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Kevin E O'Brien

Publications and source records attributed to Kevin E O'Brien.

5 recordsLinked to original sources
PubMed2004

Diffuse T-wave inversions associated with electroconvulsive therapy.

Electroconvulsive therapy (ECT) can lead to ST depression and arrhythmias in patients with coronary artery disease, most likely secondary to increased myocardial oxygen demand. This report describes a case of ECT-associated, global T-wave inversions in a patient with chronic atrial fibrillation treated with digoxin. Laboratory evaluation and echocardiography were normal. These T-wave changes may result from increased sympathetic activity associated with ECT. Prospective studies suggest that this finding may be seen in up to 4% of patients undergoing ECT.

Aged↗
PubMed2003

Effect of a physician-directed educational campaign on performance of proper diabetic foot exams in an outpatient setting.

BACKGROUND: The established guidelines for a diabetes foot examination include assessing circulatory, skin, and neurological status to detect problems early and reduce the likelihood of amputation. Physician adherence to the guidelines for proper examination is less than optimal. OBJECTIVE: Our objective was to increase compliance with the performance of a proper foot examination through a predominantly physician-directed interventional campaign. METHODS: The study consisted of 3 parts: a retrospective chart review to estimate background compliance, an educational intervention, and prospective chart review at 3 and 6 months. A properly documented foot examination was defined as assessing at least 2 of the 3 necessary components. The educational intervention consisted of 2 lectures directed at resident physicians and a quality assurance announcement at a general internal medicine staff meeting. Clinic support staff were instructed to remove the shoes and socks of all diabetic patients when they were placed in exam rooms, and signs reminding diabetics were placed in each exam room. RESULTS: There was a significant increase in the performance of proper foot examination over the course of the study (baseline 14.0%, 3 months 58.0%, 6 months 62.1%; P <.001). Documentation of any component of a proper foot examination also increased substantially (32.6%, 67.3%, 72.5%; P <.001). Additionally, performance of each component of a proper exam increased dramatically during the study: neurological (13.5%, 35.8%, 38.5%; P <.001), skin (23.0%, 64.2%, 69.2%; P <.001), and vascular (14.0%, 51.2%, 50.5%; P <.001). CONCLUSIONS: Patients with diabetes are unlikely to have foot examinations in their primary medical care. A simple, low-cost educational intervention significantly improved the adherence to foot examination guidelines for patients with diabetes.

Adult↗
PubMed2002

Paget's disease of bone in an Indian patient: genetic and environmental factors.

Epidemiologic data have shown that Paget's disease of bone is common among people of Anglo-Saxon descent, but it is believed to be rare in India and Asia. The worldwide prevalence of the disease shows pronounced geographic and ethnic heterogeneity, and can vary in populations through migration or loss of geographic isolation. The risk to an individual who changes geographic locations, however, is difficult to quantify because the specific genetic or environmental factors responsible for Paget's disease have yet to be completely determined. We describe a case of monostotic Paget's disease in a 59-year-old Asian Indian man, and consider the potential epidemiologic and etiologic influences (moving to an area of higher disease prevalence, role of genetics, viral exposures) that may have increased his risk for the disorder. The patient presented with several months of right anterior leg pain, and was found on examination to have anterior bowing of the tibia as well as warmth and an audible bruit. Radiographs of the tibia demonstrated a V-shaped lucency, enhanced trabecular pattern, and cortical thickening. Whole-body bone scan confirmed monostotic disease with expansile uptake in the tibia, and laboratory data revealed an elevated urinary collagen N-telopeptide that normalized after bisphosphonate treatment, as did his clinical symptoms. In light of the environmental factors that appear significantly to influence the development of Paget's disease, the diagnosis should be considered in patients traditionally considered at low risk for the disorder.

Journal Article↗