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Biomedical subjects

M Lutman

Publications and source records attributed to M Lutman.

At least 19 recordsLinked to original sources
PubMed2001

Evaluating training courses for parents of children with cochlear implants.

The purpose of this study was to investigate the change in effective communication between parents and children with cochlear implants when the parents attended a modified Hanen training course (Watson 1995). The study demonstrates that the course led to improvement in the effectiveness of the parent-child interaction, as rated by naïve independent observers. The Erber rating scale (Erber et al. 1995) was implemented as a tool for evaluating changes before and after the courses. Using video samples taken at the above intervals, the ratings showed a significant increase in effective communication at the end of the courses.

Child, Preschool↗
PubMed1997

An evaluation of a nurse-led ear care service in primary care: benefits and costs.

BACKGROUND: Nurses trained in ear care provide a new model for the provision of services in general practice, with the aim of cost-effective treatment of minor ear and hearing problems that affect well-being and quality of life. AIM: To compare a prospective observational cohort study measuring health outcomes and resource use for patients with ear or hearing problems treated by nurses trained in ear care with similar patients treated by standard practice. METHOD: A total of 438 Rotherham and 196 Barnsley patients aged 16 years or over received two self-completion questionnaires: questionnaire 1 (Q1) on the day of consultation and questionnaire 2 (Q2) after three weeks. Primary measured outcomes were changes in discomfort and pain; secondary outcomes included the effect on normal life, health status, patient satisfaction, and resources used. RESULTS: After adjusting for differences at Q1, by Q2 there was no statistical evidence of a difference in discomfort and pain reduction, or differential change in health status between areas. Satisfaction with treatment was significantly higher (P = 0.0001) in Rotherham (91%) than in Barnsley (82%). Average total general practitioner (GP) consultations were lower in Rotherham at 0.4 per patient with an average cost of 6.28 Pounds compared with Barnsley at 1.4 per patient and an average cost of 22.53 Pounds (P = 0.04). Barnsley GPs prescribed more drugs per case (6% of total costs compared with 1.5%) and used more systemic antibiotics (P = 0.001). CONCLUSIONS: Nurses trained in ear care reduce costs, GP workload, and the use of systemic antibiotics, while increasing patient satisfaction with care. With understanding and support from GPs, such nurses are an example of how expanded nursing roles bring benefits to general practice. Nurses trained in ear care reduce treatment costs, reduce the use of antibiotics, educate patients in ear care, increase patient satisfaction, and raise ear awareness.

Adult↗
PubMed1994

[Computed tomography in acute inflammation of the orbit].

Acute orbital infection, which is usually secondary to sinusitis, requires prompt diagnosis and timely treatment to prevent the infection from spreading and to avoid severe complications, such as osteomyelitis, orbital and cerebral abscesses, meningitis and cavernous sinus thrombophlebitis. Fifteen young patients with orbital cellulitis were examined: they were 13 men and 2 women, whose mean age was 23 years, with orbital cellulitis secondary to fronto-ethmoidal sinusitis (10 cases), to maxillary sinusitis (4 cases) and to craniofacial trauma (1 case). On the basis of CT findings the patients were divided into two groups according to whether the inflammatory process involved the preseptal (4 cases) or the postseptal (11 cases) space; postseptal cellulitis was classified as orbital cellulitis and subperiosteal abscesses. The site of the inflammatory process must always be accurately located because orbital septum integrity does affect treatment choice, which in our series was medical in preseptal cellulitis and always surgical in subperiosteal abscess. After describing the CT patterns of cellulitis and its possible complications, the authors emphasize the role of CT as the method of choice to confirm clinical diagnosis and to demonstrate the site, the extent and the complications of acute orbital cellulitis.

Acute Disease↗
PubMed1993

[Seat belt syndrome].

The increasingly common use of seat belts in the standard features of cars has markedly reduced the seriousness of lesions due to motor vehicle accidents but, at the same time, has caused the appearance of a specific pattern of injuries strictly related to the type of restraint. Thus, the seat belt syndrome consists of soft-tissues, skeletal and visceral injuries associated with the use of the passenger restraint system. After describing the site of injuries, we report the most common features of traumatic lesions, also comparing the consequences of the three possible occurrences: unrestrained, with two- and three- point restraints. With lap seat belts, which are the less complex, injuries most frequently involve the abdomen and vertebrae while with the three-point variety of seat belts the chest and shoulder girdle are involved. No matter what the type of restraint, skin abrasions are nearly always observed, and associated with internal injuries in 30% of cases. From the analysis of distribution, type and seriousness of injuries we can summarize that: a) the use of passenger restraint systems has surely reduced mortality and morbidity associated with motor vehicle accidents; b) the seat belt will never be able to avoid traumatic events because strong forces act and strike in a very short time on small areas of textile fabric; c) seat belts can be still considered the easiest, most reliable and cost-effective preventive method.

Abdominal Injuries↗
PubMed1991

[Spontaneous regression of lumbar disk hernia].

