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J Barlow

Publications and source records attributed to J Barlow.

At least 55 records · Page 3Linked to original sources
PubMed1999

Prescribing for leg ulcers in general practice, Part 2.

This study, the second of a two-part article, reports the findings of a survey undertaken to establish who selects the product used in the management of leg ulcers, and the factors influencing their decision making. The use of interviews (n = 9) followed by postal questionnaires (n = 197) confirms that the majority of decisions are made by practice nurses and district nurses. The findings suggest that, of the factors considered, patient comfort and compliance are the most important factors influencing product selection. This study also suggests that nurses are not using the best available evidence because of inaccessibility of resources and lack of time to search the literature. Nurses also cited difficulty in discriminating between a biased presentation and reliable research.

Acute Disease↗
PubMed1998

Project Charlie.

Explore the source record for details and available documents.

Health Education↗
PubMed1998

Systematic review of the school entry medical examination.

AIMS: To summarise and critically evaluate research conducted in the UK between 1962 and 1996, on the effectiveness and efficiency of the school entry medical (SEM) examination. METHODS: An electronic search of a large number of databases, in conjunction with a search of reference lists, and sources in the grey literature produced a total of 64 studies. RESULTS: Only one overview and 16 primary studies met the review's broad inclusion criteria. The results showed significant differences in the identification and referral of new and ongoing problems not only between the routine and selective SEM but also within the two types of SEM examination. There were also large differences in the numbers of children selected for SEM examination. No study included in the review defined either the methods or the criteria used to identify children as screen positive. No study provided follow up of children after referral to estimate the positive predictive value or yield of the screening, or follow up of the whole cohort to identify false negative cases. CONCLUSION: Data on the effectiveness and efficiency of both the routine and selective SEM examination in accurately identifying children with new or ongoing health problems are not available at the present time. The studies reviewed here demonstrate the fragility of the evidence on which the school entry medical is based, and call into question the ethical basis of this programme.

Child, Preschool↗
PubMed1998

Evidence for a lipid specific effect in nutrient induced human proximal gastric relaxation.

BACKGROUND/AIM: The presence of lipid in the upper gut is able to modify gastrointestinal motor performance, but its influence on the relaxation of the human stomach, which is known to modify gastric emptying, remains incompletely understood. The relaxation of the proximal stomach in response to various lipid concentrations was therefore studied in healthy volunteers. Since the observed effects could be mediated through osmolality or energy sensitive pathways, the effects of equicaloric and equiosmolar non-lipid solutions were also determined. METHODS: The tone of the proximal stomach was measured during stepwise inflation of a non-compliant bag sited in the proximal stomach, both before and after a test meal was delivered intragastrically. Iso-osmolar lipid emulsions were diluted in iso-osmolar saline at concentrations of 1.25, 2.5, 5, 10, and 20%. NaCl solutions at osmolalities of 300, 600, 1200 and 2400 mmol/kg and glucose solutions of 836 and 3344 kJ/l were also given. RESULTS: All lipid meals of 2.5% or greater concentration induced a reduction in gastric tone in a non-dose-dependent manner, responses to 5% lipid (median (range) 74 (62-92)%) being similar to those to 20% lipid (80 (55-83)%; p > 0.05). No relaxation was elicited by isocaloric glucose. NaCl only consistently caused relaxation at 2400 mmol/kg. CONCLUSION: Lipid meals reduce human proximal gastric tone by a lipid specific mechanism, independently of their energy content or osmolality.

Adult↗
PubMed1998

Responses to support groups for family caregivers in schizophrenia: who benefits from what?

With increasing focus on community-based mental health services, family caregivers require and deserve professional support. The aim of the paper is to provide information useful to mental health professionals planning to run support groups for family caregivers in chronic mental illness. The data presented here combine qualitative information with quantitative information. From 36 group members who were caring for a relative with schizophrenia, eight were selected with extreme positions on four intake dimensions: (i) length of time since patient's diagnosis; (ii) amount of carer-patient contact; (iii) level of psychological distress; and (iv) level of rejecting attitudes to the patient. Differences in the responses of these individuals to the group meetings, as shown by their comments on both short and long-term effects, suggest how meetings, as shown by their comments on both short and long-term effects, suggest how groups might be selected and structured for maximum effectiveness. While all carers wanted better mental health rehabilitation services, accurate information regarding their relatives' illness and respect from mental health professionals, their length of experience as carers fundamentally affected their responsiveness to the discussion topics.

Aged↗
PubMed1997

Estrogen affects development of alveolar structures in whole-organ culture of mouse mammary glands.

In order to determine if estrogen affects lobulo-alveolar development, and to determine if whole organ culture of mouse mammary glands is an appropriate model of estrogen effects on mammary development, mouse mammary glands were cultured in the presence or absence of phenol red and estrogen. Lobulo-alveolar development did not occur in vitro when phenol red was eliminated from culture medium. Lobulo-alveolar development was stimulated by 17 beta-estradiol in a dose dependent manner over a physiological range. These results support the hypothesis that estrogen plays a critical role in alveolar development in the mammary gland. In this report an in vitro model of mammary development is identified in which the effects of estrogen are morphologically described and quantified.

