Search PubMed⌕ Search

Biomedical subjects

N Edwards

Publications and source records attributed to N Edwards.

At least 19 recordsLinked to original sources
PubMed2007

Queensland psychiatrists' attitudes and perceptions of adults with intellectual disability.

BACKGROUND: Quality mental health care for adults with an intellectual disability (ID) depends upon the availability of appropriately trained and experienced psychiatrists. There have been few surveys of psychiatrists working with this population. METHOD: This Australian study obtained psychiatrists' attitudes to and perceptions of the mental health needs of adults with an ID. Training needs were also sought. The survey instrument used was a purposely designed, 28-item self-administered questionnaire featuring multiple-choice and open-ended questions. RESULTS: The majority of psychiatrists expressed concerns about treatment of this group, describing unmet needs. A total of 75% considered that antipsychotics were overused to control aggression, and 34% of psychiatrists were reluctant to treat adults with an ID. In total, 85% agreed that mental health in ID should be offered as a training option for psychiatric registrars, and that specialized mental health services would provide a high standard of care for this population. CONCLUSION: Broad concerns are raised regarding pathways to mental health care for adults with an ID in Australia. An Australia-wide training strategy needs to be developed. Partnerships between mental health, disability and community services that serve the mental health needs of this population, should actively seek to engage psychiatrists.

Adult↗
PubMed2005

Home-like versus conventional institutional settings for birth.

BACKGROUND: Home-like birth settings have been established in or near conventional labour wards for the care of pregnant women who prefer and require little or no medical intervention during labour and birth. OBJECTIVES: Primary: to assess the effects of care in a home-like birth environment compared to care in a conventional labour ward. Secondary: to determine if the effects of birth settings are influenced by staffing or organizational models or geographical location of the birth centre. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (18 May 2004) and handsearched eight journals and two published conference proceedings. SELECTION CRITERIA: All randomized or quasi-randomized controlled trials that compared the effects of a home-like institutional birth environment to conventional hospital care. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. Two review authors evaluated methodological quality. Double data entry was performed. Results are presented using relative risks and 95% confidence intervals. MAIN RESULTS: Six trials involving 8677 women were included. No trials of freestanding birth centres were found. Between 29% and 67% of women allocated to home-like settings were transferred to standard care before or during labour. Allocation to a home-like setting significantly increased the likelihood of: no intrapartum analgesia/anaesthesia (four trials; n = 6703; relative risk (RR) 1.19, 95% confidence interval (CI) 1.01 to 1.40), spontaneous vaginal birth (five trials; n = 8529; RR 1.03, 95% CI 1.01 to 1.06), vaginal/perineal tears (four trials; n = 8415; RR 1.08, 95% CI 1.03 to 1.13), preference for the same setting the next time (one trial; n = 1230; RR 1.81, 95% CI 1.65 to 1.98), satisfaction with intrapartum care (one trial; n = 2844; RR 1.14, 95% CI 1.07 to 1.21), and breastfeeding initiation (two trials; n = 1431; RR 1.05, 95% CI 1.02 to 1.09) and continuation to six to eight weeks (two trials; n = 1431; RR 1.06, 95% CI 1.02 to 1.10). Allocation to a home-like setting decreased the likelihood of episiotomy (five trials; n = 8529; RR 0.85, 95% CI 0.74 to 0.99). There was a trend towards higher perinatal mortality in the home-like setting (five trials; n = 8529; RR 1.83, 95% CI 0.99 to 3.38). No firm conclusions could be drawn regarding the effects of staffing or organizational models. AUTHORS' CONCLUSIONS: When compared to conventional institutional settings, home-like settings for childbirth are associated with modest benefits, including reduced medical interventions and increased maternal satisfaction. Caregivers and clients should be vigilant for signs of complications.

Birthing Centers↗
PubMed2004

Unconscious auditory priming during surgery with propofol and nitrous oxide anaesthesia: a replication.

