments, but this is an area in which resource use can be improved. In the postoperative management of breast cancer, a change in practice to use 15 fractions uniformly would reduce overall radiotherapy workload by 4%. By contrast, a change to 25 fractions would increase overall workload by 7%.

Data Collection↗
PubMed2006

Hands-on robotic unicompartmental knee replacement: a prospective, randomised controlled study of the acrobot system.

We performed a prospective, randomised controlled trial of unicompartmental knee arthroplasty comparing the performance of the Acrobot system with conventional surgery. A total of 27 patients (28 knees) awaiting unicompartmental knee arthroplasty were randomly allocated to have the operation performed conventionally or with the assistance of the Acrobot. The primary outcome measurement was the angle of tibiofemoral alignment in the coronal plane, measured by CT. Other secondary parameters were evaluated and are reported. All of the Acrobot group had tibiofemoral alignment in the coronal plane within 2 degrees of the planned position, while only 40% of the conventional group achieved this level of accuracy. While the operations took longer, no adverse effects were noted, and there was a trend towards improvement in performance with increasing accuracy based on the Western Ontario and McMaster Universities Osteoarthritis Index and American Knee Society scores at six weeks and three months. The Acrobot device allows the surgeon to reproduce a pre-operative plan more reliably than is possible using conventional techniques which may have clinical advantages.

Aged↗
PubMed2006

Investigation of a tuberculosis cluster at a job centre in Manchester, United Kingdom.

During the summer of 2005, four cases of active tuberculosis from the same occupational setting were investigated in Manchester, UK. The index case had been diagnosed in December of the previous year. At that stage the closest occupational contacts had been screened, all of whom were assessed as being free from active disease, and none had met nationally recommended criteria for chemoprophylaxis for latent tuberculosis infection (LTBI). In June 2005, two work contacts developed progressive primary extrapulmonary (pleural) TB. Following a detailed risk assessment, the screening programme was widened to include 137 staff who worked at the job centre (employment agency) where the first four cases had been found. This screening programme was based on tuberculin Mantoux testing, CXR and gamma-interferon testing. Of these 137 contacts screened, one additional person was found to have active disease and six others were offered chemoprophylaxis for LTBI. The isolates from the index case and the first two secondary cases were indistinguishable on VNTR-MIRU (variable number tandem repeat--mycobacterial interspersed repetitive unit) typing at 15 loci. No samples were available for testing from the fourth case of active disease. Management of this incident has benefited from the evolving fields of both genotyping and diagnostic testing for LTBI. However, further research into the epidemiological inferences made through genotyping, as well as the significance of a positive gamma-interferon test in assessing the risk of development of active disease, is still required.

Cluster Analysis↗
PubMed2004

Re-audit of radiotherapy waiting times 2003.

AIMS: There has been increasing concern, by clinical oncologists in the UK, about the continuing long waiting times for radiotherapy treatment. An audit of patients starting treatment in 1 week in 2003 was carried out to determine waiting times and to compare current results with those obtained from a similar audit in 1998. MATERIALS AND METHODS: All centres in the UK completed the audit, which recorded waiting-list status and treatment intent for all new treatments started in 1 week, date of booking form completion and fractionation scheme used. RESULTS: Waiting times have lengthened in most centres for all categories of patients although, for palliative treatments, there was no additional increase in median waiting time compared with the last audit. Fewer patients in all categories are being treated within the Joint Collegiate Council for Oncology (JCCO) guidelines. Single-fraction treatments are now common for palliation. Most adjuvant treatment uses one of three prescriptions. In each Strategic Health Authority (StHA), the same proportion of the total number of patients with cancer seemed to be given radiotherapy. There was no obvious simple correlation of radiographer, physicist or treatment machine numbers with waiting times. CONCLUSION: The results of this survey suggest a continuing mismatch between capacity and demand. Increased complexity of radical treatments, and possibly more patients being referred for treatment, may have been offset in part by reduced fractionation for palliation.

Chemotherapy, Adjuvant↗
PubMed2004

Guidelines for the infrastructure of training institutes and teaching departments for radiotherapy in Europe.

