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Biomedical subjects

J Carr

Publications and source records attributed to J Carr.

At least 37 records · Page 2Linked to original sources
PubMed2001

Subacute myocardial infarction: assessment by STIR T2-weighted MR imaging in comparison to regional function.

PURPOSE: Increased T2 signal intensity (SI) can be regularly observed in myocardial infarction. However, there are controversial reports about the relationship of elevated T2 SI to myocardial viability and some authors propose that high T2 SI serves as a sign of irreversible myocardial injury. This study investigates increased T2 SI compared to myocardial function in patients with reperfused subacute myocardial infarction. Preserved function was used as criterion for viability. METHODS: Ten healthy volunteers and 17 patients with myocardial infarction and patent infarct related coronary artery were examined on a 1.5 T Magnetom Vision system (Siemens). For T2-weighted MR imaging a breath-hold STIR sequence with dark-blood preparation was used. Cine FLASH 2D imaging was applied to assess myocardial function. Signal-to-noise (S/N) in STIR T2 images was measured in normal and infarcted regions and subsequently identified by two independent observers. Based on a 20 segment model of the left ventricle findings were compared to regional myocardial function. RESULTS: Elevated STIR T2 SI was found in all 17 patients and observed in 27% (204/754) of segments. S/N of normal myocardium was 5.1 +/- 0.7 in volunteers and 4.9 +/- 0.8 in patients (P = NS). Infarcted myocardium presented with significantly increased S/N 12.8 +/- 1.9 (P < 0.0001). Significant transmural elevation of T2 SI was noted in 32% of segments with preserved systolic function. CONCLUSION: Increased STIR T2 SI can be observed transmurally in post-ischemic myocardial regions with preserved function. It therefore cannot be used as an exclusive marker for the non-viable region.

Aged↗
PubMed2001

The vascular impact of uterine artery embolization: prospective sonographic assessment of ovarian arterial circulation.

PURPOSE: The etiology of premature ovarian failure after uterine artery embolization (UAE) is unknown. The authors prospectively assessed ovarian arterial circulation before and after UAE with use of ultrasonography (US). The authors hypothesize that nontarget embolization of the ovary occurs during routine UAE. MATERIALS AND METHODS: Twenty-three women (mean age of 42.6 years; range, 35-51 y) participated in the study. Grayscale, color, and pulsed-wave Doppler US studies were performed immediately before and after UAE. Resistive index (RI) and pulsatility index (PI) were calculated. The proportion of women who developed increased vascular impedance after UAE was statistically assessed with use of the Yates-corrected chi(2) test. RESULTS: Seventeen of 23 patients (74%) completed the study. Nine of 17 (54%) showed complete loss of ovarian arterial perfusion after UAE. Six of 17 (35%) had increases in RI and PI, whereas two of 17 (11%) had decreases in RI and PI. The increase in vascular impedance after UAE in 15 of 17 patients was significant (P <.0001). CONCLUSION: Loss of detectable ovarian arterial perfusion occurs in the majority of patients undergoing UAE. Ovarian vascular impedance increases in nearly all patients as a result of UAE. The authors conclude that inadvertent nontarget embolization of the ovarian arterial bed occurs during routine UAE.

Adult↗
PubMed2001

The value of community mental health nurses based in primary care teams: 'switching the light on in a cellar'.

This paper explores the impact of placing Community Mental Health Nurses (CMHNs) at two primary care practices in South Staffordshire. Data were collected by means of a questionnaire which was sent to primary care personnel at these practices, to ascertain their opinions with respect to the contribution of practice-based CMHNs. Overall, primary care personnel were satisfied with the quality of the service received from the CMHNs, especially in terms of improved communication. They felt that the new arrangements enabled a quicker and more efficient access to the services of the CMHN. The results are discussed in terms of the value of having CMHNs within the primary care setting, and in terms of service planning and future recommendations for mental health services within primary care.

