PubMed Health⌕ Search

Biomedical subjects

M Barry

Publications and source records attributed to M Barry.

At least 37 records · Page 2Linked to original sources
PubMed2003

Ilizarov wire tensioning and holding methods: a biomechanical study.

AIM: To investigate and compare two specific methods of Ilizarov wire tensioning and hold. METHOD: This study utilised the vertical Hounsfield test machine H25KS, a stress/strain device with a load-cell linked to a computer program. Firstly, the department's present mechanical tensioners were assessed. Secondly, the method of twisting the three designs of wire holding bolts to achieve wire tension, as described by Ilizarov, was assessed. These bolts are described as "cannulated", "slotted" and "Russian" (which are hexagonal headed with a slot down one side). RESULTS: The mechanical tensioners were found to be accurate, if inefficient, with a maximum producible tension of 1330N. The most effective bolts for creation of tension were the Russian, which produced mean wire tensions of 785N at 45 degrees; 1200N at 90 degrees; 1695N at 135 degrees. The cannulated and slotted bolts regularly broke the wires at 90 degrees twist. CONCLUSION: The findings demonstrated two effective methods. The present tensioners were found to be inefficient when compared to the simple twisting of the wire holding bolts, which created equivalent tensions with ease and are capable of producing greater wire tensions. The Russian bolts are recommended for use when wire tension is created by bolt twisting.

Biomechanical Phenomena↗
PubMed2003

The biomechanics of wire fixation in the Ilizarov system.

The purpose of this study was to establish the optimal fixation of tensioned wires to the frame construct in the Ilizarov system. The usual torque to which the fixation bolts were tightened in clinical practice was established by serial testing of orthopaedic surgeons' work in our unit. The force required to produce wire slippage from the different types of wire fixation bolts, tightened to a predetermined torque, was measured using a testing rig. Analysis of the usual torque to which bolts were tightened in clinical practice, revealed values in the range of 5-10Nm. The load required to cause failure of the tensioned wire varied considerably depending on the bolt configuration used and the applied torque. In clinical practice, wires are tensioned using a dynamometer to a variety of loads, depending on the clinical situation, up to 1275N. In applying multiple wires across a single ring, as is normal practice, these loads may be increased still further. The total load transmitted by single wires in weightbearing may be up to 2000N. Utilising the results of our work has enabled us to choose, where practically possible, the optimal bolt configuration for wire fixation. In addition, this work has revealed that in order to withstand the loads seen in clinical practice, wire fixation bolts should be tightened to at least 10Nm. Post-operatively, we now tighten all our wire fixation bolts to 10Nm, using a calibrated torque wrench.

Biomechanical Phenomena↗
PubMed2003

Diaphyseal forearm fractures in children treated with intramedullary fixation: outcome of K-wire versus elastic stable intramedullary nail.

Intramedullary fixation of children's diaphyseal forearm fractures is becoming the surgical technique of choice, in those cases that warrant surgical intervention. This method offers both technical advantages and patient benefits over alternative techniques and implants that have been used in the past. We present a two-centre study assessing the outcome of either Kirschner wires or elastic stable intramedullary nails (ESIN) as the method of fracture stabilisation in such diaphyseal forearm fractures.A total of 36 children underwent K-wire fixation and 24 children underwent ESIN fixation. All fractures united with no resultant subjective disability. The complication rate following K-wires was 16% and that following nail fixation 9%. Loss of forearm rotation was documented in four children in the K-wire group and three children stabilised with nails. These results confirm an excellent outcome following intramedullary fixation. We have demonstrated no difference in outcome between K-wires and ESIN, although the nails do offer some theoretical advantages.

Adolescent↗
PubMed2003

Different fertilization rates between immotile testicular spermatozoa and immotile ejaculated spermatozoa for ICSI in men with Kartagener's syndrome: case reports.

We report two cases of infertility treatment in couples where males suffered from Kartagener's syndrome (KS) and a total absence of motile sperm in the ejaculate. A total of three ICSI cycles was carried out. In all cycles, viable ejaculated or testicular spermatozoa were selected using the hypo-osmotic swelling (HOS) test. Case 1: In the first ICSI cycle total fertilization failure occurred after using ejaculated spermatozoa. In the following cycle testicular spermatozoa were used for ICSI, resulting in 75% fertilized oocytes and a pregnancy. Case 2: In the same ICSI cycle 50% of the oocytes were injected with ejaculated and 50% with testicular spermatozoa. The fertilization rates were 44 and 56% respectively and high quality embryos were achieved in both groups. One single embryo derived from testicular sperm was transferred with a resulting singleton pregnancy. In conclusion, testicular sperm for ICSI seem to have reliable fertilization capacity in men with KS, while ejaculated sperm, even if tested viable, seem more unpredictable. HOS test for selection of viable sperm for ICSI is recommended when ejaculated as well as testicular sperm are used for ICSI.

