Biomedical subjects

M Harkness

Publications and source records attributed to M Harkness.

At least 19 recordsLinked to original sources

PubMed2006

Cardiopulmonary resuscitation: capacity, discussion and documentation.

BACKGROUND: End-of-life care decisions, including treatment such as cardiopulmonary resuscitation (CPR), are complex issues requiring a patient to have the capacity for effective decision-making. AIM: To assess the prevalence and documentation of CPR decisions in our hospital in patients aged > 65 years. DESIGN: Prospective audit. METHODS: Review of patient notes and resuscitation forms within our acute Trust on Elderly Care and General Medicine wards, including the decisions made, involvement of patient and/or family members and whether an assessment of capacity was made. RESULTS: On the Elderly Care wards, 37 CPR decisions were made on 104 patients, and nearly all of these were clearly documented. On the General Medical wards, only one decision out of 40 patients was made. Geriatricians incorporated patient views in one quarter of decisions; all but one of these patients wanted CPR. Of those patients 'not for CPR', family members were informed in only one third of cases, according to the documentation. Capacity was documented on only four occasions. DISCUSSION: Geriatricians make significantly more CPR decisions than general physicians do, but still involve patient and family views in only a minority of cases, and an assessment of capacity is rarely explicitly documented. We suggest a three-step approach to clinical decision making, to increase both the volume and the quality of CPR decisions, which may be improved further by the use of information leaflets for patients and their families.

Aged↗

PubMed2005

Prevalence of vitamin D inadequacy in Scottish adults with non-vertebral fragility fractures.

BACKGROUND: It is well established that vitamin D levels are sub-optimal in the elderly and that adults with fragility fracture are more likely to have serum vitamin D levels either lower than those of control patients of similar age, or below the normal range. OBJECTIVES: To investigate the prevalence of vitamin D inadequacy in an elderly population presenting to the South Glasgow Fracture Liaison Service with non-vertebral fragility fractures in order to assess the extent of the problem. RESEARCH DESIGN AND METHODS: The retrospective arm of this study used data from an established database to identify patients aged over 50 years admitted to South Glasgow University Hospitals over the previous 4 years with hip fracture. The prospective arm identified the first 50 patients aged over 50 presenting with a clinical non-vertebral fragility fracture with osteoporosis as measured by axial spine and/or hip DEXA (T-score < -2.5) after November 2004. RESULTS: In the retrospective arm, 626 patients were identified from the database: mean age 80.5 years; 94% were aged over 60 and 74% were aged over 75. Data analysis was limited to 548 patients aged over 60 years with vitamin D recordings and not receiving supplementation with calcium and vitamin D. The mean vitamin D level was 24.7 nmol/L (9.9 ng/ml) SD = 17, however, it is likely that the true mean is lower since in approximately 25% of cases vitamin D levels were reported as < 15 nmol/L (effectively unrecordable). These were transcribed as 15 nmol/L in order to permit a numerical value to be calculated. In the absence of an agreement on what should constitute a diagnostic serum level of vitamin D inadequacy, a number of thresholds were considered--97.8% had vitamin D levels below 70 nmol/L and 91.6% had vitamin D levels below 50 nmol/L. There were no significant differences by patient sex, age or season of presentation. The mean age of patients in the prospective arm was 65.8 years (range 50.6-83.8), 72% were aged over 60 and 16% were aged over 75. The mean vitamin D level was 44.1 nmol/L (18.4 ng/ml) SD = 25.3; 82% had vitamin D levels below 70 nmol/L and 72% had vitamin D levels below 50 nmol/L. Although numbers were too small to justify extensive subgroup analyses, the mean vitamin D level in the 13 patients with hip fracture (34.5 nmol/L) was lower than in the 37 with non-hip fractures (48.2 nmol/L). CONCLUSIONS: This study confirms almost universal vitamin D inadequacy among 548 elderly patients admitted to hospital with hip fracture, regardless of whether a threshold of 50 nmol/L or 70 nmol/L was used. However, among a prospective subset of 50 patients with clinical fragility fractures, especially those with non-hip fractures, the prevalence of inadequacy was substantially lower. It may be that vitamin D represents a correctable risk factor for fragility fracture in the elderly, possibly specifically for the hip.