Attitude of Health Personnel↗
PubMed2001

Biomechanical comparison of ankle arthrodesis techniques: crossed screws vs. blade plate.

Many different techniques for ankle arthrodesis have been described. Experience at our institution with crossed screws internal fixation has not met the 90+% union rate reported in the literature. A compression blade plate is one technique for ankle arthrodesis which has not been evaluated biomechanically. A biomechanical study comparing two groups of sawbone ankle fusion constructs fixed with crossed screws and compression blade plates was performed in order to evaluate the stiffness and rigidity of these two arthrodesis techniques. The crossed screws construct demonstrated superior stiffness during dorsiflexion (p < 0.001) and valgus (p < 0.001) loading. The two constructs were found to have equal strength in resisting plantarflexion, varus and torsional loads although there was a trend for greater resistance by the crossed screws construct. These findings lend biomechanical support to the use of crossed screws for tibiotalar arthrodesis.

Ankle Joint↗
PubMed2001

The attitudes of GPs towards the nurse-practitioner role.

In recent years, nursing and health-care policy have promoted the advanced role of the nurse -- that of nurse practitioner. But such a role has not been integrated widely into the primary health-care team. This study investigates the knowledge and attitudes of GPs who do not employ nurse practitioners to find out what prevents them doing so. Ten GPs who did not already employ a nurse practitioner took part in semi-structured interviews. Our findings show that GPs, although confused about the role, were generally supportive of advanced nursing practice. Skills identified with the role were prescribing, disease diagnosis and minor-illness management. GPs thought that protocols and guidelines should govern practice, which differs fundamentally from the Royal College of Nursing definition. None of the GPs had encountered the role in primary care, and the lack of professional regulation and role definition for practice nurses and nurse practitioners who work in primary care may have affected GPs' perceptions.

Attitude of Health Personnel↗
PubMed2000

Prospective evaluation of three different models for the pre-operative diagnosis of ovarian cancer.

OBJECTIVE: To test the accuracy of the risk of malignancy index, the revised risk of malignancy index and Tailor's regression model to diagnose malignancy in women with known adnexal masses. DESIGN: Prospective collaborative study. SETTING: Gynaecology Assessment Unit, Department of Obstetrics and Gynaecology, King's College Hospital, London. SAMPLE: Sixty-one women with known adnexal masses were examined pre-operatively. Women were recruited from three South London hospitals. METHODS: The demographic, biochemical and sonographic data recorded for each patient included: age; menopausal status; CA125 levels; tumour volume; ultrasound characteristics; and Doppler blood flow analysis (peak and mean blood velocities, the pulsatility and resistance indices). The diagnosis of malignancy was made for each woman using all three models and the results compared with the final histopathological diagnosis. RESULTS: Thirty-eight women had benign tumours and 23 had ovarian cancer. Women with malignant tumours were significantly older than those with benign masses. There were also significant differences in CA125 levels, locularity, presence of papillary proliferations and ascites between the two groups. Tailor's regression model achieved a 43% sensitivity and 92% specificity in the diagnosis of malignancy. This compared with a 74% sensitivity and 92% specificity with the risk of malignancy model, and a 74% sensitivity and 89% specificity with the revised risk of malignancy model. CONCLUSION: When applied prospectively all three diagnostic models performed less accurately than originally reported, despite clinical signs of malignancy being present in many cases. It is likely that their accuracy would be even less in a population of women in whom there was a substantial clinical uncertainty. Intra-tumoral blood velocity and CA125 levels were the best individual parameters for discrimination between benign and malignant tumours.

Adult↗
PubMed2000

Randomised controlled trial of two pressure-relieving systems.

