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Biomedical subjects

E McCarthy

Publications and source records attributed to E McCarthy.

At least 19 recordsLinked to original sources
PubMed2003

Viewing conditions for diagnostic images in three major Dublin hospitals: a comparison with WHO and CEC recommendations.

Accurate interpretation of X-ray images is dependent on image viewing conditions. A recent study in Ireland demonstrated that even with the advent of digital departments the majority of images are still viewed using viewing boxes. This investigation aimed to measure average viewing box brightness, percentage uniformity and ambient light levels in radiology and radiographer viewing areas and wards within three major Dublin hospitals. The results were compared with published recommendations by the World Health Organization and Commission of the European Communities. Following analysis of more than 4650 measurements, it was shown that mean values for average viewing box brightness for all departments failed to achieve recommended levels. Only one third of areas met the most lenient guideline for percentage uniformity. Ambient lighting was shown to be unacceptable for ward areas. For all three parameters, radiology areas generally fared best, with wards gaining the poorest scores. Following a 3 min cleaning regimen of viewing boxes, the average brightness and percentage uniformity were improved in 100% and 80%, respectively, of viewing boxes, but average brightness values remained below recommended levels. The importance of comprehensive quality assurance programmes for viewing boxes has been highlighted so that visualization of images is not reduced to sub-optimal levels. The need for consistent and more informative recommendations has been emphasized.

Hospitals, District↗
PubMed2002

Skin metastasis from conventional giant cell tumor of bone: conceptual significance.

A conventional giant cell tumor of the proximal femur recurred twice locally and developed pulmonary nodules. The lung lesions were felt to be an example of "benign" metastases. Eight months after the initial presentation, the patient developed a single skin nodule on the contralateral leg. Histologic features of the skin nodule showed conventional giant cell tumor identical to the bone lesion. This nodule is a manifestation of arterial metastasis typical of any malignant tumor and seemingly contradicts the concept of "benign" metastasis.

Adult↗
PubMed2002

The nature and timing of seasonal affective symptoms and the influence of self-esteem and social support: a longitudinal prospective study.

BACKGROUND: Seasonal affective disorder (SAD) is characterized by recurrent episodes of depression occurring regularly with the onset of winter. METHOD: The study was a prospective naturalistic follow-up of the emergence of symptoms of seasonal depression with the passage of time and change in seasons. Participants were screened during summer for SAD. Participants were excluded if they were depressed (BDI > 14) during the summer reruitment. Eligible participants prospectively monitored their mood and anxiety by completing the BDI and BAI every 2 weeks from 1 September through to the 31 March. RESULTS: Forty-five participants met criterion for SAD were included in the final data analyses. Depression scores rose gradually over the 30 week period reaching a peak median score around weeks 22 to 24 (January-February). The 'hallmark' physiological symptoms (changes in sleep, appetite and fatigue) emerged earlier in the winter period than cognitive symptoms. The emergence of anxiety symptoms was highly correlated with depressive symptoms, although the median anxiety scores did not reach a clinically significant level. Low self-esteem and poor perceived social support were significantly related to an earlier onset in the emergence of depressive symptoms. Both these factors together resulted in the speediest onset of depression. Poor perceived social support, but not low self-esteem, was associated with earlier emergence of anxiety symptoms. CONCLUSIONS: Physiological symptoms may activate negative cognitions in individuals with risk factors of low self-esteem and poor social support so that the disorder is precipitated earlier and is of longer duration.

Adult↗
PubMed2001

Reliability and concurrent validity of the movement assessment battery for children.

Reliability and concurrent validity of the Movement Assessment Battery for Children were evaluated with a sample of 106 boys and girls, distributed into four age groups: 5-6 yr. (n = 20), 7-8 yr. (n = 20), 9-10 yr. (n = 46), and 11-12 yr. (n = 20). Test-retest reliability of the Movement Assessment Battery for Children, estimated using intraclass correlation coefficients, was high across all age groups, and concurrent validity yielded moderate Pearson correlation coefficients between the Move ment battery and long and short forms of the Bruininks-Oseretsky Test of Motor Proficiency. These results support the use of the Movement battery as a measure of motor ability in children, ages 5 to 12 years.

