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M J Barry

Publications and source records attributed to M J Barry.

At least 19 recordsLinked to original sources
PubMed2004

Clinical inertia in the management of Type 2 diabetes metabolic risk factors.

AIMS: Delays in the initiation and intensification of medical therapy may be one reason patients with diabetes do not reach evidence-based goals for metabolic control. We assessed intensification of medical therapy over time, comparing the management of hyperglycaemia, hypertension, and hyperlipidaemia. METHODS: Prospective cohort study of 598 adults with Type 2 diabetes receiving primary care in an academic medical centre from May 1997 to April 1999. We assessed whether patients failing to achieve standard treatment goals for haemoglobin A1c (HbA1c), systolic blood pressure (SBP), or low density lipoprotein (LDL) cholesterol when last measured during 12 months (Year 1, 5/97-4/98) had increases in their corresponding medical regimen during the following 12 months (Year 2, 5/98-4/99). RESULTS: Among untreated patients in Year 1, seven of 12 (58%) of those above goal for HbA1c were initiated on medical therapy in Year 2, compared with 16 of 48 (34%) above SBP goal (P=0.02) and 26 of 115 (23%) above LDL cholesterol goal (P=0.02). Among patients on therapy and above goal, 124 of 244 (51%) patients with elevated HbA1c had their regimen increased in Year 2, compared with 85 of 282 (30%) with elevated SBP (P<0.001) and 22 of 79 (30%) with elevated LDL cholesterol (P<0.001). From Year 1 to Year 2 there was a decline in the overall proportion of patients above goal for LDL cholesterol (from 58% to 45%, P=0.002) but not for HbA1c or blood pressure. CONCLUSIONS: Greater initiation and intensification of pharmaceutical therapy, particularly for elevated blood pressure or cholesterol, may represent a specific opportunity to improve metabolic control in Type 2 diabetes.

Aged↗
PubMed2002

Fecal occult blood testing for colorectal cancer: a perspective.

Colorectal cancer is an important health problem in western countries. Early detection of colorectal cancer reduces mortality. The best evidence for the effectiveness of screening for colorectal cancer is with annual or biennial fecal occult blood testing. While the benefit of fecal occult blood testing is small in absolute terms, the incremental cost-effectiveness of this screening strategy appears acceptable. Combining fecal occult blood testing with periodic flexible sigmoidoscopy or replacing it altogether with infrequent colonoscopy are theoretically attractive screening strategies, but the incremental costs and effectiveness of these more intensive screening strategies have not been well defined. Whether and how to implement population-based screening for colorectal cancer depends largely on available resources.

Colorectal Neoplasms↗
PubMed2001

Outcomes for men with clinically nonmetastatic prostate carcinoma managed with radical prostactectomy, external beam radiotherapy, or expectant management: a retrospective analysis.

BACKGROUND: With a lack of data from randomized trials, the optimal management of men with nonmetastatic prostate carcinoma is controversial. The authors sought to define the outcomes of three common strategies for managing patients with nonmetastatic prostate carcinoma: expectant management, radiotherapy, and radical prostatectomy. METHODS: The authors conducted a retrospective cohort study with standardized collection of key prognostic data, including centralized assignment of Gleason grades from original biopsy specimens. Participants included all Connecticut hospitals (the expectant management cohort) and three academic medical centers in other states (the radiotherapy and surgery cohorts). Two thousand three hundred eleven consecutive men ages 55-74 years who were diagnosed during 1971-1984 with nonmetastatic prostate carcinoma and were treated at the participating sites were included. RESULTS: Kaplan-Meier estimates with 95% confidence intervals (95% CI) of overall survival at 10 years for each cohort were as follows: expectant management cohort, 42% of patients (95% CI, 38-46%); radiotherapy cohort, 52% of patients (95% CI, 46-58%); and radical prostatectomy cohort, 69% of patients (95% CI, 67-71%); for disease specific mortality, the estimates were as follows: expectant management cohort, 75% of patients (95% CI, 71-79%); radiotherapy cohort, 67% of patients (95% CI, 61-73%); and radical prostatectomy cohort, 86% of patients (95% CI, 84-88%). There were large differences in distributions of important prognostic factors among men in the different treatment groups. CONCLUSIONS: These data provide precise estimates of the outcomes of patients who have been treated with different modalities for nonmetastatic prostate carcinoma in the recent past. Direct comparisons of outcomes between treatment groups are inadvisable because of the different characteristics of patients who select these alternative management strategies.

