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Biomedical subjects

J R Barton

Publications and source records attributed to J R Barton.

At least 37 records · Page 2Linked to original sources
PubMed2001

Does a lean prepregnancy body mass index influence outcome in pregnancies complicated by mild preeclampsia remote from term?

OBJECTIVES: To determine the influence of a lean prepregnancy body mass index (BMI) on pregnancy outcome in women with mild preeclampsia. STUDY DESIGN: A matched cohort design was used. A total of 99 pregnant women with mild preeclampsia and a nonobese prepregnancy BMI (22-28 kg/m2) were matched 1 : 1 for gestational age at diagnosis, race, and parity to 99 women with mild preeclampsia, but a lean prepregnancy BMI (< or = 20 kg/m2). All patients were enrolled in an outpatient management program between 24 and 36 weeks' gestation for a minimum of 2 days, had singleton pregnancies, and exhibited proteinuria of > or = 1+ at the start of the program. Outpatient monitoring included automated blood pressure measurements and daily assessment of weight, proteinuria, and fetal movement. RESULTS: The mean gestational age at enrollment was 33.4 +/- 2.8 weeks for both groups. By matching, 65% of patients in each group were nulliparous and 79% of patients in each group were of the white race. There were no patients in either group with a history of preterm delivery. The mean gestational age at delivery (36.8 +/- 2.3 versus 36.3 +/- 2.3 weeks, p = 0.047) was greater in the lean prepregnancy BMI group with a lower cesarean section rate (32% versus 52%, p = 0.006) but similar mean birth weights (2728 +/- 698 versus 2679 +/- 802 g, p = 0.635). There were two perinatal deaths in the lean prepregnancy BMI group and one in the nonobese prepregnancy BMI group (p = 1.0). CONCLUSION: In patients with mild preeclampsia remote from term, a lean prepregnancy BMI was associated with a later gestational age at delivery and a reduced incidence of cesarean delivery. Neonatal outcomes, however, did not differ significantly between the groups.

Adult↗
PubMed2001

The short inflammatory bowel disease questionnaire is reliable and responsive to clinically important change in ulcerative colitis.

OBJECTIVE: The Short Inflammatory Bowel Disease Questionnaire (SIBDQ) is a health-related quality of life (HRQoL) tool measuring physical, social, and emotional status (score 10-70, poor to good HRQoL). The SIBDQ has been predominantly used in trials for Crohn's disease, and further validation of the SIBDQ is desirable in ulcerative colitis (UC) patients. The primary objective was to further validate the SIBDQ by examining discriminant ability against measures of disease activity. The secondary objectives were to examine reliability and responsiveness to change. METHODS: UC patients attending hospital completed the SIBDQ and two activity indices. Patients' disease status (remission, mild, moderate, or severe relapse) was determined subjectively by the patients and their physician. RESULTS: Scores were obtained for 69 events in 61 patients. mean age 47.8 yr (range 16-79). All classes of disease extent were represented. The mean SIBDQ score was 48.4 (13-70). The difference between mean score in patients in remission and relapse was -20.1 (95% CI = -25.1 to -15.1). The difference for remission and mild relapse was -14.6 (95% CI = -8.9 to -20.2). The correlation between SIBDQ and the activity indices were good, r = -0.83 and r = -0.61. Eight patients presented twice. Those with unchanged disease status showed no significant difference in the mean SIBDQ score. Patients whose disease status had deteriorated from remission to mild relapse, or from mild to moderate relapse demonstrated a mean reduction of 11.8 points (95% CI = 20.1-3.4). CONCLUSIONS: This study contributes to the validation of the SIBDQ as a HRQoL tool in UC. It is reproducible and responsive to changes in disease activity.

Adolescent↗
PubMed2000

Clarifying the concepts of confidence and competence to produce appropriate self-evaluation measurement scales.

