Biomedical subjects
P Fahey
Publications and source records attributed to P Fahey.
Infection control procedures. The elderly's susceptibility to infection mandates stopping the spread of germs.
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Sports-related and other soft-tissue injuries, tendinitis, bursitis, and occupation-related syndromes.
In this review, four areas are discussed: fluoroquinolone-induced tendinitis, volar flexor tenosynovitis (trigger finger), Achilles tendon lesions, and occupational medicine issues. The relationship of fluoroquinolone treatment to musculoskeletal lesions, especially Achilles tendinitis and tear, is most intriguing. The steady increase in reports of the association cannot be ignored. Although Achilles tendinitis and rupture have comprised the most frequently seen lesions, articles on additional sites of involvement, such as in lateral epicondylitis and De Quervain's tenosynovitis, are reviewed. Volar flexor tenosynovitis and trigger finger are among the most common musculoskeletal problems, and additional studies support the success of corticosteroid injections. Although the value of injections was reported well over 25 years ago, surgery is still unfortunately the first-choice treatment of some physicians. We review three studies on Achilles tendinopathy. In one of the reports, diagnostic ultrasonography is again demonstrated to be of value in assessing tendon lesions. The push to use the term tendinosis rather than tendinitis continues as a result of histologic studies of tendinitis that lack the usual findings of inflammation. However, the presence or absence of chemical inflammation is yet to be ascertained. We review an article that fails to show that work activities are the sole cause of such musculoskeletal syndromes as cumulative trauma or repetitive use. Further studies are needed in the area of work-related upper extremity disorders.
Increasing generalist production.
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An inappropriate thyrotropin-secreting pituitary adenoma in a 30-year-old man.
Thyrotropin-secreting pituitary adenomas are rare, especially in the family practice setting. We report a case of such a tumor and review the literature. The key clinical finding is hyperthyroidism in the absence of a suppressed thyrotropin level. The patient was unusual in not having an elevated alpha-subunit. All patients with hyperthyroidism should be screened for a thyrotropin level to rule out this unusual cause of hyperthyroidism. Other aspects of this case pertinent to primary care management are reviewed.
Statistical tools for understanding variation: the allocation of operating suite time.
Australian hospitals are becoming increasingly familiar with the 'new' tools for continuous quality improvement. In particular, many are becoming increasingly competent in establishing and supporting quality improvement teams for process evaluation and improvement. The main problems with such teams now seems to arise in relation to the analysis and interpretation of data on the process. This paper provides an example of the types of analyses and interpretations required of today's quality improvement practitioner in health care.
Silicide formation and dopant diffusion in silicon.
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The validity of parental report of vaccination as a measure of a child's measles immunisation status.
OBJECTIVE: To determine the validity of parental report of vaccination as a measure of a child's measles immunisation status. DESIGN: Cross-sectional survey. SETTING: Four 24-hour medical centres in western Sydney. PATIENTS: Parents of children aged 12-36 months were approached in the clinic waiting room. Of the 160 parents approached, 137 agreed to be interviewed and a successful venepuncture to yield a 2 mL blood sample was achieved with 128 children. MAIN OUTCOME MEASURES: Measles IgG antibody, determined by means of an indirect ELISA, was compared with parental report of measles vaccination status by McNemar's chi 2 test. RESULTS: Parental report significantly over-estimates the immunisation status of children. Eighty-four per cent of the parents in the sample stated that their child had been vaccinated, but only 74% were immune (95% confidence interval, 65%-81%). A positive predictive value of 84% meant that only 84% of children who were reported to have been vaccinated were immune to measles. Further, of all those who were not immune to measles, only one half would have been identified by asking the parents. Failed seroconversion may have accounted for up to 70% of cases of non-immunity in children reported to have been vaccinated. CONCLUSIONS: Parental report is limited as a measure of a child's measles immunisation status.
Novel diffusion phenomenon of dopants in silicon at low temperatures.
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Patient education policy and practice in Australian hospitals.
In Australia little is known of the quality and range of patient education programs or their level of support. A national survey was conducted to establish a baseline of the number of programs being conducted, the level of administrative support and the sophistication of practice. This survey shows that most hospitals in Australia conduct some patient education programs. Teaching and metropolitan public hospitals conduct the most, 95% and 88%, respectively, private hospitals the least, 47%. The programs conducted mainly cover chronic health problems such as diabetes (80% of all hospitals offering programs), heart disease (52%) and cancer (36%). The main reason given for not conducting education programs is lack of trained staff (59%). Of the programs which are conducted only half are planned. Most of the hospitals surveyed had few of the administrative components found to be necessary to support planned, patient education programs. The two most common administrative components were documentation in patient notes (48% of hospitals conducting programs) and a resource center (34%).
A comparison of two methods of eliciting the ankle jerk.
