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C Barker

Publications and source records attributed to C Barker.

At least 37 records · Page 2Linked to original sources
PubMed2000

General practitioner psychological management of common emotional problems (I): Definitions and literature review.

General practitioners' (GPs') treatment of patients with common emotional problems often includes some form of psychological management within the consultation. Such psychological management may be limited to listening and discussion or may also include more specific psychological approaches, such as use of counselling, problem-solving, or cognitive-behavioural techniques. This paper defines GP psychological management and reviews what is known about its frequency and effectiveness. MEDLINE and PsychLIT searches were undertaken of empirical studies of the psychological management of emotional problems by GPs in routine consultations published up to 1998. Thirty-six studies were identified. Most lacked details of the nature of the psychological management reported, making it difficult to compare studies. The frequency of use of psychological management by GPs was found to be generally less when rated by external observers than when assessed by GP self-report. There is preliminary evidence from a few studies of the clinical effectiveness of GP psychological management in routine consultations.

Affective Symptoms↗
PubMed2000

General practitioner psychological management of common emotional problems (II): A research agenda for the development of evidence-based practice.

The majority of patients with common emotional or psychological problems are treated solely by general practitioners (GPs). Such treatment frequently includes some form of psychological management within the consultation, whether limited to listening and discussion or involving more specific techniques. This paper sets out a research agenda for the development of effective approaches to GP psychological management. Evidence is reviewed on three core components of all psychological treatments: establishing a positive therapeutic relationship, developing a shared understanding of the problem, and promoting change in behaviour, thoughts or emotions. The application of these components in GP psychological management is outlined and methodological issues in the development and evaluation of GP management approaches are discussed. Since the number of patients with emotional problems seen by each GP is so large, the population effects of even small improvements in psychological management would be sizeable.

Affective Symptoms↗
PubMed1999

Quality of life outcomes of combination zalcitabine-zidovudine, saquinavir-zidovudine, and saquinavir-zalcitabine-zidovudine therapy for HIV-infected adults with CD4 cell counts between 50 and 350 per cubic millimeter. PISCES (SV14604) Study Group.

BACKGROUND: This double-blind study evaluated treatment with zalcitabine-zidovudine, saquinavir-zidovudine, or saquinavir-zalcitabine-zidovudine on the health-related quality of life of HIV-infected adults with CD4 cell counts between 50 and 350 cells/mm3. METHODS: Nine hundred and ninety-three HIV-infected male or female quality of life substudy patients aged 18 years or older, with CD4 cell counts between 50 and 350 cells/mm3 naïve to antiretroviral therapy or with less than 16 weeks of zidovudine therapy, were randomly assigned to one of three daily regimens: zalcitabine 0.75 mg and zidovudine 200 mg every 8 h (ddC/ZDV); saquinavir 600 mg and zidovudine 200 mg every 8 h (SQV/ZDV); or saquinavir 600 mg, zalcitabine 0.75 mg and zidovudine 200 mg every 8 h (SQV/ddC/ZDV). The health-related quality of life was measured using the Medical Outcome Study HIV (MOS-HIV) Health Survey subscale and physical and mental health summary scores, and a global visual analogue scale (VAS) score. The primary health-related quality of life endpoints were the MOS-HIV physical and mental health summary scores. RESULTS: After 24 weeks of treatment, no statistically significant differences were observed between the three treatment groups on physical health and mental health summary scores (global test P = 0.118). After 48 weeks of treatment, statistically significant differences among the groups were observed for physical health and mental health summary scores (global test P = 0.020); no change in physical health summary scores from the baseline were seen in the triple combination therapy, whereas the ddC/ZDV combination therapy group showed decreases from baseline in physical health summary scores (P = 0.008). Six of the 10 individual MOS-HIV subscale scores and the VAS scores showed results consistent with the physical health summary endpoints after 48 weeks of therapy. No statistically significant differences in baseline to 48 week changes in MOS-HIV subscale or summary scores were seen between the ddC/ZDV and SQV/ZDV groups (P > 0.05). CONCLUSIONS: Patients on triple combination therapy maintained their quality of life over 48 weeks compared with significant decreases in the quality of life for ddC/ZDV combination therapy.

Adult↗
PubMed1999

Evaluation of 99mTc-mercaptoacetyltriglycine-biocytin as a new hepatobiliary imaging agent in mice coinjected with bilirubin.