Aldosterone↗
PubMed1997

Improving outpatient clinic efficiency using computer simulation.

To assess and plan alterations in outpatient clinic structure, produces a computer simulation of an outpatient clinic based on detailed time and role measurements from the authors' clinic. The stimulation which used an object-oriented design method is able to indicate the impact of changes in clinic structure using patient and doctor waiting times in clinic as endpoint measures. The effects of changes in clinic size, consultation time, patient mix, appointment scheduling and non-attendance were examined. We found that patient waiting time could be shortened considerably by using an optimizing appointment scheduler to determine appointment intervals. Clinic mix influences patient waiting time, which was shorter with a 1 in 4 ratio of new to follow-up patients. In mixed clinics, new patients appointments are optimally spread throughout the clinic to reduce patient waiting time. In all new or all follow-up clinics, waiting time is improved if the appointment interval reflects the consultation time. Computer modelling can help in optimizing clinic management so improving the delivery of care in outpatient services.

Appointments and Schedules↗
PubMed1997

Cranial nerve modulation of human cortical swallowing motor pathways.

Animal data indicate that cortical swallowing pathways can be modulated by cranial nerve afferent stimulation. We therefore studied the effects of human trigeminal and vagal nerve excitation on the corticofugal pathways to the oropharynx and esophagus, using electromagnetic stimulation. Unilateral stimulation of either the trigeminal or vagus nerve evoked two distinct reflex electromyographic responses in the pharynx and esophagus, an early response (latency range 19-30 ms) and a late response (latency range 42-72 ms). In the mylohyoid muscles, however, only a single response was seen (latency range 36-64 ms). Cortical stimulation also evoked electromyographic responses in the mylohyoid muscles, pharynx, and esophagus, with latencies of 8.5 +/- 0.3, 9.3 +/- 0.3, and 10.1 +/- 0.4 ms, respectively. When either trigeminal or vagus nerve stimulation preceded cortical stimulation, the cortically evoked responses were facilitated, with maximal effects at interstimulation intervals of 30-200 ms for pharynx and esophagus (P < 0.02) and at interstimulation intervals of 50-100 ms for mylohyoid muscles (P < 0.05). Our results demonstrate that stimulation of human cranial nerve afferent fibers facilitates cortical swallowing motor pathways.

Adult↗
PubMed1997

Effect of cholecystokinin-A receptor blockade on lipid-induced gastric relaxation in humans.

The purpose of this study was to assess the role of endogenous cholecystokinin (CCK) in regulating fat-induced changes in human gastric relaxation. Proximal gastric pressure-volume relationships were determined in 12 healthy volunteers during a series of gastric distensions, both fasting and after intragastric instillation of 250 ml of 10% Intralipid. All subjects were studied twice, in a randomized, double-blind study, during intravenous infusion of either loxiglumide (CCK-A antagonist) or saline. For each distension, intragastric pressure and compliance were determined together with perception intensity. During saline infusion, Intralipid reduced intragastric pressure (prelipid, 11.7 +/- 0.8; postlipid, 9.7 +/- 0.6 mmHg; P = 0.002) and increased compliance (pressure-volume slope values: prelipid, 87.6 +/- 9.7; postlipid, 47.2 +/- 7; P < 0.01). Loxiglumide infusion during fasting exerted no effect on either intragastric pressure or compliance. After lipid, however, loxiglumide abolished the expected postlipid reduction in intragastric pressure (prelipid, 12.1 +/- 0.7; postlipid, 11.5 +/- 0.8 mmHg; P = 0.4) but did not consistently abolish the postlipid increase in compliance. Loxiglumide exerted no effect on the cumulative perception score or on the volume at perception threshold, although it prevented the fat-induced reduction in pressure at perception threshold [control: prelipid, 15.4 +/- 1.1; postlipid, 10.7 +/- 0.5 (P < 0.05); loxiglumide: prelipid, 13.8 +/- 1.5; postlipid, 12.2 +/- 0.9 (P > 0.05)]. Endogenous CCK or CCK-A receptors therefore play a role in the fat-induced reduction of intragastric pressure and might also modulate gastric perception after lipid.

Adult↗
PubMed1996

The topographic representation of esophageal motor function on the human cerebral cortex.

BACKGROUND & AIMS: Corticofugal pathways to the human esophagus have been recently identified in humans using transcranial magnetic stimulation. The aim of this study was to determine the topographic representation of the esophagus on the cerebral cortex. METHODS: Focal magnetic stimulation of 1-cm areas was performed over both hemispheres in 10 healthy subjects. Esophageal electromyographic responses were recorded 2 cm below the upper esophageal sphincter. The studies were repeated to determine reproducibility in 3 subjects; in 2 subjects, esophageal topography was compared with thenar muscle topography. RESULTS: In all subjects, esophageal electromyographic responses were evoked by stimulation of either the right or left hemisphere. Largest amplitude responses were obtained anterior to those of the thenar muscles, indicating that the esophagus may be represented on either the anterior aspect of the motor cortex or on the premotor cortex. In all subjects, the area of response was asymmetric, being more extensive on the right hemisphere than on the left hemisphere in 8 subjects. In 2 subjects, the area of response on the left hemisphere was more extensive than on the right. Repeat studies showed that this asymmetry was consistent. CONCLUSIONS: Esophageal motor function shows bilateral cortical representation with consistent interhemispheric asymmetry.

