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Biomedical subjects

Donna Stewart

Publications and source records attributed to Donna Stewart.

8 recordsLinked to original sources
PubMed2005

Psychological side-effects of clomiphene citrate and human menopausal gonadotrophin.

OBJECTIVE: This study evaluated the psychological side-effects of clomiphene citrate (CC) and hMG in women undergoing fertility treatment. METHOD: This study was a cross-sectional, self-report survey of 454 women at various stages of treatment for infertility. At the time of study, 139 women had not taken fertility drugs and 315 women had taken one or more cycles of CC or hMG. All subjects were asked to complete the State-Trait Anxiety Inventory (STAI). Women taking CC or hMG were also asked to complete a self-administered questionnaire on the side-effects of their medications. RESULT(S): In the CC group (n = 162) and hMG group (n = 153), 77.8% (126 of 162) and 94.8% (145 of 153) reported at least one side-effect, respectively. Irritability, mood swings, feeling down, and bloating had high frequencies in both CC and hMG groups, with a higher mean number of side effects reported in the hMG group (4.4 +/- 3.7 for the CC group and 6.8 +/- 3.7 for the hMG group, p < 0.001). There was no significant difference among the CC, hMG and no medication groups for mean state and trait anxiety scores. However, there were significant differences among the three side-effect groups (those who reported 1 to 4, 5 to 7, and more than 7 side-effects) for the mean scores of state (df = 2, F = 8.7, p < 0.001) and trait (df = 2, F = 11.9, p < 0.001) anxiety in women taking fertility drugs. CONCLUSION(S): Women taking CC or hMG reported high frequencies of psychological side-effects, and should be advised of these before treatment.

Anxiety↗
PubMed2004

Posterior cruciate ligament reconstruction using single-bundle patella tendon graft with tibial inlay fixation: 2- to 10-year follow-up.

PURPOSE: Reconstruction of the posterior cruciate ligament (PCL) using the tibial inlay fixation has been reported as an alternative to the transtibial tunnel technique. Previous failures in PCL reconstruction and early reports raising potential biomechanical and clinical advantages have spurred interest in this technique. The purpose of this study was to evaluate the minimum 2-year results of PCL reconstruction using a single-bundle bone-patellar tendon-bone graft and tibial inlay fixation. METHODS: The authors prospectively studied 44 patients having isolated or combined PCL reconstruction using the direct tibial inlay fixation technique. The study period was from 1991 to 2001. Two-year minimum follow-up was 93% (41/44) and averaged 39.4 months. These 41 patients comprised the study group. Thirty-one patients were male and 10 patients were female; average age was 28 years. There were 35 primary and 6 revision reconstructions. Surgery was performed in the acute or subacute setting (<8 weeks) in 34% (14/41) and chronic setting in 66% (27/41). Combined reconstructions involving the posterolateral corner, anterior cruciate ligament (ACL), or medial collateral ligament (MCL) were done in 85% (35/41). In all patients, preoperative posterior drawer (PD) examination demonstrated greater than 12 mm posterior translation. All PCL reconstructions were performed with bone-patellar tendon-bone graft, which was 12 to 18 mm in width (16 autograft; 25 allograft). Wider tendon grafts were prepared from the allografts and tubularized to fit through an 11-mm tunnel. All patients were evaluated with preoperative and postoperative examination and x-rays. Final follow-up International Knee Documentation Committee (IKDC) subjective evaluation, final follow-up IKDC objective evaluation, and final follow-up Telos stress radiography were performed in all patients. RESULTS: Postoperative PD examination demonstrated the following: 0 (normal) in 9 patients, 1+ in 25 patients, 2+ in 7 patients, and none >2+, as compared to preoperative PD 3+ or greater in all patients in this report. No patient had <12 mm PD preoperatively. Mean improvement in PD was >2 grades of translation as compared to preoperative exam. Forty of forty-one demonstrated a solid endpoint on clinical PD testing. Final follow-up Telos stress radiography with 25 kg posterior load applied at 80 degrees to 90 degrees of flexion demonstrated average side-to-side difference of 4.11 mm (-2 to 10 mm). Average flexion loss was 4 degrees (0-15 degrees ). None lost extension. Preoperative IKDC objective evaluation rated all knees as severely abnormal based on instability. Final follow-up objective IKDC evaluation distribution was as follows: A, 4 knees; B, 24 knees; C, 11 knees; and D, 2 knees, as compared to all 41 D preoperatively. Average final follow-up IKDC subjective score was 75.1 (20-100). When assessing final follow-up stability with Telos stress radiography, primary cases were significantly more stable than revision cases (P <.05). There was no difference in stability when comparing allograft versus autograft, but improved IKDC scores were seen with allograft (P <.05). There was a trend for combined reconstructions to be more stable than isolated reconstructions. All patients evaluated their knee as improved or greatly improved and would repeat the procedure. CONCLUSIONS: Reconstruction of the PCL-deficient knee with severe posterior laxity is a challenging surgical problem, as combined instability patterns frequently coexist (85% in this study). When appropriate combined reconstructions or primary repair is used, PCL reconstruction with autologous or allograft bone-patellar tendon-bone graft using tibial inlay fixation was shown to be a successful technique at 2- to 10-year follow-up. Based on their initial experience with this technique and previous experience with open and arthroscopic techniques using a transtibial tunnel, the authors continue to use the tibial inlay technique as their preferred technique for isolated or combined reconstruction of the PCL.