Child↗
PubMed2000

Prefabrication of combined composite (chimeric) flaps in rats.

The purpose of this study was to prefabricate a new combined composite (chimeric) flap that consists of four different tissues. The tissues were prefabricated around two independent pedicles that ultimately join as a single main pedicle. In the inguinal area of 36 rats, the saphenous and the superficial inferior epigastric (SIE) pedicles were dissected and prepared as vascular carriers. A fascial graft and a local muscle flap were wrapped around the saphenous pedicle. The SIE pedicle was then implanted under the abdominal skin to supply a future skin flap. An ear cartilage graft was also inserted under the abdominal skin and adjacent to the implanted SIE pedicle. After allowing 2-, 4-, 6-, and 12-week prefabrication periods in different groups of nine animals, the prefabricated tissues were raised around two pedicles nourished by the femoral pedicle and then transferred. Flap survival was assessed by observation, microangiography and histology. The skin flaps showed survival rates of 52 +/- 17% (mean +/- standard error of the mean), 64 +/- 16%, 86 +/- 11%, and 100 +/- 0% of the total areas in the 2-, 4-, 6-, and 12-week prefabricated flaps respectively. None of the control grafts that were prepared on the contralateral side survived totally. A significant difference was found between the 12- and 2-week (p < 0.008), 12- and 4-week (p < 0.02), and 6- and 2-week (p < 0.05) prefabrication groups. Histologically, fascial and cartilage grafts, and portions of muscle were viable in the 2- and 4-week groups. Also, noticeable necrosis was found in the skin flaps in these groups. The muscle showed mild (at 2, 4, and 6 weeks) and moderate (at 12 weeks) atrophy. After prefabrication for 6 weeks, all tissues demonstrated good survival. This study shows that a combined composite flap can be prefabricated successfully in rats after a 6-week period of prefabrication.

Anastomosis, Surgical↗
PubMed2000

Two-year follow-up of cognitive--behavioral therapy and supportive counseling in the treatment of persistent symptoms in chronic schizophrenia.

The article reports the 2-year follow-up of patients suffering persistent symptoms of schizophrenia who entered a single blind randomized controlled trial. Patients were randomly allocated to cognitive-behavioral therapy (CBT) plus routine care (RC), supportive counseling (SC) plus RC, or RC alone. Treatment took place over 3 months, and follow-up was made 12 and 24 months after treatment finished. Sixty-one patients were available to the 2-year follow-up and assessed for positive and negative symptoms and clinical improvement; all of the 87 patients who entered the trial were assessed for relapse over the follow-up period. On all measures, patients who received RC alone did significantly worse at 2 years. There were no significant differences at 2 years between the CBT and SC groups.

Adult↗
PubMed1999

Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment.

OBJECTIVE: To determine the efficacy of teaching patients with bipolar disorder (manic-depressive psychosis) to identify early symptoms of relapse and seek prompt treatment from health services. DESIGN: Single blind randomised controlled trial with matching on four baseline variables using a minimisation algorithm. SETTING: Mental health services in four NHS trusts (one teaching, three non-teaching). SUBJECTS: 69 patients with bipolar disorder who had had a relapse in the previous 12 months. INTERVENTIONS: Seven to 12 individual treatment sessions from a research psychologist plus routine care or routine care alone. MAIN OUTCOME MEASURES: Time to first manic or depressive relapse, number of manic or depressive relapses, and social functioning examined by standardised interviews every six months for 18 months. RESULTS: 25th centile time to first manic relapse in experimental group was 65 weeks compared with 17 weeks in the control group. Event curves of time to first manic relapse significantly differed between experimental and control groups (log rank 7.04, df=1, P=0.008), with significant reductions in the number of manic relapses over 18 months (median difference 30% (95% confidence interval 8% to 52%), P=0.013). The experimental treatment had no effect on time to first relapse or number of relapses with depression, but it significantly improved overall social functioning (mean difference 2.0 (0.7 to 3.2), P=0.003) and employment (mean difference 0.7 (0.1 to 1.3), P=0.030) by 18 months. CONCLUSION: Teaching patients to recognise early symptoms of manic relapse and seek early treatment is associated with important clinical improvements in time to first manic relapse, social functioning, and employment.