Aged↗
PubMed2001

Preliminary toxicity assessment of water after treatment with UV-irradiation and UVC/H2O2.

Photooxidation (UV radiation) and enhanced photooxidation (UVC/H2O2) are water treatment technologies which remove aquatic natural organic matter (NOM) by photodegradation, producing lower molecular weight components and CO2. Since these technologies are being investigated for the treatment of drinking water, knowledge of the potential toxicity of the photooxidation by-products is vital. The potential toxicity of UVA-, UVB-, UVC-irradiated, and UVC/H2O2-treated aquatic NOM in two spot samples from two Australian reservoirs was analysed in two spot samples using Vibriofischeri in the Microtox test, African green monkey kidney cells (AS/NZS 4020:1999), and Daphnia carinata in an acute immobilisation test. Toxicity was not apparent for both the Microtox procedure and cytotoxicity analyses for the UVC-irradiated and UVC/H2O2-treated NOM samples, while UVA- and UVB-irradiated water samples were non-toxic to D. carinata. In contrast, acute toxicity was observed for UVC- and UVC/H2O2-treated water samples. The observed toxicity was attributed to photooxidative degradation of NOM-metal binding sites, which resulted in the release of bioavailable copper ions, as evidenced by higher concentrations of free copper ions in photooxidised water. As the total copper concentrations of the two raw water samples were well below the Australian Water Quality Guidelines for metals in domestic supplies, the release of copper from photooxidised NOM is unlikely to cause health concerns in these samples.

Animals↗
PubMed2001

Evaluation of symptoms and quality of life in men with benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is a common histologic condition among older men, which conveys its morbidity through lower urinary tract symptoms and complications, such as acute urinary retention, obstructive uropathy, and urinary tract infections. The mechanisms linking the histologic process and lower urinary tract symptoms remain uncertain; prostatic enlargement and bladder outlet obstruction are involved. However, measurements of prostate size and the severity of bladder outlet obstruction correlate poorly with the severity of lower urinary tract symptoms. The severity of lower urinary tract symptoms associated with BPH can be measured reliably, from the patient's perspective, with a number of validated questionnaires, including the International Prostate Symptom Score, the Danish Prostate Symptom Score, and the International Continence Society (ICS)male questionnaire. In the clinical setting, these questionnaires can be used (1) to assess the severity of symptoms in men with lower urinary tract symptoms that may be attributable to BPH, based on their age and clinical characteristics; and (2) to follow changes in symptoms over time and with treatment. None of these questionnaires can accurately determine whether a symptomatic patient has underlying bladder outlet obstruction. Additional questionnaires are available to measure the impact of lower urinary tract symptoms on men's lives, as well as associated phenomena, such as continence and sexual function, which may be affected by BPH and its treatments. Men with a severe burden of lower urinary tract symptoms often have measurable decrements in overall health-related quality of life, which can be ameliorated by treatment.

Aged↗
PubMed2001

Treatments for prostate cancer in older men: 1984-1997.