Aged↗

PubMed2004

A case of two adverse reactions.

Low molecular weight heparins are now widely prescribed in the treatment of thromboembolic disease and acute coronary syndromes. Anaphylaxis is a recognised but rare potentially life threatening side effect of heparin. Common clinical features of anaphylaxis are cardiovascular collapse, bronchospasm, cutaneous symptoms, angioedema, generalised oedema, or gastrointestinal symptoms. It is extremely rare, however, for patients to experience such dramatic and potentially life threatening consequences as seen in the case reported here. It has been shown that patients may be tolerant of certain low molecular weight heparins but sensitive to others. Adrenaline is regarded as the most important drug for any severe anaphylactic reaction. Administration by the intramuscular route produces significantly higher peak plasma concentrations compared with subcutaneous injection, which is clearly beneficial in the critically compromised patient. Current UK Resuscitation Council guidelines support the use of 0.5 ml of 1:1000 adrenaline to be administered intramuscularly.

Aged↗

PubMed2003

Peritonitis due to the dermatiaceous mold Exophiala dermatitidis complicating continuous ambulatory peritoneal dialysis.

Exophiala (Wangiella) dermatitidis is a dermatiaceous mold that is an occasional cause of infection in the immunocompromised. We report a case of continuous ambulatory peritoneal dialysis-associated peritonitis probably due to environmental contamination with this organism. Prompt catheter removal and aggressive treatment with amphotericin B allowed an eventual return to peritoneal dialysis.

Exophiala↗

PubMed2001

Stable carbon isotope evidence for intrinsic bioremediation of tetrachloroethene and trichloroethene at area 6, Dover Air Force Base.

Area 6 at Dover Air Force Base (Dover, DE) has been the location of an in-depth study by the RTDF (Remediation Technologies Development Forum Bioremediation of Chlorinated Solvents Action Team) to evaluate the effectiveness of natural attenuation of chlorinated ethene contamination in groundwater. Compound-specific stable carbon isotope measurements for dissolved PCE and TCE in wells distributed throughout the anaerobic portion of the plume confirm that stable carbon isotope values are isotopically enriched in 13C consistent with the effects of intrinsic biodegradation. During anaerobic microbial reductive dechlorination of chlorinated hydrocarbons, the light (12C) versus heavy isotope (13C) bonds are preferentially degraded, resulting in isotopic enrichment of the residual contaminant in 13C. To our knowledge, this study is the first to provide definitive evidence for reductive dechlorination of chlorinated hydrocarbons at a field site based on the delta13C values of the primary contaminants spilled at the site, PCE and TCE. For TCE, downgradient wells show delta13C values as enriched as -18.0/1000 as compared to delta13C values for TCE in the source zone of -25.0 to -26.0/1000. The most enriched delta13C value on the site was observed at well 236, which also contains the highest concentrations of cis-DCE, VC, and ethene, the daughter products of reductive dechlorination. Stable carbon isotope signatures are used to quantify the relative extent of biodegradation between zones of the contaminant plume. On the basis of this approach, it is estimated that TCE in downgradient well 236 is more than 40% biodegraded relative to TCE in the proposed source area.

Biodegradation, Environmental↗

PubMed2000

Craniofacial form and obstructive sleep apnea in Polynesian and Caucasian men.

STUDY OBJECTIVES: This aim of this study was to determine the relative contributions of craniofacial form and anthropometric factors to obstructive sleep apnea (OSA) in two different racial groups, both markedly obese and with a similar mean respiratory disturbance index (RDI). DESIGN: A cross-sectional study of New Zealand Maori (Polynesian) and European (Caucasian) men with RDI> or =15, using lateral and postero-anterior cephalometric radiography. SETTING: N/A. PATIENTS OR PARTICIPANTS: N/A. MEASUREMENTS AND RESULTS: Measurements of facial and cranial width, length and height, airway size, stature, weight, body mass index (BMI), neck circumference, RDI, and age were obtained. The Polynesian men had, on average, a greater neck circumference than the Caucasian men. There were no significant differences in age, weight, BMI or RDI between the two groups. The Polynesian men also had broader craniofacial skeletons, larger and more prognathic mandibles, greater neck extension, and some larger airway dimensions than the Caucasian men. In the Polynesian men, the width of the bony nasal aperture was positively associated with RDI, and mandibular prognathism was negatively associated with RDI. In contrast, in the Caucasian men only neck circumference was positively associated with RDI, while the retropalatal airway was negatively associated with RDI. CONCLUSIONS: The results indicate that OSA in these two racially distinct groups is due to different etiological factors. Small reductions in mandibular prognathism and a wider bony nasal aperture were major factors associated with OSA in Polynesians. On the other hand, in the Caucasian group OSA was associated with a larger neck circumference and a reduced retropalatal airway size.

