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Biomedical subjects

D O'Neill

Publications and source records attributed to D O'Neill.

At least 19 recordsLinked to original sources
PubMed2006

Defining and quantifying coping strategies after stroke: a review.

The coping strategies that people use after a stroke may influence recovery. Coping measures are generally used to assess the mediating behaviour between a stressor (ie, disease or condition) and the physical or psychological outcome of an individual. This review evaluates measures that quantified coping strategies in studies on psychological adaptation to stroke. The main aspects of the coping measures reviewed were (a) conceptual basis; (b) coping domains assessed; (c) coping strategies used after a stroke; and (d) psychometric properties of coping measures used in studies assessing patients with stroke. Four databases (Medline, CINAHL, PsychINFO and Cochrane Systematic Reviews) were searched to identify studies that used a coping measure in stroke. 14 studies assessed coping strategies in patients after stroke. Ten different coping measures were used, and the studies reviewed had many limitations. Few studies provided definitions of "coping" and the psychometric properties of the coping measures were under-reported. The need for future studies to more clearly define the coping process and to present data on the reliability and validity of the measures used is emphasised.

Adaptation, Psychological↗
PubMed2006

Ethicists and clinicans: the case for collaboration in the teaching of medical ethics.

It has become part of conventional wisdom that medical students experience a clear separation between the explicit ethics curriculum of the lecture room and the implicit curriculum of the clinic. This paper outlines and critiques some important assumptions made about the teaching of ethics in medical schools. It identifies the need for close collaboration between clinical and non-medical ethics teachers to advance the teaching of ethics in medical training.

Cooperative Behavior↗
PubMed2005

Significant variation in mortality and functional outcome after acute ischaemic stroke between Western countries: data from the tinzaparin in acute ischaemic stroke trial (TAIST).

BACKGROUND: The medical care of patients with acute stroke varies considerably between countries. This could lead to measurable differences in mortality and functional outcome. OBJECTIVE: To compare case mix, clinical management, and functional outcome in stroke between 11 countries. METHODS: All 1484 patients from 11 countries who were enrolled into the tinzaparin in acute ischaemic stroke trial (TAIST) were included in this substudy. Information collected prospectively on demographics, risk factors, clinical features, measures of service quality (for example, admission to a stroke unit), and outcome were assessed. Outcomes were adjusted for treatment assignment, case mix, and service relative to the British Isles. RESULTS: Differences in case mix (mostly minor) and clinical service (many of prognostic relevance) were present between the countries. Significant differences in outcome were present between the countries. When assessed by geographical region, death or dependency were lower in North America (odds ratio (OR) adjusted for treatment group only = 0.52 (95% confidence interval, 0.39 to 0.71) and north west Europe (OR = 0.54 (0.37 to 0.78)) relative to the British Isles; similar reductions were found when adjustments were made for 11 case mix variables and five service quality measures. Similarly, case fatality rates were lower in North America (OR = 0.44 (0.30 to 0.66)) and Scandinavia (OR = 0.50 (0.33 to 0.74)) relative to the British Isles, whether crude or adjusted for case mix and service quality. CONCLUSIONS: Both functional outcome and case fatality vary considerably between countries, even when adjusted for prognostic case mix variables and measures of good stroke care. Differing health care systems and the management of patients with acute stroke may contribute to these findings.

Activities of Daily Living↗
PubMed2005

Chronic kidney disease in the elderly; a silent epidemic.