BACKGROUND: Priming during anaesthesia has been hard to replicate and the conditions under which it occurs remain poorly understood. We replicated and extended a recent study to determine whether intraoperative priming during propofol and nitrous oxide anaesthesia is a reliable phenomenon, whether it occurs due to awareness during word presentation and whether it is suppressed by a dose of fentanyl at induction. METHODS: Words were played through headphones during surgery to 62 patients receiving propofol and nitrous oxide anaesthesia. Thirty-two patients received fentanyl 1.5 microg kg(-1) at induction and 30 received no fentanyl. Neuromuscular blocking drugs were not used. Depth of anaesthesia was measured using the bispectral index (BIS). Anaesthetic variables were recorded at 1 min intervals during word presentation. On recovery, implicit and explicit memory were assessed using an auditory word-stem completion test and a yes-no word-recognition test, respectively. RESULTS: BIS, blood pressure, end-tidal carbon dioxide and heart rate during word presentation did not differ between the study groups. The infusion rate of propofol and the patients' ventilatory frequency were significantly higher in the group not receiving fentanyl. No patient had unprompted explicit recall of surgery, although there was above-zero performance in six patients on the yes-no recognition task (P<0.05). There was no physiological evidence of awareness during anaesthesia (median mean-BIS=38 in the no-fentanyl group and 42 in the fentanyl group). There was evidence for priming (mean priming score=0.09, P<0.05 in the no-fentanyl study group; mean priming score=0.07, P<0.05 in the fentanyl group) even when patients with momentary light anaesthesia (maximum recorded BIS> or =60) and/or positive recognition scores were excluded from the analysis. CONCLUSIONS: Existing knowledge can be primed by information presented during propofol and nitrous oxide anaesthesia. This priming is evidence of unconscious information processing and not the result of moments of awareness.

Acoustic Stimulation↗
PubMed2004

Unconscious learning during surgery with propofol anaesthesia.

BACKGROUND: Learning during anaesthesia has been demonstrated, but little is known about the circumstances under which it may occur. This study investigated the hypothesis that learning during anaesthesia occurs during, but not before, surgical stimulation. METHODS: Words were played through headphones to 64 day-surgery patients during propofol anaesthesia. Fourteen words were played repeatedly (15 times) for 1 min each either before (n=32) or during (n=32) surgical stimulation. The depth of anaesthesia was estimated using the bispectral index (BIS). Heart rate, ventilatory frequency, mean arterial pressure, end-tidal carbon dioxide concentration, and infusion rate of propofol were recorded at 1 min intervals during word presentation. On recovery, memory was assessed using an auditory word stem completion test and word recognition test. RESULTS: The mean BIS, arterial pressure, end-tidal carbon dioxide and heart rate during word presentation did not differ between the groups. The infusion rate of propofol and the ventilatory frequency were significantly greater in the during-surgical stimulation group. There was no evidence for explicit recall or recognition, nor of awareness during anaesthesia (median mean-BIS=38 in the before-surgical stimulation group and 42 in the during-surgical stimulation group). Only patients who were played words during surgical stimulation showed significant implicit memory on recovery (mean score=0.08, P<0.02) However, their scores were not significantly higher than those of the before-surgical stimulation group (mean score=0.01). CONCLUSIONS: Learning during anaesthesia seems more likely to occur during rather than before surgical stimulation at comparable anaesthetic depth. We hypothesize that surgical stimulation facilitates learning during anaesthesia, independently of its effects on anaesthetic depth.

Acoustic Stimulation↗
PubMed2004

Inter-rater agreement in defining chemical incidents at the National Poisons Information Service, London.

BACKGROUND: National surveillance for chemical incidents is being developed in the UK. It is important to improve the quality of information collected, standardise techniques, and train personnel. OBJECTIVE: To define the extent to which eight National Poison Information Service specialists in poison information agree on the classification of calls received as "chemical incidents" based on the national definition. DESIGN: Blinded, inter-rater reliability measured using the kappa statistic for multiple raters. SETTING: National Poison Information Service and Chemical Incident Response Service, Guy's and St Thomas's NHS Trust, London. PARTICIPANTS: Eight specialists in poison information who are trained and experienced in handling poisons information calls and have been involved in extracting information for surveillance. RESULTS: The overall level of agreement observed was at least 69% greater than expected by chance (kappa statistic). Fire and incidents where chemicals were released within a property had a very good level of agreement with kappa statistic of 83% and 80% respectively. The lowest level of agreement was observed when no one or only one person was exposed to a chemical (33%) and when the chemical was released into the air (48%). CONCLUSION: High levels of agreement were observed. There is a need for more training and improvement in consistency of the data collected by all organisations.