Adult↗
PubMed2003

Generic drug utilisation on the General Medical Services (GMS) scheme in 2001.

Expenditure on medicines under the Community Drug Schemes was Euro 674.8 million in 2001, a 27% increase as compared with the year 2000. Prescribing less expensive generic drugs is one method of reducing costs whilst maintaining therapeutic efficacy. In this study the cost and quantity of generic drugs dispensed and the potential savings for GMS prescribing in 2001 that could be made by increasing utilisation of generic drugs was investigated. Twenty two per cent of prescription items were dispensed generically (branded generics (17%) and non-branded generics (5%)) in 2001. This represented approximately 13% of the total ingredient cost of drugs dispensed in that period. Eighteen per cent of prescription items were dispensed as proprietary preparations when a generic equivalent was available. Eleven of the top 30 drugs, of highest cost to the GMS scheme, had a generic equivalent which if substituted could produce savings in the region of Euro 5.65 million. The results of this study highlight the potential for cost savings to be made by generic substitution, facilitating the most efficient use of the limited drugs budget.

Drug Prescriptions↗
PubMed2003

Cost of treating stroke in an Irish teaching hospital.

In contrast to CHD and cancer, the burden of stroke lies with long term disability as opposed to death and it is the most common cause of neurological disability in the western world. Consequently such patients frequently require longer acute hospital stays followed by lengthy periods of rehabilitation where such services are available, long term nursing care or indefinite dependency on community care. Inevitably stroke is a major economic burden on healthcare systems. It has been estimated that approximately 6% of total healthcare resources are consumed in the management of this condition a figure which is expected to grow with an increasing elderly population. Due to the high level of disability caused by stroke, patients often require longer and therefore costly periods of acute hospital stay. The aim of this study is to determine the cost of treating an acute episode of ischaemic stroke in an Irish teaching hospital. The costing evaluation was from the hospital admission perspective and the strategy used was a microcosting detailed collection of resources used on patients admitted to St. James's hospital between January 1999 and March 2000. The average cost of a hospital admission for the treatment of an episode of acute ischaemic stroke was 6,722 euros. The average cost per day was calculated at 263 euros. Approximately 83% of hospital costs were associated with ward costs whereas medications accounted for just 1% of total costs. The projected cost for the treatment of stroke in euros using the consumer price index for October 2002 would be 7,686 euros. The availability of Irish cost data is essential for the assessment of the cost effectiveness of therapeutic interventions for the treatment of stroke in our healthcare system.

Aged↗
PubMed2003

[Biometry and structure of the left internal thoracic and radial coronary arteries].

In an attempt to elucidate the causes of occlusion of radial arteries for coronary artery bypass grafts, we studied the biometry and histology of the coronary, radial and left internal thoracic arteries of 20 anatomical subjects (13 males and 7 females). These specimens were calibrated to the various bypass graft sites using coronary calibrators, and were then submitted to histological examination to determine the structure of the vessel wall. Our preliminary results show no correlation between the internal calibres of these various arteries. Like the coronary arteries and their branches, the radial artery is a muscular artery. In contrast, the left internal thoracic artery like the aorta, is an elastic artery.

Aged↗
PubMed2002

St Johns wort increases expression of P-glycoprotein: implications for drug interactions.

