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Biomedical subjects

Brian Nolan

Publications and source records attributed to Brian Nolan.

7 recordsLinked to original sources
PubMed2006

The impact of disability transitions on social inclusion.

As the extent of disability increases in society, there is an increasing need to understand its consequences for many aspects of social inclusion. Using the Living in Ireland Survey 1995-2001 (n=2727 adults), we provide a rigorous analysis of the transitions into and out of disability and the related consequences for various characteristics of social inclusion. We compare the effect of onset, exit and persistent disability on household income and the probability of being in poverty. We also look at the impact on daily societal participation for individuals with varying durations of disability. Results show that people with disabilities have much lower levels of social inclusion and imply that related policy should focus on the heterogeneity of disabled people, depending on their respective transitions into disability and the duration of their disability.

Adolescent↗
PubMed2006

Comparison of embolization protection device-specific technical difficulties during carotid artery stenting.

BACKGROUND: Embolic protection devices (EPDs) consisting of an internal carotid artery (ICA) filter or balloon occlusion are typically used during carotid artery stenting (CAS). This study compares the technical difficulties encountered using these two types of EPD. METHODS: A retrospective review was conducted of patients undergoing CAS using a balloon occlusion EPD (balloon group: PercuSurge GuardWire) or filter EPD (filter group: Accunet, AngioGuard, or FilterWire). Complications were defined as minor stroke, National Institutes of Health (NIH) stroke scale <3; major stroke, NIH stroke scale > or =3; transient ischemic attack (TIA), reversible focal neurologic impairment; technical, reversible neurologic compromise during EPD deployment, inability to cross lesion, ICA spasm requiring treatment, EPD-related factors that prolonged CAS. RESULTS: CAS (n = 141) was performed in 133 patients (82% men) with a mean age of 72 of years. Comorbidities included diabetes, 35%; coronary artery disease, 75%; hypertension, 82%; and renal insufficiency, 15%. Indication was previous cerebrovascular accident in 10%, TIA in 29%, and asymptomatic >80% stenosis in 61%. Primary lesions were treated in 83% vs restenosis in 17%. The 30-day event rate was 1.4% major stroke, 2.1% minor stoke, 1.4% myocardial infarction, and 0.7% death. The overall combined 30-day stroke, death, and myocardial infarction rate was 5.6%. The 30-day stroke and death rate was 4.0% in the balloon group (n = 99) and 4.6% in the filter group (n = 42, P = .51). EPD-related technical difficulties occurred in 15% of the balloon group and 31% of the filter group (P < .05). Technical difficulties included a 10% incidence of reversible neurologic compromise during balloon deployment compared with 0% in the filter group (P = .002) and 12% incidence of inability to cross the lesion before predilation in the filter group compared with 0% in the balloon group (P = .001). CONCLUSIONS: During CAS, both balloon occlusion and filter devices provide acceptable results and appear complimentary. Filters can be used preferentially to avoid a 10% incidence of reversible neurologic compromise associated with balloon occlusion, except in critically narrowed or tortuous lesions when balloon occlusion may be preferred because of a 12% need for unprotected predilatation with filters.

Aged↗
PubMed2005

GP reimbursement and visiting behaviour in Ireland.

In Ireland, approximately 30% of the population receive free GP services (medical card patients) while the remainder (private patients) must pay for each visit. In 1989, the manner in which GPs were reimbursed by the State for their medical card patients was changed from fee-for-service to capitation while private patients continued to pay on a fee-for-service basis. Concerns about supplier-induced demand were in part responsible for this policy change. The purpose of this paper is to examine the extent to which the utilisation of GP services is influenced by the reimbursement system facing GPs, by comparing visiting rates for the two groups before and after this change. Using a difference-in-differences approach on pooled micro-data from 1987, 1995 and 2000, we find that medical card eligibility has a consistently positive and significant effect on the utilisation of GP services. However, the differential in visiting rates between medical card patients and others did not narrow between 1987 and 1995 or 2000, as might have been anticipated if supplier-induced demand played a major role prior to the change in reimbursement system.

Adult↗
PubMed2004

Early results of carotid stent placement for treatment of extracranial carotid bifurcation occlusive disease.

OBJECTIVE: The purpose of this study was to review the initial results of carotid artery angioplasty with stenting (CAS) performed by vascular surgeons to treat bifurcation occlusive disease. Most patients were selected for CAS if they had indications for endarterectomy (CEA) but were considered at high risk for surgery. METHODS: Since December 2000, 74 carotid arteries in 69 patients underwent CAS, with distal balloon embolization protection in 96%. Mean patient age was 72 years; 82% of patients were men. Indications for CAS included asymptomatic disease (62%), transient ischemic attack (TIA; 23%), and cerebrovascular accident (15%). Mean internal carotid artery diameter stenosis was 82%. CAS was chosen over CEA because of cardiac (49%) or pulmonary (4%) comorbid conditions, hostile neck (25%), distal extent of disease (6%), and contralateral cranial nerve injury (1%). CAS was performed in 15% patients who were good surgical candidates, because of patient preference. Pathologic conditions were primary atherosclerosis (81%), recurrent carotid stenosis (18%), and dissection (1%). Procedures were transfemoral in 95% of cases and transcarotid in 5%. In 30% of cases the contralateral carotid artery had 80% or greater stenosis or was completely occluded. RESULTS: Technical success was achieved in 96% of cases. There were no deaths, no major strokes, one minor stroke (National Institutes of Health Stroke Scale, 3), and one TIA (neurologic event rate, 2.6%). The single minor stroke resolved completely by 1 month. One patient (1.3%) had a perioperative myocardial infarction. Transient neurologic changes occurred in 8% of patients during the protection balloon inflation, and all resolved with deflation. Bradyarrhythmia requiring pharmacologic treatment occurred in 14% of patients. At mean follow-up of 6 months there have been two instances of recurrent stenosis greater than 50% as noted at duplex scanning. During the same period, 266 carotid CEAs were performed, with a neurologic event rate of 0.8% (major stroke, 0.4%; no minor strokes; TIA, 0.4%) and a myocardial infarction rate of 3%. Combined stroke and death rate was 1.3% in patients who underwent CAS and 0.5% in patients who underwent CEA. CONCLUSION: CAS with cerebral protection can be performed safely in patients at high surgical risk, with low perioperative morbidity and mortality. The durability of the procedure must be determined with longer follow-up.