AIM: To develop guidelines for the infrastructure of training institutes and teaching departments for medical specialist training in radiotherapy within Europe. MATERIAL AND METHODS: Guidelines for teaching departments were developed under consideration of the updated European Core Curriculum for Radiotherapists (Radiation Oncologists) by an expert panel jointly appointed by the European Union of Medical Specialists and the European Society of Therapeutic Radiology and Oncology. The group approached national professional and scientific societies for information on national requirements for teaching departments. Based on this information, a draft document was circulated among the national and professional societies for radiotherapy in Europe for review before a European consensus conference took place in Brussels in December 2002. RESULTS: The guidelines for the infrastructure of training institutes and teaching departments for medical specialist training in radiotherapy within Europe were endorsed by representatives of 35 European nations during the Brussels consensus conference on December 14, 2002. CONCLUSION: The infrastructure guidelines represent an important instrument that can be used by teaching departments for comparison of their situation with that of other departments in Europe as a basis for negotiations with authorities on resources provided for training.

Clinical Competence↗
PubMed2003

Management of soft tissue sarcomas of the abdomen and pelvis.

OBJECTIVE: Soft tissue sarcomas of the abdomen or pelvis are rare tumours that usually arise in the retroperitoneum but may also arise from the gastrointestinal tract or other abdominal organs. The aim of this study was to assess patient outcome following treatment of these tumours at a tertiary referral centre. PATIENTS AND METHODS: Data on all patients with soft tissue tumours treated under the care of one surgeon between January 1990 and December 2000 was reviewed. RESULTS: Over the 11-year period 61 patients underwent 79 operations for a soft tissue sarcoma of the abdomen or pelvis. Macroscopic clearance of tumour at operation was achieved in 45 (74%) of the 61 patients, for primary tumours this was 97%, recurrent tumours 50% and metastases 33%. The median survival for those undergoing complete resection was 50 months (range 3-238 months, median follow-up 33 months). This compared with a median survival of only 6 months range (1-127 months) for those that had incomplete resection (P = 0.001). The 5-year survival for patients that had complete resection was 61.5%, however, over one-third of the 5-year survivors have since recurred. CONCLUSION: This study confirms that most primary soft tissue sarcomas of the abdomen or pelvis are resectable and the majority of patients will experience a long disease free interval following resection.

Abdominal Neoplasms↗
PubMed2003

Optimisation of acid fast smears for the direct detection of mycobacteria in clinical samples.

AIMS: Despite its long history, the acid fast smear remains unstandardised. Technical variations in both the preparation of clinical material and subsequent staining mean that smear sensitivity relative to culture may vary from 50% to over 80%. This study assessed the sensitivity of acid fast microscopy at each of five stages of sample preparation and by both commonly used staining methods. METHODS: Sputum samples thought for varying reasons to be highly likely to be culture positive were used to prepare a series of smears in which the effects of digestion (liquefaction), concentration (centrifugation), and decontamination (sodium hydroxide) could be assessed, together with a comparison of staining by the auramine/phenol and Ziehl-Neelsen techniques. RESULTS: The most effective method for the demonstration of acid fast organisms in sputum was found to be an auramine phenol stain applied to a liquefied, concentrated sample and examined before the decontamination process. CONCLUSIONS: The auramine phenol stain applied to a liquefied, concentrated sample and examined before the decontamination process is the most effective method for the demonstration of acid fast organisms in sputum.

Bacteriological Techniques↗
PubMed2001

Radiobiological modelling of the treatment of leukaemia by total body irradiation.