AIMS: St John's Wort (SJW) is widely used in the treatment of depression but concerns have been raised about its potential to interact with other drugs. Co-administration with SJW has resulted in significant reductions in trough plasma concentrations of indinavir and cyclosporin [1, 2]. Induction of cytochrome P450 3A4 (CYP3A4) has been implicated as the most likely interaction mechanism. However, the magnitude of the interaction seen in clinical practice is greater than that predicted by in vitro studies suggesting additional interaction mechanisms may exist. As indinavir and cyclosporin are substrates for both CYP3A4 and the multi drug transporter P-glycoprotein we hypothesized that modulation of P-glycoprotein expression and function by SJW may contribute to the development of potentially harmful drug-drug interactions. METHODS: Healthy volunteers were randomized to either SJW (0.15%) 600 mg three times daily for 16 days (n = 15) or placebo (n = 7). Blood samples were obtained for P-glycoprotein expression and function at baseline, 16 and 32 days post treatment. Peripheral blood lymphocytes (PBMCs) were isolated by Ficoll density gradient centrifugation, fixed and permeabilized. Cells were stained with a P-glycoprotein specific antibody, quantified by flow cytometry and median fluorescence intensity (MFI) values obtained. Vimentin and IE (nonsense antibody) were used as controls. The presence of the MDR 1 gene product was confirmed by RT-PCR. P-glycoprotein mediated drug efflux was determined as a function of rhodamine efflux in the absence and presence of ritonavir. Data are expressed as mean +/- s.d. and were subjected to nonparametric analysis. RESULTS: P-glycoprotein expression increased 4.2 fold from baseline in subjects treated with SJW (7.0 +/- 1.9 vs 29.5 +/- 14.3 (MFI); P < 0.05). There was no effect with placebo (5.1 +/- 1.3 vs 6.0 +/- 1.9 MFI). SJW increased P-glycoprotein mediated rhodamine efflux (reduced ratio) compared with baseline (0.12 +/- 0.04 vs 0.24 +/- 0.18 P < 0.05). There was no change with placebo. Ritonavir (5 microm) inhibited P-glycoprotein mediated efflux in both groups producing greater intracellular accumulation of rhodamine. However, this effect was attenuated following treatment with SJW (23.9 +/- 15.3% vs 75.4 +/- 16.4% P < 0.05). CONCLUSIONS: SJW increased expression and enhanced the drug efflux function of the multi drug transporter P-glycoprotein in PBMCs of healthy volunteers. This may represent a second mechanism for the drug-herb interactions seen in clinical practice and account for the discrepancies between in vitro and in vivo data. Since P-glycoprotein and CYP3A4 have distinct though overlapping substrates, patients receiving drugs, which are P-glycoprotein substrates should be warned against self-medication with SJW as clinically significant drug interactions may occur.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed2002

Cost effectiveness of beta blocker therapy for patients with chronic severe heart failure in Ireland.

Management of heart failure is estimated to consume 1% to 2% of total healthcare resources and recent data from the UK suggests this may be as high as 4% with hospital admissions accounting for approximately 70% of this expenditure. The safety and efficacy of b-blockers when added to standard therapy i.e. ACE inhibitors in chronic heart failure has recently been demonstrated in large placebo controlled trials. The ability of b-blockers to reduce hospital admission rates would be expected to prove cost effective. In this study the cost effectiveness of the b-blocker carvedilol when added to standard therapy in patients with severe heart failure was determined. Using economic modelling techniques and Irish cost data the incremental cost effectiveness ratio (ICER) for carvedilol therapy was 1,560 Euro per life year gained (LYG). Sensitivity analysis demonstrated an ICER range of 1,560 Euro/LYG to 7,322 Euro/LYG under a variety of assumptions. This suggests that carvedilol therapy for patients with severe chronic heart failure is not only safe and effective but is highly cost effective in the Irish healthcare setting.

Adrenergic beta-Antagonists↗
PubMed2002

Perceived quality of life and mental health status of Irish female prisoners.

Mental health status and quality of life of female prisoners, the majority of whom are drug-users, was examined as part of a larger, cross-sectional, general healthcare study of the Irish prisoner population. Comparisons were made with drug using and non-drug using male prisoners and females from the general population. Instruments include the GHQ-12 and the WHOQOL-BREF. While their quality of life profile was closer to drug-using male prisoners than other comparison groups, female prisoners still had significantly poorer physical and psychological Quality of Life scores. While poorer quality of life scores may be associated with the more severe drug use patterns of female prisoners it is likely that other factors also contribute. Before resorting to drugs/crime women may have already experienced adversity. There may also be gender differences in response to the combined dimensions of environmental distress. If women are to be imprisoned appropriate comprehensive mental health promotion approaches must address their specific needs.

Adult↗
PubMed2002

Audit of acute myocardial infarctions at Saint James's Hospital, Dublin, from 1996 to 1999.

Saint James' Hospital is a 650-bed tertiary referral hospital. An audit was performed of acute transmural myocardial infarctions for the years 1996 to 1999 inclusive. On average there were 2043 cardiology admissions annually, 9.8% of all hospital admissions. Acute transmural myocardial infarction was diagnosed in 178 patients annually, and was less common during the summer. The figure of 72% receiving revascularisation therapy (thrombolysis 67%, primary angioplasty 5%) compares favourably with 35% in 1992. The main reason for not receiving thrombolysis was late presentation (15%) with contraindications present in only 5%. The case fatality rate was 16% confirming the higher mortality in clinical practice than that of thrombolytic trials. The prescription of aspirin or warfarin (99%) and betablockers (67%) was in line with international trials. The use of angiotensin converting enzyme inhibitors (34%) and statins (28%) is similar to other studies but less than would be expected according to trial evidence.

