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Biomedical subjects

H McGee

Publications and source records attributed to H McGee.

At least 19 recordsLinked to original sources
PubMed2005

Information leaflets for venous leg ulcer patients: are they effective?

OBJECTIVE: To validate the usefulness of written information for patients with venous leg ulcers and test the hypothesis that patients who receive written information retain more knowledge than those who receive verbal information alone. METHOD: Twenty patients newly diagnosed with venous leg ulcers were recruited into this prospective trial. Patients were randomised either to the control group (given verbal information on their condition) or the intervention group (same verbal information and an information leaflet). The verbal information was in the same format as in the leaflet. Patients' knowledge of the condition was ascertained at an initial interview and at follow-up four to six weeks later. RESULTS: At follow-up both groups showed an overall improvement in knowledge, with no statistical difference between them. CONCLUSION: The results indicate there is limited value in providing information leaflets to this patient group, who were predominantly older patients with low levels of education. The relatively small sample size may explain the disappointing results. Further research may reveal a benefit of providing these leaflets to carers.

Aged↗
PubMed2004

Has CONSORT improved the reporting of randomized controlled trials in the palliative care literature? A systematic review.

BACKGROUND: In 1996, the CONSORT (CONsolidated Standards Of Reporting Trials) statement for the reporting of clinical trials was produced, based on empirical evidence regarding bias. AIMS: This study assessed the quality of reporting of randomized controlled trials (RCTs) in the palliative care literature. METHODS: Three specialist journals were hand searched for RCTs. A checklist was devised based on CONSORT recommendations. Two investigators independently assessed all the trials against this checklist. The trials were grouped into time cohorts of five years and quality comparisons made. Trials looking at pain were compared with those trials looking at other aspects of palliative care. RESULTS: Ninety-three RCTs were identified. The number of trials has increased over time: nine in the first cohort, 37 in the second and 47 in the last cohort. The number of patients in the individual trials has also increased over time. Generally, the reporting quality was poor, particularly the areas of allocation concealment, randomization technique and intention to treat analysis, where there is empirical evidence, that it leads to trial bias. Although there were more pain papers than non-pain papers, the quality of reporting was only better for blinding and intention to treat analysis. CONCLUSION: The quality of reporting of RCTs in the palliative care literature is generally poor. However, there has been an increase in the number and the size of RCTs being carried out. This shows recognition of the importance of an evidence base in palliative care. However, in order to guide clinical decision making, future trials need to improve the quality of their reporting by adhering to the CONSORT statement.

Guideline Adherence↗
PubMed2004

A case series of inferior vena cava stenting for lower limb oedema in palliative care.

Inferior vena caval obstruction (IVCO) is an occasional cause of lower limb oedema in palliative care patients with metastatic malignancy. We present five cases who underwent IVC stenting for symptomatic relief. Four of the five cases had significant reduction in their oedema but three of these four patients died within two weeks of the procedure. The procedure itself is described and the appropriateness of this intervention in patients with end-stage disease is discussed.

Adult↗
PubMed2003

Secondary prevention through cardiac rehabilitation: position paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology.

The purpose of this statement is to provide specific recommendations in regard to evaluation and intervention in each of the core components of cardiac rehabilitation (CR) to assist CR staff in the design and development of their programmes; the statement should also assist health care providers, insurers, policy makers and consumers in the recognition of the comprehensive nature of such programmes. Those charged with responsibility for secondary prevention of cardiovascular disease, whether at European, at national or at individual centre level, need to consider where and how structured programmes of CR can be delivered to the large constituency of patients now considered eligible for CR.

Europe↗
PubMed2003

Physical activity for primary and secondary prevention. Position paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology.

There is now clear scientific evidence linking regular aerobic physical activity to a significant cardiovascular risk reduction, and a sedentary lifestyle is currently considered one of the five major risk factors for cardiovascular disease. In the European Union, available data seem to indicate that less than 50% of the citizens are involved in regular aerobic leisure-time and/or occupational physical activity, and that the observed increasing prevalence of obesity is associated with a sedentary lifestyle. It seems reasonable therefore to provide institutions, health services, and individuals with information able to implement effective strategies for the adoption of a physically active lifestyle and for helping people to effectively incorporate physical activity into their daily life both in the primary and the secondary prevention settings. This paper summarizes the available scientific evidence dealing with the relationship between physical activity and cardiovascular health in primary and secondary prevention, and focuses on the preventive effects of aerobic physical activity, whose health benefits have been extensively documented.

