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Biomedical subjects

W G Kernohan

Publications and source records attributed to W G Kernohan.

At least 19 recordsLinked to original sources
PubMed2006

Patients with head and neck cancer prefer individualized cognitive behavioural therapy.

Cognitive behaviour therapy (CBT) is a widely practiced and approved form of psychotherapy for many psychosocial difficulties. As the efficacy of CBT is recognized, its demand has increased and today exceeds the availability of qualified practitioners. Therefore, the effectiveness of delivering CBT using less labour-intensive modes than individualised therapy has been explored. These include group therapy, bibliotherapy and computer assisted therapy. Given the UK Government's impetus towards patient choice and involvement in the planning of healthcare, it was thought essential to ascertain the preferred delivery mode of patients with head and neck cancer for a CBT based intervention. Therefore, a small retrospective cohort (n= 28) of patients following treatment for head and neck cancer were sent postal questionnaires to ascertain their preferences on mode of CBT delivery. Simultaneously, the views of accredited cognitive behaviour therapists (n= 14) were determined on the optimal mode of CBT delivery to these patients. Findings indicated that patients preferred the more individualized mode of CBT delivery, namely one-to-one therapy, followed closely by bibliotherapy, with group format being the least preferred option. Professionals concurred with patients, in that one-to-one interaction was considered an optimal mode of CBT delivery, but professionals considered it equal to group therapy.

Cognitive Behavioral Therapy↗
PubMed2005

Bed occupancy and turnover interval as determinant factors in MRSA infections in acute settings in Northern Ireland: 1 April 2001 to 31 March 2003.

The following data were obtained from annual hospital statistics in Northern Ireland and from the Communicable Diseases Surveillance Centre (CDSC) Northern Ireland for 2001-2002 and 2002-2003: bed turnover interval (TI), percentage bed occupancy (PO) and methicillin-resistant Staphylococcus aureus rates per 1000 bed-days of patient episodes [MRSA (PE)]. A significant negative correlation was established (r=-0.854; P<0.01) between TI and MRSA (PE) in 2002-2003. A significant positive correlation for PO and MRSA (PE) (r=0.679; P<0.05) was also found for the same year. The correlation for TI and MRSA (PE) in 2001-2002 was r=0.621 (P<0.05), but no significant correlation was established for PO and MRSA (PE) in the same year. Partial correlation indicated that the influence on MRSA (PE) rates was greater for TI than for PO. These results infer that a rapid turnover of patients is an important factor influencing MRSA rates within acute hospitals.

Bed Occupancy↗
PubMed2005

A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis.

OBJECTIVE: To assess the effectiveness of intra-articular triamcinolone injection and physiotherapy singly or combined in the treatment of adhesive capsulitis of the shoulder. METHODS: Eighty patients with adhesive capsulitis of less than 6 months duration were randomized to one of four groups: Group A, injection of triamcinolone 20 mg and eight sessions of standardized physiotherapy; Group B, injection of triamcinolone 20 mg alone; Group C, placebo injection and eight sessions of standardized physiotherapy; or Group D, placebo injection alone. All subjects were given an identical home exercise programme. Outcome measures were assessed at 6 weeks and 16 weeks. The primary outcome measure was Shoulder Disability Questionnaire (SDQ) score. Secondary outcomes were measurement of pain using a visual analogue scale (VAS), global disability using VAS and range of passive external rotation. A two-way analysis of variance was used to explore the effects of corticosteroid injection and physiotherapy. RESULTS: At 6 weeks, the SDQ had improved significantly more in the groups receiving corticosteroid injection (P = 0.004). Physiotherapy improved passive external rotation at 6 weeks (P = 0.02) and corticosteroid injection improved self-assessment of global disability at 6 weeks (P = 0.04). There was no interaction effect between injection and physiotherapy. At 16 weeks, all groups had improved to a similar degree with respect to all outcome measures. CONCLUSION: Corticosteroid injection is effective in improving shoulder-related disability, and physiotherapy is effective in improving the range of movement in external rotation 6 weeks after treatment.

