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Biomedical subjects

E O'Brien

Publications and source records attributed to E O'Brien.

At least 109 records · Page 6Linked to original sources
PubMed1996

Critical care of the pediatric oncology patient.

The survival rate of children with neoplastic disease has increased significantly because of advances in the diagnosis and treatment of malignancy. The consequences of these scientific advances have led to increased malignancy-related critical complications requiring the expertise of intensive care practitioners. In this article, the authors review common complication associated with malignancies that require admission to the pediatric intensive care unit. Disorders are grouped according to the pathophysiologic mechanism: mechanical effects, systemic effects, related to brain tumors, and complications of intensive chemotherapy or chemo-radiotherapy regimens. Superior vena cava syndrome and brain tumors are described in detail. In conclusion, there is a discussion of outcome data for children with neoplastic disease who are admitted to the pediatric intensive care unit and the role of the advanced practice nurse in influencing patient and family perceptions of the experience.

Critical Care↗
PubMed1996

Transforaminal arthroscopic decompression of lateral recess stenosis.

The purpose of this study was to evaluate the feasibility and efficacy of arthroscopic decompression of lateral recess stenosis, determine potential associated complications, and present an alternative method to access the lateral recess of the lumbar spine. Forty patients were selected in whom the authors found clinical and computerized tomography evidence of lateral recess stenosis and sequestered foraminal herniations. All 40 were treated with a posterolateral arthroscopic technique, and 38 were available for this follow-up evaluation. A satisfactory result was obtained in 31 patients (82%). No neurovascular complications were encountered; however, other complications included an infection of the disc space in one patient and a causalgic-type pain in the involved extremity in four patients. The associated postoperative morbidity in this group of patients was minimal and resulted in rapid rehabilitation and return of patients to preoperative functioning level.

Adult↗
PubMed1996

Profile of persons with disabilities in Medicare and Medicaid.

This DataView presents descriptive information on beneficiaries with disabilities in Medicare and Medicaid. Medicare data show that persons with disabilities have more functional limitations, poorer health status, lower incomes, and experience more barriers to health care than aged Medicare beneficiaries. Medicaid data reveal that significant growth in the Medicaid disabled population has led to the disabled outnumbering the Medicaid-eligible elderly. Additionally, Medicaid serves an increasingly younger disabled population and more persons with mental impairments.

Demography↗
PubMed1996

Evaluation of three devices for self-measurement of blood pressure according to the revised British Hypertension Society Protocol: the Omron HEM-705CP, Philips HP5332, and Nissei DS-175.

OBJECTIVE: We evaluated three devices for self-measurement of blood pressure - the Omron HEM-705CP, the Philips HP5332 and the Nissei DS-175 - according to the revised protocol of the British Hypertension Society (BHS). The results were also analysed according to the criteria for accuracy of the revised standard of the Association for the Advancement of Medical Instrumentation (AAMI). DESIGN: The revised BHS protocol is divided into two parts. Part I, the part applicable to this study, comprises the main validation procedure and has five phases: Before-use device calibration; in-use (field) phase; after-use device calibration; static device validation; report of evaluation. METHODS: Three models of each device passed the before-use device calibration test, after which they entered the in-use phase, which involved use of the three recorders for a month; inter-device calibration was assessed again at the end of the month. There was no difference in calibration testing between the three models of each device, and therefore one of each was selected randomly; the main validation test was carried out in 85 subjects with a wide range of pressures, and the results were analysed according to the BHS grading system from A to D. RESULTS: The Omron HEM-705CP achieved an overall B/A grading and fulfilled the AAMI accuracy criteria; the Philips HP5332 achieved an overall C/A grading and failed the AAMI accuracy criteria for measuring systolic pressure; the Nissei DS-175 achieved an overall D/A grading and failed the AAMI accuracy criteria for measuring systolic pressure. When the BHS and AAMI criteria were applied to tertiles of pressure (low-pressure range < 130/80 mmHg; medium-pressure range 130-160/80-100 mmHg; high-pressure range > 160/100 mmHg) all three devices were less accurate in the high-pressure range: the Omron HEM-705CP achieved C/B grading while continuing to fulfil the AAMI criteria; the Philips HP5332 dropped to D grading for systolic pressure and the Nissei DS-175 achieved a lower D grading for systolic pressure. The mean and standard deviation of the first mercury sphygmomanometer measurements were 148+/-35/88+/-22 mmHg. Acceptability by the users was good and the manufacturer's manual was satisfactory for all three devices. CONCLUSIONS: On the basis of these results, the Omron HEM-705CP was the most accurate of the three devices tested, achieving Grade B for systolic and Grade A for diastolic pressure, as well as fulfilling the AAMI criteria for accuracy for both systolic and diastolic pressure. It can therefore be recommended for the clinical measurement of blood pressure and is the first inexpensive device to satisfy the accuracy criteria of these protocols.