INTRODUCTION: This paper reviews the literature on self-evaluation and discusses the findings of a small-scale qualitative study which explored the terms 'confidence' and 'competence' as useful measures in a self-evaluation scale. Four pre-registration house officers took part in interviews and completed a provisional instrument to assess their perceived competence. FINDINGS: Competence and confidence are useful terms for house officers expressing beliefs about their ability to perform their job but the terms should not be used synonymously. In our study, 'competent' represented what individuals knew about their ability and was based on the individual's previous experience of the task. 'Confident' described a judgement which influenced whether an individual was willing or not to undertake an activity. Confidence was not necessarily based on known levels of competence and therefore performance of tasks which were unfamiliar to the house officer also involved the assessment of risk. The authors give examples of task and skill scales which may be useful in the process of self-evaluation by pre-registration house officers. CONCLUSIONS: The authors suggest that the process of assessing oneself is complicated, and by its very nature can never be objective or free from the beliefs and values individuals hold about themselves. Therefore self-evaluation instruments are best used to help individuals analyse their work practices and to promote reflection on performance. They should not be used to judge the 'accuracy' of the individual's evaluation.

Attitude↗
PubMed2000

Compliance of orthopaedic patients with postoperative oral nutritional supplementation.

BACKGROUND: Studies have shown clinical benefits of nutritional supplementation in orthopaedic and elderly patients in both under and well nourished groups. However, patient compliance with the supplementation has not been reported. AIM: To assess level of patient compliance with nutritional supplementation when prescribed postoperatively to unselected orthopaedic patients as part of a large controlled trial researching the clinical benefits of non-targeted nutritional supplementation. METHODS: Patients in the intervention group were prescribed two oral supplements each day of their hospital stay, in addition to usual meals. Information describing the supplements was given by the dietitian. Supplements were issued on drug rounds and the proportion of each drink consumed was recorded and collated. Patients could choose to change the type of drink or to discontinue the supplements completely at any time. Twenty-four hour food intake was analysed for a random sub-sample of 48 patients. RESULTS: Eighty-four patients (27 men, 57 women; mean age, 72 years) were prescribed supplements. Median length of stay was 14.4 days. Supplements were taken for a mean of 6.7 days. Median compliance was 14.9%. Despite this, median energy intake in the study group was 1523 kcal/day and 1289 kcal/day in the control (P= 0. 0214). CONCLUSION: Compliance with non-targeted, postoperative nutritional supplementation is poor in unselected orthopaedic patients but even low levels of supplementation significantly increase energy intake.

Adult↗
PubMed2000

Demographics, management, and outcome of peripartum cardiomyopathy in a community hospital.

OBJECTIVE: The purpose of this study was to describe the outcome of peripartum cardiomyopathy in patients cared for in a community hospital. STUDY DESIGN: The cases of peripartum cardiomyopathy treated at Central Baptist Hospital in Lexington, Kentucky, from January 1, 1992, to December 31, 1998, were reviewed. RESULTS: Eleven patients with peripartum cardiomyopathy were identified. The patient population was 91% white and 9% African American. Seventy-two percent of patients were nulliparous, and the prevalence of chronic hypertension was 27%. All patients were examined with echocardiography and met diagnostic criteria for the disease when this modality was used. The mean ejection fraction was 32% +/- 10%. Invasive techniques used to assist in diagnosis included left ventricular catheterization (63%), right ventricular catheterization (54%), and cardiac biopsy (54%). One patient required cardiac transplantation. This patient also had an embolic stroke from a confirmed mural thrombus. No study patient died of the disease, and no other major complications were observed. CONCLUSIONS: The patient profile of peripartum cardiomyopathy in this study differed remarkably from profiles in published reports. Nulliparous white women have better outcomes than indicated by previous reports, probably because of the low frequency of coexisting chronic disease and a younger age at diagnosis.

Adult↗
PubMed2000

Risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.