Environmental Exposure↗
PubMed2003

Patients with chronic pain and abnormal pituitary function require investigation.

Misuse of opioids is associated with abnormalities of pituitary function. Patients with chronic pain frequently complain of fatigue and undergo endocrine testing. To test whether oral opioid treatment causes abnormal pituitary function we prospectively assessed pituitary function in 37 patients with chronic pain who were receiving either oral opioid analgesia or non-opioid analgesia. Oral opioid treatment was not associated with abnormal pituitary function although a few patients had abnormal results mainly related to obesity. Our results suggest that patients with chronic pain who have abnormal endocrine results should have a complete assessment, since abnormal test results cannot be attributed to their analgesia.

Analgesics, Opioid↗
PubMed2003

Oral antioxidant supplementation for fatigue associated with primary biliary cirrhosis: results of a multicentre, randomized, placebo-controlled, cross-over trial.

BACKGROUND: We have previously reported, in an uncontrolled trial, an improvement in fatigue scores in patients with primary biliary cirrhosis given oral antioxidant supplementation. We now present data from a controlled trial. PATIENTS AND METHODS: Sixty-one patients with primary biliary cirrhosis-associated fatigue were randomized into a double-blind, placebo-controlled, cross-over trial. Participants received 12 weeks each of placebo and antioxidant supplementation (vitamins A, C and E, selenium, methionine and ubiquinone) in random order, separated by a 4-week washout period. The primary trial outcome (fatigue) was assessed using the Fisk scale. Other symptoms of primary biliary cirrhosis were measured using Likert and visual analogue scales. RESULTS: Forty-four patients completed both arms of the trial. No significant changes in fatigue were recorded in the active phase of treatment (median improvement in Fisk score, 1; P = 0.61). Small improvements in Fisk scores were recorded during placebo therapy (median improvement, 4; P = 0.03). Neither medication was associated with improvement in any other symptoms related to primary biliary cirrhosis. Adverse effects were more common during active therapy and were mild and self-limiting. One patient died from unrelated causes during active treatment. CONCLUSIONS: Although oral antioxidant supplementation appears to be safe, we could not find any evidence for a beneficial effect on fatigue or other liver-related symptoms.

Administration, Oral↗
PubMed2003

Doctors and managers: poor relationships may be damaging patients-what can be done?

The problem of poor relationships between doctors and managers is a common feature of many healthcare systems. This problem needs to be explicitly addressed and there are a number of positive steps that could be taken. Firstly, there would be value in working to improve the quality of relationships and better mutual understanding of the necessarily different positions of doctors and managers. Finding a common approach to managing resources, accountability, autonomy, and the creation of more systematic ways of working seems to be important. The use of costed clinical pathways may be one approach. Rather than seeing guidelines and accountability systems as a threat to autonomy there is an argument that they are an essential adjunct to it. Redefining autonomy in order to preserve it and to ensure that it encompasses accountability and responsibility will be an important step. A key step is the development of clinical leadership.

Hospital-Physician Relations↗
PubMed2002

Lactation is associated with an increase in slow-wave sleep in women.

Major physiological changes occur following parturition and the onset of lactation, including the withdrawal of oestrogen and progesterone, with a consequent increase in circulating prolactin (PRL). Changes in other circulating hormones are well known to alter sleep architecture in other circumstances. We therefore aimed to assess whether sleep architecture is altered in fully lactating women as a result of hormonal changes associated with lactation. A descriptive comparison study was undertaken on 12 fully breastfeeding women (B/F), 12 age-matched control women (CTRL), and seven postnatal women who had chosen to bottle-feed their infants (BOTTLE). Maternal age, infant age and body mass index (BMI) were similar between all three groups. We performed overnight polysomnography utilizing the Portable Compumedics P-series. The total sleep time (TST) and rapid eye movement (REM) sleep time were similar in the three groups of women. However, B/F women demonstrated a marked increase in slow wave sleep (SWS), 182 +/- 41 min compared with CTRL (86 +/- 22 min, P < 0.001 compared with B/F) and BOTTLE subjects (63 +/- 29 min, P < 0.001 compared with B/F). There was a compensatory reduction in light non-rapid eye movement (NREM) sleep in B/F when compared with CTRL and BOTTLE. The most likely explanation for the altered sleep architecture noted to occur in women who are fully breastfeeding their infants is an increase in circulating PRL, which occurs in lactating women. Enhanced SWS may be another important factor to support breastfeeding in the postnatal period.

