Hypernatremia, azotemia, and dehydration ue to high-protein tube feeding.
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Aged↗
Biomedical subjects
M Doyle
Publications and source records attributed to M Doyle.
Aortoiliac disease: two-dimensional inflow MR angiography with lipid suppression.
A magnetic resonance (MR) imaging strategy, SLIP (spatially separated lipid presaturation), which can be incorporated into existing MR imaging and MR angiographic techniques, has been developed to suppress lipid signal. The authors report the clinical application of this technique, with a triple comparison of two-dimensional inflow MR angiography, with and without SLIP, and x-ray angiography in patients with aortoiliac disease. SLIP improved visualization of arterial segments, with 50 of 63 (79%) arterial segments visualized versus 41 of 63 (65%) for non-SLIP MR angiography. The SLIP strategy aids in the depiction of slow or turbulent flow, because the lipid signal is suppressed while the intravascular signal is left undisturbed. Image quality improves because of the combination of decreased background lipid signal intensity and use of the maximum-intensity-projection algorithm. Compared with x-ray arteriography, non-SLIP MR angiography had a sensitivity and specificity of 60% and 56%, respectively, for detection of lesions with 50%-100% diameter reduction, while SLIP MR angiography had a sensitivity and specificity, respectively, of 53% and 67%.
Aged↗
Endoscopic ultrasonography verifies effect on endoscopic treatment of reflux in dogs and man.
We have previously reported that endoscopic sclerosis of the gastric cardia is an effective treatment for experimental gastroesophageal reflux in dogs. The histologic effect of endoscopic sclerosis is limited to the proximal stomach; mucosal deformity provides endoscopic evidence of sclerosis, and the intramural effects are shown by ultrasonographic technique. This report describes histologic and ultrasonographic results in the dogs at the completion of endoscopic sclerosis. This report also describes the endoscopic ultrasound results in the first two patients who have completed endoscopic treatment for reflux by means of endoscopic sclerosis of the gastric cardia. All canine and human subjects had sonodense lesions involving all layers of the proximal stomach at the injection site at the conclusion of treatment. Histologic examination of canine tissues showed dense submucosal and muscularis fibrosis in the stomach; the esophagus was normal. Endoscopic ultrasound demonstrates the effect of endoscopic sclerosis; this technique may be useful in the evaluation of symptomatic responses after this treatment.
Animals↗
HELLP syndrome: a condition of varied presentation.
Three cases of HELLP syndrome are presented which illustrate its varied clinical presentation, the difficulty in making a diagnosis and the management problems. The cases varied in severity; all showed thrombocytopenia and abnormal liver function tests, but in one case the blood pressure remained within "normal limits" whereas another patient suffered grand mal seizures due to hypertensive encephalopathy.
Adult↗
Fetal and neonatal cerebral oxygen monitoring with NIRS: theory and practice.
Near infra-red spectroscopy (NIRS) is a comparatively new method for monitoring the oxygenation in blood and tissue in the brain of the fetus and the neonate. Absorption of light in the wavelength range 700-1000 nm through such tissue is measured, which is then used to calculate changes in the concentration of cerebral oxygenated and de-oxygenated haemoglobin (HbO2 and Hb) and hence cerebral blood volume (CBV). Studies carried out on several groups of newborn babies have shown clear changes in HbO, Hb and CBV with hypoxia and bradycardia. These changes may well have implications in the occurrence of hypoxic/ischaemic brain injury. Intra partum NIR measurements on the fetal brain have demonstrated clear changes in HbO2, Hb and CBVm, coinciding with the onset of contractions.
Brain↗
Cervical spine fracture following a motor vehicle accident.
We present the case of a 50-year-old man who visited our emergency department 12 h after an alcohol-related motor vehicle accident complaining of shoulder pain and neck stiffness. Cervical spine radiographs were obtained and interpreted as normal, and the patient was discharged. Subsequent review by a radiologist raised the question of a second cervical vertebra (C-2) abnormality, and the patient was recalled. Cervical computed tomography (CT) scan revealed an unstable oblique fracture of C-2 and a congenital nonfusion of the arch of C-1. The patient was placed in halo traction, and subsequent radiographs revealed a fracture of the transverse process of C-7. The patient made an uneventful recovery. The limitations of routine cervical radiographs are well-documented, but no feasible alternative exists as a screening procedure. Thus, a certain level of uncertainty must be accepted. Both physician and patient must recognize the limitations inherent in all medical practice and that follow-up examination and treatment are essential.