Chronic kidney disease has been shown to be associated with significant increases in mortality and morbidity even in early stages. Despite this it is rarely diagnosed, actively investigated or managed in the elderly. We set out to establish the prevalence of CKD and identify causative factors in a consecutive series of referrals to a geriatric medical clinic. We calculated glomerular filtration rates (GFR) for 101 patients attending a geriatric medical clinic using the Cockroft and Gault formula, and collected data on medications and relevant past medical history. Mild CKD (GFR <60ml/min) was present in 80% of the group. Only 10% of these patients had serum creatinine >130(mmol/L. hypertension was present in 50% and only 9% were diabetic. Almost one third were on inappropriate drugs or dosages; most commonly non-steroidal anti-inflammatory drugs (99%). Chronic kidney disease is extremely common in older people attending a geriatric medical clinic and carries significant risks. CKD will not be detected by serum creatinine alone in 90% of cases. Routine calculation of GFR should be used to provide a more accurate measure of renal impairment and allow earlier intervention, risk factor reduction and improve prescribing practices.

Aged↗
PubMed2005

Gait abnormalities in older people--comparison of inter-professional assessment.

Gait abnormalities are common in older people but relatively under-diagnosed. We investigated the prevalence of gait abnormalities among patients presenting to a geriatric medicine day hospital, classified them according to whether they were lower, middle or higher level gait disorders and compared inter-professional (physician and physiotherapist) assessments for this classification. Prospective independent assessment by a physician and a senior physiotherapist of 50 consecutive patients presenting to a day hospital. Presence of a gait abnormality was determined and then classified. Levels of agreement were determined between the two professions. There was 98% agreement that a gait abnormality existed in 43 people. In classifying the gait abnormality there was complete agreement in over two-thirds of cases (67.4%). There was further agreement of higher level gait disorders (but disagreement in the sub-classification) in 11.6% of cases. Given the high prevalence of gait abnormality presenting to the day hospital, screening for gait and balance disorders should be of paramount importance. While levels of agreement between the two professions were high, disagreement existed in approximately one-third of cases. Agreement among professionals essential for appropriate tailoring of treatment and intervention.

Aged↗
PubMed2005

Validating the Orpington Prognostic Score in an Irish in-patient stroke population.

An accurate assessment of stroke severity and the ability to predict prognosis is important for determining rehabilitation needs and long term management of patients after stroke. The Orpington Prognostic Score (OPS) is a clinically derived stroke severity scale that can be used to stratify patients into different severity groups. The aim of this study was to validate the Orpington Prognostic Score (OPS) in an Irish in-patient stroke population. Fifty 'first stroke' patients (21 male, median age 72.5 [range 31-93] years) were assessed within two weeks following stroke onset. Subjects were stratified into mild, moderate and severe groups using previously established cut-offs for the OPS. Outcomes were determined prospectively and compared to initial severity groups. Patients in the severe group had a significantly increased chance of dying (Odds ratio [95%CI] 2.16 [1.72-2.72] and this persisted after adjustment for age and gender. Length of stay increased significantly with increasing stroke severity group (F ratio 7.0 p=0.0025) and this association remained after adjusting for age and gender. The odds of being discharged home or of being able to walk independently by time of discharge decreased significantly (all p<0.001) as stroke severity increased and adjusting for age and gender did not alter these associations. A higher OPS score within 2 weeks of stroke onset was significantly associated with longer length of stay, increased mortality, reduced mobility at discharge and a reduced likelihood of discharge home. The OPS is a valid measure of stroke severity in Irish stroke in-patients.

Aged↗
PubMed2004

Quantification of the role of temporal artery biopsy in diagnosing clinically suspected giant cell arteritis.

