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Biomedical subjects

M Barnes

Publications and source records attributed to M Barnes.

At least 73 records · Page 4Linked to original sources
PubMed1996

Assessing appropriateness of treatment: a case study of transplantation in older patients with congestive heart failure.

OBJECTIVE: To evaluate the appropriateness of transplantation therapy for older patients with congestive heart failure (CHF). DATA SOURCES: Comparative review of contemporary survival and quality of life data of CHF patients treated medically versus by transplantation. DATA SYNTHESIS: Approximately 300,000 Canadians have CHF and the incidence is increasing as the population ages; suitable donor allografts are found for about 300 CHF patients each year. Overall survival among cardiac allograft recipients, with a mean age of 48 years, is approximately 80% at two years. However, risk from all causes appears higher, and survival lower (range 40 to 78%), for transplant patients 55 years of age and older. Among medically treated patients, with mean age over 60 years, survival is inversely related to level of functional disability, averaging more than 90% at two years for patients with mild limitation and decreasing to 75% and 40% for patients with moderate and severe symptoms, respectively. Perceived quality of life is low in all CHF patients, but is significantly improved by intense out-patient care and education, irrespective of medical or transplant allocation. CONCLUSIONS: Among adults with CHF, the greatest benefit of transplantation is enhanced survival in younger severely disabled patients. However, noncardiac risks are substantial, particularly for older recipients. The great discrepancy between donor and candidate availability prohibits transplantation from being a life expanding therapy for the whole CHF population. When physicians are, simultaneously, patients' and society's advocates a utilitarian decision model using the totality of efficacy data, including degree of efficacy and population effectiveness, may assist determination of the most appropriate therapy.

Activities of Daily Living↗
PubMed1996

Protecting the rights of detained patients.

Compulsory detention in a psychiatric hospital constrains, but does not remove the rights of those admitted. The mental health laws of different countries provide for various mechanisms intended to protect the rights of detained patients. In the U.K. the Mental Health Act Commission (MHAC) was established to oversee the implementation of the 1983 Mental Health Act as a whole, and to ensure the proper treatment of individuals detained under the Act. This paper will consider the way in which the MHAC fulfills its remit, and reflect on its capacity to preserve the rights of mentally disordered people as citizens as well as patients.

Commitment of Persons with Psychiatric Disorders↗
PubMed1995

Bloodborne pathogen transmission from healthcare worker to patients. Legal issues and provider perspectives.

Health-care providers have an obvious, primary obligation to patients. Yet providers also have obligations to the public health (society), their institutional or individual self-interests, and their employees (fellow health-care workers). These obligations contain inherent conflicts, and attempts to reconcile the conflicts often perpetuate contradictions. This article identifies and discusses some of the moral and legal bases of these conflicts.

Blood-Borne Pathogens↗
PubMed1995

Can practice patterns and outcomes be successfully altered? Examples from cardiovascular medicine. The Clinical Quality Improvement Network (CQIN) Investigators.

OBJECTIVE: To offer an attributive opinion of recent improvements in acute myocardial infarction (AMI) practice patterns and patient outcomes in the culture of an active health care research program. DATA SOURCES: Review of original clinical data from five sequential, consecutively enrolled, AMI patient cohorts at the University of Alberta Hospitals from 1987-93. DATA SYNTHESIS: Early cohorts had low use of trial-proven efficacious therapies for AMI, particularly among high risk older and female patients. Over time, there were continuous and marked increases in the use of efficacious therapies and decreased use of nonefficacious therapies, with a parallel decrease in mortality among high risk patients. CONCLUSIONS: In a large tertiary care hospital between 1987 and 1993 the use of evidence-based AMI therapy and survival in high risk patients significantly increased. The continuity and large size of these improvements in AMI practice patterns, compared with similar populations reported in the contemporary literature, suggest it is unlikely they were due to chance. Rather, intercurrent repeated measurement and reporting of key health care performance indicators, and initiation of explicit critical path AMI practice guidelines provide a more likely explanation. Future studies by a network of community and university investigators will test whether these findings are true for a broad AMI population and whether similar practice definition and improvement tools are effective for other cardiac problems, including the management of congestive heart failure.

Adult↗
PubMed1995

An architecture for a distributed guideline server.

