PubMed Health⌕ Search

Biomedical subjects

A Ireland

Publications and source records attributed to A Ireland.

At least 19 recordsLinked to original sources
PubMed2006

Does initiation of an ambulance pre-alert call reduce the door to needle time in acute myocardial infarct?

OBJECTIVES: To assess the effect an ambulance pre-alert call for patients with suspected acute myocardial infarction (AMI) would have on door to needle (DTN) times. METHODS: We carried out back to back audits of DTN times following the initiation of the pre-alert calls. PARTICIPANTS: All patients thrombolysed within the emergency department between July 2003 and April 2004 (inclusive). STATISTICAL ANALYSIS: Mean DTN times and time to ECG pre-change and post-change were compared using the Two sample t test. The Fisher's exact test was used to compare pre-change and post-change proportions of patients seen within guideline times. RESULTS: In total, 73 patients were thrombolysed with 40 of these arriving by ambulance. Eighteen of these 40 were pre-change and 22 were post-change. Four patients were excluded. Fifty per cent of the pre-change group had a DTN time of <30 minutes compared with 91% of the post-change group (p = 0.005, Fisher's exact test). The phase one mean DTN time was found to be significantly greater than that for phase two (Two sample t test, p = 0.016; 95% CI 1.6 to 14.6). CONCLUSIONS: There was a significant reduction in DTN times after the introduction of the pre-alert call.

Ambulances↗
PubMed2005

Progression of collagenous colitis to Crohn's disease.

Collagenous colitis is a condition usually characterized by watery diarrhoea, macroscopically normal colonic mucosa and a typically thickened subepithelial collagen band on histological examination. It is rare in children, and coexistence with other inflammatory bowel diseases has been reported only rarely. We describe a case of diarrhoea presenting in infancy subsequently proved to be collagenous colitis that progressed to the typical features of Crohn's disease.

Child, Preschool↗
PubMed2004

The Gene Ontology (GO) database and informatics resource.

The Gene Ontology (GO) project (http://www. geneontology.org/) provides structured, controlled vocabularies and classifications that cover several domains of molecular and cellular biology and are freely available for community use in the annotation of genes, gene products and sequences. Many model organism databases and genome annotation groups use the GO and contribute their annotation sets to the GO resource. The GO database integrates the vocabularies and contributed annotations and provides full access to this information in several formats. Members of the GO Consortium continually work collectively, involving outside experts as needed, to expand and update the GO vocabularies. The GO Web resource also provides access to extensive documentation about the GO project and links to applications that use GO data for functional analyses.

Animals↗
PubMed2004

Current diagnosis and management of blunt internal carotid artery injury.

BACKGROUND: Blunt carotid artery injury (BCI) is a rare but potentially devastating injury. When undiagnosed it can result in severe disability or death. METHODS: A Medline-based literature search was performed using key words 'blunt carotid injury' and cross-referenced with further original papers obtained from the references from this search. RESULTS AND CONCLUSIONS: The incidence of BCI is very low. However, given the serious consequences of a missed injury, recent efforts have focussed on targeted screening for this injury in trauma patients. Conventional angiography remains the investigation of choice but may be superceded in the future by non-invasive methods such as magnetic resonance angiography or CT angiography. Operative intervention is rarely required and anti-coagulation remains the treatment of choice where dissection or pseudoaneurysm is diagnosed. The role of anti-platelet therapy is currently being investigated. Endovascular management using stents has been described but medium to long term results are not yet available.

Anticoagulants↗
PubMed2003

Specialty audit leads--has this concept been effective in implementing clinical audit in an acute hospital?

Clinical audit has a pivotal role to play in improving the quality of patient care. As part of the programme for co-ordinating clinical audit across the trust each clinical area has a nominated doctor to lead and co-ordinate the audit programme in their specialty. This qualitative survey reviews the effectiveness of having specialty audit leads and reviews the progress that specialties have made in developing their audit programme. The semi-structured interviews with 30 clinical audit leads identified an uneven level of development of clinical audit across the trust, and demonstrated that dedicated time would be needed to make these posts more universally successful. Although one size will not fit all, the interviews highlighted some recurring themes--seeds of success--in functioning audit programmes.

