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Biomedical subjects

A A McConnell

Publications and source records attributed to A A McConnell.

At least 19 recordsLinked to original sources
PubMed2002

Unnecessary out-of-hours biochemistry investigations--a subjective view of necessity.

OBJECTIVE: To investigate the extent to which pre-registration house officers (PRH0s) admit to requesting 'unnecessary' out-of-hours biochemistry tests and assess the reasons why this occurs. DESIGN: Semi-structured interviews conducted over a 2-year period covering 1998/99. SETTING: Inverclyde Royal District General Hospital SUBJECTS: 79 PRHOs. RESULTS: Seventy-nine PRHOs were interviewed. Eighty-seven percent admitted requesting 'unnecessary' out-of-hours tests in between 5% and 50% of cases. The reasons cited include uncertainty about the diagnosis (80%), the need for medico-legal protection (79%), to avoid leaving work for colleagues (66%), and to prevent criticism from consultant staff and others (71%). Seventy six percent of PRHOs indicated that ordering 'unnecessary' tests helped to lessen anxiety and reduce stress levels associated with their work. Seventy one percent agreed an attempt should be made to reduce 'unnecessary' tests. CONCLUSIONS: This study has shown that a significant proportion of PRHOs admits to requesting 'unnecessary' out-of-hours tests. A better understanding of why these tests are requested has been established. The need for self-protection and a fear of criticism from senior staff are prominent factors affecting stress levels amongst junior medical staff in the hospital workplace.

Attitude of Health Personnel↗
PubMed1999

Desmopressin in the treatment of nocturnal polyuria in the male.

OBJECTIVES: To assess whether desmopressin (1-desamino 8-d-arginine vasopressin) is safe and effective in the treatment of nocturnal polyuria in elderly men. PATIENTS AND METHODS: Twenty men (age 52-80 years) complaining of nocturia were found to have nocturnal polyuria, determined from frequency-volume charts and defined as the production of >33% of the 24 h urine volume overnight, averaged over a 1-week period. In a double-blind study of cross-over design, a 1-week placebo run-in period was followed by two 2-week periods of placebo or 20 microg intranasal desmopressin, and ended with an open 2-week treatment period with 40 microg desmopressin. RESULTS: Desmopressin caused a significant reduction in nocturnal urine volume and the percentage of urine passed at night, but the reduction in nocturnal frequency was only significant during treatment with 40 microg desmopressin. Four patients on desmopressin experienced side-effects, three of which were thought to be due to fluid retention. CONCLUSION: Desmopressin is an effective treatment for nocturnal polyuria in some elderly men. However, it can cause fluid retention and should not be given to patients with cardiac failure. Those undergoing treatment must be closely monitored.

Aged↗
PubMed1999

Role of atrial natriuretic peptide in nocturnal polyuria in elderly males.

OBJECTIVES: To demonstrate nocturnal polyuria objectively and to assess the role of atrial natriuretic peptide (ANP) in healthy elderly males with and without nocturnal polyuria (NP). PATIENTS AND METHODS: 31 healthy elderly men known to have NP (passing more than 33% of their 24-hour urine output during an 8-hour period overnight) and 12 controls without NP were invited to take part in the study. Blood and urine samples were collected at 4-hourly intervals in order to measure urine output, serum and urine electrolytes and osmolality as well as serum cortisol, renin, aldosterone, arginine vasopressin (AVP) and ANP. RESULTS: 26 men with NP and 8 controls agreed to take part in the study. Subjects with NP were found to have a diuresis and natriuresis as well as a significant increase in ANP overnight compared to the control group. There was no difference in the other parameters between the 3 groups, with the exception of aldosterone and AVP. CONCLUSIONS: This study has shown a group of subjects with increased natriuresis and diuresis overnight, associated with an increase in ANP. It is possible that subclinical cardiac failure causes an increase in ANP therefore causing nocturnal urinary symptoms and this theory needs further exploration.

Aged↗
PubMed1996

Venepuncture: the medicolegal hazards.

Venepuncture is commonly regarded as a trivial procedure allocated to the most junior medical staff. The result of this policy is that junior doctors are required to perform a minimally invasive procedure on consenting patients without any structured venepuncture training or assessment. Consequently, inexperienced doctors may perform multiple and sometimes unnecessary, venepunctures, which could damage essential venous access, eg, in the diabetic or renal patient. We review the medicolegal position and suggest that structured venepuncture training is essential and argue that unskilled treatment may be regarded by the Courts as demonstrating the mens rea of assault in the form of recklessness.

Clinical Competence↗
PubMed1995

Battered granny or spontaneous fractures? A legal dilemma.

A 70-year-old woman was admitted from a local nursing home with extensive bruising and bilateral hip discomfort. The referring doctor had reported the possibility of elder abuse to the police. Full examination showed that osteomalacia, precipitated by a poor diet and lack of exposure to sunlight, was sufficient to explain the patient's condition. Caution is recommended in diagnosing elder abuse until other possibilities have been excluded.

Aged↗
PubMed1995

Consent in medicine and sport.

Last year's football World Cup serves to highlight the confusion now surrounding the classical aim of both sport and sports medicine, namely a healthy mind in a healthy body. The recent focus on violent injuries and the exponential increase in medical litigation suggests that this relationship is not so clearly defined. One cornerstone of this traditional relationship is the concept of informed consent. We review the legal position of consent in sport, especially soccer, which still awaits clarification and draw clear parallels with surgical consent.

Female↗
PubMed1990

Serum alanine transaminase (ALT) reference ranges estimated from blood donors.

It has been suggested that an increase in serum alanine transaminase (ALT) activity in blood donors may identify infection with non-A, non-B hepatitis. To facilitate identification of such donors, the reference range for ALT was measured on a Technicon SMAC 1 Analyser, using serum from 364 blood donors and 567 plasmapheresis donors. The distribution of ALT activities displayed a positive skewness, and so both logarithmic transformation and subsequent calculation of mean and standard deviation as well as non-parametric analysis were used to obtain best estimates of reference ranges for men and women, 5-65 IU/1 and 5-35 IU/1, respectively. ALT activities were found to be higher in plasmapheresis donors than in normal blood donors of both sexes, and it is postulated that this difference may be related to the increased frequency of donation in the former group.

Alanine Transaminase↗
PubMed1990

Saline infusion and amiloride in the management of lithium toxicity.

This paper describes the case of a 74 year old patient who became lithium toxic after 15 years of lithium therapy. We discuss the clinical presentation of the case and some of the possible causes of the sudden development of his toxicity. Although haemodialysis is the treatment of choice for severe lithium toxicity it is not always available. In this paper we propose that the combination of saline diuresis and Amiloride may provide a suitable alternative in the management of lithium toxicity.

Aged↗
PubMed1988

Resonance Raman spectroscopy of hemoglobin in intact cells: a probe of oxygen uptake by erythrocytes in rheumatoid arthritis.

Resonance Raman spectra from intact viable erythrocytes can be used to study oxygen uptake in solution. In addition to changes in the oxidation state marker (nu 4), other bands due to the porphyrin ring (nu 3) and vinyl modes indicate subtle changes at oxygen pressures close to where the T/R change occurs. A comparison of whole cell and lysate spectra indicates a partial denaturation of hemoglobin on lysis. A simple smear technique is used to measure spectra from rheumatoid and normal blood. Results indicate a faster but less complete uptake of oxygen in cells from patients with rheumatoid arthritis than is the case in normal cell populations.

Arthritis, Rheumatoid↗