Adolescent↗
PubMed2002

Development of a health-related quality of life instrument for nausea and vomiting of pregnancy.

OBJECTIVE: To develop a questionnaire that measures change in symptoms of nausea and vomiting of pregnancy (NVP). METHODS: Eligible and consenting callers to the NVP Healthline at the Hospital for Sick Children, Toronto, underwent telephone interview by using a structured questionnaire. Callers were asked to indicate which of 195 items had been a problem for them and the importance of that problem. For each item, the "frequency" (of women who identified the item as problematic) and "mean importance" (mean importance score of women who indicated that the item was problematic) were multiplied to give the "overall impact." Patterns of response were examined by maternal characteristics. Factor analysis was used to explore relationships between factors. RESULTS: Among 500 women enrolled, areas of quality of life impairment were frequent and similar by maternal characteristics. The questionnaire contains 30 items in 4 domains (physical symptoms/aggravating factors, fatigue, emotions, and limitations) and takes 10 minutes to administer. CONCLUSIONS: This questionnaire contains topics of quality of life impairment important to women with NVP and shows promise for use as an outcome measure in clinical trials.

Adult↗
PubMedDate not supplied

From research to application: the development of an antenatal psychosocial health assessment tool.

OBJECTIVE: To describe the development of an assessment tool for antenatal psychosocial risk factors associated with poor postpartum outcomes. METHODS: A survey of Ontario family physicians established a need for an antenatal psychosocial health assessment (ALPHA) form. A critical literature review identified important antenatal factors for inclusion on the form. Focus groups of obstetrical care providers indicated acceptance of the provider-completed ALPHA; their feedback led to the development of a self-report ALPHA. Satisfaction, yield and reliability of the self-report and provider-completed ALPHA forms were studied and found to be comparable. RESULTS: Physicians and patients reported good satisfaction and usefulness of the ALPHA form in identifying antenatal psychosocial risk factors. The provider ALPHA was further tested in clinical practice. ALPHA endorsement was obtained from physicians, nurses and midwives. CONCLUSION: A program planning process, which included multidisciplinary involvement, evaluation and endorsement by professional organizations, aided the development, refinement and application of the ALPHA forms as primary care tools. ALPHA topic headings are incorporated into the official 2000 Ontario Antenatal Record and the ALPHA adopted for use on Prince Edward Island.

Child Abuse↗