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Biomedical subjects

J Ryan

Publications and source records attributed to J Ryan.

At least 55 records · Page 3Linked to original sources
PubMed2000

Do patient age and medical condition influence medical advice to stop smoking?

OBJECTIVE: to determine whether the age and medical condition of a patient influences hospital-based doctors' decision making when advising patients to stop smoking cigarettes. METHODS: we presented 142 doctors from four grades (consultant, registrar, senior house officer and house officer) and four specialities (medicine, surgery, psychiatry and anaesthetics), based in a Dublin teaching hospital, with 20 clinical vignettes. Each vignette described a patient from one of five age groups with one of four levels of health. The vignettes were randomly mixed. We asked doctors to say whether they would advise the patient in each case to quit smoking. RESULTS: hospital-based doctors are significantly less likely to advise patients aged over 65 years than younger patients of the hazards of cigarette smoking, irrespective of the person's physical or mental health (P < 0.001). CONCLUSION: the advice given to patients about their cigarette smoking habits by hospital doctors is strongly influenced not only by the patient's health, but also by the patient's chronological age.

Age Factors↗
PubMed2000

Evaluating the use of computerised clinical guidelines in the accident and emergency department.

OBJECTIVES: To investigate the pattern and frequency of use of computerised clinical guidelines (CCG) in an accident and emergency department. METHODS: A software program was written to record information on a central database each time the CCG were used. Data were collected prospectively for a six month period. Users were blind to the study. The date, time of use and guidelines consulted were recorded. RESULTS: 1974 individual sessions were logged comprising of 10204 "hits". The CCG were used for a median of 10 sessions per day (range 1-38, SD 5.49). A median of three subjects were accessed during each session (range 1-39, SD 5). The CCG were used most often during peak daily activity; 11 am (609 hits), 5 pm (678 hits) and 12 pm (604 hits) and on Sundays (1875 hits), Thursdays (1770 hits) and Saturdays (1608 hits). The most frequently used guidelines concerned orthopaedics and fracture management (1590 hits), wound care (546 hits), poisoning (473 hits), medical emergencies (267 hits) and radiological policy (148 hits). CONCLUSIONS: In this department CCG have become easily integrated as part of normal day to day working practice. The CCG are accessible 24 hours a day. They can also be easily updated according to best evidence, local policy or national guidelines. The results of this study have helped the authors to focus education to areas of clinical need.

Emergency Service, Hospital↗
PubMed2000

Next day telephone follow up of the elderly: a needs assessment and critical incident monitoring tool for the accident and emergency department.

BACKGROUND: Patients over the age of 75 years comprise an increasing proportion of accident and emergency (A&E) department attendances. Within this group there is a high incidence of comorbidity, which mandates effective discharge coordination from the A&E department. OBJECTIVES: The aims of this study were to assess the needs of these patients the day after discharge, target patients for appropriate interventions and identify critical incidents. SETTING: The study was undertaken in a district general hospital A&E department that has 62000 new patient attendances per year. INCLUSION CRITERIA: Patients aged 75 years or over who were discharged from the A&E department. EXCLUSION CRITERIA: Nursing home patients. Patients without a telephone. STUDY DESIGN: Pre-discharge information was collected from the medical notes. A community liaison nurse (CLN) then contacted patients by telephone. A semistructured questionnaire was used to assess patients. Patients were risk stratified and appropriate interventions made. Interventions initiated by the CLN were scored from 1 to 6 based on the level of input required. RESULTS: 551 patients or their carers were contacted by telephone. Existing home support was felt to be insufficient in 44 (8%) cases and in need of immediate intervention in a further 45 (8%) cases. Sixty five (11%) Category 1 patients required no intervention, 223 (42%) Category 2 patients required advice only, 107 (19%) Category 3 patients were referred to their GP, 127 (23%) Category 4 patients required a domicillary visit by a GP or a nurse, 26 (5%) Category 5 patients were at risk requiring urgent home assessment and three Category 6 patients had to re-attend A&E. Advice was given by the CLN on a broad range of issues and a wide range of health care services was accessed. Five hundred and fifty nine referrals were made by the CLN after telephone assessment. CONCLUSIONS: Telephone follow up of patients over 75 attending our A&E department identified a number of areas where care could be improved before and after discharge. This low cost, high quality intervention has the potential for decreasing inappropriate return visits to the department by a vulnerable group of patients as well as improving overall quality of care.

