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Biomedical subjects

A Hickey

Publications and source records attributed to A Hickey.

34 records · Page 2Linked to original sources
PubMed1992

Individual quality of life in patients undergoing hip replacement.

Quality of life (QoL) assessment is becoming increasingly important for measuring the impact of illnesses, diseases, and their treatment and for deciding priorities when allocating resources. We developed a novel method to measure QoL from the perspective of the individual patient. The schedule for the evaluation of individual quality of life (SEIQoL) was devised from the technique known as judgment analysis to measure patients' level of functioning in five self-nominated facets of life and the relative weight or importance attached to these areas. We applied this method, together with traditional measures of health status, in a prospective intervention study of 20 patients undergoing unilateral total hip-replacement surgery with six-month follow-up by comparison with matched, non-patient controls. Health status was significantly improved by hip replacement on the McMaster health index questionnaire (p less than 0.001) and the arthritis impact measurement scales (p less than 0.001). Individually measured QoL was significantly increased after surgery when measured by SEIQoL (p less than 0.02). The individual nature of QoL was reflected in the variety of life areas nominated as important by individual patients, the differences in relative weights attached to these areas, and the complex nature of the changes that occurred postoperatively. Our data not only highlight such individuality but also show that SEIQoL provides a means by which this can be assessed scientifically.

Adult↗
PubMed1991

Prosthodontic consideration in the treatment of patients with maxillary and mandibular deficiencies.

Despite advancements in surgical osteotomy repositioning procedures for congenital and developmental intermaxillary deficiencies, prosthetic rehabilitation remains a viable alternative in some patients. In developing a treatment plan, the advantages and disadvantages of both surgical and prosthetic rehabilitation must be weighed. The interdisciplinary team approach is best for treatment planning. The treatment options are presented with a variety of treatment philosophies. Maxillofacial surgical and/or prosthetic treatments must be carefully coordinated to ensure the best results for patients with moderate to severe "jaw" discrepancies.

Adolescent↗
PubMed1991

Computed tomography in malignant external otitis.

Malignant external otitis is a severe infection of the external auditory meatus occurring predominantly in diabetics and usually caused by Pseudomonas aeruginosa. The infection may spread along several routes: directly by bony erosion into the adjacent mastoid bone, anteriorly into the parotid gland and temporomandibular joint and inferiorly into the soft tissues of the infratemporal fossa. We present four cases of malignant external otitis that illustrate the typical patterns of spread of this disease and the role that radiology, and in particular computed tomography, plays in its diagnosis and management.

Aged↗
PubMed1991

Assessing the quality of life of the individual: the SEIQoL with a healthy and a gastroenterology unit population.

Current methods of measuring quality of life (QoL) impose an external value system on individuals, rather than allowing them to describe their lives in terms of those factors which they consider important. The Schedule for the Evaluation of Individual Quality of Life (SEIQoL) was developed to overcome such limitations. The QoL of 42 healthy attenders at an international immunization clinic was assessed using SEIQoL. Judgement reliability was high (r = 0.74) and individuals' judgement policies accounted for a large percentage of the variance in overall QoL (R2 = 0.75) demonstrating the construct validity of judgement analysis in this context. In a second study of QoL of out-patient suffering from irritable bowel syndrome (IBS) (N = 20) or peptic ulcer disease (PUD) (N = 20) was assessed using SEIQoL. Judgement reliability was lower (r = 0.54) although statistically highly significant (P less than 0.01), and the variance in overall QoL judgements explained was high (R2 = 0.74). SEIQoL is an acceptable, reliable and valid technique for measuring individual QoL that takes greater account of individual perspectives than traditional measurement approaches.

Activities of Daily Living↗
PubMed1990

Comparative studies of angioscopy and ultrasound for the evaluation of arterial disease.

In this in vitro investigation, we studied the histopathological basis for intravascular ultrasound image interpretation and how this technique compares with fiberoptic angioscopy in assessing atherosclerosis. This article presents the sensitivity and specificity of these techniques in the recognition of arterial abnormalities. The relevance of these data in interventional therapeutic procedures and the clinical implications of intravascular imaging methods are also discussed.

Animals↗
PubMed1986

Coronary angioscopy in patients with unstable angina pectoris.

To visualize intracoronary lesions in patients with different clinical expressions of coronary disease, we performed coronary angioscopy during coronary-artery bypass surgery in 10 patients with unstable angina and 10 patients with stable coronary disease. We examined a total of 32 vessels, using flexible fiberoptic angioscopes. Twenty-two vessels had no acute intimal lesion; three had complex plaques, six had thrombi, and one had both. Coronary angiography correctly identified the absence of complex plaque and thrombus in 22 vessels, but it detected only one of four complex plaques and one of seven thrombi. On angioscopy, none of the 17 arteries in the patients with stable coronary disease had either a complex plaque or thrombus. In the "offending" arteries of the patients with unstable angina, all three patients with accelerated angina had complex plaques and all seven with angina at rest had thrombi. We conclude that angioscopy frequently reveals complex plaques or thrombi not detected by coronary angiography. Our observations suggest that anginal syndromes that are refractory to medical treatment can be caused by unstable pathologic processes in the intima. Ulceration of plaques may increase the frequency and severity of effort angina, and the subsequent development of partially occlusive thrombi may cause unstable rest angina.

Adult↗
PubMed1983

Increased tight junction permeability: a possible mechanism of oestrogen cholestasis.