Adult↗
PubMed2002

Sleep disordered breathing and pregnancy.

Many changes in the respiratory system occur during pregnancy, particularly during the third trimester, which can alter respiratory function during sleep, increasing the incidence and severity of sleep disordered breathing. These changes include increased ventilatory drive and metabolic rate, reduced functional residual capacity and residual volume, increased alveolar-arterial oxygen gradients, and changes in upper airway patency. The clinical importance of these changes is indicated by the increased incidence of snoring during pregnancy, which is likely also to reflect an increased incidence of obstructive sleep apnoea/hypopnoea syndrome. For the respiratory physician asked to review a pregnant patient, the possibility of sleep disordered breathing should always be considered. This review first examines the normal physiological changes of pregnancy and their relationship to sleep disordered breathing, and then summarises the current knowledge of sleep disordered breathing in pregnancy.

Female↗
PubMed2001

Age-related changes in frontal and temporal lobe volumes in men: a magnetic resonance imaging study.

BACKGROUND: Imaging and postmortem studies provide converging evidence that, beginning in adolescence, gray matter volume declines linearly until old age, while cerebrospinal fluid volumes are stable in adulthood (age 20-50 years). Given the fixed volume of the cranium in adulthood, it is surprising that most studies observe no white matter volume expansion after approximately age 20 years. We examined the effects of the aging process on the frontal and temporal lobes. METHODS: Seventy healthy adult men aged 19 to 76 years underwent magnetic resonance imaging. Coronal images focused on the frontal and temporal lobes were acquired using pulse sequences that maximized gray vs white matter contrast. The volumes of total frontal and temporal lobes as well as the gray and white matter subcomponents were evaluated. RESULTS: Age-related linear loss in gray matter volume in both frontal (r = -0.62, P<.001) and temporal (r = -0.48, P<.001) lobes was confirmed. However, the quadratic function best represented the relationship between age and white matter volume in the frontal (P<.001) and temporal (P<.001) lobes. Secondary analyses indicated that white matter volume increased until age 44 years for the frontal lobes and age 47 years for the temporal lobes and then declined. CONCLUSIONS: The changes in white matter suggest that the adult brain is in a constant state of change roughly defined as periods of maturation continuing into the fifth decade of life followed by degeneration. Pathological states that interfere with such maturational processes could result in neurodevelopmental arrests in adulthood.

Adult↗
PubMed2001

Hemodynamic responses to obstructive respiratory events during sleep are augmented in women with preeclampsia.

Preeclampsia is the most common disease of pregnancy, occurring in up to 10% of the pregnant population. The cause of the disease is as yet undetermined; however, most of the clinical effects are commonly attributed to damage to the endothelial layer, leading to increased pressor activity of all the maternal blood vessels. Therefore, we suspected that if obstructive sleep apnea (OSA) coexisted with preeclampsia in pregnancy, the hemodynamic effects of the OSA would be markedly potentiated. To test this hypothesis, we performed full sleep studies and overnight beat-to-beat blood pressure (BP) monitoring. The control patient group included 10 pregnant women with OSA and no evidence of hypertensive disease either before or during their current pregnancy. The test group included 10 women with preeclampsia and coexisting OSA. The pressor responses to obstructive respiratory events during sleep were enhanced in preeclamptic patients compared with control OSA patients (21+/-2/12+/-1 mm Hg and 38+/-5/25+/-4 mm Hg above baseline in control OSA and preeclamptic OSA patients, respectively, P = .005/.005). In contrast, there was no difference in heart rate responses between the two groups of subjects (34+/-5 beats/min and 49+/-13 beats/min above baseline in control and preeclamptic patient groups, respectively, P = .326). We suggest that the augmented pressor responses in preeclamptic women occur as a result of maternal endothelial damage induced by the preeclampsia disease process. These findings may have important implications in the management of preeclamptic patients.

Adult↗