Accidents, Traffic↗
Cardiac MR spectroscopy in the new millennium.
Spectroscopy is close to becoming an integral part of the clinical MR examination to achieve a complete morphological, functional, and metabolic evaluation of the human heart. 31P-NMR spectroscopy is used to noninvasively assess human myocardial energy metabolism. Abnormalities in the phosphocreatine (PCr) to ATP ratio are observed in ischemic heart disease, heart failure, transplanted hearts, and hypertrophic cardiomyopathy. NMR spectroscopy 31P spectra obtained at rest, during exercise or pharmacological stress allow the observation of the earliest metabolic responses of myocardial ischemia. 1 spectroscopy can evaluate the concentration of intracellular creatine and myocardial lipids as a means of evaluating myocardial viability. The increase in total 23Na in ischemic tissue provides information about the extent and location of viable tissue. Higher magnetic fields, gradient strength, and technological advances in pulse sequence and localization will result in better spatial and temporal resolution improving the clinical utility of the technique.
Animals↗
Interface design and cognitive style in learning an instructional computer simulation.
An experimental design was used to investigate how cognitive style interacts with interface design to affect users' abilities to learn to use a computer simulation. Eighteen nursing students were assigned to two groups, based on their cognitive style, and asked to solve 3 physiologic problems using 3 interface designs: a strip-chart display, an integrated balloon display, and an etiologic display. Students were given up to 2 minutes to solve each problem by administering 6 different hypothetical drugs targeted at different aspects of the simulated hemodynamic system. A mixed-design analysis of variance was used to determine the effects of interface design and cognitive style on number of problems solved, time to initiate treatment, percentage of time system maintained within normal parameters, and number of drugs used. We found that the effects of cognitive style on performance were mediated by interface design and tended to decrease with practice.
Analysis of Variance↗
Legibility of doctor's signatures: novel approaches to improving an age-old problem.
UNLABELLED: In today's medico-legal environment, the importance of identification of the authors of notes in patient medical charts cannot be overemphasized. We evaluated three different techniques of signing patient notes, over a one month period, in order to determine which technique was the most effective in identifying the author of the note. Surgical NCHDs in our hospital were divided into three groups. Group 1 was asked to sign the notes as they normally would. Group 2 was asked to print their name in block capitals after their signature and Group 3 was given pens with a personal self inking stamp to be used in addition to signing the notes. The number of signatures in all the charts, compliance with the assigned technique and the legibility of signatures were calculated. RESULTS: in Group 1, all NCHDs signed their name when writing notes (100% compliance), however the NCHD's signature was identified only 37% of the time. In Groups 2 (who signed in block capitals) and Group 3 (who used the pen with personalised stamp) the author was identifiable 100% of the time when the respective signing method was used. Using the pen with personalised self inking stamp was significantly more popular (77% compliance) compared to signing in block capitals (46% compliance). In conclusion the pen, with personalised self inking stamp, provides a fast and effective means to clarify signatures of NCHD's documentation, which is not only important in a day to day patient management, but is essential from a medico-legal stand point.
Handwriting↗
Nurses' perceptions of their health educator role.
A questionnaire was designed to describe and understand the role of the registered nurse in patient teaching as perceived by nurses. The questionnaire was distributed to 1355 nurses working in an acute care tertiary teaching hospital. The data indicated most nurses expressed strong agreement with the majority of items relating to their skill and educational preparation to teach patients. Selected questions relating to the nurse's role as a patient educator showed nurses viewed their patient education role as satisfying and expected by their patients. Needs relating to their patient education role included: additional time to teach patients, more educational materials, peer feedback regarding teaching effectiveness, and sufficient medical information. Additionally, the majority of nurses perceived that patients did not have sufficient knowledge to care for themselves after leaving the hospital and that too much information about their condition was withheld from them. Summary scales showed significant differences in area of work and position with the nurse's perception of the health educator role.
Clinical Competence↗
Echo planar imaging in paediatrics: real-time-nuclear magnetic resonance.
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Coronary Circulation↗
Continence. Suffering in secret.
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Exercise↗
Clinical risk assessment for mental health nurses.
This article proposes a risk management cycle for mental health nurses, it can be used as a guide to assessing and managing the risk of harm associated with people with mental health problems alongside systematic approaches to planning care.
Humans↗