OBJECTIVES: To examine the temporal trends in radical prostatectomy (RP), brachytherapy (BT), and external beam radiotherapy (EBRT) rates among men aged 65 years or older for the period 1984 to 1997. METHODS: We used the retrospective population-based analysis of treatments for prostate cancer among Medicare beneficiaries. The rates of RP were obtained from Part A (hospital) Medicare data for 20% of the national sample for 1984 to 1997. The BT and EBRT rates for the period 1993 to 1997 were obtained from a 5% national sample of Physician/Supplier Part B data. The rates of treatment, 30-day mortality, and readmissions were included. RESULTS: The rate of RP peaked in 1992. From 1993 to 1997, its use decreased by 6% among men aged 65 to 69 years, 34% among men aged 70 to 74 years, and 50% for men aged 75 years or older. However, by 1997, the RP + BT treatment rate again approached the 1992 levels of RP alone; BT was used twice as often as RP in men aged 75 years or older. By 1997, the RP + BT + EBRT rate exceeded the 1993 rate for men aged 65 to 69 years and was again approaching the 1993 rate for men aged 70 to 74 years. From 1984 to 1997, the presence of comorbid conditions gradually declined for RP and accounted for more than 60% of the decrease in the short term mortality during this period. Variations in RP use by geographic region have also decreased. CONCLUSIONS: RP is now more selectively targeted for treatment of prostate cancer in men older than 70 years than in the past. However, since BT has been substituted for radical surgery in many of these older men, the total population-based treatment rates have changed very little over time.

Age Factors↗
PubMed2001

A frequently used patient and physician-directed educational intervention does nothing to improve primary care of prostate conditions.

OBJECTIVES: To measure the impact of an educational intervention directed at both patients and their primary care physicians about prostate-related conditions. METHODS: We used a randomized, control design for 50 physicians in 33 rural primary care practices from New England and Arkansas and a probability sample of 2402 of their male patients. For the physicians, we mailed two newsletters, conducted two face-to-face research staff visits, and provided printed educational manuals about the management of prostate conditions. For the patients, mailed educational pamphlets were targeted to the baseline symptom levels. After 18 months, 87% of patients and 92% of physicians completed a final survey. The patient survey measured health status, urinary symptoms and bother, treatments received, and prostate-related knowledge. The final physician survey asked them about their management of common prostate conditions. RESULTS: Before randomization, most men (59%) said they knew little or nothing about prostate problems that affect urination, and 63% also reported "little" or "no" knowledge about prostate-specific antigen testing. Eighteen months later, we observed no differences between the intervention and control patients in the measures of health status, urinary symptoms and bother, treatments received, and prostate-related knowledge. The intervention, physicians' knowledge, and self-reported practices for managing common prostate conditions were no better than the control physicians'. CONCLUSIONS: This commonly used education strategy had no measurable impact on prostate-related care.

Adult↗
PubMed2001

Risk factors for clinical benign prostatic hyperplasia in a community-based population of healthy aging men.

We defined risk factors for a clinical diagnosis of benign prostatic hyperplasia (BPH) among subjects of the population-based Massachusetts Male Aging Study. In 1987-89 1709 men aged 40-70 provided baseline risk factor data and were followed for a mean of 9 years; 1019 men without prostate cancer provided follow-up data. We classified men with clinical BPH at follow-up if they reported (1) frequent or difficulty urinating and were told by a health professional that they had an enlarged or swollen prostate or (2) if they reported having surgery for BPH. At follow-up the prevalence of clinical BPH was 19.4%, increasing from 8.4% of men aged 38-49 years to 33.5% of men aged 60-70 years (P < 0.001 for trend). Elevated free PSA levels (age- and total PSA-adjusted OR, top vs. bottom quartile ng/mL 4.4, 95% CI 1.9-10.5), heart disease (age-adjusted OR 2.1, CI 1.3-3.3), and use of beta-blocker medications (OR 1.8, CI 1.1-3.0) increased odds for BPH, while current cigarette smoking (OR 0.5, CI 0.3-0.8) and high levels of physical activity (top vs. bottom quartile kcals/day OR 0.5, CI 0.3-0.9) decreased odds of BPH. All but the medication effects persisted in fully adjusted multivariable models. Total or fat calorie intake, sexual activity level, alcohol intake, body mass index, waist-hip ratio, diastolic blood pressure, a history of diabetes, hypertension, vasectomy, or serum levels of androgens or estrogens did not individually predict clinical BPH. We conclude that physical exercise and cigarette smoking appear to protect against development of clinical BPH. Elevated free PSA levels predict clinical BPH independent of total PSA levels. Risk associated with heart disease does not appear to be due solely to detection bias or to effects of heart disease medications. A wide variety of other characteristics appear to have no influence on risk for clinical BPH.

