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Biomedical subjects

P O'Rourke

Publications and source records attributed to P O'Rourke.

13 recordsLinked to original sources
PubMed2006

Exercise for overweight or obesity.

BACKGROUND: Clinical trials have shown that exercise in adults with overweight or obesity can reduce bodyweight. There has been no quantitative systematic review of this in The Cochrane Library. OBJECTIVES: To assess exercise as a means of achieving weight loss in people with overweight or obesity, using randomised controlled clinical trials. SEARCH STRATEGY: Studies were obtained from computerised searches of multiple electronic bibliographic databases. The last search was conducted in January 2006. SELECTION CRITERIA: Studies were included if they were randomised controlled trials that examined body weight change using one or more physical activity intervention in adults with overweight or obesity at baseline and loss to follow-up of participants of less than 15%. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. MAIN RESULTS: The 43 studies included 3476 participants. Although significant heterogeneity in some of the main effects' analyses limited ability to pool effect sizes across some studies, a number of pooled effect sizes were calculated. When compared with no treatment, exercise resulted in small weight losses across studies. Exercise combined with diet resulted in a greater weight reduction than diet alone (WMD -1.1 kg; 95% confidence interval (CI) -1.5 to -0.6). Increasing exercise intensity increased the magnitude of weight loss (WMD -1.5 kg; 95% CI -2.3 to -0.7). There were significant differences in other outcome measures such as serum lipids, blood pressure and fasting plasma glucose. Exercise as a sole weight loss intervention resulted in significant reductions in diastolic blood pressure (WMD -2 mmHg; 95% CI -4 to -1), triglycerides (WMD -0.2 mmol/L; 95% CI -0.3 to -0.1) and fasting glucose (WMD -0.2 mmol/L; 95% CI -0.3 to -0.1). Higher intensity exercise resulted in greater reduction in fasting serum glucose than lower intensity exercise (WMD -0.3 mmol/L; 95% CI -0.5 to -0.2). No data were identified on adverse events, quality of life, morbidity, costs or on mortality. AUTHORS' CONCLUSIONS: The results of this review support the use of exercise as a weight loss intervention, particularly when combined with dietary change. Exercise is associated with improved cardiovascular disease risk factors even if no weight is lost.

Adult↗
PubMed2005

Psychological interventions for overweight or obesity.

BACKGROUND: Overweight and obesity are global health problems which are increasing throughout the industrialised world. If left unchecked, they will continue to contribute to the ever increasing noncommunicable disease burden. OBJECTIVES: To assess the effects of psychological interventions for overweight or obesity as a means of achieving sustained weight loss. SEARCH STRATEGY: Studies were obtained from searches of multiple electronic bibliographic databases. The date of the latest search was June 2003. SELECTION CRITERIA: Trials were included if the fulfilled the following criteria: 1) they were randomised controlled clinical trials of a psychological intervention versus a comparison intervention, 2) one of the outcome measures of the study was weight change measured by any method, 3) participants were followed for at least three months, 4) the study participants were adults (18 years or older) who were overweight or obese (BMI > 25 kg/m(2)) at baseline. DATA COLLECTION AND ANALYSIS: Two people independently applied the inclusion criteria to the studies identified and assessed study quality. Disagreement was resolved by discussion or by intervention of a third party. Meta-analyses were performed using a fixed effect model. MAIN RESULTS: A total of 36 studies met the inclusion criteria and were included in the review. Overall, 3495 participants were evaluated. The majority of studies assessed behavioural and cognitive-behavioural weight reduction strategies. Cognitive therapy, psychotherapy, relaxation therapy and hypnotherapy were assessed in a small number of studies. Behaviour therapy was found to result in significantly greater weight reductions than placebo when assessed as a stand-alone weight loss strategy (WMD -2.5 kg; 95% CI -1.7 to -3.3). When behaviour therapy was combined with a diet / exercise approach and compared with diet / exercise alone, the combined intervention resulted in a greater weight reduction. Studies were heterogeneous however the majority of studies favoured combining behaviour therapy with dietary and exercise interventions to improve weight loss. Increasing the intensity of the behavioural intervention significantly increased the weight reduction (WMD -2.3 kg; 95% CI -1.4 to - 3.3). Cognitive-behaviour therapy, when combined with a diet / exercise intervention, was found to increase weight loss compared with diet / exercise alone (WMD -4.9 kg; 95% CI -7.3 to - 2.4). No data on mortality, morbidity or quality of life were found. AUTHORS' CONCLUSIONS: People who are overweight or obese benefit from psychological interventions, particularly behavioural and cognitive-behavioural strategies, to enhance weight reduction. They are predominantly useful when combined with dietary and exercise strategies. The bulk of the evidence supports the use of behavioural and cognitive-behavioural strategies. Other psychological interventions are less rigorously evaluated for their efficacy as weight loss treatments.