Adult↗
PubMed2001

Periprosthetic tibial fractures after cementless low contact stress total knee arthroplasty.

Periprosthetic fractures are a recognized complication of total knee arthroplasty. Fractures may occur intraoperatively or postoperatively, and risk factors have been identified that may predispose an individual to such a complication. We report 7 cases of periprosthetic tibial fractures after low contact stress total knee arthroplasty, a complication encountered by the senior author (D.E.B.) only after a change in practice from a cemented implant to a cementless one. In light of this previously unreported complication in our unit, we attempted to identify common features within this group of patients that may have contributed to fracture occurrence. Statistical analysis revealed a highly significant (P<.005) risk of periprosthetic tibial fracture in patients with a preoperative neutral or valgus knee. Age, gender, and diagnosis did not appear to increase the risk of fracture significantly. All patients displayed evidence of reduced bone mineral density in the lumbar spine and femoral neck regions on dual-energy x-ray absorptiometry scanning. Patients with a preoperative neutral or valgus knee and local evidence of osteopenia represent a high-risk group, in whom particular care in alignment should be taken. In this group, it may be preferable to have the tibial component inserted with cement fixation.

Aged↗
PubMed2000

Numerical model of deep venous thrombosis detection using venous occlusion strain gauge plethysmography.

Strain gauge plethysmography (SGP) is a non-invasive method used in the detection of deep venous thrombosis (DVT). The technique is based on the measurement of calf volume changes in response to venous occlusion by a thigh cuff, the volume changes reflecting the rates of arterial inflow and venous outflow. A numerical model of the blood circulation within the limb and the response of this to a SGP test has been derived, based on treating the different parts of the circulatory system in the leg as resistance and capacitance elements. The simulation results were compared with clinical studies and support the ability of SGP to detect non-occlusive clots of more than 50-60% of the lumen, as well detecting calf vein occlusion. The non-linear behaviour of the venous compliance with intra-luminal pressure appears to be a particularly important factor within the model. In addition, increases in venous tone due to post-operative venospasm were shown to be a potential source of false positive results.

Humans↗
PubMed1999

Evaluation of a range of hospital replacement mattresses.

A combination of physical measurement and clinical testing was used to evaluate a range of pressure-reducing replacement mattresses, which had met tender specifications, in order to reduce the number available for selection in the purchasing process. Factors considered included mattress price and expected life-span. The results presented have supported a purchasing decision to replace mattresses but care should be taken in adopting these findings in a different context from that of a district general hospital. Optimum performance was found in one mattress replacement (Pentaflex).

Beds↗
PubMed1999

WWW as a teaching resource for introductory medical informatics in primary care.

This pro and contra report assesses the current state of the WWW as a teaching aid for Medical Informatics, using the experience gained from the delivery of a module to a heterogeneous group of health workers enrolled in an MSc/PgDip in Primary Care. The students were expected to act as both information consumers in a directed bibliographic retrieval task and information providers for Primary Care. The students' perceptions as to the usefulness and local relevance of current resources on the world wide web (WWW) are discussed.

Curriculum↗
PubMed1995

High incidence of congenital dislocation of the hip in Northern Ireland.

To determine the incidence of congenital hip dislocation (CDH) a retrospective study was carried out of cases occurring in a defined population using multiple information sources. Of 138,600 children born in the period 1983-1987, a total of 243 were diagnosed with CDH, defined as those requiring splintage or surgery whose treatment extended beyond 6 months of age. Incidence and estimates of relative risks for pre-disposing factors were determined. The rate was 1.75 cases per 1000 livebirths. Major risk factors were female gender and breech presentation. The proportions of cases identified before 1, 3 and 6 months of age were 8, 14 and 35%, respectively. Despite using a restrictive definition, we have obtained an incidence rate among the highest reported in any United Kingdom population. Early detection is widely accepted as desirable, but neonatal screening has proved ineffective.