Cardiovascular Diseases↗
PubMed2001

Dislocation of Insall-Burstein II modified total knee arthroplasty.

Dislocation of total knee arthroplasty is a rare but serious complication. The experience with the Insall-Burstein II modified knee prosthesis, which was designed to address the issue of dislocation, has been favorable. We present a series of 3 dislocations in 1,500 total knee arthroplasties done with this prosthesis, accounting for about 0.2% of cases.

Aged↗
PubMed2001

Relatives' views of health care in the last year of life.

This article reports the views of 155 relatives of patients who died during a 12-month period with varying degrees of palliative care service (hospital-based, home care and no palliative care). Although overall care was rated as excellent or good by the majority of interviewees, the Critical Incident Technique (Flanagan, 1954) was used to gather examples of good and poor care from relatives' perspectives. These incidents are recounted here under a framework describing the process of care from access to services through to care at the time of death and aftercare for relatives. The range of incidents reported suggest that relatives consider all aspects of care - technical and interpersonal - as important towards the end of life, but particular importance is placed on the attitudinal and dignity-preserving aspects of care. The movement to integrate principles of palliative care into all clinical practice is reinforced by the findings from this study.

Communication↗
PubMed1998

Quality of life following repair of ruptured and elective abdominal aortic aneurysms.

OBJECTIVE: To find out whether patients undergoing repair of ruptured abdominal aortic aneurysms (AAA) had more emotional problems and limitations of lifestyle than those listed for elective resection. DESIGN: Retrospective study SETTING: Teaching hospital, Eire. SUBJETS: 28 patients, 14 in each group, matched for age, sex, duration of stay in the intensive care unit (ICU), hospital stay postoperatively, and length of time since operation. INTERVENTIONS: Application of structured questionnaire. MAIN OUTCOME MEASURES: Emotional problems, mobility, activities of daily living, ability to sleep, degree of psychological stress, presence of symptoms, and Rosser index to measure quality of life (QoL). RESULTS: There were no significant differences between the groups in any measure. CONCLUSIONS: Patients have few emotional difficulties or disturbances of QoL after emergency or elective repair of AAA. Survivors after repair of ruptured AAA can expect as good a quality of life as those operated on electively. These results support an aggressive approach to the treatment of ruptured AAA.

Aged↗
PubMed1996

Dioxins and dioxin-like chemicals in blood and semen of American Vietnam veterans from the state of Michigan.

This exposure assessment pilot study tested the hypothesis that elevated blood levels of the dioxin congener 2,3,7,8-TCDD ("TCDD"), due to Agent Orange exposure, in American Vietnam veterans could be demonstrated two to three decades after Vietnam service. A second objective was to determine if dioxins, including TCDD, are present in the semen of adult males. In the early 1990s, blood samples from 50 Vietnam veterans and three pooled semen samples from 17 of them were analyzed by high-resolution gas chromatography-mass spectroscopy for dioxins, dibenzofurans, and the dioxin-like PCBs. Fifty volunteers from the Michigan Vietnam veteran bonus list, which documented Vietnam service, were invited to participate based on their self-reported exposure to Agent Orange in Vietnam. Screening of military and medical records was performed by an epidemiologist and a physician to assure that Agent Orange exposure was possible based on job description, location of service in Vietnam, and military Agent Orange spray records. Elevated 2,3,7,8-TCDD levels, over 20 ppt on a lipid basis, could still be detected in six of the 50 veterans in this nonrandomly selected group. The dioxin and dibenzofuran congeners commonly found in the U.S. population, including TCDD, were also detected in the three pooled semen samples. Quantification and comparison on a lipid basis were not possible due to low lipid concentrations where levels were below the detection limit. Therefore, semen samples were measured and reported on a wet-weight basis. Elevated blood TCDD levels, probably related to Agent Orange exposure, can be detected between two and three decades after potential exposure in some American veterans. Original levels were estimated to be 35-1,500-fold greater that that of the general population (4 ppt, lipid) at the time of exposure. In addition, the detection of dioxins in semen suggests a possible mechanism for male-mediated adverse reproductive outcomes following Agent Orange or other dioxin exposure.

2,4,5-Trichlorophenoxyacetic Acid↗
PubMed1995

Proportionate mortality study of Vietnam-era veterans of Michigan.

