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Biomedical subjects

D McCormack

Publications and source records attributed to D McCormack.

At least 37 records · Page 2Linked to original sources
PubMed2001

Research with homeless people uncovers a model of health.

This grounded theory research study, explored health experiences of 11 homeless persons in shelters in three New Brunswick cities and the strategies that they used to attain, maintain, or regain health. Audiotaped interviews were conducted, transcribed verbatim, and analyzed. The model that emerged from analysis consists of three pathways to health. This model of health has two central components, person and health. Person is influenced directly by family values and beliefs, and directly and indirectly by societal values and beliefs. Health is the outcome and is reached through two mediating factors of lifestyle behaviors and sector services. The first pathway to health contains the mediating factor of lifestyle behaviors, the second contains the mediating factor of sector services, and the third contains both mediating factors. Pathway strategies of choosing, accessing, and appraising appropriateness of methods influence the active participation of the person that directs the action within the model. Implications of the study include that a fragmented system of help hinders access to services intended to promote health in this population.

Adaptation, Psychological↗
PubMed2000

An integrative review illuminates curricular applications of primary health care.

The International Council of Nurses supported primary health care and advocated its acceptance by other intersectorial stakeholders. Nurse educators involved in curriculum development have respected this direction. To pursue the primary health care vision and influence the adoption of primary health care delivery systems, all principles of primary health care must be implemented simultaneously. An integrative review was conducted to ascertain the interpretation of primary health care held by nurse authors. A content analysis of the nursing literature revealed that 184 of the 254 articles retrieved (72%), applied primary health care in a manner that is consistent with the World Health Organization (WHO) definition. Through curricular applications of different interpretations of the primary health care principles, differences in the created learning environment are discussed. The Declaration of Alma Ata, evolving from beliefs and values shared by 134 member nations present at the Assembly, delineated that primary health care was the accepted infrastructure to guide policies that direct health care delivery systems regardless of the context in the country (WHO, 1978). Even with this overwhelming endorsement, very few countries have made changes in policies and infrastructure for implementing the underlying values and beliefs ascribed in primary health care. Changes that have occurred have not been organized around the vision or the principles of primary health care. This delay has had, and will continue to have, a huge impact on nursing education, practice, and research. Nurses are interested in helping people attain, maintain, or regain health; primary health care has the potential to achieve health for all citizens of the world.

Attitude of Health Personnel↗
PubMed1998

Short-term effects of macronutrient preloads on appetite and energy intake in lean women.

This study investigated the relative satiating hierarchy of the four energy-providing macronutrients (fat, carbohydrate (CHO), protein, and alcohol) in lean women. On four separate occasions, the composition of an iso-energetic lunch preload was manipulated in 12 lean (BMI < 25 kg/m2) women. The four treatments comprised a 1-MJ baseline meal and drink (40% fat, 48% CHO, 12% protein) to which was covertly added: 1) + 1MJ protein; 2) + 1MJ alcohol; 3) + 1MJ CHO; and 4) + 1MJ fat. Prior to and at 30-min intervals, subjects completed 100-mm visual analogue scales rating subjective hunger and satiety. Ninety min following the preload, an ad lib. lunch meal was given (40% fat, 48% CHO, and 12% protein) and energy intake (EI) measured. Energy intake at the lunch meal was 2195 (880, SD) kJ, 2772 (1191, SD) kJ, 2502 (681, SD), kJ and 2558 (1050, SD) kJ for the protein, alcohol, CHO, and fat preloads, respectively. There was no significant difference between the pleasantness of the preloads (p > 0.05). Macronutrient composition had a significant effect on short-term hunger (F = 3.19; p < 0.05), subjects being less hungry after the protein preload. Subjects also had a lower energy intake after the protein preload (F = 3.11; p < 0.05). We conclude that only protein has a differential short-term satiating effect when incorporated iso-energetically and at a similar energy density into the diet.

Adult↗
PubMed1998

Patellofemoral contact forces and pressures during intramedullary tibial nailing.

Patellofemoral joint forces and pressures were measured in a cadaver model during intramedullary nailing of the tibia. A significant increase in contact pressures was found at the lateral facet of the patellofemoral articulation using the medial paratendinous approach (P = 0.01) and at the medial facet when using the trans-patellar tendon approach (P = 0.001) to the proximal tibia. Increased contact pressures at the patello-femoral joint may result in chondral injury, which in turn may cause anterior knee pain, a common complication of tibial nailing.

