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Biomedical subjects

P MacFarlane

Publications and source records attributed to P MacFarlane.

14 recordsLinked to original sources
PubMed2001

Life circumstances of mothers with serious mental illnesses.

Individuals with a severe mental illness now have greater opportunities to pursue normal adult roles, including parenting. The research reported involved 379 women carrying out parenting responsibilities, recruited from the public mental health system in an urban area. The sample displayed great heterogeneity in educational levels, number of children, number of fathers for their children, and family living arrangements, except that most women were very poor. These women faced many significant stresses: living alone with their children, significant child behavior problems, and financial worries. Still, most of the women endorsed the significance of motherhood in their lives. Inattention by most mental health providers to parenting issues leaves many important needs unmet and is likely to have adverse consequences for these women and their children. Implications for psychosocial rehabilitation practice are discussed.

Adolescent↗
PubMed1999

The carvedilol hibernation reversible ischaemia trial; marker of success (CHRISTMAS). The CHRISTMAS Study Steering Committee and Investigators.

BACKGROUND: Carvedilol improves left ventricular (LV) function when heart failure is due to LV systolic dysfunction, but the magnitude of the response is heterogeneous among patients with coronary disease, possibly reflecting the presence or volume of hibernating myocardium. AIMS: The primary objective of the study is to determine whether the presence of hibernating myocardium predicts the magnitude of improvement in LV ejection fraction in response to carvedilol among patients with heart failure and LV systolic dysfunction due to coronary disease. METHODS: The study is a prospective, randomised, parallel-group, double-blind, multi-centre study comparing carvedilol and placebo over a period of approximately 6 months in the above patient population. The primary end-point is the comparison of the mean change, from baseline to the final visit, in radionuclide-determined LV ejection fraction among patients on placebo with those on carvedilol stratified according to the presence of hibernating myocardium. Hibernating status will be determined by a combination of echocardiographic and myocardial perfusion (technetium-99m sestamibi) imaging. RESULTS: 255 patients have undergone screening tests of which 207 have been randomised so far. The study intends to randomise 400 patients and the first report of results is expected in 2000. CONCLUSIONS: As far as we are aware this is the first randomised controlled trial to investigate the effects of treatment in patients stratified according to the presence of hibernating myocardium. The study will provide insights into the prevalence of myocardial hibernation, its natural history, and its influence on prognosis as well as the interaction between the presence of hibernating myocardium and the effects of treatment with carvedilol.

Adrenergic beta-Antagonists↗
PubMed1999

Endoluminal stenting of obstructed colorectal tumours.

A series of patients were selected to evaluate the clinical efficacy of a new self expanding metallic endoprosthesis in the management of left-sided colonic obstruction. The aim was to reduce the morbidity and mortality associated with the surgical management of patients with distal colonic obstruction. Six patients with complete sigmoid colon obstruction were managed with the Wallstent Enteral Endoprosthesis [Schneider (USA) Inc.]. Four underwent subsequent elective colonic resection, while two were placed for palliation. Stent placement was successful in all cases with resulting bowel decompression and there were no procedural complications. All four patients with resectable tumours avoided emergency surgery. Stenting allowed time for medical improvement and staging investigations in this group. Two patients with advanced metastatic colonic carcinoma were successfully palliated. We found the Wallstent Enteral Endoprosthesis to be safe and effective in relieving obstruction in patients with resectable colonic tumours, permitting elective surgery and avoiding a temporary stoma. It can also be used to palliate those patients with advanced disease.

Aged↗
PubMed1993

Scoring acuity hours and costs of nursing for trauma care.

OBJECTIVE: To determine nursing resource utilization (acuity hours and dollars) by trauma patients based on analysis of a nursing acuity system and five trauma scoring systems. METHODS: Retrospective review of 448 trauma patients who required transport by aircraft to a level I trauma center. Values from the institution's automated nursing acuity system were compared with the Glasgow Coma Scale score, trauma score, revised trauma score, CRAMS score and injury severity score to obtain acuity hours and financial cost of care for trauma patients. RESULTS: Consistently, analysis of scores computed by five scoring instruments confirmed that nursing resource utilization is greatest for patients who are severely injured but likely to recover. For example, patients with a trauma score of 1 required 49 (+/- 66) mean acuity hours of care; those with a trauma score of 8 needed 189 (+/- 229) mean acuity hours; and those with a trauma score of 16 used 73 (+/- 120) mean acuity hours. Mean dollar costs were $980 (+/- 1293), $3812 (+/- 4518) and $1492 (+/- 2473), respectively. CONCLUSIONS: Nursing resource utilization can be determined for trauma patients by using an automated nursing acuity system and trauma scoring systems. Data acquired in this way provide a concrete basis for healthcare and reimbursement reform, for administrators who design nursing allocations and for nursing educators who prepare graduates to meet the needs of healthcare consumers.