Aged↗
PubMed2002

Tidal breathing flow-volume loops in bronchiolitis in infancy: the effect of albuterol [ISRCTN47364493].

OBJECTIVES: To evaluate the effect of nebulized albuterol on tidal breathing flow-volume loops in infants with bronchiolitis due to respiratory syncytial virus. DESIGN: A randomized, double-blind, control study. SETTING: Pediatric unit in a community teaching hospital. PARTICIPANTS: Twenty infants younger than 1 year of age (mean age, 5.8 +/- 2.8 months) with a first episode of wheezing due to respiratory syncytial virus bronchiolitis. INTERVENTIONS: Chloral hydrate (50 mg/kg) was administered orally for sedation. One dose each of nebulized albuterol (0.15 mg/kg in 3 ml saline) and saline (3 ml) were given at 6 hour intervals in a random order. MEASUREMENTS: Tidal breathing flow-volume loops were obtained before and after each aerosol treatment with a Neonatal/Pediatric Pulmonary Testing System (Model 2600; Sensor Medics, Anaheim, CA, USA). At the same time, the fraction of tidal volume exhaled at peak tidal expiratory flow (PTEF) to total tidal volume (VPTEF/VE), and the fraction of exhaled time at PTEF to total expiratory time (tPTEF/tE) were measured. The PTEF, the tidal expiratory flows at 10%, 25%, and 50% of the remaining tidal volume (TEF10, TEF25, and TEF50), and the wheeze score were also determined. RESULTS: There were no significant changes in VPTEF/VE and tPTEF/tE after albuterol or saline treatment. PTEF increased significantly both after albuterol and saline treatments but the difference between the two treatments was not significant (P = 0.6). Both TEF10 and the ratio of the tidal expiratory flow at 25% of the remaining tidal volume to PTEF (25/PT) decreased significantly (P < 0.05) after administration of albuterol. All other investigated variables were not significantly affected by aerosol administration. CONCLUSIONS: Nebulized albuterol in infants with mild bronchiolitis due to respiratory syncytial virus did not improve VPTEF/VE and tPTEF/tE but did decrease TEF10 and 25/PT.

Albuterol↗
PubMed2002

Down-regulated circulating PMN function after injury despite enhanced p38 MAPK activity.

BACKGROUND: Neutrophils (PMN) are initially primed by injury. However, remaining PMN found in the circulation postinjury demonstrate a down-regulated phenotype with inhibited apoptosis, CXCR2 expression, and endotoxin (LPS) responsiveness that may contribute to infectious complications and organ dysfunction. The p38 mitogen activated protein kinase (MAPK) signal transduction pathway has been implicated in regulating each of these PMN functions. We, therefore, hypothesize that p38 signaling is similarly down-regulated in postinjury circulating PMN. MATERIALS AND METHODS: PMN were isolated from trauma patients (ISS > 20, postinjury day 3) and concurrently from healthy volunteers (control). PMN were cultured with LPS (100 ng/mL) and p38 activity assessed by Western blotting of cell lysates using a dual phosphospecific antibody for phosphorylated, active p38. In separate experiments, PMN from healthy volunteers were cultured in plasma from either healthy or injured subjects +/- LPS and p38 activity assessed by a cell-free in vitro kinase assay using the transcription factor, ATF-2, as a substrate. Apoptosis and IL-1beta secretion of the cultured PMN from each experimental condition were also quantified. RESULTS: Circulating PMN from trauma patients have an upregulated LPS signaled p38 MAPK response (threefold) compared to PMN from healthy volunteers (p < 0.05). Furthermore, circulating factors present in trauma plasma can transfer this response to normal PMN. There was no significant alteration in apoptosis following LPS treatment between control and trauma patient's PMN (control: 62 +/- 3% vs. trauma: 55 +/- 5%), but there was decreased secretion of IL-1beta (control: 100 +/- 28 pg/mL vs. trauma: 12 +/- 5 pg/mL, p < 0.05). CONCLUSION: We conclude that injury down-regulates selective PMN function despite enhanced p38 activity. These results suggest a shift in the role of PMN p38 signal transduction following injury with additional critical regulation of LPS responses downstream to p38 MAPK activity.

Apoptosis↗