Search PubMed⌕ Search

Biomedical subjects

P Barker

Publications and source records attributed to P Barker.

At least 109 records · Page 6Linked to original sources
PubMed1991

Coagulation screening before epidural analgesia in pre-eclampsia.

A questionnaire survey of current practice at a small cross-section of obstetric units, covering 22% of all United Kingdom deliveries, revealed a marked lack of standard practice regarding requests for coagulation screens on pre-eclamptic patients who require epidural procedures. A retrospective audit was therefore carried out on 434 coagulation screens requested for pre-eclamptic patients in whom epidural analgesia might have been considered. Borderline abnormalities of coagulation were found in only 10 patients (2%). Platelet counts of less than 150 x 10(9)/litre were present in 28% of cases. 'Significant' thrombocytopenia (less than 100 x 10(9)/litre) and all coagulation abnormalities were only encountered in severe pre-eclampsia (diastolic blood pressure of greater than 110 mmHg and proteinuria of + + or greater). Furthermore, coagulation abnormality was always associated with a reduced platelet count (mean, 97 x 10(9)/litre). This study would therefore support anaesthetic practice which restricted any requests for coagulation testing to severe pre-eclamptic patients only. For these patients first line testing could be limited to a platelet count.

Analgesia, Epidural↗
PubMed1991

Computerised axial tomography of the trachea. A useful investigation when a retrosternal goitre causes symptomatic tracheal compression.

Case histories are reported of three patients who had large retrosternal goitres which were responsible for significant abnormalities of the airway. Computerised axial tomography demonstrated the exact anatomy. The site of tracheal compression was shown and accurate measurements of the diameter of the trachea at its narrowest point were made. This information was useful when the management of the patient was planned.

Aged↗
PubMed1991

Effect of prior administration of cold saline on pain during propofol injection. A comparison with cold propofol and propofol with lignocaine.

A single-blind, randomised, controlled study was undertaken to compare the efficacy of three methods of preventing pain during injection of propofol on induction of anaesthesia. Patients were allocated randomly to receive unmodified propofol, propofol with 0.05% lignocaine, propofol at 4 degrees C and unmodified propofol preceded by 10 ml of 0.9% saline at 4 degrees C. Prior injection of cold saline reduced the incidence of pain and discomfort significantly (22%) compared with unmodified propofol (75%; p less than 0.005) and was similar to that after cold propofol (33%) and propofol with lignocaine (44%). There was no significant difference between the treatment groups.

Adult↗
PubMed1991

Relationships between skin temperature and perfusion in the arm and leg.

Relationships between skin temperature (Tsk) and perfusion have been studied to provide a basis for the use of Tsk in the non-invasive assessment of limb circulation in peripheral vascular disease. Raising the ambient temperature (Ta) from 20 to 30 degrees C increased the perfusion of the glabrous skin of the hands and feet without changing that of the skin of the forearm or calf. On a fractional basis the response in the hand and foot was the same. Tsk was higher in the arms than the legs and in the proximal than distal parts of the limbs. A fall in Tsk was often seen when Ta rose from 20 to 25 degrees C and was attributed to counter-current cooling. Subsequently Tsk rose even in regions where there was no increase in skin perfusion. Tsk can only be related to its perfusion in the fingers, palm and toes. Forearm Tsk was related to the perfusion of the digits. This relationship implies a link with the arterial inflow to the limb which determines the size of its thermal core. Heat conduction from the core seemed important for the skin of areas like the forearm and calf where the constant, low perfusion limited the amount of heat which could be transported to it directly by the blood. The importance of conduction was supported by studies, at Ta 20 degrees C, on subjects during calf muscle exercise and on patients with arterio-venous fistulae. Here an increase in the arterial inflow to the limb was associated with a rise in Tsk of the forearm/calf unrelated to the perfusion of its skin.

Adult↗
PubMed1990

The Leicester experience.

Clinical directorates have been successfully working at Leicester Royal Infirmary for five years. Paul Barker charts their progress and looks forward to the next stages of resource management.

England↗
PubMed1990

Are obstetric spinal headaches avoidable?