Adult↗
PubMed2001

Intrathecal baclofen for generalized dystonia.

The aim of this study was to evaluate the effects of intrathecal bacolfen (ITB) on patients with severe generalized dystonia. Eighty-six participants ranging in age from 3 to 42 years (median age 13 years) with generalized dystonia refractory to oral medications were offered treatment with ITB. Dystonia was associated with cerebral palsy in 71% of participants. Response to ITB was tested by continuous infusions in 72%, and by bolus injections in 17% of participants who had both dystonia and spasticity. Ninety-one percent of participants responded to the screening infusion and 93% to the bolus injections. Pumps were implanted in 77 participants. Dystonia scores at 3, 6, 12, and 24 months were significantly decreased (p<0.005) compared with baseline scores. Dystonia scores were significantly lower in those with intrathecal catheters positioned at T4, or higher than in those with catheters at T6 or lower (p=0.005). Ninety-two percent of participants implanted with a pump retained their responses to ITB during a median follow-up of 29 months. Patient questionnaires indicated that quality of life and ease of care improved in 86% and speech improved in 33%. Side effects of ITB occurred in 26% of participants. Surgical complications occurred in 38% and included CSF leaks, infections, and catheter problems. ITB is probably the treatment of choice for generalized dystonia if oral medications are ineffective.

Adolescent↗
PubMed2001

The prevalence and implications of incidental findings on ED abdominal CT scans.

We reviewed reports from 321 consecutive emergency department (ED) noncontrast, helical "renal stone" abdominal CT scans obtained at a single medical center between April 1996 to June 1997 for incidental findings. Incidental findings were common (45% of scans), and approximately half were rated of "moderate" or "serious" concern by 2 independent reviewers (kappa = 0.72). ED records indicated that only 21% of incidental findings were documented, and only 11 (18%) of cases with findings of "moderate/severe" concern had evidence of follow-up on hospital chart review. Although work-up of these 11 cases did not yield any serious diagnoses, many potentially serious incidental findings without follow-up remain worrisome.

Abdomen↗
PubMed2001

Selective serotonin reuptake inhibitors: Their effect on high-intensity exercise performance.

OBJECTIVE: To determine the neuromuscular and performance effects of acute and long-term exposure to selective serotonin reuptake inhibitors (SSRIs). DESIGN: Two randomized, double-blind, crossover studies. SETTING: Departments of Kinesiology and Medicine, McMaster University, Hamilton, Ont, Canada. PARTICIPANTS: Eleven healthy, college-aged men in the acute study; 12 healthy, college-aged men in the chronic study. INTERVENTIONS: In the acute study, subjects were given a placebo and fluoxetine (40 mg) 6 hours before testing, in the chronic study, they were given fluoxetine (40mg/d) and an identical placebo for 2 weeks before testing. MAIN OUTCOME MEASURES: Target measures were maximum voluntary contractions (MVCs), evoked peak torque, and percentage of motor unit activation for muscle strength and central drive. Repeated Wingate cycle ergometer tests were used to measure anaerobic power, capacity, and fatigue index. VO2max tests (80%, 90%) were used to measure time to exhaustion and cardiorespiratory responses. RESULTS: In the acute study phase, MVC was lower for fluoxetine versus placebo (p =.05) and a slight fatigue resistance was measured in the repeated Wingate tests for the fluoxetine group; however, there were no affects on any other measured variable. In the chronic study phase, minute ventilation was lower for the fluoxetine trial (p <.05); however, there were no treatment affects on any of the other measurements. CONCLUSION: Acute and chronic SSRI intake does not effect strength or high-intensity exercise performance in young adult men.