The primary objective of this randomised controlled trial was to determine whether there were significant differences between two pressure-relieving systems. A secondary aim was to investigate whether the availability of extra pressure-relieving equipment would reduce the incidence of ulcers in an acute hospital setting. A total of 141 patients in a care-of-the-elderly unit, who were assessed to have a high risk of developing pressure ulcers using the Waterlow score, were recruited; 70 were nursed using Huntleigh Nimbus 3 in conjunction with the Aura cushion (Group A), and 71 using the Pegasus Cairwave Therapy System in conjunction with the Proactive 2 Seating cushion (Group B). The main outcome measure was visual assessment, supported by a photographic record. There were three main findings: for non-heel ulcers and overall improvement, there was no statistically significant difference between the two products tested; for heel ulcers there was a significant difference (P = 0.019) with more patients healing in Group A than in Group B. The average length of stay of patients who completed the trial was 21.6 days (Group A) and 21.7 days (Group B) for patients completing a live (range 1-121 days) and for patients who died 29.7 days (Group A) and 24.3 days (Group B). Routine monitoring showed that, before the trial, the incidence of hospital-acquired pressure ulcers (Torrance grade 2+) was 0.2%; during the trial, this dropped to 0.13%. The study showed differences in the efficacy of different mattress products; with a sufficiently large study, it is possible to demonstrate statistically significant results. Provision of extra pressure-relieving equipment can reduce the incidence of pressure ulcers but may not influence length of stay.

Aged↗
PubMed2000

Human papillomavirus. Epidemiology, transmission, and pathogenesis.

Like many viruses, HPV is a fascinating organism. It is extremely difficult to grow in vitro; but once an individual becomes infected with HPV, it can be difficult or even impossible to eradicate. HPV is associated with mild to moderate disease that even in the absence of therapy may spontaneously regress. On the other hand, some HPV infections progress to cancer, which can be fatal if treatment is delayed. The reader is invited to learn more about the aspects of the biology, diagnosis, and treatment of HPV in the articles that follow.

Condylomata Acuminata↗
PubMed2000

Why don't we have enough cornea donors? A literature review and survey.

BACKGROUND: Organ donation provides a second chance for those who have experienced severe disease or injury. Unfortunately there is a huge discrepancy between the supply and demand of transplantable organs, despite the existence of sufficient numbers of potential donors. Through a review of the literature and a survey of optometry students, this article provides insight into the reasons for the shortage of corneal donors and how more corneal donors might be obtained. METHOD: A survey of 200 optometry students at the University California, Berkeley, School of Optometry was conducted to augment the literature review. Seventy-six students (38% of those surveyed) completed the survey process. RESULTS: Results of the survey indicated that 64.5% of who responded were willing to donate body organs, while 31.6% were not. Of those not willing to donate organs, 11.8% cited religious reasons. Other personal reasons included: fear (4%), respect for the human body (7.9%), and parental disapproval (6.4%). Only 46.1% of respondents had donation stickers on their driver's licenses. CONCLUSION: The literature review and survey indicate that age, religion, culture, personality characteristics, views on death and mortality, body image, and humanitarian concerns are among the many factors that influence people's opinion concerning organ donations. Education of the public and health care professionals' awareness of the importance of obtaining corneas for donation is crucial to end the shortage of organ donors.

Cornea↗
PubMed1999

Re-engineering an Australian emergency department: can we measure success?

In 1996, in response to perceived deficiencies of the Emergency Department, Sir Charles Gairdner Hospital made emergency medicine a key strategic initiative. Major staffing and functional changes occurred as a result, including creation of the first Chair in Emergency Medicine in Australasia. We present a before and after study, using a range of measured variables, including the accepted Australian Council on Healthcare Standards emergency medicine clinical indicators. Clinically, there were great improvements in waiting times, time to thrombolysis in acute myocardial infarction, complaint rate, and misdiagnosed fracture rate. Increased throughput of short stay patients in a re-opened observation ward greatly shortened average length of stay for patients with a range of acute conditions. Data also indicated significant improvements in teaching and research. We conclude that with firm commitment from hospital management, re-engineering an emergency department can be shown to improve the quality-of-care.

Australia↗