Adult↗
PubMed2003

Infant to staff ratios and risk of mortality in very low birthweight infants.

OBJECTIVES: To assess the effect that infant to staff ratios, in the first three days of life, have on the survival to hospital discharge of very low birthweight infants (<1500 g), having adjusted for initial risk and unit workload. DESIGN: In a retrospective analysis of a cohort of patients, the number of infants per nurse per shift were averaged for the first three days after admission and related to risk of mortality by logistic regression analysis. Infant to staff ratio was divided into terciles of low (1.16-1.58), medium (1.59-1.70), and high (1.71-1.97) infants per staff member. SUBJECTS: 692 very low birthweight infants admitted to the Intensive Care Nursery, Royal Women's Hospital, Brisbane over a four year period from January 1996 to December 1999. MAIN OUTCOME MEASURES: Survival to hospital discharge, adjusted for initial risk using the Clinical Risk Index for Babies (CRIB) score, and adjusted for unit workload using dependency scores. RESULTS: There were 80 deaths among the 692 babies analysed for the study period. The odds of mortality, adjusted for initial risk and infant dependency scores (unit workload), were improved by 82% when an infant/staff ratio of greater than 1.71 occurred, suggesting improved survival with the highest infant/staff ratio. The low and medium staffing levels corresponded with similar odds ratios for mortality. CONCLUSIONS: Infants exposed to higher infant to staff ratios have an improved adjusted risk of survival to hospital discharge.

Birth Weight↗
PubMed2003

Familial growth and skeletal features associated with SHOX haploinsufficiency.

This study was designed to determine the intrafamilial effect of SHOX haploinsufficiency on stature, by comparing the growth and phenotype of 26 SHOX haploinsufficient individuals with 45 relatives and population standards. It confirmed that SHOX haploinsufficiency leads to growth restriction from birth to final height. Compared to unaffected siblings, the SHOX haploinsufficient cohort was 2.14 SDS (3.8 cm) shorter at birth and 2.1 SDS shorter through childhood. At final height females were 2.4 SDS (14.4 cm) shorter and males 0.8 SDS (5.3 cm) shorter than normal siblings. The family height analysis suggests that the effect of SHOX haploinsufficiency on growth may have been previously underestimated at birth and overestimated in males at final height. SHOX haploinsufficiency leads to short arms in 92%, bilateral Madelung deformity in 73% and short stature in 54%. Females were more severely affected than males. We conclude that SHOX is a major growth gene and that mutations are associated with a broad range of phenotype.

Adolescent↗
PubMed2001

Enhanced efficiency of electrostatically charged insecticide aerosols.

The bioefficacy of a standard domestic aerosol insecticide has been compared with that of a similar spray in which the droplets were electrostatically charged. The aerosol was charged without the need for an external power supply, by enhancing natural charge separation processes that occur during atomisation. The charge-to-mass ratio achieved was 1.1 x 10(-4) C kg-1, compared with 2.2 x 10(-5) C kg-1 for the standard aerosol. Efficiency was assessed for insects in free flight. A direct space-spray application method was used to study the bioefficacy of these aerosols on houseflies, Musca domestica, and an indirect space-spray method on houseflies and mosquitoes, Culex quinquefasciatus. Two levels of concentration of active ingredients were compared. At low concentrations of 1.57 g kg-1 of bioallethrin and 0.29 g kg-1 of bioresmethrin, the charged aerosol achieved a significant reduction in KDT50 (time at which 50% of the flies were knocked down), compared with the standard aerosol. In the direct spray application to houseflies, the KDT50 was reduced by 50%, while in the indirect spray the KDT50 was reduced by 40%. In the indirect spray of mosquitoes, the KDT50 was reduced by 22%. With higher active ingredient concentrations of 2.09 g kg-1 for bioallethrin and 0.39 g kg-1 for bioresmethrin, the charged aerosol also demonstrated faster knockdown than the standard, but the improvement was less marked. In the direct spray application to houseflies, the KDT50 was reduced by 21% compared with the standard aerosol, while in the indirect spray the KDT50 was reduced by 16%. In the indirect spray of mosquitoes, the KDT50 was reduced by 24%. The percentage mortality after 24 h was also increased with the charged aerosol. Charge carried by the droplets results in increased interception of the insecticide, as the droplets are attracted to the insects in flight and space charge effects within the aerosol could cause improved dispersion in the test chamber.