Aged↗
PubMed2000

Radiation somnolence syndrome.

Although initially described 7 decades ago, somnolence syndrome remains a poorly understood subacute effect of cranial irradiation. Despite the relatively transient and benign nature of somnolence syndrome, its symptoms can be distressing for children and caregivers. Anticipatory guidance related to radiation-induced somnolence remains a critical nursing intervention. This article reviews what is known about somnolence syndrome, including its causes, symptoms, and management.

Child↗
PubMed2000

Disaster medicine: an emerging specialty.

The diverse nature of natural and man-made disasters demands a wide range of medical skills and resources from any attendant clinician. Working in a hostile environment may also require armed protection. This article considers the types of disasters, their medical requirements and the training of doctors wishing to be involved in this field of medicine. It includes a description of the Diploma in the Medical Care of Catastrophes.

Disaster Planning↗
PubMed2000

Academic performance and participation in physical activity by secondary school adolescents.

This study investigated the relationship between adolescents' academic performance and participation in physical activity. 232 boys and girls from Years 8-11 (ages 13-16 years) were randomly selected, and their academic performance was assessed on previous examination scores in English, Mathematics, and Science. Participants were also asked to list all the sports based physical activities in which they normally participated during a typical week and to indicate how many times per week they took part in each activity and the duration of each. Overall, no significant correlations were found, although weak negative correlations were recorded between the amount of time (in minutes) in sport and exercise and English scores for children ages 13, 14, and 16 years. A similar association was also noted for Science scores of children 16 years old.

Adolescent↗
PubMed2000

Coeliac disease. Update 2000.

BACKGROUND: Coeliac disease is increasingly recognised as a cause of nutritional disturbance in the Australian community. Diagnosis may be delayed because the presentation is highly variable. OBJECTIVE: To outline an approach to diagnosis and management of coeliac disease. DISCUSSION: Newer, more specific serological testing is helpful in screening asymptomatic individuals but endoscopic small intestinal biopsy is required for diagnostic certainty. A gluten free diet induces remission but not cure. Lifelong adherence reduces the risk of complications, including malignancy. All patients diagnosed with coeliac disease require expert dietetic assessment and counselling and all should be encouraged to join their state Coeliac Society. Excellent internet based sites now offer appropriate information for patients and their families.

Adult↗
PubMed2000

Abuse during and before pregnancy: prevalence and cultural correlates.

This study examined the prevalence of abuse during pregnancy and the influence of cultural norms and acculturation on abuse in 1,004 Mexican American, Puerto Rican, Cuban American, Central American, African American and Anglo American women. Women were recruited from consecutive delivery logs in general community hospitals in Florida and Massachusetts. The Index of Spouse Abuse and the Abuse Assessment Screen ascertained history of adult physical, sexual, and emotional abuse, abuse during pregnancy, and childhood sexual abuse. An Interview Protocol assessed cultural attitudes, acculturation, and demographic information. Hispanic American women, as a whole, did not differ significantly from Anglo American women in their prevalence of abuse during pregnancy, after controlling for sociodemographic variables. However, Cuban American and Central American partners were significantly less likely to abuse their pregnant partners than were other groups even after adjustment. Women who spoke only Spanish (less acculturated) were less likely to report physical abuse from their partners both before and during pregnancy. Cultural norms, such as a partner's belief in wife/mother role supremacy and cultural group acceptability of men hitting women, were significantly positively related to both physical and emotional abuse. Other risk factors for abuse were the abuser not being the biological father of the baby, low income and little education, and being unmarried.

Acculturation↗
PubMed1999

Alien babies

Explore the source record for details and available documents.

Journal Article↗
PubMed1999

Physical and nonphysical partner abuse and other risk factors for low birth weight among full term and preterm babies: a multiethnic case-control study.