PURPOSE: (1) To see the effectiveness of applying the criteria laid down by the American college of Rheumatology in the diagnosis of giant cell arteritis (GCA). (2) To quantify the role of temporal artery biopsy (TAB) in diagnosing GCA using the Greenwich grading system. METHODS: A retrospective case notes review of consecutive patients undergoing TAB over 6 years, from 1995 to 2000, in a UK hospital eye unit was done. The American college of Rheumatology 1990 criteria for diagnosis of GCA were applied. A detailed analysis of age of onset, mode of presentation, laboratory findings and histology was done for all the patients. In an attempt to quantify the clinical value of TAB in patients with clinically suspected GCA, the Greenwich grading system was used. The role of TAB was graded as essential, important, helpful, unnecessary, and adverse effect. RESULTS: Out of the 53 patients who underwent TAB, 13 were found to have positive TAB, while 40 had negative biopsies. On application of the American College of Rheumatology criteria, 36 patients fulfilled the criteria required to make a diagnosis of GCA. Temporal headache, ESR>50 mm/h and temporal artery tenderness were found to occur more often in patients with positive biopsy. CONCLUSION: (1) The American College of Rheumatology criteria provide a framework in which the clinician can continually assess the need for TAB. (2) The Greenwich grading system, as applied in evaluating the role of TAB in the management of GCA, demonstrated the clinical usefulness of this invasive procedure in the majority of cases. It identified the patient groups that benefit the most from a TAB.

Age of Onset↗
PubMed2004

Community-based study of atrial fibrillation and stroke prevention.

The benefits of anticoagulation and antiplatelet agents for stroke prevention in atrial fibrillation (AF) have been established. There is little data on the use of this form of stroke prevention in patients with AF in Ireland. To determine whether adequate stroke prevention measures are taken regarding anticoagulation and aspirin use for patients in the community with chronic AF. Audit of general medical services (GMS) patients with atrial fibrillation in two Dublin general practices. A total of 70 patients with AF were identified from 2684 GMS patients in the two practices: contraindications to anticoagulation were established in 26 of these. In those for whom warfarin was indicated, 21 of 44 (47%) were not anticoagulated. In those not anticoagulated and where aspirin was not contra-indicated, 20 of 42 were not on aspirin. Our study found that almost one third of patients with AF could be anticoagulated but were not, and the alternative of aspirin was only used in just over one half of patients. This represents a lost opportunity for stroke prevention. Various approaches should be explored to remedy this.

Aged↗
PubMed2003

Causes of sensitisation in patients awaiting renal transplantation in Ireland.

Sensitisation to HLA antigens, formed as a result of transfusion, previous allografts or pregnancy, remains a significant problem in transplantation. The aim of this study was to define the causes of sensitisation of potential renal allograft recipients in Ireland in the post-EPO era. A retrospective survey of all patients who were active on the renal transplant waiting list during 1996 was performed evaluating the panel reactive antibodies (PRA), history of sensitising events, and waiting time for transplantation. Of a total of 244 patients (151 males, 93 females), 163 (67%) were not sensitised (PRA < 10%), and 35 (14%) were sensitised (PRA 10-59%), 15 subjects (6%) were significantly sensitised (60-79%) and 31 (13%) were highly sensitised (PRA > 80%). Only 59 (24%) patients had no sensitising events recorded. Fifty-eight (24%) subjects had previous allografts. Transfusion was documented in 173 (71%) subjects. Pregnancy was noted in 55/93 (59%) female subjects. All highly sensitised patients had been transfused. Eighty per cent (12/15) significantly sensitised and 97 (60%) of the non-sensitised subjects had been transfused. The level of sensitisation clearly increased with the number of units transfused. Non-sensitised subjects received a mean of 5.65 units (SEM 1.38), sensitised subjects a mean of 9.8 units (SEM 3.17), significantly sensitised a men of 18.2 units (SEM 6.51), while highly sensitised subjects received a mean of 37.8 units, (SEM 8.4). There was a direct relationship between the waiting time for transplantation and the degree of sensitisation. The percentage of patients who had been transfused in the 1996 cohort (71%) was similar to the percentage of patients transfused on the waiting list in August 1999 (75%). These data demonstrate that transfusion remains an important cause of sensitisation, despite the use of EPO. Measures to further reduce the use of transfusion or the use of immunosuppression at the time of transfusion in potential allograft recipients may be of value in the future.

Female↗
PubMed2002

Community and social interventions at a geriatric medical OPD.