A number of barriers exist which prevent the widespread integration of practice guidelines with electronic medical record systems. These include dependencies on clinical databases, as well as problems with converting existing guideline specifications into computable rules. We are developing the MBTA (Modeling Better Treatment Advice) practice guideline system which uses a distributed client-server architecture and an object-oriented data representation to support practice guidelines usable by different electronic medical record systems. We describe the structure and organization of MBTA, focusing on how an open systems design, combined with principles of guideline implementation, can be used to provide a general purpose guideline server for use by a variety of clinical workstations.

Computer Communication Networks↗
PubMed1994

Late effects of intraoperative radiation therapy on retroperitoneal tissues, intestine, and bile duct in a large animal model.

PURPOSE: The late histopathological effects of intraoperative radiotherapy (IORT) on retroperitoneal tissues, intestine, and bile duct were investigated in dogs. METHODS AND MATERIALS: Fourteen adult foxhounds were subjected to laparotomy and varying doses (0-45 Gy) of IORT (11 MeV electrons) delivered to retroperitoneal tissues including the great vessels and ureters, to a loop of defunctionalized small bowel, or to the extrahepatic bile duct. One control animal received an aortic transection and reanastomosis at the time of laparotomy; another control received laparotomy alone. This paper describes the late effects of single-fraction IORT occurring 3-5 years following treatment. RESULTS AND CONCLUSION: Dogs receiving IORT to the retroperitoneum through a 4 x 15 cm portal showed few gross or histologic abnormalities at 20 Gy. At doses ranging from 30-45 Gy, radiation changes in normal tissues were consistently observed. Retroperitoneal fibrosis with encasement of the ureters and great vessels developed at doses > or = 30 Gy. Radiation changes were present in the aorta and vena cava at doses > or = 40 Gy. A 30 Gy dog developed an in-field malignant osteosarcoma at 3 years which invaded the vertebral column and compressed the spinal cord. A 40 Gy animal developed obstruction of the right ureter with fatal septic hydronephrosis at 4 years. Animals receiving IORT through a 5 cm IORT portal to an upper abdominal field which included a defunctionalized loop of small bowel, showed a few gross or histologic abnormalities at a dose of 20 Gy. At 30 Gy, hyaline degeneration of the intestinal muscularis layer of the bowel occurred. At a dose of 45 Gy, internal intestinal fistulae developed. One 30 Gy animal developed right ureteral obstruction and hydronephrosis at 5 years. A dog receiving 30 Gy IORT through a 5 cm portal to the extrahepatic bile duct showed diffuse fibrosis through the gastroduodenal ligament. These canine studies contribute to the area of late tissue tolerance to IORT.

Anastomosis, Surgical↗
PubMed1994

The inadequacy of standard treatment of dysplasias in a woman with acquired immune deficiency syndrome.

The current state of knowledge regarding the gynecologic care of HIV-infected women is in its infancy. Standard algorithms are not valid. We present an example of the inadequacy of routine surveillance and treatment methods in these patients. Practitioners should maintain a high index of suspicion for multifocal genital dysplasias and individualize patient follow-up and therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Properties of the nuclear P1 protein, a mammalian homologue of the yeast Mcm3 replication protein.

Polyclonal antibodies were raised against a multiprotein 'holoenzyme' form of calf thymus DNA polymerase alpha-primase and used to probe a human cDNA-protein expression library constructed in the lambda gt11 vector. The probe identified a series of cDNA clones derived from a 3.2 kb mRNA which encodes a novel 105 kDa polypeptide, the P1 protein. In intact cells, the P1 protein was specifically associated with the nucleus, and in cell extracts, it was associated with complex forms of DNA polymerase alpha-primase. The synthesis of human P1-specific mRNA was stimulated upon addition of fresh serum to growth-arrested cells, and RNA blot analyses with the human P1-cDNA probe indicated that P1 is encoded by a strictly conserved mammalian gene. The amino acid sequence deduced from a 240-codon open reading frame resident in the largest human P1-cDNA (0.84 kb) displayed greater than 96% identity with that deduced from the equivalent segment of a 795-codon open reading frame of a larger mouse P1-cDNA (2.8 kb). Throughout its length, the primary structure of mammalian P1 displayed strong homology with that of Mcm3, a 125 kDa yeast protein thought to be involved in the initiation of DNA replication (Gibson et al. 1990. Mol. Cell. Biol. 10: 5707-5720). The P1-Mcm3 homology, the strong conservation of P1 among mammals, its nuclear localization, and its association with the replication-specific DNA polymerase alpha strongly suggest an important role of the P1 protein in the replication of mammalian DNA.

Amino Acid Sequence↗