Attitude of Health Personnel↗
PubMed2000

Effects of sample size on the noise floor and distortion product otoacoustic emissions.

This study investigated the effects of sample size on the noise floor and distortion product otoacoustic emissions (DPOAEs) in 55 normal-hearing subjects as a function of intensity. More specifically, we investigated the effects of sample size (12-400 sweeps) as a function of intensity (L1 = L2 = 35, 45 and 55 dB SPL), firstly, on the identifiability of DPOAEs (2F1-F2), secondly, on the noise floor adjacent to DPOAEs, and thirdly, on the magnitude of DPOAEs centred around geometric means of 531 Hz, 1,000 Hz, 2,000 Hz and 4,000 Hz. Testing was conducted with a commercially available system for measuring DPOAEs (Grason-Stadler, GSI-60). A constant F2:F1 ratio of 1.21 was used. As sample size increased from 12 to 400 sweeps, the noise floors decreased by about 13 dB; this closely corresponds to the expected 15 dB reduction based on the square root rule of noise reduction. The highest noise floors were measured at 531 Hz and the lowest noise floors at 2,000 Hz and 4,000 Hz. Identifiability increased as intensity increased from 35 to 55 dB SPL and as sample size increased from 12 to 400 sweeps for all stimulus conditions. Mean DPOAEs for all frequencies (531-4,000 Hz) appeared to decrease as sample size increased, particularly at stimulus levels of 35 dB and 45 dB SPL. These results may be explained by a reduction in the noise levels within the bandwidth of the DPOAE bin. That is, the DPOAE bin is comprised of the DPOAE plus background noise and these two quantities are not separated within the measured bin. Because the magnitude of bin containing DPOAEs is critically dependent on sample size, clinicians should carefully document this variable when collecting normative data. Similarly, clinicians who compare the magnitude of their DPOAEs to published data should note the sample size employed.

Acoustic Stimulation↗
PubMed2000

Junior doctors' views on clinical audit--has anything changed?

A postal questionnaire survey of junior doctors' views was conducted in a large acute hospital in the south-east of England, amongst 146 junior medical staff recorded as being employed by the Trust across 21 specialities. It profiled their level of participation in audit and the quality of current audit programmes within their specialities and assessed their knowledge and understanding of clinical governance. Our findings suggest: a high level of involvement in activities labelled audit, but that these activities did not necessarily conform to robust audit methodologies; that junior doctors' professional attitudes towards clinical audit are influenced by negative experience of undertaking audit within their specialities; and that there was a variety of understanding about the principles and meaning of clinical governance. It concluded that the conditions for coherent strategy aimed at promoting effective audit programmes which could support the use of clinical audit as a tool for continuous professional development are not yet in place across the Trust.

Attitude of Health Personnel↗
PubMed1998

Breaking the rules! Cardiac injury from remote entry sites.

An unusual case of penetrating injury to the heart is reported. This presented late, after an initial silent period. A high index of suspicion must be maintained when chest injuries are managed conservatively. If there is doubt, a subxiphoid pericardial window may allow cardiac injury to be excluded.

Adult↗
PubMed1997

Ranitidine bismuth citrate and clarithromycin twice daily in the eradication of Helicobacter pylori.

