PubMed Health⌕ Search

Biomedical subjects

B Ryan

Publications and source records attributed to B Ryan.

At least 55 records · Page 3Linked to original sources
PubMed1990

New developments in the Life Table Analysis System of the National Institute for Occupational Safety and Health.

In the 1970s, the National Institute for Occupational Safety and Health developed a Life Table Analysis System to analyze occupational cohort studies. We have updated the original system by adding two new features: direct standardization with a test for linear trend, and analyses by lagged exposure (either duration of exposure or cumulative exposure). We have also updated US reference rates through 1989. The updated systems and documentation (version F) are available upon request. In collaboration with the National Cancer Institute, we have also developed multiple cause-of-death rate files, which consider contributory as well as underlying cause. These files (also available upon request) will enable investigators to derive the expected prevalence of diseases at death, which can then be compared with the observed prevalence in an exposed cohort. Work is currently underway to produce a personal computer version of the Life Table Analysis System.

Cause of Death↗
PubMed1990

Evaluation of pre- and postoperative chemotherapy for resectable adenocarcinoma of the esophagus or gastroesophageal junction.

Thirty-five consecutive patients with resectable adenocarcinoma of the esophagus or gastroesophageal junction were treated with two preoperative and three or four postoperative chemotherapy courses consisting of etoposide, fluorouracil, and cisplatin (EFP) to evaluate the rate of curative resection, clinical and pathologic response, toxic effects, and survival. One hundred thirty-seven courses with a median number of five courses (range, one to six) were administered. Preoperative EFP resulted in 17 (49%) major responses, including six patients who did not have carcinoma cells in the repeat endoscopic biopsy specimens and cytologic brushings. Among 32 patients who had surgery, 25 (78%) had curative resection, one patient had a complete pathologic response, and one had microscopic carcinoma in the resected specimen. Six patients had microscopic carcinoma at the resection margins and received postoperative radiotherapy. At a median follow-up of 20 months, the projected survival of 35 patients is 23 months (range, 6 to 33+). Fifteen patients died of their carcinomas, and 15 patients were alive (median follow-up, 20+ months; range, 15+ to 33+ months) with no evidence of relapse. There were no deaths related to chemotherapy, surgery, or radiotherapy. EFP-induced toxic reactions were moderate. Our data suggest that multiple courses of EFP are feasible. Future strategies for this disease should consider prolonged chemotherapy with regimens that result frequently in pathologic complete responses.

Adenocarcinoma↗
PubMed1989

Criteria mapping: a method of quality assurance.

Criteria mapping is a flexible and responsive method of chart audit that allows the simultaneous assessment of both the process and the outcome of care by means of health record abstraction. This method of audit is particularly suited to occupational therapy because it includes branching to reflect the sequential judgments of therapists and does not penalize the clinician for omitting unnecessary procedures. The purpose of this study was to determine the utility and reliability of the criteria mapping process in evaluating the quality of care for a self-care disability in an acute care setting. Three occupational therapists and one independent abstractor evaluated 12 charts twice. Intraobserver reliability calculated with intraclass correlation coefficients was .77 for the therapists and .65 for all observers. Interobserver reliability was .73 for the therapists and .72 for all observers. The criteria map provided comprehensive and relevant information about each chart. This paper discusses the implications of these findings for the ongoing monitoring of the quality of care in occupational therapy.

Disability Evaluation↗
PubMed1989

Perioperative care of the liver transplant patient.

1. Communication among team members on the liver transplant team is crucial; individual responsibilities must be considered while problem solving is shared as a team. 2. A major goal of the OR nurse is to maintain the patient's skin integrity; proper patient positioning and protection is essential. 3. Constant awareness of blood and blood product availability is urgent.

Humans↗
PubMed1988

Primary health care through a community based smoking-cessation program.

The International Conference on Primary Health Care, meeting in Alma-Ata, in the Soviet Union, September 12, 1978, expressed the need for urgent action by all governments, all health and development workers and the world community, to protect and promote the health of all people of the world. The world was caught by the phrase which emerged from this conference, "Health For All by the Year 2000" and many have examined the articles of the Alma-Ata declaration and tried to implement them in their corner of the world. This paper describes a community-based smoking-cessation program which was implemented in the province of Nova Scotia, Canada, during the years 1980-1984. Primary to this project was the belief that people have the right and the duty to participate individually and collectively in planning and implementing their health care. This paper describes one community's effort in putting this belief into practice.