Adolescent↗
PubMed1999

A randomised controlled trial of home-based rehabilitation versus outpatient-based rehabilitation for patients suffering from chronic schizophrenia.

BACKGROUND: Outpatient-based treatments for patients suffering from chronic schizophrenia inadvertently exclude a significant proportion of subjects because they are often too poorly motivated to attend for treatment. In addition there are also concerns about whether the skills that are learnt in a hospital setting will generalize to situations when the individuals are at home. This study attempted to redress some of these potential deficiencies and followed on from an earlier local study which found that a community-based team met more of the needs of patients suffering from chronic schizophrenia. METHOD: Seventy-five patients suffering from chronic schizophrenia were allocated randomly to receive traditional outpatient-based or home-based rehabilitation from a clinical psychologist and an occupational therapist. They were assessed before and after 9 months of treatment on a range of clinical, social and quality of life outcomes. Distress to carers was also assessed. Readmission to hospital was recorded for each subject. RESULTS: There were significant reductions in socially embarrassing behaviour (SBS), increases in interpersonal functioning and recreational activities and a trend for quality of life to improve in the home-based group. There were fewer admissions in the home-based group but the differences, although financially substantial, were not statistically significant. CONCLUSIONS: The home-based rehabilitation service was well received by the majority of patients suffering from chronic schizophrenia and led to some improvement in social behaviour, interpersonal functioning, recreational activities and quality of life.

Adult↗
PubMed1999

A case report and review of pregnancies in rudimentary noncommunicating uterine horns.

A liveborn and subsequently thriving child was delivered abdominally from a pregnancy in a rudimentary noncommunicating uterine horn. This is the 13th English language report of neonatal survival from such an unusual and life-threatening situation. The case presents some 'clues' in the history and a review of the literature suggests that the previously reported bleak outlook for these pregnancies can now be tempered with cautious optimism. Ultrasound diagnosis of Müllerian abnormalities during pregnancy remains difficult but has been reported in several other cases in the literature and may become more common in the future.

Adult↗
PubMed1999

Durability of the effects of cognitive-behavioural therapy in the treatment of chronic schizophrenia: 12-month follow-up.

BACKGROUND: Persistent drug-resistant psychotic symptoms are a pervasive problem in the treatment of schizophrenia. AIMS: To evaluate the durability of the treatment effects of cognitive-behavioural therapy for chronic schizophrenia one year after treatment termination. METHOD: A comparison of clinical outcomes was made at one-year follow-up from a randomised trial of cognitive-behavioural therapy, supportive counselling and routine care alone in the treatment of chronic schizophrenia. RESULTS: Seventy out of the 72 patients (97%) who completed treatment were assessed at follow-up. There were significant differences between the three groups when positive and negative symptoms were analysed by means of ANCOVAs. Between-group comparisons indicated significant differences between cognitive-behavioural therapy and routine care at follow-up for positive symptoms. There was a trend towards significance for both cognitive-behavioural therapy and supportive counselling to be superior to routine care alone on negative symptoms. CONCLUSIONS: At 12-month follow-up the significant advantage of cognitive-behavioural therapy compared to routine care alone remained.

Adolescent↗
PubMed1999

Changing patterns of surgical care in the United States, 1980-1995.

National inpatient and ambulatory surgery data were combined to examine changes over time in the location and amount of surgical care. The main pattern was a decline in the rate of inpatient operations that was outweighed by growth in ambulatory operations. However, the rate of inpatient operations did not decrease for patients age 65 years or over, despite the growth in ambulatory surgery. Other patterns seen for specific types of operations were the substitution of ambulatory for inpatient operations, increases primarily in the rate of inpatient operations, and decreases in total operations. These patterns have implications for control of health care costs.