Adult↗
PubMed1996

The cortical topography of human swallowing musculature in health and disease.

Because no detailed information exists regarding the topographic representation of swallowing musculature on the human cerebral cortex in health or disease, we used transcranial magnetic stimulation to study the cortical topography of human oral, pharyngeal and esophageal musculature in 20 healthy individuals and the topography of pharyngeal musculature in two stroke patients, one with and one without dysphagia. Our results demonstrate that swallowing musculature is discretely and somatotopically represented on the motor and premotor cortex of both hemispheres but displays interhemispheric asymmetry, independent of handedness. Following stroke, dysphagia appeared to be associated with smaller pharyngeal representation on the intact hemisphere, which increases in size with recovery of swallowing.

Adolescent↗
PubMed1996

Ambulatory care groups and the profiling of primary care physician resource use: examining the application of case mix adjustments.

A variety of profiling models and tools is utilized by payers, providers, and regulators to evaluate physician work, performance, and resource utilization. In physician profiling, the provider's pattern of practice is expressed as a rate of service or outcome. The article by Tucker, Weiner, Honigfeld, and Parton (this issue) compares the practice-based norms of primary care physicians by adjusting for case mix using ambulatory care groups (ACGs), a population-based classification method. Once the case mix is adjusted, the actual use of resources, as measured by overall charges, is compared with the expected value of resource use. In the Center for Research in Ambulatory Health Care Administration (CRAHCA) Physician Profiling Project, funded by The Robert Wood Johnson Foundation, physicians learn which services other physicians in their specialties perform. Physicians are able to compare their profiles with state and national level medians. The profiling project is one of the first demonstration projects in the field to profile ambulatory care practice patterns and collect patient demographics. An aspect of the project is to test the ACG classification system to data selected from 130 nonacademic practices representing over 5,000 physicians.

Ambulatory Care↗
PubMed1996

Effect of distension and feeding on phasic changes in human proximal gastric tone.

BACKGROUND: Proximal stomach by virtue of its property of accommodation acts as a reservoir for the ingested food, but its role in emptying and the factors modulating it remain unexplored. AIM: To assess the effects of distension and of feeding on proximal gastric tone. SUBJECTS: 14 healthy volunteers with no current or past history of any gastro-intestinal symptoms. METHODS: Isobaric changes in volume of the proximal stomach were recorded both during fasting and for the first 30 minutes after a meal. RESULTS: For a given degree of distension, the mean (SEM) intragastric pressure was consistently lower, immediately after meal ingestion (9.8 (1.1), mm Hg) than during fasting (12.9 (0.6) mm Hg; p < 0.01). Proximal gastric tone was continuously variable with a frequency of fluctuation of 0.9-1.3/minute and an amplitude of 16.8 (2.2) ml, superimposed upon slower higher amplitude fluctuations in baseline tone. These variations in tone were unaffected by the degree of gastric distension or by food. CONCLUSIONS: While proximal gastric tone decreases after meal ingestions consistent with accommodation, the fluctuations in tone are not an importance factor in the modulation of nutrient emptying from the proximal stomach in the immediate postprandial period.

Adult↗
PubMed1996

Yield pressure: a new concept in the evaluation of GERD?

This study evaluates the yield pressure at the gastroesophageal junction in a group of 73 patients undergoing diagnostic endoscopy and in another group of 82 patients during the course of manometry for suspected GERD. The group included 17 patients who had previously undergone a successful Nissen fundoplication and eight patients who had a failed Nissen fundoplication. Air is insufflated into the stomach, and a water perfused pressure transducer is used to detect intragastric pressure. The pressure at which the cardia was seen to open at endoscopy, or when a common cavity phenomenon was detected at manometry, was taken as the opening pressure. Yield pressure was calculated as the difference between the opening pressure of the cardia and the resting gastric pressure. Results indicated a significant decrease in yield pressure in 65 patients with esophagitis compared with 65 patients with no evidence of reflux or esophagitis. A significant inverse correlation was found between yield pressure and the size of the hiatus hernia noted in these patients. There was also a correlation between valvular appearance of the cardia at endoscopy and the yield pressure. A progressive decrease in yield pressure occurred with an increasing deterioration in the physical appearance of the valve. There was no significant relationship found between yield pressure and lower esophageal sphincter (LES) pressure or intra-abdominal length. A small but significant relationship was found between yield pressure and acid exposure of the lower esophagus. The 17 patients with a successful Nissen showed a significantly increased yield pressure to supranormal values. In contrast, the eight patients with a failed Nissen had yield pressures within the range of the patients with esophagitis. In eight patients, yield pressure was measured by both manometry and endoscopy and showed no significant differences between the two methods.

Esophagogastric Junction↗