OBJECTIVE: This study was undertake to determine risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. STUDY DESIGN: Maternal medical records of pregnancies complicated by HELLP syndrome managed between July 1, 1992, and April 30, 1999, were reviewed. Risk factors evaluated included maternal age, parity, race, previous preeclampsia, chronic hypertension, gestational age at diagnosis, mean arterial blood pressure, nadir blood platelet count (<50,000 cells/microL vs > or =50,000 cells/microL), and peak serum levels of aspartate aminotransferase and lactate dehydrogenase. Maternal outcome variables analyzed included eclampsia, abruptio placentae, disseminated intravascular coagulopathy, pulmonary edema, pleural effusion, ascites, acute renal failure, liver hematoma, need for transfusion of blood products, cesarean delivery, and death. Statistical analysis was performed with the Student t test, the chi(2) test, and logistic regression analysis. RESULTS: A total of 183 women with HELLP syndrome were studied. Eclampsia was present in 6%, abruptio placentae was present in 10%, and disseminated intravascular coagulopathy was present in 8%. Forty-one women (22%) required transfusion of blood products. Incidence of eclampsia significantly decreased with increasing gestational age, from 16% at < or =28 weeks' gestation to 3% at >32 weeks' gestation (P <.05) and was higher among African American patients than among white patients (12% vs 3%; P <.05). Logistic regression analysis showed an independent relationship between eclampsia and race (P <.05). Incidence of abruptio placentae was higher among women with previous preeclampsia than among women without this clinical history (26% vs 5%; P <.05). Disseminated intravascular coagulopathy was significantly associated with abruptio placentae (P <.0001) and acute renal failure (P <.0001). A nadir platelet count of <50, 000/microL, a peak serum aspartate aminotransferase level of >150 U/L, and a peak serum lactate dehydrogenase level of >1400 U/L were not independent risk factors for adverse outcome. CONCLUSIONS: Among women with HELLP syndrome, African American race is a risk factor for eclampsia. Both acute renal failure and abruptio placentae are associated with disseminated intravascular coagulopathy. Laboratory parameters of HELLP syndrome are not independent risk factors for adverse maternal outcome.

Abruptio Placentae↗
PubMed2000

HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome versus severe preeclampsia: onset at < or =28.0 weeks' gestation.

OBJECTIVE: Our purpose was to determine whether the onset of the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome in women at < or =28.0 weeks' gestation is associated with an increased risk of adverse maternal and perinatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age. STUDY DESIGN: Sixty-four patients with either the HELLP syndrome (n = 32) or severe preeclampsia but absent HELLP syndrome laboratory test results (n = 32), admitted at < or =28.0 weeks' gestation between July 1, 1992, and April 30, 1999, were studied. Maternal and perinatal outcomes were compared between the 2 groups. Statistical analysis was performed by the Student t test and the Fisher exact test. RESULTS: There were no significant differences between the 2 groups regarding African-American race (59% vs 75%), nulliparity (50% vs 56%), or the use of corticosteroids (59% vs 78%). There were no maternal deaths. One woman with the HELLP syndrome had a liver hematoma. The rate at which transfusion of blood products was required was significantly greater in women with the HELLP syndrome than in those with severe preeclampsia only (25% vs 3%; P <.05). There were no significant differences between the 2 groups with respect to eclampsia (16% vs 13%), abruptio placentae (6% vs 9%), disseminated intravascular coagulopathy (13% vs 0%), pulmonary edema (13% vs 6%), acute renal failure (3% vs 0%), pleural effusion (3% vs 3%), or ascites (6% vs 16%). No significant differences were found between the 2 groups with respect to neonatal death (11% vs 17%), respiratory distress syndrome (78% vs 86%), or composite neonatal morbidity. CONCLUSIONS: Except for the need for transfusion of blood products in women with the HELLP syndrome, onset at < or =28.0 weeks' gestation is not associated with an increased risk of adverse maternal or neonatal outcomes in comparison with the risk for women with severe preeclampsia but without the HELLP syndrome at a similar gestational age.