Anthropometry↗

PubMed2000

Ratings of profile attractiveness after functional appliance treatment.

The aim of this study was to determine the change in profile attractiveness in children with Class II Division 1 malocclusion after 18 months' treatment with functional appliances. Changes in profile attractiveness were assessed by panels of art students, dental students, and parents of orthodontic patients. Each panel consisted of an equal number of male and female raters. The raters first decided whether the initial or 18-month profile silhouette was more attractive, and then scored the degree to which it was more attractive on an unmarked visual analog scale. There were no significant differences between either male and female raters or among panels in their assessments of the change in profile attractiveness in the whole sample. Neither were there significant differences between the change in profile attractiveness of the untreated subjects and the subjects treated with either Fränkel function regulators or Harvold activators. It is concluded that treatment with functional appliances does not lead to more attractive profiles than nontreatment.

Analysis of Variance↗

PubMed2000

A longitudinal study of orthodontic treatment need in Dunedin schoolchildren.

The Index of Orthodontic Treatment Need (IOTN) was used to assess unmet orthodontic treatment need in 152 13-year-old Dunedin schoolchildren, and to compare the findings with those obtained in the same children 3 years previously. The children were randomly selected from Dunedin schools as 10-year-olds, and had not received orthodontic treatment. Approximately 86 percent of the 13-year-old children had "No-little" need for orthodontic treatment when assessed by the child-assessed Aesthetic Component (AC) and the examiner-assessed AC. Slightly less than half the children had "No-little" need for orthodontic treatment when assessed with the Dental Health Component (DHC). More 10- and 13-year-old children "Needed" orthodontic treatment with the DHC than with the AC. Both the examiner-assessed AC and the DHC assessed significantly fewer 13-year-olds as needing orthodontic treatment than the same children as 10-year-olds. Complete agreement between the grades assigned at 10 and 13 years occurred in 30-43 percent of the children and, in the treatment-need categories, between 53 percent (DHC) and 84 percent (child-assessed AC) of the children. The fall in treatment need over the 3-year period may be due to selection bias, over-sensitivity of the IOTN to mixed dentition traits, or both. Although a number of 10-year-old children were assigned different grades as 13-year-olds, many remained within the same treatment category. The apparent stability of the IOTN to assess treatment need in 10- and 13-year-old children is attributed to the grouping of different occlusal traits in the same treatment-need category, and to the small number of treatment-need categories in each component.

Adolescent↗

PubMed2000

Prevalence of malocclusion and orthodontic treatment need in 10-year-old New Zealand children.

The need for orthodontic treatment was determined in a random sample of 10-year-old Dunedin, New Zealand schoolchildren using the Dental Aesthetic Index (DAI); an index based on the social acceptability of dental appearance. When absent or unerupted teeth were disregarded, orthodontic treatment was considered to be "mandatory" for one-third of the children. The remaining children were almost equally divided into the three other treatment-need groups: "highly desirable", "elective", and "not necessary". The majority of the children had crowding and spacing in at least one incisor segment, and a molar occlusion other than Angle Class I. In this predominately mixed-dentition sample, more children were considered to need orthodontic treatment than older children in studies using the DAI. This raises some questions about the suitability of the DAI as a tool to assess orthodontic treatment need in mixed-dentition samples.

Chi-Square Distribution↗

PubMed2000

A comparison of two methods of assessing orthodontic treatment need in the mixed dentition: DAI and IOTN.