PURPOSE: Total body irradiation (TBI) has been used as part of the conditioning regimen before bone marrow transplantation or stem cell re-infusion for more than 30 years. A wide variety of regimens have been used, and no single one has emerged as the best. Experimental evidence suggests a diversity of radiosensitivities of leukaemia cells in culture, which may correlate with a significant variation of leukaemic cell radiosensitivities between patients. The purpose of this project was to compute leukaemic cell killing by different schedules and determine whether a "best treatment" could be devised for individual patients. METHODS: We have developed a mathematical model for leukaemic cell killing by alternative TBI schedules, applied to a patient population with diverse leukaemic radiosensitivities. We considered 13 schedules in clinical use, and 14 theoretical schedules calculated (by the linear-quadratic model) to be iso-effective for risk of radiation pneumonitis. When each schedule of treatment is applied to the patient population, a distribution of leukaemic cell kills (log cell kill values) can be obtained for that schedule. The leukaemic kill distribution was also computed for optimized individual scheduling, each individual being treated by the schedule that was most effective for that patient. Using available data on the clinically observed dose response relationship for acute myeloid leukaemia, the model was extended to provide leukaemia cure probabilities for each of the schedules and for the individualized strategy. RESULTS: The computer simulations show that each schedule, applied to the treatment of a radiobiologically diverse patient population, results in a broad distribution of leukaemic log kill values, with a mean of 3-5 for most schedules (i.e. 10(-3)-10(-5) surviving fraction of leukaemic cells), and a broad variation (1-10 log kill) amongst patients. The distributions generated by the various schedules were found to be overlapping, implying that many of the schedules would be difficult to distinguish reliably in clinical trials. Individualized optimum treatment is possible if radiobiological parameters are known for each patient and would improve the leukaemic log kill distribution by about 1 log on average, corresponding to an increase of leukaemia cure probability of several percent overall. For some individual patients, however, optimal scheduling could make a large difference to treatment outcome. CONCLUSIONS: The use of many different clinical treatment schedules may be continuing because outcomes are similar when these diverse schedules are applied to unselected patient populations. The measurement of individual leukaemic cell radiosensitivity would allow individualized scheduling, which could result in modest increases in overall curability, but substantial improvements in survival or duration of remission for individual patients.

Cell Death↗
PubMed2001

Low grade astrocytomas in the West of Scotland 1987-96: treatment, outcome, and cognitive functioning.

BACKGROUND: Low grade astrocytomas are among the most common central nervous system tumours in children. AIMS: To identify risk factors for the development of persistent intellectual handicap. METHODS: The notes of 30 children with histologically proven low grade astrocytoma who presented during the period 1987-96 were reviewed. Thirteen of these children who were diagnosed with intracranial tumours between 1992 and 1996 underwent cognitive assessment one year after the completion of treatment. RESULTS: Low grade astrocytomas were found in the cerebellum (59%), thalamus (17%), cerebral hemispheres (10%), and the cervical spinal cord (9%). Where possible all patients were treated with gross total resection of the tumour. Symptomatic children with tumours judged to be inoperable underwent biopsy followed by radiotherapy (13%). Three patients developed progressive disease following surgery and underwent repeat surgery and radiotherapy. Survival at a median follow up of 75 months (range 30-131) is 97%. At one year after the completion of treatment persisting cognitive impairment was common. The strongest predictor of IQ scores was the duration of symptoms of increased intracranial pressure preoperatively. CONCLUSIONS: Although the overall survival rate of children with low grade astrocytoma is excellent, significant long term disability occurs. Early diagnosis is essential to reduce postoperative cognitive morbidity.

Adolescent↗
PubMed2001

Identifying sputum specimens of high priority for examination by enhanced mycobacterial detection, identification, and susceptibility systems (EMDISS) to promote the rapid diagnosis of infectious pulmonary tuberculosis.

AIMS: To compare clinical information and sputum microscopy as methods for the selection of samples for enhanced mycobacterial detection, identification, and susceptibility systems (EMDISS) to promote the rapid diagnosis of patients with infectious pulmonary tuberculosis. METHODS: Two thousand, two hundred and sixty four specimen request forms were examined for clinical details, which were then used to identify specimens likely to yield Mycobacterium tuberculosis on culture. These results were compared with the results of sputum microscopy for acid fast bacilli (AFB). Both methods were assessed against the results of culture using a combination of continuous automated mycobacterial liquid culture (CAMLiC) and conventional solid culture. RESULTS: Classification based on clinical details was an inefficient method of identifying high priority specimens for EMDISS. Although, when given, clinical details were often consistent, a substantial proportion of specimens arrived with no details. This approach would result in the referral of at least 16% of the workload but lead to the detection by culture of only 46% of the M tuberculosis present within it. In contrast, microscopy for AFB defined a much smaller number of specimens (4.8% of the total), which contained 90% of the M tuberculosis isolates. CONCLUSIONS: Microscopy for AFB is the most efficient method for defining sputum specimens suitable for referral for enhanced mycobacteriological techniques. However, it is essential that the methods used for smear preparation and microscopy are of the highest possible standard, otherwise some patients with infectious pulmonary tuberculosis will be denied, unnecessarily, the benefits of important advances in mycobacteriology.