Journal Article↗
PubMed1996

Conventional and ambulatory blood pressure measurement in older patients with isolated systolic hypertension:second progress report on the ambulatory blood pressure monitoring project in the Syst-Eur trial.

OBJECTIVES: To compare clinic and ambulatory blood pressure measurement and the reproducibility of these measurements in older patients with isolated systolic hypertension.PATIENTS: A total of 477 patients aged >/= 60 years with isolated systolic hypertension on clinic measurement were monitored during the placebo run-in phase of the Syst-Eur trial. METHODS: The time-weighted 24 h blood pressure, clock time day and night blood pressure, the cumulative sum-derived crest and trough blood pressure and the high and low blood pressure levels of the square-wave model were computed. The daily alteration between the high and low blood pressure spans was quantified using the clock time day-night difference, the cumulative sum-derived circadian alteration magnitude, the Fourier amplitude and the difference between the high and low blood pressure levels of the square-wave model. RESULTS: The daytime ambulatory systolic blood pressure was, on average, 21 mmHg lower than the clinic blood pressure, whereasthe diastolic blood pressure was, on average, similar with both techniques of measurement. In the 132 patients who underwent repeat measurements, clinic blood pressure levels and the parameters describing the difference betgween the daily high and low blood pressure spans were equally reproducible. However, both were less reproducible than the ambulatory blood pressure levels. The repeatability coefficients, expressed as percentages of near maximum variation, were 50 and 51% for the clinic systolic and diastolic blood pressures, 30 and 33% for the mean 24 h systolic and diastolic blood pressures and between 44 and 54% for the parameters describing the daily alteration between the high and low blood pressure spans. CONCLUSION: In older patients with isolated systolic hypertension, clinic and ambulatory systolic blood pressure may differ greatly; the prognostic significance of this difference remains to be elucidated. Furthermore, the level of blood pressure in these patients is more reproducible by ambulatory measurement than it is by clinic measurement.

Journal Article↗
PubMed1996

Devices for measuring 24 h blood pressure.

INTRODUCTION: When the technique of blood pressure measurement was introduced into clinical medicine during the early years of this century, the importance of accuracy and the limitations of the technique were well recognized [1]. However, the standards called for by the clinicians and scientists who introduced the technique were relaxed as the twentieth century progressed. Now, once again, the methodology of blood pressure measurement both in clinical practice and in hypertension research is recognized as a cause for concern [2,3]. The history of ambulatory blood pressure measurement (ABPM) [1,3] and the development of validatory techniques [4] have been reviewed recently.

Journal Article↗
PubMed1996

The importance of thrombus organization and stellate cell phenotype in collagen I gene expression in human, coronary atherosclerotic and restenotic lesions.