This paper assesses the unmet orthodontic treatment need in a random sample of 10-year-old schoolchildren, using two indices: the Dental Aesthetic Index (DAI) and the Index of Orthodontic Treatment Need (IOTN). The DAI scores were adjusted by omitting the missing teeth component of the index because many children were in the mixed dentition with unerupted permanent teeth. Although both indices assessed the same number of children with malocclusions requiring orthodontic treatment, not all were ranked similarly by each index.

Bicuspid↗

PubMed2000

Functional appliance treatment assessed using the PAR index.

The aims of this study were, first, to determine in children with Class II, division 1 malocclusions treated with functional appliances if, according to the Peer Assessment Rating (PAR) Index, lower incisor proclination affects the assessment of treatment outcome; and, second, to evaluate the effectiveness of such treatment before and after adjustment for any lower incisor proclination. Fifty-one children (32M, 19F; age and gender matched; 10 to 13 years) were randomly assigned to either an untreated group, one treated with Fränkel function regulators or one treated with Harvold activators. Study casts were assessed at the start, and after 6, 12, and 18 months of treatment/observation. The inclination of the upper and lower incisors was measured on lateral cephalometric radiographs taken at the start and 18 months later. There was wide variation in treatment response. The PAR scores decreased by more than 30% in 33% of the Fränkel group and by 75% in the Harvold group. When the score was adjusted to remove the effects of lower incisor proclination on the overjet, the treatment outcomes were "worse/no different" in 66% and "improved" in 33%, in both groups. It was concluded that functional appliances be used only on selected cases.

Activator Appliances↗

PubMed2000

Age changes in orthodontic treatment need: a longitudinal study of 10- and 13-year-old children, using the Dental Aesthetic Index.

The Dental Aesthetic Index (DAI) was used to assess the prevalence of unmet orthodontic treatment need in 150 13-year-old schoolchildren in Dunedin, New Zealand, and to compare the findings with those obtained in the same children at 10 years of age. Fewer 13-year-olds (27%) had a "mandatory" need of orthodontic treatment than when they were 10 years old (33%), 20% had "no/little" need for orthodontic treatment, 33% had an "elective" need for treatment and 20% had a "desirable" need for treatment. The fall in DAI scores is attributed to over-sensitivity of the Index to mixed dentition traits. When the individual scores were analysed, only 7% of the 10-year-olds were given the same scores as when they were 13 years old, 52% were given higher scores and 41% were given lower scores. This disagreement between scores was masked to a limited extent by the DAI categories: 49% of the 10-year-olds were assigned to the same DAI category at 13 years of age, 20% to a greater treatment-need category and approximately 30% to a lower treatment-need category. The DAI, in common with other malocclusion indices, is unreliable over time because it is affected by developmental changes in the occlusal traits measured.

Adolescent↗

PubMed1999

Elongated stylohyoid process: a report of three cases.

The stylohyoid process is part of the stylohyoid chain--the styloid process, the stylohyoid ligament, and the lesser cornu of the hyoid bone. The stylohyoid chain is derived from the second branchial arch. Mineralisation of the stylohyoid ligament and ossification at the tip may increase the length of the styloid process. An elongated stylohyoid or styloid process is considered to be the source of craniofacial and cervical pain commonly known as Eagle's syndrome. In some instances the stylohyoid process may be considerably elongated, yet remain asymptomatic. This paper reports three patients with elongated stylohyoid processes discovered incidentally on routine radiographic examination.

Adolescent↗

PubMed1997

Thermal debonding of ceramic brackets: an in vitro study.