In a prospective study of one hundred obstetric patients given spinal anaesthesia using either a 25 or 26 gauge spinal needle, a significantly greater incidence of spinal headache and blood patch was found in the 25-gauge group. It is concluded that a 26-gauge needle should be used when performing spinal anaesthetics for obstetric procedures.

Anesthesia, Obstetrical↗
PubMed1989

Altered images.

Explore the source record for details and available documents.

Humans↗
PubMed1989

Reflections on the philosophy of caring in mental health.

The trend towards definition of the role of the nurse as 'therapist' in mental health has resulted in clarification of what some nurses might do, with some patients, to resolve fairly specific problems of living. Not all psychiatric nurses are, however, satisfied that the developments which arise from this role definition will necessarily benefit the service overall. Indeed, the concept of the nurse-as-therapist has led, indirectly, to an expression of anxiety over the balance of 'care' versus 'therapy'. This is manifested at a time when nurses outwith the mental health setting are describing the need for a stronger emphasis upon therapeutic factors in nursing care, especially involving psychosocial variables.

Health Promotion↗
PubMed1989

Medical expansionism: some implications for psychiatric nursing practice.

The paper discusses how health care models in general have been influenced by the authors' concept of 'medical expansionism'. Emphasis is given to addressing the impact of medical theory and practice on models of psychiatric nursing. The initial section discusses the concepts of medicalisation and medical imperialism, offering general health definitions and examination of mental health problems in more detail. From this analysis a definition is presented of a medical model in psychiatry. The effects of this model of health care on the future development of nursing models in psychiatry is discussed.

Authoritarianism↗
PubMed1989

The Foster Care Research Project: clinical impressions.

A two-year prospective study compared individual and group models of support for foster parents. Results showed greater foster parent satisfaction with the group model. An independent critique identified methodological flaws that would preclude further differentiation of the models and suggested that clinical impressions and trends in favor of the group model be given credibility. Operation of the group model is described, and reasons for the differences between clinical and experimental findings are discussed.

Adolescent↗
PubMed1988

The Foster Care Research Project: summary and analysis.

This paper analyzes and summarizes five more detailed papers describing the Foster Care Research Project (F.C.R.P.). This compared two (individual and group) models of foster care as to their effects on foster parent satisfaction, placement breakdowns and several indices of children's adjustment in care. The group model is described and contrasted with other "extended family" models, and the results of the project, which were mixed, are summarized. A critique of the experimental design suggests why clinical gains noted in the children were not borne out experimentally. Following a clinician's analysis of the process by which the group model operated (illustrated by clinical vignettes), the paper ends by describing the content and process of two support groups for the natural children of the foster parents.

Adaptation, Psychological↗
PubMed1988

Partial amino acid sequence analysis and variable subgroup determination (VH and VL) of a monoclonal rheumatoid factor derived from a rheumatoid arthritis patient.

Continuous cell lines secreting monoclonal rheumatoid factors (RF) were derived from rheumatoid arthritis (RA) patients by cloning Epstein-Barr virus (EBV) transformed B cells and by hybridoma techniques. We studied five different clones with stable RF secretion. All were IgM, 4 kappa and 1 lambda. One of these clones, RFAN was extensively studied, and the partial amino acid sequences of the variable regions of both heavy and light chains were determined. After affinity purification, the IgM lambda RF antibody derived from the EBV clone was run under reducing conditions on SDS-polyacrylamide gel electrophoresis. The separated heavy and light chains were blotted and then sequenced by a gas-phase sequenator. The N-terminal sequence of the lambda light chain corresponded to that of the V lambda III subgroup. The heavy chain of the same IgM RF clone had a blocked N-terminus, but a cyanogen bromide peptide starting after methionine at position 82 showed a sequence typical of the VHIII subgroup. Heavy and light chains were also prepared by gel filtration after reduction and carboxymethylation from the same EBV clone made into a hybridoma. After this preparation, the heavy chain was not blocked and the N-terminal sequence confirmed that the heavy chain variable region belonged to the VHIII subgroup. We believe this to be the first amino acid sequence study of a monoclonal RF derived from the repertoire of an RA patient.

Amino Acid Sequence↗