Critical Care↗
PubMed1990

The effects of felodipine in angina pectoris.

The clinical response to felodipine, in addition to a beta-blocker, was evaluated and compared with placebo in this double-blind cross-over study. Twenty patients with exertional angina pectoris completed the study. Felodipine reduced the number of angina attacks and the Glyceryl Trinitrate (GTN) consumption. The median exercise capacity was increased 33% after 4 weeks' felodipine treatment compared with placebo. At maximal exercise, systolic blood pressure and rate pressure product were reduced by felodipine while no change was seen in heart rate or ST-depression. Felodipine reduced both supine and erect blood pressure. The mean supine blood pressure at rest was 138/82 mm Hg after four weeks' placebo treatment compared with 114/71 mmHg after felodipine 5-10 mg b.i.d. Felodipine has overall a modest but significant anti-anginal benefit when combined with a beta-blocker.

Adult↗
PubMed1986

Continuous 24-hour electrocardiography in thyrotoxicosis before and after treatment.

Ten thyrotoxic individuals, who otherwise had no evidence of cardiovascular disease, underwent continuous ambulatory 24-hour ECG monitoring, before and after antithyroid treatment. The mean age of the subjects was 41 +/- 14.4 years (mean +/- SD) with a range of 22 to 66 years. When subjects were thyrotoxic, the mean heart rate for the group was 104 +/- 10.8 bpm. This fell to 82 +/- 6.8 bpm when the subjects were rendered euthyroid (p less than 0.001). Circadian rhythm of heart rate response was maintained in the thyrotoxic state, although heart rate variability was significantly increased (p less than 0.001). The prevalence of ventricular premature contractions was not significantly different before and after treatment, although premature atrial contractions were more prevalent during the middle third of the day (p less than 0.01) when subjects were euthyroid. These findings support the view that normal adrenergic responsiveness persists in hyperthyroidism, and for most individuals treatment does not significantly alter the prevalence of ectopic activity.

Adult↗
PubMed1983

The risk of infection related to radial vs femoral sites for arterial catheterization.

To evaluate risk factors for infections associated with indwelling arterial catheters, 186 catheters were randomly allocated for either femoral or radial insertion in 155 critically ill patients. Femoral catheters were easier to insert and it was easier to obtain blood specimens from them. Rates of local infection at the insertion sites and rates of positive catheter-tip cultures were similar for femoral and radial catheters. Evidence of local infection was not predictive of a positive catheter-tip culture. Percutaneously inserted femoral and radial artery catheters had a similarly low incidence of catheter-associated infections. There was only one catheter-related infection, and no cultured catheter was judged the cause of bacteremia. Routine prophylactic replacement of arterial catheter systems may be unnecessary in critical care units where rates of arterial catheter-associated infections are low.

Adult↗
PubMed1983

Ambulatory electrocardiography in squash players.

Ambulatory electrocardiography was carried out in 21 healthy, fit, male squash players (aged 23-43 years) before, during, and after match play. Resulting electrocardiograms were analysed with respect to heart rate and changes in rhythm. The results indicate that squash increases the heart rate to 80% of an individual's predicted maximum heart rate for the duration of a game. Ventricular arrhythmias were detected in seven of the subjects during play and in seven in the immediate post-exercise period, an incidence which was not reproduced on subsequent maximal treadmill exercise testing. This study indicates that squash is a physiologically demanding sport which places a severe strain on the myocardium for considerable periods of time and is capable of generating cardiac arrhythmias. These findings are particularly important for an individual already at risk of sudden death from coronary artery disease or structural cardiovascular abnormalities. Medical advice before participation in the game will identify those at high risk of cardiovascular disease. Subjects in this study who developed arrhythmias were not, however, identified by history, examination, or exercise electrocardiography. Thus, it seems unwise to begin playing squash after the age of 40 years. Whether subjects in this age group already participating in the game should continue to play remains a matter for individual judgment.

Adult↗
PubMed1980

The stress test.

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Exercise Test↗