We evaluated 99mTc-labeled mercaptoacetyltriglycine (99mTc-MAG3)-biocytin as a hepatobiliary imaging agent in the absence and presence of bilirubin in mice. We then compared its pharmacokinetic parameters; peak liver/heart activity ratio (rmax) and half clearance time (HCT) with those of 99mTc-labeled diisopropyl-iminodiacetic acid (99mTc-disofenin). Balb/c mice were injected intravenously with hepatobiliary agent (99mTc-MAG3-biocytin or 99mTc-disofenin) alone or in combination with bilirubin at two doses (7 and 14 mg/kg) dissolved in 5% human serum albumin. Images were acquired every 15 s for 30 min with a gamma-camera equipped with a pinhole collimator. Dynamic images showed rapid hepatic uptake of 99mTc-MAG3-biocytin, with rapid clearance from the blood and rapid excretion via the biliary system. Its hepatic uptake was not affected by bilirubin coinjection, whereas 99mTc-disofenin coinjected with bilirubin showed a higher blood background than 99mTc-disofenin alone. These qualitative findings were reflected in pharmacokinetic parameters, rmax and HCT. The rmax was obtained from plots of time versus liver/heart activity ratios obtained in equal-area regions of interest over the heart and liver. The HCT was calculated from the hepatic clearance curve from plots of time versus liver activity. 99mTc-MAG3-biocytin without bilirubin coinjection showed an rmax of 8.9+/-1.3 and an HCT of 399+/-36 s. These values did not change even when 14 mg/kg of bilirubin were coinjected. By contrast, the parameters for 99mTc-disofenin with bilirubin were significantly (p < 0.01) affected by 14 mg/kg of bilirubin coinjection: rmax was decreased from 7.9+/-2.5 to 1.4+/-0.2 and HCT was increased from 292+/-32 s to 782+/-133 s. 99mTc-MAG3-biocytin hepatobiliary scintigraphy in mice is not affected by bilirubin coinjection, and this hepatobiliary agent appears to offer promise for estimating hepatic function in patients with high bilirubin levels.

Animals↗
PubMed1999

Using problem structuring methods in strategic planning.

In this paper we present approaches to problem structuring that have been employed to derive planning guidelines as part of a comprehensive strategic planning process. The approaches were developed for use in the context of a developing country, where quantitative data is particularly scarce. They rely heavily upon the informed judgement of technical planning officers. We discuss ways of ensuring that the approach remains flexible and participative.

Catchment Area, Health↗
PubMed1999

Client preferences for compression threshold in single-channel wide dynamic range compression hearing aids.

OBJECTIVE: Compression in hearing aids can be applied with low compression ratios over a wide range of input levels, but reverts to linear amplification below the compression threshold (CT). In this study, we aimed to determine which of two CTs was preferred by subjects as they used their hearing aids in their own environments, and whether they would prefer to have no low ratio compression at all. DESIGN: Subjects were fitted with a multimemory hearing aid incorporating input controlled compression with a 2:1 compression ratio and output controlled compression limiting. The two memories contained identical programs except that they differed in CT. Sixteen mild to moderately sensorineurally hearing-impaired subjects compared low (approximately 40 dB SPL) and moderate (approximately 65 dB SPL) CTs over 2 mo of field trials using hand held remote controls to switch between the alternatives. In a third month's trial, the preferred option (which also included output controlled compression limiting) was compared with compression limiting alone. RESULTS: The higher CT was preferred by 14 of the subjects. The combination of input compression and output compression limiting was preferred to compression limiting alone by 14 of the subjects. CONCLUSIONS: Several real world advantages of frequency independent 2:1 compression with a CT of about 65 dB SPL were demonstrated over linear amplification. Extending the compression to much lower input levels appears to carry more disadvantages than advantages, at least for clients with mild and moderate hearing losses, when fitted with single-channel compression aids with a 2:1 compression ratio.

Aged↗
PubMed1999

Impact of immunomodulating therapy on morbidity in patients with severe sepsis.