Health and social services in Ireland tend to be relatively poorly coordinated. Surveys confirm the perceptions of older people with disability that access to and availability of both health and social services are limited. Multi-disciplinary geriatric medical clinics may provide a focus for better utilization and coordination of these services. The purpose of this study was to measure not only the existing service use but also the potential for community and social-care intervention with older people living in the community when using multi-disciplinary geriatric medical clinics. A sample of 60 consecutive patients aged over 65, attending our geriatric medical OPD for the first time, were interviewed using a semistructured questionnaire on the current and potential use of community and social care services. Our service arranged for 229 interventions or referral to services, an average of 3.8 interventions per patient. Ninety-six services were already in place (an average of 1.6 per patient) and 455 services were not applicable, an average of 7.6 per patient. A combined health and social care response is critical to a successful strategy to disease and disability in later life. Although this study describes a relative utilitarian approach to increase community and social care support, it shows there is significant scope to improve uptake of basic community and social care services by a focussed approach to the care needs of older people.

Aged↗
PubMed2001

Tinzaparin in acute ischaemic stroke (TAIST): a randomised aspirin-controlled trial.

BACKGROUND: Low-molecular-weight heparins and heparinoids are superior to unfractionated heparin in the prevention and treatment of venous thromboembolism, but their safety and efficacy in acute ischaemic stroke are inadequately defined. METHODS: This randomised, double-blind, aspirin-controlled trial tested the safety and efficacy of treatment with high-dose tinzaparin (175 anti-Xa IU/kg daily; 487 patients), medium-dose tinzaparin (100 anti-Xa IU/kg daily; 508 patients), or aspirin (300 mg daily; 491 patients) started within 48 h of acute ischaemic stroke and given for up to 10 days. Primary intracerebral haemorrhage was excluded by computed tomography. Outcome was assessed, with treatment allocation concealed, by the modified Rankin scale at 6 months (independence [scores 0-2] vs dependence or death [scores 3-6]). FINDINGS: Of 1486 randomised patients, two did not receive treatment and 46 were lost to follow-up. The proportions independent at 6 months were similar in the groups assigned high-dose tinzaparin (194/468 [41.5%]), medium-dose tinzaparin (206/486 [42.4%]), or aspirin (205/482 [42.5%]). There was no difference in effect in any predefined subgroup, including patients with presumed cardioembolic stroke. Other outcome measures were similar between the treatment groups (disability, case-fatality, and neurological deterioration rates). During the in-hospital treatment period no patient assigned high-dose tinzaparin developed a symptomatic deep-vein thrombosis compared with nine assigned aspirin. Conversely, seven patients assigned high-dose tinzaparin developed symptomatic intracerebral haemorrhage compared with one in the aspirin group. INTERPRETATION: Treatment with tinzaparin, at high or medium dose, within 48 h of acute ischaemic stroke did not improve functional outcome compared with aspirin. Although high-dose tinzaparin was superior in preventing deep-vein thrombosis, it was associated with a higher rate of symptomatic intracranial haemorrhage.

Aged↗
PubMed2001

Isolated juvenile xanthogranuloma of the subglottis: case report.

BACKGROUND: Juvenile xanthogranulomatosis (JXG) is a relatively rare macrophage proliferative disorder. It usually presents as a localized cutaneous lesion but may affect other organs. Until now it has never been described in the subglottic region of the larynx. METHODS: We report the first case of juvenile xanthogranulomatosis (JXG) in the subglottis in a 3 year old child. RESULTS: The localization in the subglottis caused airway obstruction requiring tracheostomy to secure the airway. On the basis that most cutaneous lesions regress spontaneously the lesion was managed expectantly and regressed over a period of 28 months allowing decannulation of the child. CONCLUSION: JXG should be considered in the differential diagnosis of subglottic lesions. Once the airway has been secured, JXG of the subglottis can be managed conservatively. Long-term follow-up is required because of the possibility of relapse at other sites.

Child, Preschool↗