BACKGROUND: Ranitidine bismuth citrate (RBC) 400 mg when given twice daily (b.d.) for 4 weeks with clarithromycin 250 mg four times daily (q.d.s.) for the first 2 weeks effectively heals duodenal ulcers and eradicates Helicobacter pylori. AIMS: To compare two dosage regimens of clarithromycin, 250 mg q.d.s. and 500 mg b.d., used with ranitidine bismuth citrate (Pylorid) 400 mg b.d., for the eradication of H. pylori and for symptom relief in patients with active duodenal ulcers. SUBJECTS: 236 patients with active duodenal ulcer and confirmed H. pylori infection. METHODS: In a randomized, double-blind, parallel group, multi-centre study, RBC was given with clarithromycin for 2 weeks followed by 2 weeks treatment with RBC alone to allow for ulcer healing. Ulcer status was assessed by endoscopy at entry. H. pylori status was assessed by CLO Test and 13C-urea breath test (UBT) at entry and UBT alone 4 weeks after the end of treatment. At entry, during the study and at follow-up, ulcer symptoms were recorded on a scale of none, mild, moderate or severe. RESULTS: 176 patients had an evaluable UBT at least 4 weeks post-treatment. H. pylori eradication rates were 96.2% for the RBC plus clarithromycin b.d. regimen and 91.8% for the RBC plus clarithromycin q.d.s. regimen (observed data). Four weeks post-treatment, 92% of patients receiving RBC b.d. plus clarithromycin q.d.s. and 89% receiving RBC b.d. plus clarithromycin b.d. were considered symptom successes (none or mild symptoms). CONCLUSIONS: RBC 400 mg b.d. plus clarithromycin 500 mg b.d. was as effective as RBC 400 mg b.d. plus clarithromycin 250 mg q.d.s. in eradicating H. pylori and both regimens were well tolerated. The simpler dual therapy in a b.d. regimen might well encourage greater patient compliance.

Adult↗
PubMed1997

Acute auto immune haemolytic anaemia secondary to hepatitis A infection.

Auto immune haemolytic anaemia has been described in association with a variety of hepatotropic viruses, in particular cytomegalovirus, Epstein-Barr virus and hepatitis B. There is a well-recognized association between chronic active hepatitis and auto immune haemolytic anaemia. We present the first reported case of acute hepatitis A which resulted in a fall in haemoglobin concentration from 14.6 to 4.5 g/dl due to an acute haemolytic anaemia with an associated rise in bilirubin from 149 to 960 mumol/l.

Acute Disease↗
PubMed1997

Effect of intraduodenal fat on lower oesophageal sphincter function and gastro-oesophageal reflux.

BACKGROUND AND AIMS: Fatty foods are commonly reported to aggravate gastro-oesophageal reflux symptoms. In this study the hypothesis that fat provokes reflux by stimulating transient lower oesophageal sphincter relaxations via small intestinal receptors was investigated. METHODS: In 12 healthy volunteers and 11 patients with reflux oesophagitis, oesophageal motility and pH were measured over 30 minute periods during which saline or fat (10% Intralipid) were infused in random order into the duodenum. The infusion periods were separated by a 30 minute washout. The stomach was loaded with 200 ml 10% dextrose, maintained by an intragastric infusion. RESULTS: Fat decreased basal LOS pressure from 16.9 (SEM 2.1) to 12.4 (SEM 1.5) mm Hg in normal subjects but had no effect in patients with oesophagitis (18.8 (SEM 4.3) v 18.2 (SEM 3.0) mm Hg). During saline infusion, the rates of transient lower oesophageal sphincter relaxation and reflux episodes were greater in patients (4.5 (interquartile range 2-11)/30 min and 5 (2-14)/30 min respectively) than in controls (3 (2-4)/30 min and 3 (2-3.5)/30 min respectively). Fat increased the rate of reflux episodes in the reflux patients to 6.5 (3-25)/30 min. This effect was due to an increase in the incidence of reflux during transient LOS relaxations (65% v 91%), the rate of transient relaxations remaining unchanged. CONCLUSIONS: Instillation of fat directly into the duodenum aggravates reflux in patients with reflux disease, by increasing the proportion of transient LOS relaxations accompanied by reflux.

Adolescent↗
PubMed1997

Prospective trial of the role of fine bore intubation of the cystic duct at the time of operative cholangiography.