Two methods of eliciting the ankle jerk have been compared. One, the traditional method, involved tapping the Achilles tendon (the tendon tap); the other (the plantar tap) involved tapping the sole of the foot. The study was done on 110 inpatients in the medical wards of a teaching hospital. The results showed an 89% agreement between the two methods. The extent of agreement was unrelated to the level of experience of the examiner. Forty three per cent of patients favoured the plantar tap method; 14% the tendon tap. The plantar tap method of eliciting the ankle jerk is an acceptable alternative to the traditional method.
The fate of elderly patients discharged from the accident and emergency department of a general teaching hospital.
This paper describes the experience of a cohort of elderly patients who were discharged after attending the accident and emergency department of a large Australian teaching hospital. Before-and-after comparisons of aspects of physical functioning revealed a considerable loss of independence in the period immediately after the visit to the hospital. Subsequent hospital admission or death was observed in 30 of the 90 patients studied. It is suggested that elderly patients discharged from the accident and emergency department are at risk and require special consideration and a high index of suspicion in terms of evaluation at the time of presentation. Before discharge, account should be taken of aspects of physical and mental function, social networks, and community supports available to each patient. A lowered threshold for admission is recommended on the basis of the high rate of return found in this study.
Discriminant attitudes and beliefs about condoms in young, multi-partner heterosexuals.
Four hundred and eight people aged 15-35 years who reported having more than one sexual partner of the opposite sex in the past year or who thought it likely that they would do so in the next year were surveyed about their sexual behaviour, concern about acquired immunodeficiency syndrome and sexually transmitted diseases and attitudes to condom use. Differences in concerns and attitudes between regular and non- or irregular condom users and between men and women are reported. Three conceptually coherent factors (condom use as positive action; condom use as cue to embarrassment; and condom use as antithetical to good sex) discriminated between users and non-users. Implications for health promotion campaigns designed to promote condom use are discussed.
Oral hygiene program for orthodontic patients.
The gingival and periodontal health of 62 adolescent orthodontic patients was assessed before and again after orthodontic treatment in a controlled clinical study. Before the commencement of orthodontic treatment, the experimental group received an oral hygiene program consisting of 4 weekly sessions of oral health education, instruction on plaque-control techniques and reviews in plaque removal performance. The control group did not receive this program. It was found that there was a general trend in the study population for improved gingival health as measured by the bleeding index, gingival index, plaque index and gingival crevicular fluid volume. Furthermore, the oral hygiene program induced in the experimental group significantly lower scores in the measured clinical indices compared to the control group. However, no significant difference was noted in the measured probing depths in all subjects before or after the study period.
Interns' identification of patients' health risks in a casualty department.
This study examined whether the interns who staffed a hospital casualty department identified correctly four common health risks among their patients. When compared with patients who were attending general practitioners, patients who attended the casualty department were more likely to be cigarette smokers. They were also more likely to be heavy drinkers of alcohol and to score highly on a standardized measure of psychological disturbance. Women were less likely to have undergone a Papanicolaou smear-examination within the previous two years. The interns, who were the subjects in this study, failed to identify 56% of the smokers, 84% of the heavy drinkers, 35% of the psychologically-disturbed patients and 95% of the women who had not undergone a Papanicolaou smear-test in the last two years. The findings were in contrast with the interns' own opinions on what would constitute good-quality care in this setting. The subjects were just beginning their internship at the time of the study. Their failure to integrate important questions about common health risks suggests that their undergraduate training has been deficient in this area. The internship is the last formal opportunity to correct this deficiency before these doctors are registered for independent medical practice.
Construction and validation of a questionnaire to measure the health beliefs of general practice patients.
The health belief model has been widely used as a conceptual framework for understanding and explaining compliance behaviour. A weakness characterizing work in the area has been lack of standardization of measurement of the components of the health belief model. This paper describes the development and validation of a questionnaire to measure these components. The questionnaire was designed for use with general practice patients who have a wide range of different illnesses, therefore the nature of the patients' illness is not mentioned in the content of the items. Principal components analysis was used to determine the dimensions underlying patients' beliefs. Principal components analysis and application of Cronbach's alpha statistic identified four reliable sub-scales of the questionnaire. The sub-scales measured patient's beliefs about: the threat caused by illness, the efficacy of traditional medical care, the way illness is dealt with and the barriers to taking medications.
Peptic ulcer and non-steroidal anti-inflammatory agents.
Aspirin is generally regarded as a cause of gastric ulcer but the role of non-steroidal anti-inflammatory agents and paracetamol in the aetiology of peptic ulcer is unclear. To investigate this we conducted a case control study of 180 matched pairs of peptic ulcer patients and controls obtained from surgical and dermatology outpatient clinics. There were 95 gastric ulcer and 85 duodenal ulcer patients. A statistically and clinically association (relative risk = 5) was found between the regular use of non-steroidal anti-inflammatory agents and gastric ulcer. There was also evidence of positive associations between gastric ulcer and aspirin containing preparations with or without non-steroidal anti-inflammatory agents. By contrast, duodenal ulcer was unrelated to these drugs. Too few patients used paracetamol for any conclusion to be drawn on its role.