Female↗
PubMed1994

Continuous passive motion in computer assisted auscultation of the knee.

A study of physiological patellofemoral crepitus (PPC) signal recorded from adolescent knees has yielded information which suggests that decay time of PPC amplitude due to continuous passive motion (CPM) activity is a consistent and useful signature variable for a given knee. The PPC vibrational signal was induced in each case by 1 min of static load on the patella and postural variables during the examination were carefully controlled. The speed of CPM has been noted as a factor directly influencing the rat of PPC amplitude decay; specifically, a higher CPM speed contributes to an increased decay constant at a cost of increased inter-subject variability. It is proposed that CPM might form an important basis for the ultimate development of a computer-based auscultation technique for diagnosis of patellofemoral joint disorders.

Acceleration↗
PubMed1994

Measurement of the forces and movements involved in neonatal hip testing.

The screening for Developmental Dysplasia of the Hip in infants relies on the two manipulative tests developed by Ortolani and Barlow which are often poorly performed. This study investigated the forces applied and the sequences of physical manoeuvres underlying the tests in order to define a standard of safe practice. Eight subjects examined the hips of two training models that closely simulated the behaviour of a range of infant hip pathologies. The forces applied and the manoeuvres employed during each examination were recorded using a purpose-built force and displacement transducer system. The analysis concentrated on the peak forces and the biomechanical conditions necessary to detect an abnormality. The models' legs had to be abducted beyond certain critical angles in order to dislocate and relocate an unstable femoral head and the magnitude of the force required to dislocate the femoral head was significantly less than the peak force applied (12 N vs 33 N, p < 0.001). Also, the Palmen test, a less well known technique, provided the same level of diagnostic performance as the Barlow test but with a lower peak applied force (28 N vs 47 N, p < 0.001). Changes are therefore necessary to the training programmes for medical staff to ensure that the range of abduction during the manoeuvres is large enough to encompass the likely range of critical angles and that the forces applied are just sufficient so as not to overstress the joints.

Biomechanical Phenomena↗
PubMed1994

An evaluation of the adequacy of health visitor education for neonatal hip screening.

Congenital dislocation of the hip (CDH) affects two children per 1000, with potentially serious consequences. Student health visitors in Northern Ireland learn screening techniques for CDH at a half-day workshop at a regional hospital. In order to evaluate the adequacy of this preparation, 71 qualified health visitors were surveyed to assess their knowledge relating to CDH, their views on the adequacy of the training, and their opinions about referral of positive cases. Knowledge in some areas was poor and preparation was considered too short. Direct referrals of positive cases to orthopaedic clinics, without a general practitioner acting as an intermediary, was a frequently cited desire. Recommendations include extending the training for those involved in CDH screening while ensuring that experienced health visitors, from whom novices learn, are themselves using correct procedures.

Attitude of Health Personnel↗
PubMed1994

Reliability of the Barlow and Ortolani tests for neonatal hip instability.

OBJECTIVE: To investigate if those responsible for screening for neonatal hip instability are using acceptable manual hip stress tests as described by Ortolani and Barlow. METHOD: A video camera was used to record the technique of 35 personnel who were responsible for screening. They examined both a baby and a simulator. The study comprised five groups, classified by experience and practice: senior orthopaedic surgeons, senior paediatric staff, junior paediatric staff, nurses, community staff. RESULTS: The seven authors together with six independent expert observers viewed the video and marked the performance with the aid of a specially designed proforma. Although there was some variation between these expert observers, the results showed differences in the scores obtained by the different groups of examiners over all aspects of the test procedure. CONCLUSION: Video recording for critical analysis and feedback is a useful technique in this situation. Overall, the results suggest that testing for neonatal hip instability was inadequate. A variety of hip stress manoeuvres were being performed. The ability of each subject to perform satisfactory tests seemed to depend on their experience and education. More "hands on" training and experience of testing might provide the necessary competency for screening.

Community Health Nursing↗
PubMed1993

Consensus in medical communication.