Bacteriological Techniques↗
PubMed2001

District nurse-led beds: an alternative to care at home.

Intermediate care is a key feature of the Government's plans for the development of the health service. The intermediate care scheme described here offers a district nurse-led bed (DNLB) stay in a community hospital to patients in the community who require short-term nursing help. District nurses are given the opportunity to admit patients from their community caseloads into a DNLB in a community hospital and are responsible for their admission, care and discharge. This article describes the pilot study that monitored the first 30 patients who used the DNLBs. Patients included younger people with multiple sclerosis who were admitted for respite care, but the principal beneficiaries were those aged over 65 years with chronic conditions.

Adult↗
PubMed2000

Self-reported effects of computer workshops on physicians' computer use.

BACKGROUND: The need for physicians to be proficient in the use of computers is undeniable. As computers have become easier to use and more widespread, their use in medicine is expanding. Several organizations have produced continuing medical education programs to teach physicians about the use of computers in medicine but little has been reported on the effects of such programs. METHOD: We present the self-reported effects of a series of workshops that taught physicians about basic computer skills: information retrieval, the Internet, CD-ROMs, electronic mail, and computer-aided learning. RESULTS: A questionnaire mailed to 65 workshop participants yielded a response rate of 46% (n = 30). Of the 30 respondents, 27% (n = 8) had bought new hardware or software because of attending the workshops, with the most common purchase being a new computer. Fifty-seven percent (n = 17) had increased their use of computers, with the most common applications being use of the Internet for information retrieval and electronic mail.

Computer User Training↗
PubMed2000

Epidemiology and molecular typing of an outbreak of tuberculosis in a hostel for homeless men.

AIM: To investigate a possible outbreak of tuberculosis in a hostel for homeless men using IS6110 profiling, a polymerase chain reaction (PCR) based fingerprinting technique. METHODS: Eight cases of tuberculosis were diagnosed in residents of the hostel over a period of 28 months. To provide epidemiological data, a heminested inverse PCR (HIP) assay targeting the insertion sequence IS6110 together with its upstream flanking region was used to fingerprint the eight isolates of M tuberculosis under investigation. RESULTS: The HIP technique gave IS6110 profiles which showed that while three isolates were clearly distinct, the remaining five strains were indistinguishable, suggesting the latter were representatives of a single outbreak strain. CONCLUSIONS: The HIP assay proved discriminatory and facilitated repeated testing for the direct comparison of strains as more patients presented over the protracted course of this outbreak.

Adult↗
PubMed1999

Randomised trial of personalised computer based information for cancer patients.

OBJECTIVE: To compare the use and effect of a computer based information system for cancer patients that is personalised using each patient's medical record with a system providing only general information and with information provided in booklets. DESIGN: Randomised trial with three groups. Data collected at start of radiotherapy, one week later (when information provided), three weeks later, and three months later. PARTICIPANTS: 525 patients started radical radiotherapy; 438 completed follow up. INTERVENTIONS: Two groups were offered information via computer (personalised or general information, or both) with open access to computer thereafter; the third group was offered a selection of information booklets. OUTCOMES: Patients' views and preferences, use of computer and information, and psychological status; doctors' perceptions; cost of interventions. RESULTS: More patients offered the personalised information said that they had learnt something new, thought the information was relevant, used the computer again, and showed their computer printouts to others. There were no major differences in doctors' perceptions of patients. More of the general computer group were anxious at three months. With an electronic patient record system, in the long run the personalised information system would cost no more than the general system. Full access to booklets cost twice as much as the general system. CONCLUSIONS: Patients preferred computer systems that provided information from their medical records to systems that just provided general information. This has implications for the design and implementation of electronic patient record systems and reliance on general sources of patient information.

Attitude to Computers↗