We assessed the impact, over a 28-d period, of therapy with the tumor necrosis factor (TNF) neutralizing receptor fusion protein (p55-IgG) on the incidence of end-organ failures in patients with severe sepsis or early septic shock in a subgroup of 165 patients recruited into a randomized, multicenter clinical trial to receive placebo (n = 78) or a single infusion of p55-IgG, 0.083 mg/kg (n = 87). At study entry, distribution of organ dysfunctions and other baseline characteristics were similar for the two study groups. Treatment with p55-IgG was associated with a trend toward reduced 28-d mortality (p = 0.07), a decreased incidence of new organ dysfunctions (relative risk [RR], 0.57; 95% confidence interval [95% CI] 0.29 to 1.10, p = 0.10), and a decreased overall incidence-density of organ failures (RR 0.65; 95% CI 0.60 to 0.71, p = 0.0001). Patients treated with p55-IgG had more organ failure-free days after study entry than those who received placebo. Average intensive care unit (ICU) stay was 2.6 d shorter (95% CI 0.2 to 5.0) for patients who received p55-IgG than for those who received placebo. For those patients who survived, this difference was 4.1 d (95% CI 1.6 to 6.6). Duration of ventilatory support was 3.2 d shorter (95% CI 0.1 to 6.3) among 28-d survivors who received p55-IgG, compared with placebo. In conclusion, in the population of septic patients studied, treatment with p55-IgG was associated with a trend toward shorter need for mechanical ventilatory support, a decreased length of stay (LOS), and a decreased incidence and duration of organ failure.

APACHE↗
PubMed1999

Efficient generation of recombinant adenoviral vectors by Cre-lox recombination in vitro.

BACKGROUND: Although recombinant adenovirus vectors are attractive for use in gene expression studies and therapeutic applications, the construction of these vectors remains relatively time-consuming. We report here a strategy that simplifies the production of adenoviruses using the Cre-loxP system. MATERIALS AND METHODS: Full-length recombinant adenovirus DNA was generated in vitro by Cre-mediated recombination between loxP sites in a linearized shuttle plasmid containing a transgene and adenovirus genomic DNA. RESULTS: After transfection of Cre-treated DNA into 293 cells, replication-defective viral vectors were rapidly obtained without detectable wild-type virus. CONCLUSION: This system facilitates the development of recombinant adenoviral vectors for basic and clinical research.

Adenoviridae↗
PubMed1998

Treatment of rapidly cycling bipolar patient by using extended bed rest and darkness to stabilize the timing and duration of sleep.

BACKGROUND: The modern practice of using artificial light to extend waking activities into the nighttime hours might be expected to precipitate or exacerbate bipolar illness, because it has been shown that modifying the timing and duration of sleep can induce mania in susceptible individuals. With this possibility in mind, we treated a patient with rapidly cycling bipolar illness by creating an environment that was likely to increase and to stabilize the number of hours that he slept each night. METHODS: We asked the patient to remain at bed rest in the dark for 14 hours each night (later this was gradually reduced to 10 hours). Over a period of several years, his clinical state was assessed with twice-daily self-ratings, once-weekly observer ratings, and continuous wrist motor activity recordings. Times of sleeping and waking were recorded with sleep logs, polygraphic recordings, and computer-based event recordings. RESULTS: The patient cycled rapidly between depression and mania and experienced marked fluctuations in the timing and duration of sleep when he slept according to his usual routine, but his sleep and mood stabilized when he adhered to a regimen of long nightly periods of enforced bed rest in the dark. CONCLUSIONS: Fostering sleep and stabilizing its timing by scheduling regular nightly periods of enforced bed rest in the dark may help to prevent mania and rapid cycling in bipolar patients.

Bed Rest↗
PubMed1998

Partners and fellow patients: two sources of emotional support for women with breast cancer.

This study examined the helping process that occurred when 26 breast cancer patients (the disclosers) talked about their illness-related concerns with their partner and, in a separate conversation, with a fellow patient (the volunteer helpers). The conversations were rated by trained observers and by the disclosers in terms of several process and outcome variables. From the observers' perspective, the volunteer helpers were more helpful, empathic, and supportive, less critical, and used more self-disclosure than the partners. Disclosers did not differentiate between the two types of helper, and gave generally high ratings to both conversations. Strengths and weaknesses of each type of helper were identified. Findings are discussed in relation to the literature on formal and informal helping, and implications for training nonprofessional helpers are suggested.

Adult↗
PubMed1998

An approach to setting priorities in health planning.