Adrenergic beta-Antagonists↗
PubMed2001

Pharmaceutical management in ProCare Health Limited.

AIMS: To review pharmaceutical budget holding and management in ProCare Health Limited by; describing budget holding strategies implemented in 1995/6, identifying prescribing savings achieved, analysing variation in prescribing behaviour and comparing the findings with experience elsewhere. METHODS: With 340 members, ProCare is one of the largest and most progressive of New Zealand's independent practitioner associations (IPAs). Data were obtained for the three years 1994 to 1996 to determine pharmaceutical expenditure against budget and against national trends, by member and general medical services (GMS) consultations. RESULTS: ProCare has established a classical, quality focussed pharmaceutical management strategy. Savings against the agreed budget was 9.5% comparing 1996 with 1995 but 5.7% compared, with national trends. Wide variation in per capita and per consultation costs was not reduced and was entirely explained by prescribing volumes not drug prices. CONCLUSIONS: The most important finding is that general practitioners (GPs), working collaboratively, can establish a strategy of clinical and corporate governance which may be exerting a wide ranging influence over clinical behaviour. Although there may be doubts about the actual levels of saving these appeared to be well in excess of the financial investment in the strategy. Greater savings appear possible with a focus on addressing the large and apparently inappropriate per capita prescribing volume variation between practices. Understanding and successfully addressing this variation will be one of the key issues facing the implementation of the government's primary health care strategy.

Cost Savings↗
PubMed2001

Recurrent nonmenstrual toxic shock syndrome: clinical manifestations, diagnosis, and treatment.

We report 3 cases of recurrent nonmenstrual toxic shock syndrome (TSS) and review the clinical manifestations, diagnosis, and treatment. The primary sites of infection were the genital tract (in a patient who underwent cesarean delivery), the upper respiratory tract, and a breast abscess. In all 3 patients, the initial illness was not recognized to be TSS; only after development of recurrent illness with desquamation was this diagnosis entertained. Strains of Staphylococcus aureus that were isolated from 2 patients produced TSS toxin-1, whereas the third strain produced staphylococcal enterotoxin B. All 3 patients lacked antibody to the implicated toxins at the time of presentation with recurrent illness. Nonmenstrual TSS can occur in a variety of clinical settings and may be recurrent. The presence of desquamation during a febrile, multisystem illness could suggest this diagnosis and should prompt the clinician to obtain appropriate cultures for S. aureus.

Adult↗
PubMed2001

Decision aids for people facing health treatment or screening decisions.

BACKGROUND: Decision aids are interventions designed to help people make specific and deliberative choices among options (including status quo) by providing (at a minimum) information on the options and outcomes relevant to a person's health status. A systematic review is needed to summarize what is known about their efficacy. OBJECTIVES: 1. To create an inventory of existing decision aids. 2. To conduct a systematic review of randomized controlled trials of decision aids aimed at improving people's decision making and outcomes. SEARCH STRATEGY: The following electronic databases were searched: MEDLINE, EMBASE, PsycINFO, CINAHL, Aidsline, Cancerlit, the Cochrane Controlled Trials Register. In addition, individuals known to be active in the field of decision support were contacted. SELECTION CRITERIA: We screened titles and abstracts for all interventions providing structured, detailed, and specific information on treatment or screening options and outcomes to aid decision making. Information about the decision aids was compiled in an inventory and those evaluated in a randomized controlled trial were reviewed in detail. DATA COLLECTION AND ANALYSIS: Using Cochrane review methods, two reviewers independently screened and extracted data on several evaluation criteria. Results of randomized trials were pooled using weighted mean differences and relative risks with all data analysed using a random effects model. MAIN RESULTS: Eighty-seven decision aids were identified. Twenty-three of them had been evaluated in 24 randomized controlled trials. Among the trials comparing decision aids to usual care interventions, decision aids performed better in terms of: a) greater knowledge of options in seven of seven studies (weighted mean difference (WMD = 19 out of 100, 95% confidence interval (CI): 13,25); b) more realistic expectations in two of three studies (RR=1.48 95%CI 1.02, 2.14); c) lower decisional conflict related to feeling informed in three of three studies (WMD = -9.0 of 100 95%CI: -15, -3); d) reducing the proportion of people who were passive in decision making in three of four studies (RR = 0.63, 95% CI: 0.5, 0.8). When simpler decision aids were compared to more detailed ones, the relative improvement was significant in: a) improved knowledge in two of seven studies (WMD = 4 out of 100, 95% CI: 2, 5); b) realistic expectations in two of two studies (relative risk (RR ranged from 1.5 95%CI: 1.3,1.8); and c) decisional conflict in one of two studies (WMD= -4 95% CI -8,-0.2). There was a consistent trend for decision aids to do no better than comparison interventions in affecting: satisfaction with the decision in five of six studies, satisfaction with the decision making process in four of five studies, and anxiety in four of five studies. Decision aids had a variable effect on which screening or treatment options were selected. Exposure to decision aids relative to controls resulted in a consistent non-significant trend toward reduced preference for major surgery over conservative options by 21 to 42 per cent in five of five studies; however, they had no impact on circumcision in two of two studies. For colon and prostate cancer screening choices, the results were inconsistent. Two studies have shown no impact on persistence with chosen option and few studies have shown significant benefits on general health outcomes (two of three studies), or disease-specific health outcomes (one of four studies). REVIEWER'S CONCLUSIONS: The number of decision aids is expanding, but there is considerable overlap in some areas leaving gaps in others. Trials of decision aids indicate that they are superior to usual care interventions in improving knowledge and realistic expectations of the benefits and harms of options; reducing passivity in decision making; and lowering decisional conflict stemming from feeling uninformed. When simpler versions of decision aids are compared to more detailed aids, the differences in knowledge are marginal but there are other benefits in terms of creating realistic expectations and in reducing decisional conflict. To date, decision aids have had little effect on anxiety or satisfaction with the decision making process or satisfaction with the decision. Their effects on choices vary with the decision. The effects on persistence with chosen therapies and health outcomes require further evaluation. The essential elements in decision aids for different groups and different types of decisions need to be established. Consensus needs to be reached regarding standards for developing and evaluating decision aids.