Arthralgia↗
PubMed1997

Effect of noninvasive positive pressure ventilation on mortality in patients admitted with acute respiratory failure: a meta-analysis.

OBJECTIVE: To critically appraise and summarize the trials examining the addition of noninvasive positive pressure ventilation to standard therapy on hospital mortality and need for endotracheal intubation in patients admitted with acute respiratory failure. DATA SOURCES: We searched MEDLINE (1966 to September 1995) and key references were searched forward using the Scientific Citation Index (SCISEARCH). Bibliographies of all selected articles and review articles were examined. Authors of all selected and review articles were contacted by letter to identify unpublished work. STUDY SELECTION: a) POPULATION: patients with acute respiratory failure; b) intervention: noninvasive positive pressure ventilation; c) outcome: mortality and/or endotracheal intubation; and d) design: randomized, controlled study. Two of us independently selected the articles for inclusion; disagreements were settled by consensus. Seven (three unpublished) of 212 initially identified studies were selected. DATA EXTRACTION: Two authors independently extracted data and evaluated methodologic quality of the studies. DATA SYNTHESIS: Noninvasive positive pressure ventilation was associated with decreased mortality (odds ratio = 0.29; 95% confidence interval 0.15 to 0.59) and a decreased need for endotracheal intubation (odds ratio = 0.20; 95% confidence interval 0.11 to 0.36). Sensitivity analysis suggested a greater benefit of noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease (COPD). The inclusion/exclusion of unpublished trials did not influence these results. CONCLUSIONS: The addition of noninvasive positive pressure ventilation to standard therapy in patients with acute respiratory failure improves survival and decreases the need for endotracheal intubation. However, this effect is restricted to patients whose cause of acute respiratory failure is an exacerbation of COPD. Further research is warranted to determine whether noninvasive positive pressure ventilation confers benefit in patients without COPD who have acute respiratory failure.

Acute Disease↗
PubMed1997

An evaluation of patients comprehension of orthopaedic terminology: implications for informed consent.

We conducted a prospective study into patient comprehension of orthopaedic terminology that commonly appears on consent forms. The majority of patients questioned were unsure of the meaning of simple terms such as 'fracture reduction' or 'internal fixation'. All the patients questioned had signed consent forms recently for such procedures in an acute orthopaedic unit. We conclude that many patients willingly consent to procedures that they do not fully understand. This implies that there is an element of trust involved in the process of giving consent. We believe that this aspect of the doctor-patient relationship should be legally respected.

Adult↗
PubMed1997

Informed consent from whom?

To obtain legally safe informed consent requires that the patient has a 'substantial understanding' of the proposed procedure and that the doctor obtaining the informed consent has sufficient knowledge to explain the nature of the procedure to the patient. In this paper we have shown that significant misunderstanding exists among non-specialist junior doctors of certain common orthopaedic procedures and conditions. Junior doctors often lack sufficient technical training to fully inform their patients and thus meet legal requirements. The implications of this are that the onus falls even more on specialists to ensure that their patients receive a more detailed explanation of the proposed intervention.

Arthroscopy↗
PubMed1995

Low level laser therapy: a prospective double blind trial of its use in an orthopaedic population.

We have conducted a prospective, double blind trial of low level laser therapy (LLLT) in musculoskeletal injuries to assess its efficacy. We assigned patients with a variety of painful skeletal soft tissue conditions to one of two treatment groups, treatment from a functional machine, placebo treatment from an inactive machine. Both machines were identical and both appeared functional. The operative status of each machine was unknown to both the therapist and the patient. The results suggest that LLLT has no significant therapeutic effect and acts primarily as a placebo.

Adult↗
PubMed1994

Ambulatory paediatric surgery. The development of a day-care surgical centre.

Ambulatory surgery has become an important component in the provision of surgical care. In 1987 a day-case surgical unit was established at Red Cross War Memorial Children's Hospital, Cape Town. Experience over a 6-year period (1987-1992) is reviewed in relation to the nature and total number of surgical procedures, pre-operative preparation, daily utilisation of the facility, postoperative care and complications. During this period 16,538 patients (mean age 3 years) were operated on in the unit. Nine surgical disciplines participated. Pre-operative assessment and preparation reduced the rate of cancellations on the day of surgery to less than 6%, with a 90% effective use of schedules operating time. Scarce nursing resources were also maximally utilised. Most procedures took less than 30 minutes and only 0.8% exceeded 1 hour. The average ward stay was 6 hours. No major complications were encountered and acceptance by patients and parents was excellent. Only 16 children who were not scheduled to do so needed to stay in hospital overnight. Recommendations to establish and improve day-stay surgical services are presented. It is concluded that a practical, efficient service can be established and that the authorities should be encouraged to expand appropriate facilities.

