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Biomedical subjects

M Farrell

Publications and source records attributed to M Farrell.

At least 109 records · Page 6Linked to original sources
PubMed1994

The spectrum of bile duct complications in pediatric liver transplantation.

It has been noted that reduced-size liver transplants are associated with increased rates of biliary complications, and it has been suggested that some of these complications can be handled nonoperatively. In a 6-year period, 91 orthotopic liver transplants were performed in 77 children. The medical records were reviewed to analyze the effect of reduced-size grafts on the incidence of bile duct complications and to investigate the utility of interventional radiology techniques for treatment. Forty-two children received 47 whole-organ transplants, and 35 children received 44 reduced-size transplants. The median age and weight were greater for children receiving whole-organ transplants (age, 4.25 years; weight, 16 kg) than for those receiving reduced-size grafts (age, 1.0 year; weight, 8 kg). The overall incidence of bile duct complications was 19.5% (n = 15). The incidence was not different between the whole organ group (17%) and the reduced-size group (16%). Four of the children with bile duct complications had associated hepatic artery thrombosis, two of whom had another transplant. Complications included anastomotic stricture (n = 6), anastomotic leak (n = 5), intraparenchymal biloma (n = 3), and multiple strictures (n = 1). Twelve of 15 children presented within 3 months of transplantation. Six children had initial percutaneous drainage or placement of transanastomotic stents (external). Operative repair was eventually required for all 15 children, three of whom received a second transplant. There was a 40% incidence of cytomegalovirus infection involving the liver or extrahepatic bile ducts near the time of presentation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Hungarian midwives and their practice: a national survey.

In 1975 the Hungarian educational system for midwives was shortened from a three year programme to one of ten months duration in order to provide a more immediate supply of midwives in a relatively short period of time, and to reduce the costs associated with midwifery education. Ten years after the educational programme change, a national survey of Hungarian midwives (n = 290) was conducted by the European Regional Office of the World Health Organization and the Hungarian Ministry of Health. This study describes the effects of the two educational programmes and years of practice on Hungarian midwives' self-perception of competency, satisfaction and summative score of responsibility and autonomy. Significantly different group mean scores on variables related to competency and satisfaction were found for the two groups.

Adult↗
PubMed1994

Opiate withdrawal.

Opiate withdrawal is one of the longest studied and most well described withdrawal syndromes. Opiate withdrawal has been described as akin to a moderate to severe flu-like illness. Opiate withdrawal is appropriately described as subjectively severe but objectively mild. This paper describes the mechanisms of opiate dependence and opiate withdrawal and reviews the available instruments for the measurement of withdrawal. The time course of assisted and unassisted withdrawal is described and the range of options for the management of assisted withdrawal are described. This review concludes that the most effective and least time- and resource-consuming approach to opiate withdrawal will substantially contribute to the overall social management of opiate dependence.

Animals↗
PubMed1994

Innovations in case flow analysis: using midlier variance analysis.

This article presents the use of midlier and case flow analysis during a retrospective chart review to study the costs of hospital length of stay. The results showed that considerable savings can be realized by using these methods for one group of patients with the same diagnosis. We were able to redefine and track patients during their pre-, peri-, and postoperative period and estimated the time and cost opportunities for work flow improvement. We concluded that considerable savings are possible by extending the analysis to patients in other DRG groups.

Analysis of Variance↗
PubMed1994

Influencing physician behavior with CQI: a case study.

Health care reform will require unprecedented levels of cooperation among physicians, health care administrators, and other providers in order to ensure high-quality, affordable care for all. At the University of Massachusetts Medical Center, CQI techniques helped engage physicians in an effort to substantially alter ordering patterns to cut costs and achieve quality goals.

Academic Medical Centers↗
PubMed1994

Positive social interdependence and classroom climate.

We explored the relationship between student perceptions of social interdependence and social support. Attitudinal responses to the Classroom Life Instrument (Johnson & Johnson, 1983; Johnson, Johnson, & Anderson, 1983; Johnson, Johnson, Buckman, & Richards, 1985) were gathered in Canada from four classes totaling 123 eighth-grade students learning geometry in cooperative groups. We extended previous findings by examining the relationships among the classroom climate variables, causal attributions, and achievement, and explored the consistency among the four classroom climate studies using statistical methods for meta-analysis to determine overall effect magnitudes and the degree of study-to-study variability. Social support from the teacher and fellow students was moderately related to perceptions of positive interdependence, but social interdependence factors were less important predictors of student learning than was student self-esteem.

Achievement↗
PubMed1994

Continuous improvement, quality control, and cost containment in clinical laboratory testing. Enhancement of physicians' laboratory-ordering practices.

In 1991, the University of Massachusetts Medical Center, in Worcester, developed a model for change by using a program of continuous quality improvement to enhance physicians' laboratory-ordering practices, particularly the test for bleeding times. We describe a model that was developed through a seven-step continuous quality improvement process, and we discuss our success in increasing the appropriateness of ordering the tests for bleeding times while significantly reducing the costs for patients and hospitals. The following factors contributed to the program's success: an advisory structure; presentations to the medical staff; focused feedback sessions; and most important, well-documented guidelines with institutional support for new behavior.

