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Biomedical subjects

P Barker

Publications and source records attributed to P Barker.

At least 37 records · Page 2Linked to original sources
PubMed2002

Surgical repair of intercostal pulmonary hernia secondary to cough induced rib fracture.

Intercostal pulmonary hernia, a protrusion of lung parenchyma with overlying pleural membranes through an abnormal defect in the thoracic cage, is an uncommon phenomenon. Rib fractures caused by coughing similarly represent an infrequently occurring clinical presentation. Pulmonary herniation through an intercostal defect caused by cough fractures has been described twice in the literature to our knowledge. We present a case of pulmonary herniation secondary to cough fracture in a chronic bronchitic, successfully treated by thoracotomy with application of the basic principles of hernia repair, and a discussion of the mechanisms of injury.

Aged↗
PubMed2001

The use of 188Re to treat in-stent re-stenosis of coronary arteries.

A pilot study has been conducted in which coronary arteries subject to re-stenosis after angioplasty and stenting have been irradiated following further angioplasty. The method of irradiation has been to use radioactive 188Re in an angioplasty balloon. This paper considers all aspects of the procedure including elution of the rhenium from a tungsten/rhenium generator, its concentration, dispensing and safe delivery to the patient using specially designed equipment to reduce staff doses and radioactive spills. In the pilot study of 28 lesions in 26 patients only 1 was recorded as having angiographic re-stenosis in the treated region at 6 months although 4 other patients had edge re-stenosis. This represents less than 18% re-stenosis in a population that would have been expected to exhibit at least 50% re-stenosis at 6 months. A total of 72 patients have been treated either in the pilot study or a subsequent trial. In only one case has a minor spill of radioactivity occurred and in no case has the balloon burst. Radiation doses to staff are approximately 20 microSv per procedure and are therefore not of serious consequence. It is concluded that this procedure is safe, feasible and effective in reducing in-stent re-stenosis.

Angioplasty, Balloon, Coronary↗
PubMed2001

The Tidal Model: developing an empowering, person-centred approach to recovery within psychiatric and mental health nursing.

Nursing theories and nursing models have a low profile within psychiatric and mental health nursing in the United Kingdom. This paper describes the philosophical and theoretical background of the Tidal Model, which emerged from a 5-year study of the 'need for psychiatric nursing'. The Tidal Model extends and develops some of the traditional assumptions concerning the centrality of interpersonal relations within nursing practice. The model also integrates discrete processes for re-empowering the person who is disempowered by mental distress or psychiatric services or both. The paper reports briefly on the ongoing evaluation of the model in practice.

Humans↗
PubMed2001

Penetrating wounds of the torso.

Penetrating trauma is on the increase as a result of interpersonal violence throughout the world. It is essential that military surgeons are familiar with such injuries and trained not only in the principles of their management, but also have first-hand operative experience before deployment in the field of conflict. More often than not, this experience is to be gained in the civilian urban setting in countries such as South Africa and the USA. The article addresses the first requirement--the principles of management--and outlines basic measures to enable those unfamiliar with penetrating wounds of the torso to make a reasonable and directed approach to dealing with these patients. It does not attempt to give definitive advice on specific injuries. It is organised according to anatomical regions, but emphasises that this is only in order to put shape to the article; penetrating injuries frequently having no respect for anatomical boundaries. Particular attention is drawn to difficult areas such as mediastinal injuries, and to modern concepts of 'damage control' surgery and the 'abdominal compartment syndrome'. The emphasis throughout is on how to get out of trouble and where particular danger spots may be anticipated. Reference will be made to the differences that may be expected within the military environment as opposed to the civilian setting, where rapid and (usually) safe evacuation to a well-equipped secure facility may not be possible. The article aims to raise the awareness of those involved in the care of patients with penetrating wounds of the torso that a methodical approach with a practised team of experienced individuals can salvage injuries which at first sight may seem terrifying or hopeless.

Abdominal Injuries↗
PubMed2001

Tumour markers--magic or menace?

Breast cancer follow-up is aimed at the detection of metastatic disease at a stage when it can still be treated. Traditionally this has been done on a symptomatic basis confirmed by UICC criteria. By inference, tumour burden by this time is likely to be high, and therefore any therapy possibly less effective. Breast Serum Tumour Marker estimation, while disease volume is still low, has been shown in a District General Hospital setting to allow early treatment and monitor efficacy of therapy. A randomised multi-centre study is essential to determine whether these investigations are sensible and life-saving or costly and confusing.