This paper describes work undertaken in Pakistan within a project to strengthen the health planning system, aimed at improving the capacity of the planning cells to identify priorities and develop broad strategic guidelines. The work starts from the premise that identification of priorities requires two stages. In the first stage, problems must be structured and defined in a way that is accepted by all major stakeholders in the planning process. In the second stage, a transparent process of decision making must exist which will provide the means for the planning group to establish priorities and time-scales. The tools chosen in this instance were selected in relation to the characteristics of the local environment, and the paper describes these.

Decision Making, Organizational↗
PubMed1998

Heparin-induced skin necrosis: nurses beware.

As the prophylactic use of heparin continues to increase, nurses must be aware that heparin use may cause heparin-induced skin necrosis--a rare but serious complication. Although even more severe complications may occur from heparin use, this discussion will focus on skin necrosis caused by subcutaneous heparin. Should heparin-induced skin necrosis develop, heparin therapy must be discontinued immediately. This case presentation illustrates one patient's reaction to this complication.

Anticoagulants↗
PubMed1997

The value of home support for cancer patients: a study.

The Community Oncology Project (COPE) was initiated to investigate home support from a trained oncology nurse at various stages of treatment. Patients who received home support during treatment responded better than those having visits after treatment had finished. The author discusses the patients' continuing need for home support and the issues of dependency that this raises.

Adult↗
PubMed1997

Mycophenolate mofetil in renal allograft recipients: a pooled efficacy analysis of three randomized, double-blind, clinical studies in prevention of rejection. The International Mycophenolate Mofetil Renal Transplant Study Groups.

BACKGROUND: The search for more effective and less toxic immunosuppressive agents to control transplant rejection has led to the extensive testing of mycophenolate mofetil (MMF) in clinical renal transplantation. METHODS: A pooled analysis of three phase III, randomized, double-blind, multicenter clinical trials conducted in the United States, Canada, Europe, and Australia was performed to further characterize the efficacy of MMF in renal allograft recipients. The three studies enrolled a total of 1493 patients. Triple- and quadruple-therapy regimens of cyclosporine, corticosteroids, and standardized MMF dosages with and without antilymphocyte induction were used: MMF in twice-daily doses of 1.0 g or 1.5 g (MMF 2 g or 3 g) was compared with placebo (PLA) or azathioprine (AZA). The primary efficacy endpoint in the individual trials was biopsy-proven rejection or treatment failure at 6 months. This pooled analysis focused on graft loss, patient death, incidence and treatment of rejection episodes, and graft function (serum creatinine) at 1 year. RESULTS: At 1 year, the graft survival rate was 90.4% and 89.2% in the MMF 2 g and 3 g groups, respectively, compared with 87.6% in the PLA/AZA group. This difference was not statistically significant. MMF significantly reduced the incidence of rejection episodes: 40.8% for PLA/AZA patients versus 19.8% and 16.5% for the MMF 2 g and MMF 3 g groups, respectively. Renal function was consistently better for both MMF treatment groups at 3, 6, and 12 months. CONCLUSIONS: MMF proved superior to AZA as a posttransplant immunosuppressant in conjunction with cyclosporine and corticosteroids. MMF-treated groups showed reduced incidence and severity of rejection episodes, similar graft survival, and better graft function over 12 months.

Adult↗
PubMed1997

Social support as conversation: analysing breast cancer patients' interactions with their partners.

This paper demonstrates an alternative approach to studying the process of social support in close relationships by examining three tape-recorded conversations between breast cancer patients and their partners. We argue that existing research fails to take account of the "social" aspects of social support, and that new methods, sensitive to the complexities of human interaction, are needed. One promising method, tape-assisted recall (in which an audiotape of an interaction is played back to participants), allows researchers to examine the help-intended communication within a dyad as well as each participant's view of that communication. The conversations of the three couples and the participants' moment-by-moment perceptions of these conversations illustrate the complexities of help-intended communication. The commentaries in the tape-assisted recall sessions yielded insights into the interactions that were not always apparent on the surface: the personal meanings of the interactions, in the context of the couple's relationship, were necessary for understanding how support attempts are delivered effectively and why they sometimes fail. The strengths and limitations of the method for the study of social support are discussed. Implications for community health interventions to optimize support for couples coping with illness are also addressed.

Adaptation, Psychological↗