BACKGROUND: The incidence of common bile duct calculi in patients selected for laparoscopic cholecystectomy is 4 to 6 percent. Management is controversial. We report our experience with fine bore cannulation of the cystic duct in patients found on operative cholangiography to have common bile duct stones. STUDY DESIGN: We performed a prospective study of 310 patients who underwent laparoscopic cholecystectomy to evaluate the role of fine bore intubation of the cystic duct at the time of operation. Operative cholangiogrphy was attempted on all patients. In 9 patients, the fine bore tube was left in situ for at least 6 weeks. RESULTS: Intubation was found to be safe and well-tolerated. It permitted biliary decompression and allowed repeat cholangiography. Thirty percent of patients had spontaneous clearance of the common duct stones, which was shown on repeat studies. CONCLUSIONS: Fine bore cannulation of the cystic duct is a safe procedure that allows repeat cholangiography, thus eliminating false-positive results. It reduces the need for intervention by demonstrating the spontaneous disappearance of retained calculi in up to a third of cases.

Cholangiography↗
PubMed1996

Impact of nausea/vomiting on quality of life as a visual analogue scale-derived utility score.

Pharmacoeconomic analysis is often based upon incremental cost per increase in survival (cost-effectiveness). Using this definition supportive care measures, which increase quality but not quantity of life, generate a zero denominator and cannot be directly compared with other components of health care cost. Cost-utility analysis, which measures incremental cost per increase in quality-adjusted life-years (QALY), where QALY = utility score x time at risk, addresses this problem, since successful supportive intervention increases the utility score and thus provides a finite denominator in QALY even when absolute survival is unchanged. However, utility scores for various supportive care modalities have not been well defined. As a pilot study to generate a first approximation of a utility score for nausea/vomiting, we used a rating scale technique and administered two visual analogue scale questions to 30 patients completing a cycle of chemotherapy. Patients rated their global quality of life during their previous cycle of chemotherapy with hypothetical absence or presence of nausea/vomiting as the only variable. The study population included 8 male and 22 female patients, with a median age of 56 years. The most common malignancies were breast cancer (8 patients), lung cancer (7 patients), and hematologic malignancies (7 patients). On a 100 mm visual analogue scale, the mean score for overall quality of life during chemotherapy was 79 mm without nausea/vomiting and 27 mm with nausea/vomiting (P < 0.001, paired t-test). The implied marked increase in utility with relief of nausea/vomiting suggests a significant impact on cost-utility analysis. Similar methodology could be used to estimate utility scores in other areas of supportive care.

Adult↗
PubMed1996

Laparoscopic management of generalized peritonitis due to perforated colonic diverticula.

PURPOSE: The use of laparoscopic peritoneal lavage in conjunction with parenteral fluids and antibiotic therapy in the management of generalized peritonitis secondary to perforated diverticular disease of the colon was assessed. PATIENTS AND METHODS: This cohort comprised 8 patients with generalized peritonitis secondary to perforated diverticular disease of the left colon that was diagnosed laparoscopically. All the patients had purulent peritonitis, but no fecal contamination. They were treated with laparoscopic peritoneal lavage and intravenous fluids and antibiotics. RESULTS: All patients made a complete recovery, with resumption of normal diet within 5 to 8 days. No patient has required surgical intervention during a 12- to 48-month follow-up. This approach merits further assessment as an alternative to the traditional open surgical management.

Adult↗
PubMed1992

Comparison of 5-aminosalicylic acid and N-acetylaminosalicylic acid uptake by the isolated human colonic epithelial cell.

Isolated human colonic epithelial cell suspensions were incubated with either 0.1 mM 5-aminosalicylic acid (5-ASA) or 0.1 mM acetylaminosalicylic acid (Ac-ASA) for up to two hours. Intra- and extracellular 5-ASA and Ac-ASA were measured by high performance liquid chromatography. Mean 5-ASA uptake in one hour was 160.5 nmol/g dry weight, compared with an Ac-ASA uptake of only 5.75 nmol/g dry weight. No unchanged 5-ASA was detected inside the cell. Repeated washing had no effect on the intracellular Ac-ASA concentration. This discrepancy in drug uptake may explain why Ac-ASA seems to be ineffective when given to patients with ulcerative colitis.

Aminosalicylic Acids↗