Adult↗
PubMed2000

Impact of high-dose corticosteroid therapy for patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.

OBJECTIVE: The purpose of this study was to determine whether corticosteroid administration to patients with antepartum HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome would alter laboratory values diagnostic for the disease. STUDY DESIGN: Cases of 37 women with antepartum HELLP syndrome managed between March 1995 and July 1999 were reviewed. Patients were classified on the basis of exposure to corticosteroids and to the dose used. Group 1 did not receive corticosteroids. Group 2 received a standard corticosteroid dosage regimen for promotion of fetal lung maturation. Group 3 received a high-dose corticosteroid regimen of >24 mg/d (most frequently 10 mg dexamethasone as an intravenous bolus dose every 6 hours for 2 doses followed by 6 mg as an intravenous bolus dose every 6 hours for 2 to 4 doses). Antepartum changes in laboratory values from diagnosis to delivery were evaluated by means of the Kruskal-Wallis test. RESULTS: Eleven patients did not receive corticosteroids, 15 were given a standard dose, and 11 received high-dose therapy. For each laboratory value assessed (platelet count, aspartate aminotransferase activity, and lactate dehydrogenase activity), the corticosteroid groups differed significantly from the no-treatment group (P </=.002 for all). A further, significantly greater improvement in platelet count was noted between the high-dose group (81%) and the standard-dose group (17%; P =.04). The interval from diagnosis to delivery was also longer for patients treated with the high-dose protocol (51 +/- 25 hours) than for both those treated with a standard regimen (26 +/- 20 hours) and those who received no treatment (13 +/- 11 hours; P <. 001). CONCLUSION: Administration of corticosteroids to patients with antepartum HELLP syndrome improves platelet count, reduces liver enzyme abnormalities, and prolongs latency to delivery in a dose-dependent manner. Higher doses of corticosteroid than those traditionally prescribed for promotion of fetal pulmonary maturation should be considered for maternal and fetal benefits in cases of severe preeclampsia.

Adult↗
PubMed1999

Identifying appropriate tasks for the preregistration year: modified Delphi technique.

OBJECTIVES: To identify the tasks that should constitute the work of preregistration house officers to provide the basis for the development of a self evaluation instrument. DESIGN: Literature review and modified Delphi technique. SETTING: Northern Deanery within the Northern and Yorkshire office NHS executive. SUBJECTS: 67 educational supervisors of preregistration house officers. MAIN OUTCOME MEASURES: Percentage of agreement by educational supervisors to tasks identified from the literature. RESULTS: Over 61% of communication items, 70% of on call patient care items, 75% of routine patient care items, 45% of practical procedure items, and over 63% of self management items achieved over 95% agreement that they should be part of the house job of preregistration house officers. Poor agreement was found for the laboratory and clinical investigations that house officers could perform with or without supervision. CONCLUSIONS: The tasks of house officers were identified but issues in using this method and in devising a universally acceptable list of tasks for preregistration house officers were apparent.

Clinical Laboratory Techniques↗
PubMed1999

Experiences of volunteer patients during undergraduate examinations: printed information can lead to greater satisfaction.

BACKGROUND: Whilst most patients are happy to participate in medical examinations, previous studies have shown that some are dissatisfied with the information that they receive beforehand. OBJECTIVES: To demonstrate that patient satisfaction can be improved by the provision of written information. METHODS: Thirty-seven patients attending the final MBBS examination were sent written information about what to expect. The patients' experiences were assessed by means of an anonymous postal questionnaire 1 week after the examination. Their satisfaction with the level of information received beforehand was compared with that of an historical cohort who had received no written information. RESULTS: The patients had few complaints about their experience of participating in examinations and many enjoyed it. Only 5% of patients registered dissatisfaction with the level of information that was provided, compared with 18% in the previous study (P = 0.077). CONCLUSIONS: Written information led to a (near significant) improvement in patients satisfaction when compared to a previous cohort. We recommend that all patients attending for medical examinations should be provided with written information.