Clinical Laboratory Techniques↗
PubMed1993

Deoxyribonucleic acid ploidy studies in choroidal melanomas.

In several tumors of different organ sites, the amount of DNA in a cell (ploidy) is associated with malignancy. We performed DNA quantitation in 21 choroidal melanomas and compared flow cytometry with image analysis in 11 of these melanomas. We modified our preparation technique to overcome problems with pigment and control cell populations in the image analysis group. Fifteen tumors were diploid and two tumors were tetraploid. Four tumors were unprocessable by flow cytometry, but two of these tumors were diploid by image analysis. Image analysis also detected tetraploidy in two tumors that were diploid by flow cytometry. During image analysis, cells were classified according to the Callendar classification and histograms were plotted for each cell type. All spindle A cells were diploid and most tetraploid peaks were formed by epithelioid cells. The use of image analysis on small samples of choroidal melanomas may be of value both in confirmation of diagnosis and prognosis of these lesions, and perhaps therapeutically, for example, in the monitoring of radiation treatment.

Choroid Neoplasms↗
PubMed1993

Improved survival in biliary atresia patients in the present era of liver transplantation.

Therapy for patients with biliary atresia (BA) has become controversial, with orthotopic liver transplantation (OLTx) suggested in place of portoenterostomy. This is based on the unpredictable success of portoenterostomy, and the increased difficulty of the OLTx procedure following prior extensive liver surgery. The survival rate reported here for infants transplanted after unsuccessful portoenterostomy does not support this approach. OLTx was undertaken in 37 patients when end-stage liver failure followed primary portoenterostomy. Recipient age ranged from 6 months to 14 years (median, 13 months), and weight ranged from 5 to 45 kg (median, 8 kg) at the time of OLTx. Reduced-size allografts were used as the primary allograft in 25 patients (23 left lobe), and 12 received whole-organ allografts. Retransplantation was required in 5 patients, each received a reduced-size allograft. There was no increased incidence of vascular complications, primary nonfunction, irreversible rejection, intestinal perforation, biliary complications, sepsis, or lymphoma comparing the BA patients with all other non-BA patients who had undergone OLTx (all P = .16). There was no statistically significant difference in mean operative blood loss between BA patients (EBL = 1.99 BV) and non-BA patients (1.50 BV) (P = .14). Actuarial survival for the series of BA patients was 89% at 1 year, and 80% at 2 years. Following the introduction of reduced-size allografts, donor organs were selected for use with a priority on donor stability. The actuarial survival for BA patients during this time has improved to 96% at 1 year, and 91% at 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

Eye care for ventilated patients.

This literature survey identifies the importance of effective eye care technique, to prevent ocular complications in critically ill patients. The factors that lead to the development of such complications are outlined. Details are given of a survey of 20 intensive care units (ICUs), conducted to identify common eye care techniques. The conclusion from this review is that there is little which identifies the efficacy of current eye care techniques commonly used in ICUs. There is a need for research studies which demonstrate the best substance for maintaining eye lubrication and eyelid closure, in the care of critically ill patients.

Critical Care↗
PubMed1993

Mechanism of joint sparing in a patient with unilateral psoriatic arthritis and a longstanding hemiplegia.

The case of a 59-year-old female with a longstanding hemiplegia who developed unilateral psoriatic arthritis and unilateral psoriasis on the non-hemiplegic side only is reported. Investigations showed an erythrocyte sedimentation rate of 58 mm/h, with all classes of rheumatoid factor negative in serum and synovial fluid (SF). An inflammatory infiltrate was demonstrated in both knee joints despite the absence of clinical involvement on the hemiplegic side. In addition, while neurofilament and substance P (SP) immunoreactivity was demonstrated in both synovial specimens, conspicuously less SP was present in the clinically involved synovial membrane. Finally, SF levels of SP and IL1 beta were raised in the clinically involved knee only.

Arthritis, Psoriatic↗
PubMed1993

Effect of topical cyclosporin A on conjunctival T cells in patients with secondary Sjögren's syndrome.

The effect of topical cyclosporin A on conjunctival T cells was studied in nine patients with secondary Sjögren's disease. Patients had conjunctival biopsies performed before and after a 6-week course of topical cyclosporin. Epithelium and substantia propria in the Sjögren's patients before treatment showed significantly more CD4+ cells than specimens taken from nine age- and sex-matched controls. Following treatment with topical cyclosporin, there was a significant reduction in the number of CD4+ cells in both the conjunctival epithelium and substantia propria. Despite the fact that the treatment resulted in immunopathological improvement, the clinical benefit was not as favorable. Our results suggest that topical cyclosporin may have a local immunosuppressive effect on the conjunctiva in patients with Sjögren's disease.

Administration, Topical↗