Aerosols↗
PubMed2001

Cost comparison of hospital- and home-based treatment models for acute chronic obstructive pulmonary disease.

This trial compared the cost of an integrated home-based care model with traditional inpatient care for acute chronic obstructive pulmonary disease (COPD). 25 patients with acute COPD were randomised to either home or hospital management following request for hospital admission. The acute care at home group costs per separation ($745, CI95% $595-$895, n = 13) were significantly lower (p < 0.01) than the hospital group ($2543, CI95% $1766-$3321, n = 12). There was an improvement in lung function in the hospital-managed group at the Outpatient Department review, decreased anxiety in the Emergency Department in the home-managed group and equal patient satisfaction with care delivery. Acute care at home schemes can substitute for usual hospital care for some patients without adverse effects, and potentially release resources. A funding model that allows adequate resource delivery to the community will be needed if there is a move to devolve acute care to community providers.

Acute Disease↗
PubMed2000

Revision surgery after failed subacromial decompression.

The purpose of this study was to assess the results of revision subacromial decompression and identify clinical and psychological factors that influence its outcome. Thirty-five patients with intact rotator cuffs who underwent surgery for recurrent stage II impingement were studied at a mean follow-up time of 43 months post-surgery. Twenty-seven patients were satisfied with their surgery. The UCLA Scoring System rated 18 of 35 with good/excellent results and 17 of 35 poor/fair results, 22 patients had worker's compensation injuries, which correlated with poor outcome (P=0.0067). Patients with concomitant brachial plexopathy and/or compressive neuropathies were associated with unsatisfactory results (P=0.02).

Adult↗
PubMed2000

Predictors of an antibiotic prescription by GPs for respiratory tract infections: a pilot.

BACKGROUND: Antibiotics are over-prescribed for respiratory tract infections in Australia. OBJECTIVES: The aim of this study was to describe the clinical predictors of GPs' prescribing of antibiotics. METHODS: We used Clinical Judgment Analysis to study the responses of GPs to hypothetical paper-based vignettes of a 20-year-old with a respiratory tract infection. The nature of four symptoms and signs (colour of nasal mucous discharge; soreness of the throat; presence of fever; and whether any cough was productive of sputum) was varied and their effect on prescribing measured using logistic regression. RESULTS: Twenty GPs participated. The nature of each symptom and sign significantly predicted prescribing of an antibiotic. Cough productive of yellow sputum; presence of sore throat; fever; and coloured nasal mucus increased the probability of an antibiotic being prescribed. CONCLUSIONS: GPs are influenced by clinical signs and symptoms to use antibiotics for respiratory infections for which there is poor evidence of efficacy from the literature.

Adult↗
PubMed1995

Ombudsmen, patient complaints, and total quality management: an examination of fit.

BACKGROUND: In response to mounting health care costs in the United States and Canada, there is considerable national discussion of health care quality, including the importance of assessing and monitoring patient satisfaction and of responding to complaints. Many physicians and health care administrators cringe at the mention of using patient complaints and satisfaction levels as quality measures; others perceive the need to develop multiple source indicators of patient care. At the same time, leaders are seeking programs and methods that contribute to the continuous improvement of all aspects of health care organizations. DISCUSSION: The use of patient ombudsmen and patient complaints in quality management programs is reviewed and the relation between the two functions--ombudsmen/complaint handling and total quality management--is discussed. Purposes, objectives, problem-solving processes, program operations, data use, and the outcomes of ombudsmen efforts are reviewed. Since ombudsmen programs value patient feedback, empower customers, and help contribute to the diagnosis of organizational areas for improvement, they are consistent with the intent and workings of quality teams. The activities of ombudsmen can contribute to the broader effort to manage the whole organization toward the continuous improvement of quality.