Ethinyl oestradiol increased rat biliary permeability for 3H-inulin and 14C-sucrose, and significantly raised serum concentrations of bile acids after 3 and 7 days' treatment (P less than 0.0005) and bilirubin after 7 days (P less than 0.005) but not after 3 days. Following intravenous infusion of bromsulphthalein or phenolphthalein, ethinyl oestradiol-treated rats had elevated plasma concentrations of the three bile constituents, bromsulphthalein (P less than 0.0005 after 3 and 7 days), bromsulphthalein-glutathione conjugate (P less than 0.005 after 3 days; P less than 0.0005 after 7 days) and phenolphthalein glucuronide (P less than 0.005 after 3 days; P less than 0.0005 after 7 days), but the plasma concentration of unconjugated phenolphthalein, which was undetectable in bile, was unchanged. Similar changes followed partial biliary obstruction produced by bile cannula elevation. This pattern suggests that biliary constituents are refluxing from bile to plasma via the paracellular pathway, a concept further supported by structural changes in tight junction morphology in the oestrogen-treated rats. 'Leakiness' of canalicular tight junctions may explain the pathophysiology of oestrogen-induced cholestasis.

Animals↗
PubMed1980

Type A behavior pattern: relationship to variation in blood pressure, parental characteristics, and academic and social activities of students.

This study has analyzed the relationships between the Type A, or coronary-prone, behavior pattern and several physiological, behavioral and psychosocial characteristics and also has tested whether an increase in academic demands was associated with an increase in students' Type A scores. The Type A behavior pattern, as assessed by the Type A score of the Jenkins Activity Survey, was not related to average blood pressure, variability in blood pressure over a nine-week period, or increases in blood pressure following weeks when the respondent's normal life routine had been disrupted. Students who were more Type A spent more time studying or in classes. Type A students also had higher grade point averages. In contrast, Type A students were not more successful in relationships with the opposite sex nor in social relationships generally. Thus, the Type A behavior pattern appears to contribute to career success, which has traditionally been emphasized for men, but not to social success of the type that has traditionally been emphasized for women. Type A men recalled their fathers as having been more severe, having punished them more often physically, and having made them feel resentful rather than guilty when punished. Type A women recalled their mothers as having punished them more often physically. These parental behaviors may contribute to the development of anger and aggression, which are important components of the Type A behavior pattern. For the students who showed a large change in Type A scores between the beginning and the end of the academic semester, Type A scores increased at the end of the semester. Students with greater evidence of academic pressure showed more increase in Type A scores.

Blood Pressure↗
PubMed1980

Is the incidence of deep vein thrombosis following myocardial infarction decreasing?

A trial was undertaken to compare the effectiveness of the antiplatelet drug, flurbiprofen, and subcutaneous heparin in the prevention of deep vein thrombosis following acute myocardial infarction. The original aim of the study could not be fulfilled as the incidence of isotopically-determined venous thrombosis in the group of control patients was only 9.5%. The incidence in all three groups was too low to assess the effectiveness of flurbiprofen prophylaxis. It is suggested that the low incidence may be related to the recent practice of early physiotherapy and ambulation in coronary care units. The patients who developed venous thrombosis were, on average, a little older than those who did not. No differences were observed in blood viscosity, plasma antithrombin III concentration or mean coronary prognostic index. The low incidence of venous thrombosis following acute myocardial infarction suggests a need to reassess the practice of prophylactic anticoagulant therapy in this condition.

Antithrombin III↗
PubMedDate not supplied

Methadone maintenance in general practice: impact on staff attitudes.

BACKGROUND: The evaluation of a structured protocol for the discharge of stabilised patients on methadone maintenance to general practice provided an opportunity to evaluate the impact on the attitudes of general practitioners (GPs) and practice staff. AIM: To assess attitudes, expectations and experience among GPs and practice staff before the introduction of structured methadone maintenance and six months after its introduction. METHODS: A postal questionnaire was sent to 31 GPs and 23 receptionists in 23 Dublin general practices before the patient's first visit and six months later at the end of the study period. Outcome measures were staff attitudes, incidence of disruption, perceived difficulties in providing care and in prescribing methadone, and stress levels. RESULTS: There was a generally positive attitude to provision of methadone in general practice for stabilised patients, although it was not anticipated to be problem free. Following six months involvement attitudes were similar; stress levels were unchanged, but fewer GPs anticipated problems in delivering the service. All continued to participate in the scheme. CONCLUSION: GPs and receptionists in this sample had mixed views about methadone maintenance which were unchanged by six months experience of the service. The study illustrates important issues in the recruitment and support of general practice in meeting this need.

Adult↗
PubMedDate not supplied

Analysis of care of HIV positive patients: hospital and general practice components.

Fifty-seven HIV positive adults (mostly injecting drug users) attending two inner city Dublin general practices were followed for one year to identify the general practice and hospital components of their care. Many patients had advanced disease; during the year 10/57 (17.5%) died. The group made a median of seven visits to general practice (range 0-35) and two visits to hospital HIV clinics (range 0-21). A quarter of the group (14/57) was seen only in general practice and did not attend hospital; only two patients did not attend either the HIV Clinic or the GP during the year. Hospital admission was needed for 15/57 (26.3%) patients on a total of 31 occasions with an average length of stay of 10 days per admission; 80% of these admissions were generated by 10 patients with AIDS. The indication for almost all admissions was serious physical illness or diagnostic or therapeutic procedure. Patients with symptomatic or advanced HIV disease required a higher level of care than those with asymptomatic disease. It is essential that the agencies involved in meeting this level of demand be adequately resourced and that they liaise closely.

Adult↗