This study sought to determine the risk of low birth weight from intimate partner abuse. The case-control design was used in a purposively ethnically stratified multisite sample of 1,004 women interviewed during the 72 hours after delivery between 1991 and 1996. Abuse was determined by the Index of Spouse Abuse and a modification of the Abuse Assessment Screen. Separate analyses were conducted for 252 full term and 326 preterm infants. The final multiple logistic regression models were constructed to determine relative risk for low birth weight after controlling for other complications of pregnancy. Physical and nonphysical abuse as determined by the Index of Spouse Abuse were both significant risk factors for low birth weight for the full term infants but not the preterm infants on a bivariate level. However, the risk estimates decreased in significance in the adjusted models. Although today's short delivery stays make it difficult to assess for abuse, it is necessary to screen for domestic violence at delivery, especially for women who may not have obtained prenatal care. The unadjusted significant risk for low birth weight that became nonsignificant when adjusted suggests that other abuse-related maternal health problems (notably low weight gain and poor obstetric history) are confounders (or mediators) that help to explain the relation between abuse and low birth weight in full term infants.

Adolescent↗
PubMed1999

Hippocampal system and declarative (relational) memory: summarizing the data from functional neuroimaging studies.

In the last several years there have been impressive strides in the ability to explore the nature of hippocampal system functioning in humans by employing functional neuroimaging methods, permitting such methods to be used in conjunction with neuropsychological methods to better understand the role of the hippocampal system in memory. In this paper, we review the literature on functional imaging studies of the hippocampal system, summarizing the data and testing these data against a number of theories or explanatory accounts of hippocampal function. We consider five alternative explanatory accounts of, or ideas about, hippocampal function- some from already existing work, for which the functional imaging data can provide a new test, and others that have emerged directly from the functional imaging work, and that have yet to be tested for their fit of data from neuropsychological methods. We conclude that the relational (declarative) memory account, in which it is proposed that the hippocampal system plays a critical role in binding together multiple inputs to permit representations of the relations among the constituent elements of scenes or events, can better accommodate the full range of imaging (and other existing) data than any other explanatory account of hippocampal function.

Brain Mapping↗
PubMed1999

Maternal caffeine consumption during pregnancy does not affect preimplantation development but delays early postimplantation growth in rat embryos.

Models for studying prenatal drug-induced intrauterine growth retardation (IUGR) have, without exception, measured growth-related factors in the postimplantation embryo, fetus or neonate. Therefore, it is not known whether effects of drug exposure on growth and metabolism begin early in the preimplantation embryo, or whether IUGR is exclusively a postimplantation phenomenon. The present study investigates whether caffeine, a drug known to induce a dose-dependent fetal IUGR, affects embryo development before and/or after implantation or is exclusively a fetal phenomenon. Preimplantation embryo assessment (with treatment from Days 2 to 4 of pregnancy) included glucose utilization, cell number evaluation and stage of development (morula to hatched blastocyst); whereas, postimplantation embryo assessment (treatment from Days 2 to 10, 10.5 or 11 of pregnancy) included somite number evaluation and extent of neural tube closure, as seen using scanning electron microscopy. Comparing control preimplantation embryos with those exposed to 30 and 60 mg kg(-1) caffeine did not reveal any effects of caffeine exposure, as assessed on Day 5 of gestation. However, postimplantation embryo development assessed on Day 12 of gestation revealed that caffeine exposure of 15 and 30 mg kg(-1) significantly reduced, at both dosage levels, somite number and the extent of neural tube closure. In addition, comparisons of control and experimental groups revealed that in the high-dose caffeine group the forebrain cavity was significantly enlarged and bounded by a reduced, irregularly aligned neuroepithelium. The findings suggest that IUGR is a phenomenon first identifiable during late postimplantation embryogenesis and continues in fetal life.

Animals↗
PubMed1999

Lessons from analysis of World Wide Web server activity data: http://www.swsahs.nsw.gov.au/livtrauma.

OBJECTIVE: To establish visiting patterns and use of resources within an educational world wide web site, to develop strategies for its more effective use as a teaching medium. DESIGN: Prospective descriptive study. SETTING: A web site maintained by a major Australian metropolitan trauma service. SUBJECTS: All visitors to the web site over a 40 day period. MAIN OUTCOME MEASURES: Number of visitors, requests for pages, and transfer of files; timing and duration of visits; first and last pages viewed during visits; pages viewed most often; source of referral and country of origin of visitors. RESULTS: There were 2237 visits, and a mean of 5.8 pages/visit were viewed. Mean duration of each visit was 4 minutes 35 seconds, and only half the visitors entered through the home page. The collection of radiographs was most commonly consulted. Visitors came from 26 different countries, 42% from Australia. CONCLUSIONS: Factors that influenced the use of the site were identified and have altered our plans for development.

Australia↗