Ambulatory Surgical Procedures↗
PubMed1994

Intraoperative suction catheter tip contamination.

Suction catheter tip contamination is a potential source of intraoperative inoculation of wounds with bacteria. The continuous passage of large quantities of air through a blood-soaked catheter tip during the course of surgical procedures can lead to significant contamination. This in turn may contribute to late wound infection due to inoculation of the deeper recesses of the wound via the contaminated suction catheter tip. We have conducted a prospective clinical study to confirm the incidence of suction catheter tip contamination during orthopaedic trauma surgery and propose changes to current practice to reduce the incidence.

Adolescent↗
PubMed1993

Differential impairment of vascular reactivity of small pulmonary and systemic arteries in hyperdynamic sepsis.

We postulated that the redistribution of organ blood flow that occurs in hyperdynamic sepsis is secondary to organ-specific alterations in vascular reactivity. Chronically instrumented rats were randomized to cecal ligation and perforation (CLP) (n = 12) or to a control procedure (n = 11). Cardiac output increased from 107 +/- 23 ml/min at baseline to 152 +/- 32 ml/min at 24 h after CLP (p = 0.037 versus control values). Mean blood pressure did not change in either group. Small arterial ring segment (100- to 200-microns effective lumen radius) from the pulmonary, renal, celiac, and femora arteries were obtained for determination of in vitro responsiveness. Maximal contractile responses to three receptor-operated contractile agonists were significantly depressed in the pulmonary (p = 0.001) and the celiac (p = 0.001) arteries from CLP versus control rats. The renal artery showed a trend toward decreased responsiveness (p = 0.049), but not difference was seen in the femoral artery (p = 0.172). EC50 values were unchanged. A similar, but less marked, pattern was observed for KCI-induced contractions in that depressed responses were noted in the pulmonary (p = 0.045) and celiac (p = 0.064) arteries. Vasodilator responses to acetylcholine were normal in all vessels. Nitroprusside relaxant responses were enhanced in the pulmonary artery (p = 0.022), but they were normal in the other vessels. We conclude that hyperdynamic, normotensive sepsis is associated with an organ-specific alteration of vascular smooth muscle function that particularly affects receptor-operated contractile responses. The differential expression of this altered vascular responsiveness between organs may contribute to the observed variance in regional blood flows in sepsis.

Animals↗
PubMed1993

Human internal thoracic artery reactivity to dopaminergic agents.

BACKGROUND: Vasospasm of the internal thoracic artery (ITA) is common. The purpose of this study was to characterize the vascular reactivity of human ITA to dopaminergic agents used in patients undergoing coronary bypass surgery (CBS): dopamine, dobutamine, and dopexamine. METHODS AND RESULTS: Segments of the distal ITA 3 mm long were obtained from patients undergoing CBS, mounted on two stainless steel wires in a tissue bath filled with Krebs' solution at 37 degrees C, and attached to a force-displacement transducer. To assess the functional status of the endothelium, the arterial segments were preconstricted with phenylephrine 10(-5) mol/L and then exposed to increasing concentrations of acetylcholine (10(-8) to 10(-5) mol/L). To study vessel relaxation, segments were again preconstricted with phenylephrine 10(-5) mol/L and concentration-relaxation responses to dopamine, dobutamine, and dopexamine (10(-8) to 10(-4) mol/L) were obtained. There was significant vessel relaxation with both dobutamine (log EC50 = -5.83 +/- 0.16) and dopexamine (log EC50 = -5.37 +/- 0.06) but none with dopamine. Vasoconstrictor effects of the drugs were studied from baseline tension. Neither dobutamine nor dopexamine caused vasoconstriction from baseline tension, whereas vessels exposed to dopamine showed constriction at high concentrations. The vessel responses to the dopaminergic agents did not differ according to the functional status of the endothelium as initially assessed by acetylcholine-induced vessel relaxation. CONCLUSIONS: High-dose dopamine may aggravate ITA vasoconstriction, whereas dobutamine and dopexamine appear to cause vasodilation only.

Analysis of Variance↗