Canada↗
PubMedDate not supplied

Role of quality assessment in improving red blood cell transfusion practice.

A prospective analysis of perioperative red blood cell transfusion practice in 110 patients undergoing elective primary total hip arthroplasty was conducted as a part of a quality assessment programme at the National Orthopaedic Hospital. In addition to demographic and clinical data, blood loss and perioperative transfusions were also recorded. Blood was collected for evaluation of haematocrit levels at predetermined intervals (preoperative and 6 h, 1, 2, 3, 7 days, postoperatively). Blood transfused with the patient's haematocrit of more than 30 per cent was considered inappropriate. In addition, a discharge haematocrit exceeding 36 per cent was chosen to identify overtransfusion. Eighty-four per cent were transfused a total of 191 units of homologous blood. Only 4 units were transfused between 3 patients, intraoperatively. All intraoperative transfusions were appropriate. Using the preset criteria (i.e. blood transfused with haematocrit of more than 30 per cent), 36 per cent of total units transfused were inappropriate. Using the criterion of discharge haematocrit of more than 36 per cent, 24 per cent of the patients were overtransfused. As compared to a previous retrospective analysis of blood transfusion in the same patient population which showed that inappropriate transfusion occurred in 45 per cent of the patients, the results from this study suggest a trend towards a more conservative transfusion practice. The improvement in transfusion practice may be due to the ongoing quality assurance programme and the use of transfusion guidelines.

Aged↗
PubMedDate not supplied

Sustained secretion of ciliary neurotrophic factor to the vitreous, using the encapsulated cell therapy-based NT-501 intraocular device.

The objective of this study was to evaluate the in vivo secretion profile of ciliary neurotrophic factor (CNTF) from either of two genetically engineered cell lines contained in the encapsulated cell therapy (ECT)-based NT-501 device. ECT devices were loaded with either a low or high CNTF-secreting cell line and implanted into rabbit eyes for 1, 3, 7, 14, 30, 60, 90, 135, 180, or 365 days. After explantation, the vitreous was sampled and devices were allowed to incubate in endothelial serum-free medium for 24 h at 37 degrees C. Both the vitreous and the conditioned medium were assayed for CNTF using an ELISA. Device and vitreous CNTF, were plotted against time, and regression analysis was used to calculate half-life. Devices loaded with either cell line showed stable in vivo output for the duration of the study, with populations of healthy cells remaining in the device at study termination. For the low-dose CNTF-secreting cell line, with the final time point at 6 months, the halflife was estimated as 71 days, whereas the high-dose devices, with a final time point of 1 year, had an associated half-life of approximately 198 days. The NT-501 device is capable of delivering CNTF to the vitreous for at least 1 year. This ECT-based device, which has been shown to be safe and effective by our group, is a well-engineered ECT-based controlled delivery system capable of protein output on the order of years.

Animals↗
PubMedDate not supplied

Effects of intraarticular morphine on analgesic requirements after anterior cruciate ligament repair.

BACKGROUND AND OBJECTIVES: Intraarticular morphine has been shown to provide postoperative pain relief after knee arthroscopy. The analgesia results from local action within the knee joint. This study was conducted to assess the efficacy of intraarticular morphine as a treatment for postoperative pain after anterior cruciate ligament repair. METHODS: A randomized double blind-study was conducted in patients undergoing elective anterior cruciate ligament repair. Patients in the study group (n = 10) received intraarticularly 5 mg of morphine in a 25 ml dilution. Those in the control group (n = 10) received 25 ml of saline by the same route. Intravenous morphine with patient-controlled analgesia was used in the postoperative period in both the groups. Visual analog scores were recorded at 1, 2, 4, 8, and 24 hours after the operation. The amount of morphine used over the 24-hour postoperative period was documented. RESULTS: The total consumption of morphine over the 24-hour period was significantly lower (p < 0.01) in the study group compared to the control group. The postoperative pain scores were lower in the study group throughout the study period, but this did not reach statistical significance. CONCLUSIONS: Intraarticular morphine reduces analgesic requirements after anterior cruciate ligament repair and is an effective method of providing postoperative analgesia.

Adult↗