Community Participation↗
PubMed1988

Postoperative vomiting following strabismus surgery in paediatric outpatients: spontaneous versus controlled ventilation.

The study was designed to compare the frequency and severity of postoperative vomiting in paediatric out-patients receiving controlled ventilation (IPPV) or breathing spontaneously (SV) during anaesthesia for strabismus repair. One hundred and twenty unpremedicated children (ages 2-12 years) were studied in a randomized fashion. After intravenous induction of anaesthesia and tracheal intubation, patients breathed halothane 1-1.5 per cent inspired and N2O 66 per cent in O2 spontaneously (n = 60), or received IPPV, halothane 0.5-1 per cent, N2O 66 per cent, and pancuronium 0.05 mg.kg-1, which was reversed with neostigmine and atropine (n = 60). The incidence of vomiting with SV was 50 per cent (95 per cent confidence limits: 34.5-65.5 per cent) compared with 40 per cent (24.5-55.5 per cent) with IPPV (p greater than 0.25). Patients in the SV group experiencing emesis had longer operations than those not vomiting (mean +/- SEM = 1.5 +/- 0.1 vs 1.2 +/- 0.1 hours, p less than 0.005). This was not the case with IPPV. There was no correlation between age, sex, duration of surgery, or number of extraocular muscles repaired, and frequency or severity of vomiting or time to discharge. No significant advantage was afforded by IPPV over SV in the present study.

Child↗
PubMed1987

Human immunodeficiency virus (HIV) infection in children.

HIV infection in pediatric patients is a multisystem chronic disease that manifests as a clinical spectrum from asymptomatic infection through symptomatic infection with opportunistic infections and malignancies. The hematopoietic system is involved early in the systemic manifestations of this disease. The hematologic abnormalities seen are most probably a reflection of persistent viral infection, inflammation, and immune dysregulation, and may be complicated by secondary infections, chronic disease, drug toxicities, and nutritional deficiencies. Anemia and lymphopenia are commonly found in adult AIDS patients. Although both are also seen in pediatric patients, lymphopenia is much less common. Atypical lymphocytes with plasmacytoid characteristics have been identified in both adults and children. Pediatric bone marrow evaluation has shown an increase in plasma cells and plasmacytoid lymphocytes. Besides these findings, adult marrow findings include an increase in reticulum and lymphocytes appearing in a diffuse or aggregate pattern.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Functional changes in vascular amputee patients: evaluation by Barthel Index, PULSES profile and ESCROW scale.

This study evaluated the changes made by 60 peripheral vascular amputees from one month prior to admission to six months after attending a rehabilitation hospital. The Barthel index, PULSES profile, and ESCROW profile were used to measure functional status, social support, and rehabilitation progress. Statistical analysis consisted of t-tests to determine significant differences between the means of scores at varying intervals, and analysis of variance was added to determine interactions between amputation level, age, and sex as related to functional change. Amputees showed significant gains in Barthel scores from admission to discharge; this was attributed to rehabilitation intervention. They showed a significant decrease by the PULSES profile over the study period, indicating a decrease in independence from their premorbid function. Changes in ESCROW scores showed patients to have a greater need for social supports as they moved from admission to discharge. Age was a significant factor in mobility at discharge as measured by the Barthel index. As measured by the PULSES profile, men did better than women at six months follow-up. Unexpected results were that neither amputation level nor the presence or absence of diabetes mellitus had a significant impact on functional status as measured. The lack of significant differences by amputation level may be due to factors of age and sex, as well as to more depression in the below-knee group.

Activities of Daily Living↗
PubMed1984

Mucoid anaplastic hepatoblastoma. A case report.