Decision Support Techniques↗
PubMed2001

The role of a nurse case manager in implementing a critical pathway for infrainguinal bypass surgery.

BACKGROUND: A previous study showed the effectiveness of a clinical pathway for infrainguinal bypass surgery in reducing postoperative length of stay (LOS) in an acute care setting. Most of the deviations from the pathway were due to patient factors (50%) and/or external disposition problems (30%), but 20% were related to physician or system problems that could potentially be modified. The current study examined those factors influencing LOS following infrainguinal bypass surgery and the impact of daily rounds by a nurse case manager--a vascular nurse specialist--on LOS and pathway deviations. METHODS: Data were collected through detailed chart review and prospective tracking of pathway deviations. LOS was compared in 58 patients on the modified pathway (with the nurse case manager) to 69 patients on the original pathway and 67 prepathway controls. Multivariate analysis was used to identify factors influencing postoperative LOS and to compare LOS among the three groups. RESULTS: Use of a nurse case manager significantly reduced physician-related deviations, from the pathway from 10% to 0% (p = .015), and reduced system-related deviations from 3% to 0%. Median postoperative LOS was 7 days before the pathway was begun, 6 days with the original pathway, and 5 days after the introduction of a vascular nurse specialist (p = .0001). There were no differences in rates of complications, rates of readmission, or mortality. CONCLUSIONS: Intervention by a nurse case manager facilitated implementation of a critical pathway for patients undergoing infrainguinal bypass surgery, especially by preventing patient deviations due to intrainstitutional factors.

Aged↗
PubMed2001

Poor agreement in recognition of abnormal mitoses: requirement for standardized and robust definitions.

AIMS: The finding of abnormal mitoses is a helpful feature in differentiating between benign and malignant neoplasia and has prognostic significance for some tumours. As the use of a histopathological variable is limited by the reproducibility of its recognition, we tested the interobserver agreement in the classification of abnormal mitoses among histopathologists. METHODS adn RESULTS: Ten practising histopathologists were shown 30 potential mitotic figures and were asked to classify these as 'normal mitoses', 'abnormal mitoses' or 'not mitoses' according to the criteria each pathologist used in their routine practice. The results were analysed using kappa statistics. Overall agreement was only fair with a combined kappa of 0.31 and there was unanimous categorization of only four of 30 test items, none of which was called abnormal. The poorest result was obtained for the category 'abnormal mitosis' with only slight agreement (kappa 0.19). Agreement for the other categories varied from moderate (kappa = 0.45) for 'not a mitosis' to fair (kappa = 0.26) for 'normal mitosis'. Comparison of the results for observer pairs showed that for 12 out of the 45 possible pairings, there was no more agreement than might be expected by chance alone. CONCLUSION: Agreement is poor among practising histopathologists in the recognition of abnormal mitoses. A standardized and robust definition is needed if diagnostic and prognostic significance is accorded to the finding of an abnormal mitosis in the context of neoplasia.

Humans↗