Thermal debonding has been developed to overcome the problems of enamel damage and high forces when debonding ceramic orthodontic brackets. However, the temperature changes with thermal debonding have the potential to damage the tooth tissues. The principal aims of this study are, first, to investigate the effects of resin type, resin thickness, and debonding force on the temperature changes in human premolars during thermal debonding of ceramic brackets and, second, to record the sites of bond failure and damage to the tooth surface. Ceramic brackets were attached to each specimen by using one of four types of bonding resin in a controlled thick or thin resin layer. The ceramic debonding unit (Dentaurum, Pforzheim, Germany) was used to thermally debond the brackets with either a 40 or 80 Nmm torsional force. Higher temperature changes at the pulpal wall (> 10 degrees C in some 40 Nmm torsional force specimens) always occurred with Concise (3M Dental Products, St. Paul, Minn.) and Transbond (Unitek/3M Dental Products, Monrovia, Calif.) resins, and lower temperature changes (< 5 degrees C) with Quasar (Rocky Mountain Orthodontics, Denver, Colo.) and Ortho. B.S. (Dentaurum, Pforzheim, Germany) resins. In general, resin thickness was not significantly associated with buccal surface or pulpal wall temperature changes. However, temperature changes at the pulpal wall were significantly associated with the temperature changes at the buccal surface (r = 0.76), with the temperature of the thermal debonder blade for thin resin layer specimens (r = 0.50), and the time required to debond the bracket for both thick (r = 0.74) and thin (r = 0.63) resin layer specimens. In most specimens, the site of bond failure occurred at the bracket-resin interface. There was no evidence of enamel damage after bracket removal.

Acrylic Resins↗

PubMed1997

Patient and parent opinion of the use of recycled orthodontic brackets: an international comparison.

The aim of this study was to determine the opinion of patients and parents to the use of recycled orthodontic brackets. The design consisted of a questionnaire survey, which took place in the orthodontic departments of two teaching hospitals (Cardiff, Wales, and Dunedin, New Zealand). The subjects were patients (and parents of those under 18 years) undergoing active fixed appliance treatment and similar groups of those on the waiting list for fixed appliance treatment. There were no significant differences of opinion between gender, patient, parent, or centre. There were significant differences of opinion between those under treatment and those on the waiting list; those under treatment were less concerned about wearing recycled brackets than those waiting for treatment. All respondents felt that they should be told if recycled brackets were to be used, and any savings arising from their use passed on to the consumer.

Adolescent↗

PubMed1997

Orthodontic treatment need in 10-year-old Dunedin schoolchildren.

The prevalence of unmet orthodontic treatment need was assessed in a random sample of 294 10-year-old Dunedin schoolchildren using the Index of Orthodontic Treatment Need. Approximately one-third of the children from this mainly mixed-dentition sample were assessed as having a need for orthodontic treatment. No children needed orthodontic treatment on the basis of the Aesthetic Component alone, but slightly more than a quarter did on the basis of the Dental Health Component alone. The Dental Health Component was reliable and easy to use, and it assigned approximately the same number of children to the "Need", "Borderline", and "No/little" orthodontic treatment need categories. As the Aesthetic Component alone failed to identify any children needing orthodontic treatment, it may be unsuitable for use as a screening tool for orthodontic treatment need in the mixed dentition.

Child↗

PubMed1997

Pre-eruptive coronal radiolucency in a mandibular premolar: a case report and literature review.

This report describes a coronal radiolucency in an unerupted mandibular premolar. This anomaly, which most frequently involves the mandibular second molars, has been variously attributed to dental caries, dentine hypoplasia, inclusions of uncalcified enamel matrix, and resorption. The present instance was considered to be due to external resorption. Because these lesions may enlarge rapidly, frequent radiographic monitoring of an affected tooth is recommended. Early restorative treatment has been shown to be successful even in affected teeth with small pulp exposures.

Adolescent↗

PubMed1996

Maxillary and cranial base changes during treatment with functional appliances.

The purpose of this prospective study was to investigate the maxillary and the cranial base changes after treatment with the Harvold activator and the Fränkel function regulator appliances. Forty-two children, who are 10 to 13 years old, with Class II, Division 1 malocclusions were matched in triads according to age and sex and randomly assigned to either the control, Harvold activator, or Fränkel function regulator group. Lateral cephalometric radiographs were taken at the start of the study and 18 months later. Both appliances reduced the overjet by tipping the maxillary incisors palatally and, as a consequence, the length of the maxillary arch was reduced. The appliances had no effect on either the horizontal or vertical position of the maxillary molars. Small, but statistically significant, changes in the cranial base angle in the Fränkel function regulator group were attributed to relatively large changes at basion in several children, influencing the results because of the small size of the sample. The appliances had no effect on the position of the maxilla.

Activator Appliances↗