Four cases of spontaneous regression of herniated nucleus polposus are described, which were followed after conservative medical treatment. Three female and one male patients who suffered from severe lumbago were evaluated; their age ranged 24-59 years. From the first CT scan on which herniation was diagnosed to follow-up control after complete regression of symptoms an average period of 14 months elapsed. Comparing ours with literature data, a substantial agreement was observed of both timing of spontaneous regression and location (most often involved was the last lumbar intervertebral space). The age of one of our patients (59 years) is to be stressed, which is well above the mean age reported in literature (35 years). The pathogenesis of regression is still unknown. The most reliable hypothesis seems to be that of dehydration and progressive atrophy of the herniated nucleus polposus. The appearance, in some cases, of the vacuum disk phenomenon seems to support such a thesis. Therefore, the diagnosis of a herniated nucleus polposus of relatively small size, still contained in an intact posterior longitudinal ligament, widely justifies the choice of waiting tactics.

Adult↗
PubMed1990

[CT in hepatic injuries].

Twenty-one patients with hepatic injuries from blunt abdominal trauma were examined by Computed Tomography (CT). CT findings were correlated with those of plain X-ray films (5), radionuclide scanning (5), US (8), angiography (2), and with the findings of laparoscopy (2), exploratory laparotomy (6), and autopsy (2). CT well defines entity and severity of hepatic injuries, easily distinguishing minor from major ones. Moreover CT, by allowing the measurement of attenuation values, allows the various components of traumatic lesions (blood, clots, necrosis) to be recognized. CT is also useful in monitoring the healing patterns and in following the patients for late complications--e.g., abscess and biloma. After comparing it with other radiological investigation techniques, the authors emphasize the role of CT in defining both type and severity of liver injuries and in helping choose the better therapeutic approach (surgical or conservative). Thanks to its short execution time, to its reproducibility and to its allowing the contemporaneous evaluation of intra- and retroperitoneal organs. CT has become the radiological technique of choice in the patients with liver injuries.

Abdominal Injuries↗
PubMed1989

Pathologic assessment of computerized tomography accuracy for the evaluation of the laryngeal cartilaginous framework in laryngopharyngeal carcinomas.

Sixty-six whole-organ sectioned laryngopharyngectomy specimens removed for cancer during a seven-year period were uniformly examined to determine the accuracy of preoperative high resolution computerized tomography (CT) for detection of cartilaginous involvement. Our results indicate that CT has a high overall specificity (88.2%) but a low sensitivity (47.1%); we observed a high false-negative rate (26.5%) and a fairly low false-positive rate (5.9%). Massive cartilage destruction was easily assessed by CT, whereas both small macroscopic and microscopic neoplastic foci of cartilaginous invasion were missed on CT scans. Moreover, false-positive cases were mainly due to proximity of the tumor to the cartilage. Clinical implications of these results are discussed.

Carcinoma↗
PubMed1989

T staging of the laryngohypopharyngeal carcinoma. A 7-year multidisciplinary experience.

Sixty-six whole-organ sectioned, nonirradiated, laryngopharyngectomy specimens that were removed because of cancer during a 7-year period were uniformly examined to determine the accuracy of perioperative T staging by high-resolution computed tomography (CT) and clinical evaluation (indirect-direct laryngoscopy) by comparing this preoperative staging with the postsurgical pathologic staging. The accuracy of the clinical vs CT staging for laryngeal carcinomas was 58.8% vs 70.6%, whereas the accuracy of the staging by combination of the two modalities was 88.2%. Combined staging modalities showed the same accuracy for laryngeal and hypopharyngeal carcinomas (88.2%), whereas clinical staging accuracy for hypopharyngeal carcinomas was lower (52.9%) and CT accuracy was higher (82.4%) than that observed for laryngeal carcinomas. In the majority of the cases that were staged inaccurately, the error was one of under-estimation: in particular, tumors confined to the mucosa and early infiltration of laryngeal fat spaces were not detected by CT.

Adult↗
PubMed1988

Superficial extending carcinoma of the larynx.

Superficial extending carcinoma of the hypopharynx is a recently recognized form of carcinoma regarded as a possible pharyngeal counterpart to early gastric cancer and superficial esophageal carcinoma. In this study we report the radiological, clinical, and pathological features of three carcinomas of the larynx, which show architectural and histopathological features similar to those previously described in superficial extending carcinoma of the hypopharynx. These cases were singled out from a series of 37 consecutive laryngectomy specimens of primary infiltrating laryngeal carcinomas that were uniformly studied by means of a whole-organ sections technique. Pathologically, these cases showed a clearly invasive growth through the basal membrane into the lamina propria and an entire or predominant, extensive, superficial type of spread; infiltration of underlying muscle or gland structures was restricted to a few microscopic foci, regardless of the presence of lymph node metastases. The present study demonstrates that infiltrating carcinomas with a preferential superficial type of growth may also be encountered in the larynx. Differences between the histological features of these carcinomas of the larynx and the histopathological spectrum of so-called early laryngeal cancer are emphasized.

Aged↗