A case of an unusual type of hepatoblastoma in a 5-month-old male infant is described. The tumor showed the following unusual features as compared with the epithelial and mixed types of hepatoblastoma: (1) The tumor cells presented a primitive anaplastic appearance without any resemblance in terms of cytologic features or arrangement to embryonal or fetal liver. (2) Abundant mucoid material containing acid mucopolysaccharide was present giving a slimy, gelatinous, gross appearance to the tumor and its metastases. (3) Well-defined tubular structures were present in some foci within the tumor parenchyma. (4) The tumor resulted in a rapidly fatal course, with metastases to the lungs and widespread peritoneal seeding despite complete surgical resection of the primary tumor. Yolk sac carcinoma and undifferentiated (embryonal) sarcoma of the liver were considered in the differential diagnosis. On electron microscopic examination, the tumor cells showed cytoplasmic features and junctional complexes consistent with their epithelial origin. Alpha-fetoprotein in the blood, which was markedly elevated prior to surgery, returned to a normal level postoperatively. Hepatoblastoma with the combination of features described above has not been previously reported. Because of the two striking and easily recognizable features viz. total lack of differentiation of tumor cells and presence of abundant mucoid material, the authors designated the tumor as mucoid anaplastic hepatoblastoma.

Carcinoma, Hepatocellular↗
PubMed1976

Severe measles in Vietnam.

The effects of measles epidemic amongst Cambodian refugees who were inadequately housed and fed in a refugee camp on the Cambodian-Vietnam border are described. As the condition of the people deteriorated, kwashiokor became prevalent and from a comparatively low death rate initially, children began to die in quick succession. With the supply of extra high-protein food this trend was soon reversed. However, the mortality figures given are official ones and there is no way of checking them by counting graves, as the Cambodians burn their dead. Therefore, it is more than likely that the real situation is understated.

Child↗
PubMedDate not supplied

The early diagnosis of acute myocardial infarction. Comparison of a simple algorithm with a computer program for electrocardiogram interpretation.

The sensitivity and specificity of electrocardiographic (ECG) interpretation by a simple algorithm was compared with a computer read ECG machine. Clinical data and ECG findings on 264 consecutive patients admitted to a coronary care unit with suspected acute myocardial infarction were prospectively entered into an algorithm with 13 end-points. These end-points were compared with the interpretations of a computer read ECG machine (Marquette MAC PC). 86 patients (32.5%) had confirmed acute infarction. 85% of those with infarction had some form of ST elevation on their initial ECG. Patients with ST elevation presented earlier (4.9 +/- 4.9 versus 8.0 +/- 9.7 hours after symptom onset, p < 0.001), and were older (66.5 +/- 11.0 versus 62.0 +/- 12.5 years, p < 0.01) than those without infarction. According to the algorithm 94.2% of patients with infarction had some form of ECG abnormality, compared with 55.6% of those without infarction (p < 0.001). The area under the receiver operating characteristic (ROC) curve of the algorithm was 92.3% of the area of the graph. This was more (p < 0.01) than the area under the ROC curve of the interpretations of the computer read ECG machine (83.9%). Marked ST elevation with reciprocal changes was the most specific indicators of infarction (Likelihood ratio 51.7). The algorithm, therefore, was comparatively sensitive and specific in the early diagnosis of acute infarction.

Adult↗
PubMedDate not supplied

Audit of a rural hospital's coronary care unit: comparison of two predictive instruments of acute myocardial infarction mortality.

The purpose of the study was to compare observed mortality of a rural hospital coronary care unit with mortality rates estimated by two predictive instruments of mortality. The mortality rates of 86 consecutive patients with confirmed acute myocardial infarction were compared with those predicted by the presence or absence of eight risk factors for mortality identified by the Thrombolysis in Myocardial Infarction (TIMI) trial, and mortality predicted by a logistic regression equation LRE). Seventeen patients (20 per cent) died within 6 weeks of admission; the number of TIMI risk factors present predicted a mortality of 9.8 per cent, and the instrument of Selker's predicted a mortality of 25.9 per cent. Patients with 3 TIMI risk factors had a significantly higher mortality than predicted (46.2 versus 13.0 per cent, p < 0.01). There were no significant differences between the receiver operating characteristic (ROC) curve of either instrument. The predictions of Selker's instrument, however, showed no significant difference from observed mortality, even when the patients were grouped into quintiles, and the predicted mortality rates were corrected for any presumed benefit from thrombolysis. The predictive instrument of Selker more consistently estimates observed mortality than the presence of risk factors identified by the TIMI trial.

Aged↗