Adult↗
PubMed2000

The Phil Hearne course: an evaluation of a multidisciplinary mental health education programme for clinical practitioners.

A description and evaluation of the pilot of a 30-week multidisciplinary mental health education programme (The Phil Hearne Course) is presented. The course was based upon the expressed service needs of an NHS Trust and upon the needs of users consulted during the developmental phase of the project. The course was designed to provide core skills, relating to effective assessment, communication, intervention and networking. These skills were thought to be applicable to all mental health disciplines. The course was evaluated positively by students and staff and was found to be effective in improving practice by providing a range of core skills for mental health workers. It was also determined that students tended to over-estimate their skills in core areas, particularly care planning and record-keeping. It is intended to develop the course into a distance learning, skills-based package.

Education, Nursing, Continuing↗
PubMed2000

The required role of the psychiatric-mental health nurse in primary health-care: an augmented Delphi study.

An augmented Delphi study was employed to elicit the perceptions of CPNs, GPs, social workers, managers of psychiatric nursing services and health service purchasers in England, on the role required of a psychiatric (mental health) nurse in primary health care. In the final stage of the study, users of mental health service were enlisted in a verification study of the emergent findings. A broad consensus emerged that a gap existed in mental health services in primary care. This was perceived as placing a large burden on GPs, which might be reduced by the appropriate development of community psychiatric-mental health nursing. The study suggested the possibilities for development of a 'mental health nurse consultant' role, which might augment the current CPN role, within which the nurse might offer not only direct patient care, but also support to members of the primary care team.

Attitude of Health Personnel↗
PubMed2000

Damage control surgery--concepts and practice.

The results of prolonged and extensive procedures in the critically injured are poor, even in experienced hands. The operating theatre is a hostile and physiologically unfavourable environment for the severely injured patient. Laparotomy for major trauma involves dissipation of heat and massive blood loss requiring replacement. The result is a vicious cycle of hypothermia, acidosis and coagulopathy leading to death from an irreversible physiological insult (62). The damage control concept places surgery as an integral part of the resuscitative process, rather than an end in itself, and recognises that outcomes after major trauma are determined by the physiological limits of the patient, rather than by efforts of anatomical restoration by the surgeon. All those involved in the care of wounded patients should be familiar with this concept and its surgical and logistical implications.

Acidosis↗
PubMed2000

Sociodemography of genital Chlamydia trachomatis in Coventry, UK, 1992-6.

OBJECTIVE: To describe the sociodemographic and geographic risk factors for incident Chlamydia trachomatis genital infection. DESIGN: Cross sectional retrospective study of cases diagnosed in local genitourinary clinics. SETTING: Coventry, West Midlands, from 1992 to 1996. SUBJECTS: 582 female and 620 male Coventry residents aged 15-64 years diagnosed with one or more episodes of genital Chlamydia trachomatis infection by enzyme immunoassay. Subjects were assigned a Townsend deprivation score based on residence. The denominator population aged 15-64 years was derived from 1991 census data. RESULTS: The mean annual incidence of genital chlamydia was 151 episodes (95% CI 140-163) per 100,000 population in men and 138 episodes (95% CI 128-149) per 100,000 population in women. Highest subgroup incidence was observed in 15-19 year old black women (2367 (95% CI 1370-4560) per 100,000), and 20-24 year old black men (1951 (95% CI 1158-3220) per 100,000). In univariate analyses, the most important risk factor for chlamydia infection in males was being black (incidence 1377 (95% CI 1137-1652) per 100,000 for black v 133 (95% CI 122-145) per 100,000 for white; RR 10.4, p < 0.0001) and for women was young age (incidence 475 (95% CI 415-540) per 100,000 for age group 15-19 years v 52 (95% CI 45-60) per 100,000 for age group 25-64 years; RR 9.1, p < 0.0001). In Poisson regression models of first episodes of genital chlamydia, for both males and females the effect of ethnic group could not be fully explained by socioeconomic confounding. There were significant interactions between age and ethnic group for both sexes and between age and level of deprivation for men. Geographical analysis revealed a high incidence of genital chlamydia in estates on the edge of the city as well as the urban core. CONCLUSIONS: There is a complex interaction between geographical location, age, ethnic group, and social deprivation on the risk of acquiring genital Chlamydia trachomatis in Coventry. Better population based data are needed.

Adolescent↗
PubMed1999

Pulmonary epithelial sodium-channel dysfunction and excess airway liquid in pseudohypoaldosteronism.