Education, Medical, Undergraduate↗
PubMed1999

Intravaginal saline as a contrast agent for cervical sonography in the obstetric patient.

OBJECTIVE: To determine whether intravaginal saline alters visualization of the cervix during endovaginal sonographic examinations. DESIGN: A prospective trial with comparison of sonographic measurements of cervical length prior to and after administration of an intravaginal contrast agent. SUBJECTS: Patients with an indication for endovaginal ultrasonographic assessment of the cervix were considered as candidates for the study. METHODS: After assessment of cervical dimensions and contour of the internal cervical os, 10 ml of normal saline was placed intravaginally via a needleless syringe. Pre- and post-contrast sonographic examinations of the cervix were compared. RESULTS: Twenty-six patients were enrolled. No differences were observed in the identification of funnelling (37% in each group, p = 1.0) or the quantification of cervical length for the entire cohort (p = 0.95). However, in a subset of patients in whom the external os was not satisfactorily visualized (23%), intravaginal contrast resulted in a mean difference in cervical length pre- and post-saline infusion of 6.4 mm compared to 1.4 mm in patients in whom the external os could be easily identified (p < 0.001). No patient expressed undue discomfort related to the administration of contrast. CONCLUSION: Intravaginal saline assists in visualization of the cervix during endovaginal sonography for selected patients in whom precise identification of the external os is difficult.

Cervix Uteri↗
PubMed1999

The CLO test in the UK: inappropriate reading and missed results.

BACKGROUND: In endoscopy units, the CLO test is frequently used to detect Helicobacter pylori (H. pylori). Informal survey suggested that practice deviated from that recommended, with little account taken of possible confounders such as acid-suppressing medication. OBJECTIVES: To determine the influence of reading time and acid suppression on CLO tests and to estimate impact on test results in UK endoscopy units. DESIGN: Survey of use of CLO tests. Prospective study of time to positivity and concurrent medication in CLO tests from 782 patients. SETTING: Forty-eight endoscopy units throughout the UK, and a district hospital endoscopy unit. PARTICIPANTS: Eighteen endoscopy units in the old Northern Region, and a random sample of 30 other UK units. MAIN OUTCOME MEASURES: Time of reading of CLO tests in UK units, and time to positivity of CLO tests in one hospital. RESULTS: Endoscopy units most frequently used CLO tests to assess H. pylori colonization, with marked differences in the times when tests were read. Nineteen out of 37 units discarded tests considerably earlier than the recommended 24 h. Over 20% of CLO tests became positive more than 2 h after collection, with 11% taking 24 h to change colour. Acid-suppressing medication prolonged time to positivity. CONCLUSIONS: The majority of endoscopy units read tests earlier than recommended. Acid-suppressing medication delays the development of CLO tests and may increase numbers of false-negative tests. Endoscopy units should read tests at 24 h and preferably test patients off ulcer healing medication.

Evaluation Studies as Topic↗
PubMed1998

The inflammatory bowel disease questionnaire: a valid and reliable measure in ulcerative colitis patients in the North East of England.

BACKGROUND: The validity and reliability of the Inflammatory Bowel Disease Questionnaire (IBDQ) needed to be confirmed before its use in the UK. METHODS: The IBDQ was administered to 28 subjects with ulcerative colitis (UC) on 3 separate occasions over a period of 4 weeks, twice by an interviewer and once by self-completion. Convergent and concurrent validity was assessed by using the Colitis Activity Index (CAI) and the Short Form 36 Health Survey (SF-36). Test-retest reliability and internal consistency were also tested. RESULTS: There were moderately high Pearson correlations between related IBDQ domains and SF-36 dimensions and also between the CAI score and the IBDQ Bowel domain and the SF-36 Pain dimension. Cronbach's alpha, corrected item-total correlations, and intra-class correlation coefficients were high. CONCLUSIONS: The IBDQ is a valid and reliable health-related quality of life scale for use in patients with UC and is suitable for use in the UK.