This paper discusses a survey which was carried out to investigate the types of risks and inconveniences which are normally disclosed by surgeons before operations. By restricting the survey to a specific operation, the Charnley Hip Replacement procedure, greater precision in replies was obtained. The results, however, shed light on both the medical and the legal aspects of informed decision in surgery generally. The survey data was analysed using the concept of neighbourhood consensus [1: Dodd F. J. and Donegan H. A. Proc. of ILIAM 6, pp. 17-29. University of Ulster Press, Ulster, 1989].

Attitude of Health Personnel↗
PubMed1993

Patient assessment of treatment following knee injury.

A survey of 100 sports-injured cases was carried out to elicit patients' personal assessment of their treatment and to investigate the utility of a typical database system for recording and analysis. The cases were limited to knee injuries, with a high proportion arising from football of various types and interesting light was thrown on several possible contributory factors.

Athletic Injuries↗
PubMed1993

Pressurization of bone cement under standard, flanged and custom acetabular components for total hip replacement.

Custom acetabular components are proposed to achieve uniform cement mantles, even in irregular acetabula presented at revision, in order to enhance fixation. One aim of developing custom components was to permit pressurization of bone cement by the components at insertion and maintain the pressure during polymerization. A model acetabulum was set up for the insertion of standard, flanged and custom components under constant force. Cement pressure was measured at the floor of the acetabulum by means of a piezoelectric diaphragm transducer. Polythene tubes were inserted in the model acetabular walls to estimate penetration of cement into cancellous bone. Insertion of the standard and flanged components caused cement pressures up to 106 kPa which decayed to less than 21 kPa as cement escaped at the rim and the components came into contact with the acetabulum. The custom component maintained a pressure of over 60 kPa during polymerization from an initial pressure of 105 kPa and examination of cement mantles on removal showed no evidence of contact. The custom component also showed enhanced penetration of cement, especially around the rim of the acetabulum. It is concluded that the custom component design achieves higher cement pressures and that better fixation will result.

Bone Cements↗
PubMed1993

A statistical analysis of hip scores.

Thirteen methods of hip scoring were applied in the postoperative assessment of 47 hip arthroplasties. Their results were found to be inconsistent, often giving contrary measures of success in the same patient. Ten variables were measured during the postoperative review of 256 hip arthroplasties and the data were submitted to multivariate factor analysis. This revealed that the ten variables could be reduced to three factors: pain, which correlated poorly with any other variable (Spearman correlation, r < 0.02); functional activity (distance walked, use of walking aids, stair climbing, use of public transport, limp, sitting and tying shoelaces); and deformity and range of movement. The range of hip flexion correlated closely with the sum of the arcs of movement and with Gade's index (Spearman correlation, r > 0.9). We suggest that, for outcome assessment, only three variables need to be recorded: pain, walking distance and range of hip flexion. The combination of these three measures into a single hip score is misleading.

Evaluation Studies as Topic↗
PubMed1993

Sensitivity of manual palpation in testing the neonatal hip.

Developmental dysplasia of the hip (DDH) is a term used to describe a group of disorders of the neonatal hip in which the head of the femur is unstable or incongruous in relation to the acetabulum. Early detection and treatment of the condition generally results in normal development, whereas late diagnosis has poor success. In Northern Ireland, despite all neonates being manually examined for hip disorders by a medical officer before hospital discharge, there is an unacceptable late diagnostic rate of almost 50% of all cases. To help reduce the number of late presentations, vibration arthrometry, a noninvasive form of screening for DDH, has been used to record hip vibration events during clinical testing. In a comparative study, 300 infants were examined by nurses and medical officers to establish the sensitivity of manual palpation to neonatal hip vibrations detected by the objective detection system. Experienced research nurses detected 86% of the signals; doctors in training detected less than 10%. This suggests that objective, noninvasive screening by vibration arthrometry would detect a higher proportion of vibration events in neonates during the early stages of DDH. More time should be invested in training medical officers and others involved in DDH screening.

Hip Dislocation, Congenital↗