BACKGROUND: Active sodium absorption is the dominant mechanism of ion transport in airway epithelium, but its role in pulmonary physiology and airway host defense is unknown. To address this question, we studied the function of airway epithelial cells and determined the frequency of pulmonary symptoms in patients with systemic pseudohypoaldosteronism, a salt-losing disorder caused by loss-of-function mutations in the genes for the epithelial sodium channel. METHODS: In nine patients 1.5 to 22 years of age who had systemic pseudohypoaldosteronism, we tested for mutations in the genes for the epithelial sodium channel, estimated the rate of sodium transport in the airway, determined the volume and ion composition of airway surface liquid, reviewed clinical features, collected laboratory data pertinent to pulmonary function, and, in three adults, measured mucociliary clearance. RESULTS: The patients with systemic pseudohypoaldosteronism had loss-of-function mutations in the genes for the epithelial sodium-channel subunits, no sodium absorption from airway surfaces, and a volume of airway surface liquid that was more than twice the normal value. The mean (+/-SE) mucociliary transport rate was higher in the 3 adult patients than in 12 normal subjects (2.0+/-0.7 vs. 0.5+/-0.3 percent per minute, P=0.009). Young patients (those five years of age or less) all had recurrent episodes of chest congestion, coughing, and wheezing, but no airway infections with Staphylococcus aureus or Pseudomonas aeruginosa. Older patients (those more than five years of age) had less frequent respiratory symptoms. CONCLUSIONS: Patients with systemic pseudohypoaldosteronism fail to absorb liquid from airway surfaces; the result is an increased volume of liquid in the airways. These results demonstrate that sodium transport has a role in regulating the volume of liquid on airway surfaces.

Absorption↗
PubMed1999

Prevalence of sexual and drug-related HIV risk behaviors in the U.S. adult population: results of the 1996 National Household Survey on Drug Abuse.

CONTEXT: Data on the prevalence of HIV risk behavior that are representative of the general population are needed to help evaluate the effectiveness of prevention programs. OBJECTIVE: To use data from a large national interview survey to make estimates of the prevalence of sexual and drug-related HIV risk behaviors in the adult population of the United States. DESIGN: Nationally representative cross-sectional survey with in-person interviews collecting information on drug use and sexual behavior. SETTING AND PARTICIPANTS: 12,381 U.S. adults aged between 18 and 59 who were respondents to the 1996 National Household Survey on Drug Abuse, as part of sample of the noninstitutionalized population. Interviews took place in respondents homes using face-to-face interviewer-administered and self-administered questionnaires. RESULTS: In total, 2.8% of respondents were classified as having increased risk for HIV through sexual behavior; this represents 3.9 million persons. 1.7% reported some degree of risk through drug-related behaviors, representing 1.2 million persons. 3.5% of adults (5 million persons) were found to have some degree of HIV risk from sexual or drug-related behavior. Persons who were at risk through drug behavior were much more likely than others to be at risk through sexual behavior. Condom use was not related to HIV risk, although having a recent HIV test was found to be. Among those who reported some behaviors that placed them at increased risk for HIV infection, only 22% used a condom the last time they had sex with a regular partner. CONCLUSIONS: The high rate of sexual risk behavior on the part of drug users suggests increasing condom use for this group should be a priority goal for programs, especially condom use with main partners. Survey work needs to be continued and improved to make it possible to assess the impact of successful local prevention efforts on national rates of HIV risk behavior.

Adolescent↗
PubMed1999

What are psychiatric nurses needed for? Developing a theory of essential nursing practice.

Contemporary developments in health care have encouraged a review of the professional status of psychiatric nursing. However, little study has been made, to date, of the discrete 'need' for psychiatric nursing within a multidisciplinary service. Employing an adapted grounded theory methodology, substantive theory was developed concerning the expressed need for psychiatric nursing, by patients, their carers and mental health professionals, based on six sites from England, Eire and Northern Ireland. The study found some consensus across both recipients and providers of mental health care, that the essential feature of nursing (the core category) involved a complex of relationships: 'knowing you--knowing me'. Within that complex, nurses either elected, or were required, to move--or 'toggle'--between three discrete domains of relating: the Ordinary Me (OM); the Pseudo-ordinary or Engineered Me (POEM); and the Professional Me (PM). Four internal dimensions involving the nurses' depth of knowing, power, use of time and use of translation, distinguished these domains. The emergent theory is discussed within the context of the emergent growth in user (consumer) influence and health care technology.

Attitude of Health Personnel↗