Age Factors↗
PubMed1997

Does advanced maternal age affect pregnancy outcome in women with mild hypertension remote from term?

OBJECTIVES: Our purpose was to compare maternal and perinatal outcomes of mature women with those in younger women with pregnancies complicated by mild hypertension remote from term. STUDY DESIGN: A matched cohort design was used. A total of 379 mature pregnant women (> or = 35 years old) with mild hypertension remote from term were matched for race, gestational age, and proteinuria status at enrollment with 379 adult controls aged 20 to 30 years also with mild hypertension remote from term. All were enrolled in an outpatient management program that included automated blood pressure measurements and daily assessment of weight, proteinuria, and fetal movement. RESULTS: The mean gestational age at enrollment was 32.7 +/- 3.0 weeks for both groups (range 24 to 36 weeks). By matching 20.6% of patients in each group had > or = 1+ proteinuria on urinary dipstick at enrollment, and 77.3% of patients in each group were white. Chronic hypertension was more common in the mature group (22.4% vs 14.5%, p = 0.007). The mean gestational age at delivery (37.2 +/- 2.3 vs 37.2 +/- 2.2 weeks), the mean pregnancy prolongation (28.1 +/- 21.0 vs 28.4 +/- 22.0 days), and the mean birth weights (2864 +/- 770 vs 2906 +/- 788 gm) were similar between the mature and younger groups (all p > 0.05). There were no differences regarding abruptio placentae (2 vs 3 cases) or thrombocytopenia or HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome (7 vs 9 cases), and there were no cases of eclampsia. There were five stillbirths in the mature group and none in the younger group (p = 0.063). CONCLUSION: Outpatient management of mild hypertension remote from term in the mature pregnant women was associated with similar maternal outcomes but with a nonstatistically higher stillbirth rate compared with the younger pregnant woman.

Adult↗
PubMed1997

Septic shock in pregnancy.

OBJECTIVE: To evaluate the etiology, management, and maternal and perinatal outcome in patients with septic shock during pregnancy. METHODS: In 18 patients with septic shock during pregnancy, the criteria for the diagnosis were sepsis-induced hypotension unresponsive to adequate fluid resuscitation and requirement for vasopressors. RESULTS: Causes of shock were pyelonephritis (n = 6), chorioamnionitis (n = 3), postpartum endometritis (n = 2), toxic shock (n = 2), and one each of septic abortion, ruptured appendix, ruptured ovarian abscess, necrotizing fasciitis, and bacterial endocarditis. Five women (28%) died. Comparing medians of the initial laboratory data for the 13 survivors with those of the five nonsurvivors revealed significant differences for hematocrit (26 compared with 35%; Z = -2.267, P = .023), aspartate aminotransferase (30 compared with 287 U/L; Z = -2.068, P = .042), total bilirubin (1.6 compared with 5.8 mg/dL; Z = 2.046, P = .045), arterial carbon dioxide pressure (30 compared with 19 mmHg; Z = -2.384, P = .013), and arterial oxygen pressure (62 compared with 104 mmHg; Z = -2.004, P = .048). Comparing medians of the hemodynamic data showed differences in blood pressure (88 compared with 70 mmHg; Z = -2.439, P = .013), stroke volume (74 compared with 52 mL; Z = -2.041, P = .038), and left ventricular stroke work index (42 compared with 12 g.m.m2; Z = -1.929, P = .052). Sixty-four percent of survivors and 80% of nonsurvivors had depressed left ventricular function (Fisher exact test, P > .99). Locating the source of infection was difficult and delayed in eight patients. CONCLUSION: In women with septic shock, progression to death can be dramatically rapid. Because vascular permeability is increased, it may be appropriate to administer vasopressors early during resuscitation. An initial low cardiac output is a poor prognostic sign.

Adolescent↗