OBJECTIVES: Collagen synthesis is one of the major mechanisms of primary atherosclerotic plaque growth and is likely to be similarly important in restenosis. The patterns of collagen gene expression in human restenosis and associations with thrombosis/hemorrhage have not been described. METHODS: Using human coronary artery samples obtained via the atherectomy catheter, we compared primary plaques (40 specimens) and restenotic lesions (41 specimens) for type I collagen gene expression using immunocytochemistry (SPI.D8 antibody to type I procollagen, an intracellular precursor of mature collagen) with subsequent computer image analysis. RESULTS: Scattered positive cells were identified in specific, non-random patterns. According to logistic regression analyses, type I procollagen gene expression seems to be more closely associated with certain morphological features (organized thrombus, microvessels, regions enriched with stellate cells) than with belonging to a primary vs. a restenotic sample. However, there may be a tendency for restenotic tissue to have slightly higher numbers of type I procollagen-positive cells than primary lesion tissue. CONCLUSIONS: Symptomatic primary and restenotic lesions exhibit similar patterns of type I collagen gene expression. Plaque microvessels and thrombi/hemorrhages (common features of both kinds of advanced lesions) might stimulate collagen synthesis equally well irrelevant to the nature of the lesion.

Adult↗
PubMed1996

Theodore Caldwell Janeway (1872-1917): the quest for precision.

The memory of Theodore Caldwell Janeway wafts through the mists of time but faintly. Yet for those few who have read his remarkable book The Clinical Study of Blood-Pressure published in New York in 1904, (see reference 1) he emerges as one of the major clinical scientists in the field of hypertension in the 20th-century. In this monograph he outlines with prescient clarity the limitations of sphygmomanometry and demonstrates the diurnal variability of blood pressure (BP) and the effects of varying stresses on BP. Such was his appreciation of haemodynamics, that had a serendipitous muse been at his side we might speak today of the Janeway rather than of the Korotkoff sounds.

Education, Medical↗
PubMed1996

The dilemma of choice: which bladder for accurate blood pressure measurement?

This paper reviews the literature on a century-old controversy relating to the error that may be introduced to blood pressure measurement by using a cuff with a bladder of inappropriate dimensions for the arm for which it is intended. The use of cuffs containing inappropriate bladders is a serious source of error which must inevitably lead to incorrect diagnosis in practice and erroneous conclusions in hypertension research. There is unequivocal evidence that either too narrow or too short a bladder (undercuffing) will cause overestimation of blood pressure and there is growing evidence that too wide or too long a bladder (overcuffing) may cause underestimation of blood pressure. Undercuffing has the effect in clinical practice of overdiagnosing hypertension and overcuffing leads to hypertensive subjects being diagnosed as normotensive. Either eventuality has serious implications for the epidemiology of hypertension and clinical practice. A detailed review of the literature permits a definitive statement on bladder dimensions for a given arm circumference and clearly indicates that substantial error is caused by the use of inappropriate cuffs. On the basis of this review and aware of the advances in cuff design, the features for an "Adult Cuff", which would be applicable to all adult arms, are proposed in this paper, and it is hoped that manufacturers may take up the challenge of producing such a cuff.

Adult↗
PubMed1996

Review: a century of confusion; which bladder for accurate blood pressure measurement?

This paper reviews the literature on a century-old controversy relating to the error that may be introduced to blood pressure (BP) measurement by using a cuff with a bladder of inappropriate dimensions for the arm for which it is intended. The use of cuffs containing inappropriate bladders is a serious source of error which must inevitably lead to incorrect diagnosis in practice, and erroneous conclusions in hypertension research. There is unequivocal evidence that either too narrow or too short a bladder (undercuffing) will cause overestimation of BP and there is growing evidence that too wide or too long a bladder (overcuffing) may cause underestimation of BP. Undercuffing has the effect in clinical practice of overdiagnosing hypertension and overcuffing leads to hypertensive subjects being diagnosed as normotensive. Either eventuality has serious implications for the epidemiology of hypertension and clinical practice. A detailed review of the literature permits a definitive statement on bladder dimensions for a given arm circumference and clearly indicates that substantial error is caused by the use of inappropriate cuffs. On the basis of this review and aware of the advances in cuff design, the features for an 'Adult Cuff', which would be applicable to all adult arms, are proposed in this paper, and it is hoped that manufacturers may take up the challenge of producing such a cuff.

Adult↗