Adolescent↗
PubMed1998

Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia.

OBJECTIVES: To investigate whether intensive cognitive behaviour therapy results in significant improvement in positive psychotic symptoms in patients with chronic schizophrenia. DESIGN: Patients with chronic schizophrenia were randomly allocated, stratified according to severity of symptoms and sex, to intensive cognitive behaviour therapy and routine care, supportive counselling and routine care, and routine care alone. SETTING: Adjunct treatments were carried out in outpatient clinics or in the patient's home. SUBJECTS: 87 patients with persistent positive symptoms who complied with medication; 72 completed treatment. OUTCOME MEASURES: Assessments of positive psychotic symptoms before treatment and 3 months after treatment. Number of patients who showed a 50% or more improvement in symptoms. Exacerbation of symptoms and rates of readmission to hospital. RESULTS: Significant improvements were found in the severity (F=5.42, df =2,86; P=0.006) and number (F=4.99, df=2,86; P=0.009) of positive symptoms in those treated with cognitive behaviour therapy. The supportive counselling group showed a non-significant improvement. Significantly more patients treated with cognitive behaviour therapy showed an improvement of 50% or more in their symptoms (chi2=5.18, df=1; P=0.02). Logistic regression indicated that receipt of cognitive behaviour therapy results in almost eight times greater odds (odds ratio 7.88) of showing this improvement. The group receiving routine care alone also experienced more exacerbations and days spent in hospital. CONCLUSIONS: Cognitive behaviour therapy is a potentially useful adjunct treatment in the management of patients with chronic schizophrenia.

Adult↗
PubMed1998

Intraarticular epithelioid sarcoma.

A case of an intraarticular epithelioid sarcoma is presented. The patient was a 35 year old man who presented with a 10 months history of a chronic monoarthritis. The MRI showed a diffuse lesion involving the synovial membrane of the knee. There was a marked increased signal on T2 weighted images. Most epithelioid sarcomas involve the subcutaneous tissues of the hands or feet. This presentation is unusual and this entity should be considered in the differential diagnosis of an intraarticular proliferative process.

Adult↗
PubMed1998

Individual cognitive-behavior therapy in the treatment of hallucinations and delusions: a review.

The limitations of biochemical treatments in reducing the severity of hallucinations and delusions has led to an increased interest in the investigation of psychological treatments for these symptoms. These investigations have spanned the last 4 decades and have covered a range of psychological approaches from psychoanalytically oriented psychotherapy to behavioral approaches. More recently, findings that some psychotherapies are not effective treatments for psychosis and that cognitive-behavior therapy can be an effective treatment for neurotic disorders have led to increasing interest in the investigation of the effectiveness of cognitive-behavior therapy for psychosis. This review describes and evaluates the research on the cognitive-behavioral treatment of hallucinations and delusions and describes the cognitive models from which the treatments have developed. The conclusion is that, on the whole, the literature provides fairly strong evidence for the efficacy of cognitive-behavioral approaches in the management of chronic psychotic disorders and associated symptoms, although there are a number of areas where further development is necessary.

Adaptation, Psychological↗
PubMed1998

The histologic anatomy of the volar plate.

The volar plate (VP) is critical to the stability of the proximal interphalangeal joint. This study clarifies the macro- and micro-architectural structure of the VP and correlates these findings with its functional properties. Microscopic evaluation of cadaver specimens revealed a trilaminar structure of the VP with differential orientation and organization of collagen fibers in the volar, central core, and dorsal check rein sections of the plate. This description differs from the existing literature and adds to the understanding of the functional properties of the VP. The most important finding is a dense "basket weave" of collagen fibers oriented in 2 perpendicular planes within the central core of the VP. This orientation may contribute primarily to the resistance of the VP to both longitudinal and torsional stress. This study adds to the understanding of the histologic basis for the function of the VP and the mechanisms involved in its injury.

Cadaver↗