Adult↗
PubMed2001

ANCA pattern and LTA haplotype relationship to clinical responses to anti-TNF antibody treatment in Crohn's disease.

BACKGROUND & AIMS: In the clinical trial, a lower response to infliximab was observed in some patients after multiple infusions, suggesting that clinical subgroups of Crohn's disease (CD) exist based on response to anti-tumor necrosis factor (anti-TNF). The aim of this study was to characterize these subgroups further by antineutrophil cytoplasmic antibody (ANCA) pattern and TNF genotype. METHODS: Crohn's Disease Activity Index (CDAI) data from the North American patients in the clinical trial (n = 59) were evaluated as the response parameter. Speckled ANCA (sANCA) subjects were ANCA positive by ELISA with a speckling over the entire neutrophil on indirect immunofluorescence. Genotypes were determined for polymorphisms in the TNF/lymphotoxin alpha (LTA) region. RESULTS: Response to infliximab as median change in CDAI was placebo (least response) < perinuclear ANCA (pANCA) < not pANCA or sANCA < sANCA (greatest response) (P(overall) = 0.003; 4 weeks). The response of subjects with sANCA was significantly different from that of placebo at all time points; that of pANCA subjects was not. Homozygotes for the LTA NcoI-TNFc-aa13L-aa26 haplotype 1-1-1-1 did not respond (P(overall) = 0.007). CONCLUSIONS: These observations suggest that sANCA may identify a CD subgroup with a better response to infliximab and that pANCA and homozygosity for the LTA 1-1-1-1 haplotype may identify subgroups with a poorer response.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed2000

Comparison of recommendations by urologists and radiation oncologists for treatment of clinically localized prostate cancer.

CONTEXT: Multiple treatment options are available for men with prostate cancer, but therapeutic recommendations may differ depending on the type of specialist they consult. OBJECTIVE: To define and contrast the distribution of management recommendations by urologists and radiation oncologists for a spectrum of men with prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: Mail survey sent in 1998 to a random sample of physicians in the United States, who were listed as urologists (response rate 64%, n=504) and radiation oncologists (response rate 76%, n=559) in the American Medical Association Registry of Physicians and practicing at least 20 hours per week. MAIN OUTCOME MEASURE: Questionnaire addressing beliefs and practices regarding prostate cancer management. RESULTS: Forty-three percent of radiation oncologists vs 16% of urologists would recommend routine prostate-specific antigen testing for men aged 80 years and older. For men with moderately differentiated, clinically localized cancers, and a more than 10-year life expectancy, 93% of urologists chose radical prostatectomy as the preferred treatment option, while 72% of radiation oncologists believed surgery and external beam radiotherapy were equivalent treatments. For most tumor grades and prostate-specific antigen levels, both specialty groups were significantly more likely to recommend the treatment in their specialty than the other treatment. Both groups reported giving patients similar estimates of the risks of complications due to surgery and radiation. Neither group favored watchful waiting in their treatment management except for a subset of men with life expectancies of less than 10 years and cancers with very favorable prognoses (Gleason score of 3 or 4 and prostate-specific antigen level </=5 ng/mL). CONCLUSIONS: Based on this study, while urologists and radiation oncologists do agree on a variety of issues regarding detection and treatment of prostate cancer, specialists overwhelmingly recommend the therapy that they themselves deliver. JAMA. 2000;283:3217-3222

Adult↗
PubMed2000

The acute and chronic toxicity of lanthanum to Daphnia carinata.