This study examines the proportion of deaths from major diseases among Michigan Vietnam veterans. The distribution of deaths among Michigan Vietnam veterans was compared to deaths among veterans serving elsewhere for 1974-1989 to generate a proportionate mortality ratio (PMR). PMRs were estimated overall and for Black versus non-Black veterans. Overall, Vietnam veterans had significantly elevated PMRs for infectious and parasitic diseases and endocrine disease and lower PMRs for all malignant neoplasms combined. Vietnam veterans overall and non-Black specifically had elevated PMRs for non-Hodgkin's lymphoma. Black Vietnam veterans had elevated PMRs for cancer of the digestive organs, peritoneum, and pancreas. The elevated PMR for non-Hodgkin's lymphoma is consistent with results of individuals exposed to phenoxy herbicides. Results suggest that future studies should examine risks among racial groups separately.

Adult↗
PubMed1992

Individual quality of life in patients undergoing hip replacement.

Quality of life (QoL) assessment is becoming increasingly important for measuring the impact of illnesses, diseases, and their treatment and for deciding priorities when allocating resources. We developed a novel method to measure QoL from the perspective of the individual patient. The schedule for the evaluation of individual quality of life (SEIQoL) was devised from the technique known as judgment analysis to measure patients' level of functioning in five self-nominated facets of life and the relative weight or importance attached to these areas. We applied this method, together with traditional measures of health status, in a prospective intervention study of 20 patients undergoing unilateral total hip-replacement surgery with six-month follow-up by comparison with matched, non-patient controls. Health status was significantly improved by hip replacement on the McMaster health index questionnaire (p less than 0.001) and the arthritis impact measurement scales (p less than 0.001). Individually measured QoL was significantly increased after surgery when measured by SEIQoL (p less than 0.02). The individual nature of QoL was reflected in the variety of life areas nominated as important by individual patients, the differences in relative weights attached to these areas, and the complex nature of the changes that occurred postoperatively. Our data not only highlight such individuality but also show that SEIQoL provides a means by which this can be assessed scientifically.

Adult↗
PubMed1992

Total hip arthroplasty in patients with avascular necrosis of the hip. Follow-up observations on cementless and cemented operations.

Thirty-one patients with avascular necrosis of the hip were treated by 34 total hip arthroplasties (THAs). All patients were observed prospectively with a minimum two-year follow-up evaluation (average, 46 months; range, 24-84 months). Twenty had cemented arthroplasties using contemporary cementing techniques. This included insertion of a medullary plug, cleansing of the canal with a medullary brush, pulsatile lavage irrigation, and insertion of the cement with a cement gun. In 14 hips, a cementless prosthesis was used. Patients were rated using a modified Harris hip score. Sequential postoperative roentgenograms were analyzed in each patient. The overall Harris hip score ratings were 88 in the cemented and 84 in the noncemented groups. Mechanical failure with loosening of the femoral component occurred in one patient who developed deep sepsis. Significant thigh pain occurred in four patients in the noncemented group. Previous studies in the literature have generally reported unfavorable results in patients with avascular necrosis of the hip treated with THA. Using cementless and cemented fixation with contemporary cementing techniques, improved results can be expected. A high incidence of thigh pain (29%) in the cementless group remains a problem.

Adult↗
PubMed1990

Communication skills training in undergraduate medicine.

Good communication with patients is now recognised as the cornerstone in effective medical practice. Medical students do not automatically acquire the art of good communication through clinical training. A new course to promote the development of communication skills at undergraduate level is described. The course was provided at the juncture between pre-clinical and clinical training. Course evaluation illustrated the value of the course as perceived by students themselves and highlighted the areas of greatest need for students in communication skills training.

Communication↗
PubMed1988

Complex dislocation of the metacarpo-phalangeal joint of the index finger: a comparison of the surgical approaches.

Complex dislocation of the index metacarpo-phalangeal joint almost always requires surgical intervention. Controversy exists as to the most suitable surgical approach to reduction: palmar or dorsal. We reviewed four cases and carried out dissections in eight cadaver hands to compare the surgical approaches. The interposed volar plate was found to be the most important obstacle to reduction. Both approaches were successful in obtaining reduction. The dorsal approach was simple and safe, but necessitated longitudinal division of the volar plate and may carry a theoretical risk of late instability. The palmar approach allows restoration of normal anatomy but the radial neurovascular bundle is always vulnerable.

Adolescent↗