The rare earth elements (REEs) are increasingly being used as trace supplements in agriculture. This study measured the acute and chronic toxicity of one REE, lanthanum (La), to Daphnia carinata. The 48-h EC50 of La to Daphnia was measured in three media of differing composition and hardness. Lanthanum was most toxic to Daphnia in soft tap water (TW) with an acute 48-h EC50 of 43 microg/l compared with 1180 microg/l in ASTM hard water (ASTM). In the third daphnid growth medium (DW), based on diluted sea water, the acute 48-h EC50 was 49 microg La/l, however, there was significant precipitation of La in this media. The chronic toxicity of La to Daphnia was measured in the DW and ASTM media. Nominal exposure concentrations were 100, 200, 400, 600, 800, and 1000 microg La/l. Mortality was a more sensitive endpoint than growth or reproduction in both chronic experiments. Very little La was detected in either media after 24 h and the measured concentrations below were estimated by logarithmic mean of nominal and measured values. There was 100% mortality at concentrations > or = 80 microg La/l (400 microg/l nominal) by day six of the experiment using DW media, but no effect on survival growth or reproduction at lower concentrations. In the ASTM media, La caused significant mortality to Daphnia at concentrations > or = 39 microg/l (200 microg/l nominal), however, at least one animal survived to the end of the study at each of the tested concentrations. There was no effect of La on growth of surviving daphnids at concentrations < or = 57 microg/l (400 g/l), however, second brood clutch sizes were significantly increased at 30, 39, and 57 microg/l (100, 200, 400 g/l nominal) compared with controls. Lanthanum also caused a delayed maturation in Daphnia.

Animals↗
PubMed2000

Diagnosing and treating chronic prostatitis: do urologists use the four-glass test?

OBJECTIVES: To examine the diagnosis and treatment of chronic prostatitis, we conducted a national mail survey of practicing urologists in 1998. METHODS: Probability samples were drawn from the American Medical Association Registry of Physicians. RESULTS: Five hundred four urologists responded (response rate 64%). Urologists reported seeing a median of 30 patients (interquartile range 11 to 60) newly diagnosed with chronic prostatitis in the previous 12 months. Eighty percent of urologists responded that they "rarely" (47%) or "never" (33%) performed the Meares-Stamey four-glass diagnostic test. Only 4% answered "almost always." Forty percent of urologists responded that they treat "all" their patients with antibiotics and 42% more responded that they treat "more than half" with antibiotics. Physicians who routinely performed the four-glass test did not differ in antibiotic use from those who used the test less often; however, they were more likely to use treatment other than antibiotics. For example, alpha-blockers were used in one half or more of the patients by only 35% of physicians who never do the four-glass test compared with 42% who rarely do the test and 57% who do the test more often (P = 0.002). Results were similar for treatment with natural remedies. CONCLUSIONS: Urologists frequently diagnose chronic prostatitis but rarely perform the four-glass diagnostic test. Use of the four-glass test does not appear to affect urologists' antibiotic treatment patterns. Although bacterial prostatitis is thought to be rare, antibiotic use in the population of men with prostatitis is not. The four-glass test and empiric antibiotics are practices in the diagnosis and treatment of prostatitis that deserve scrutiny.

Adult↗
PubMed2000

Age-related changes in preschool children's systematic use of private speech in a natural setting.

This study set out to explore the contexts in which preschool children use private speech, or self-talk, in the naturalistic setting of the preschool classroom, and age-related changes in the contexts in which preschoolers talk to themselves. A total of 2752 naturalistic observations of fourteen three-year-old and fourteen four-year-old children were conducted using a time-sampling procedure in two preschool classrooms over the course of one semester. Results from logistic regression analyses revealed that both age groups were (a) more likely to use private speech during the self-selected activity classroom context as opposed to both large group and outside free play classroom contexts, and (b) most likely to talk to themselves when alone, next likely in the presence of peers, and least likely when in the presence of a teacher. Although the probability of private speech among three-year-old children did not vary as a function of the child's immediate activity, four-year-old children's private speech was more likely to occur during sustained and focused goal-directed activity as opposed to rapidly-changing and non goal-directed activity. The findings suggest that private speech appears systematically in young children and that, in several ways, four-year-old children use private speech more selectively than three-year-olds.

Adult↗