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Biomedical subjects

B O'Brien

Publications and source records attributed to B O'Brien.

137 records · Page 8Linked to original sources
PubMedDate not supplied

Surgical opportunism in emergency hand surgery.

Surgical opportunism is the exploitation of circumstances at the time of surgery which will maximize the ultimate functional result. This may be an imaginative original application of surgery and regularly demands a degree of lateral thinking to visualize the opportunity. It involves particularly the careful appraisal of all damaged or amputated tissues and assessment as to their potential usefulness. Microvascular anastomosis greatly broadens the scope of opportunism in emergency hand surgery.

Amputation, Traumatic↗
PubMedDate not supplied

A comparison of papaveretum-promethazine with morphine-ondansetron for patient-controlled analgesia.

BACKGROUND: Patient-controlled analgesia (PCA) with intravenous morphine is commonplace. Antiemetics are often added to reduce side-effects. In our institution an unusual combination of papaveretum-promethazine is in use. AIMS: We set out to compare this combination with a more commonly used one (morphine-ondansetron) by auditing the records of our pain-control team assessing analgesia and control of side-effects. METHODS: The records of two groups of 100 consecutive patients were studied. Pain scores were recorded 24 hours post-operatively on a scale of zero to ten. Also recorded were sedation scores, pruritus, emesis, and usage of breakthrough analgesia. The groups contained the work of a variety of anaesthetists and surgeons, though the majority were orthopaedic cases. All results were recorded by one pain-control nurse, using the same question, over a nine-month period. RESULTS: Sedation scores were identical, while side-effects were few and similar in both groups. The use of breakthrough analgesia was also similar. However, the median pain-score of zero in the papaveretum group was significantly lower than that of two in the morphine group, (p < 0.001, Mann-Whitney U). CONCLUSION: Papaveretum-promethazine appeared to be effective for PCA. This combination is also much less expensive than morphine-ondansetron. A previously described synergistic interaction between promethazine and opiates may be a factor in its success. Further evaluation of these drugs in PCA is warranted.

Analgesia, Patient-Controlled↗
PubMedDate not supplied

Use of indigenous explanations and remedies to further understand nausea and vomiting during pregnancy.

Professional and indigenous midwives are rich and appropriate sources of information about antenatal comfort measures. Midwives from a variety of geographic and cultural areas were interviewed to further our understanding of the phenomenon of nausea and vomiting during pregnancy (NVP). The midwives offered general physiological, psychological, and socioeconomic etiological theories that were, at times, inconsistent with their recommended remedies. The remedies generally included alterations in maternal nutrition, activity, and environment. Commonalities in the midwives theories of etiology and treatment were found across culturally and geographically diverse groups. Much of the variation that was noted in the midwives recommendations for treatment was related to (a) availability of a specific remedy and (b) the midwife's willingness to either support or discourage intuitive responses that women have to their pregnancies (e.g., encourage either additional rest or exercise and productive activity; social withdrawal or usual social interaction; and pica and food cravings or a balanced diet with high nutritive value).

Adult↗
PubMedDate not supplied

Rhodes Index of Nausea and Vomiting--Form 2 in pregnant women. A confirmatory factor analysis.

BACKGROUND: Despite widespread application of Rhodes Index of Nausea and Vomiting-Form 2 (INV2) in practice and research, empirical analyses have not been consistently performed to verify the a priori factors that guided the subclass construction of the symptoms. OBJECTIVES: To examine the dimensional structure of Rhodes INV in a sample of pregnant women. METHOD: Data were collected from 152 pregnant women who were experiencing some degree of nausea and vomiting during early pregnancy and analyzed using structural equation modeling techniques. Five competing measurement structures were tested and compared. The structure (model) that provided the closest fit to the data was selected and relationships (factor loadings) between the constructs and indicators were established. RESULTS: The model fitting the data the closest was a three-factor structure measuring nausea, vomiting, and retching as three separate, but correlated dimensions. The factor loadings were high (0.73-0.96) and significant (p < .001). The model treating nausea and vomiting as a one-factor concept as well as the model including two factors named symptom occurrence and symptom distress did not fit the data. CONCLUSION: Rhodes INV2 is a valid measurement tool if subscales are formed to reflect the multidimensional structure of nausea and vomiting in pregnancy.

Adolescent↗
PubMedDate not supplied

Cost effectiveness of alternative Helicobacter pylori eradication strategies in the management of duodenal ulcer.

Published data and techniques for decision analysis were used to construct a model to estimate the cost effectiveness of nine alternative strategies for the management of patients diagnosed with uncomplicated duodenal ulcer. Two strategies of intermittent therapy with either ranitidine or omeprazole, one strategy of continuous maintenance treatment with ranitidine, and six strategies for ulcer healing and eradication of Helicobacter pylori infection were considered. Healing time curves were estimated by using published data, allowing for estimation of expected time for acute healing episodes. The expected number of weeks to heal per patient, in a one-year period, was estimated by combining healing time data with probability of ulcer recurrence. It was found that patients that underwent any of the six H pylori eradication regimens had fewer days with ulcer per year than those who underwent maintenance or intermittent ranitidine. Four eradication regimens had lower costs and better outcomes than ranitidine therapy. In comparing H pylori strategies, the two strategies of omeprazole plus one antibiotic (either amoxicillin or clarithromycin) are most costly than omeprazole plus two antibiotics (specifically amoxicillin and metronidazole or clarithromycin and metronidazole) and result in similar outcomes. Although omeprazole-based eradication regimens are more costly than ranitidine bismuth triple therapy, they are associated with fewer recurrences of ulcer and days of symptoms. A limitation of the analysis is that it did not incorporate issues of compliance and metronidazole resistance; however, the former concern may be less of an issue as H pylori regimens become simpler and shorter in duration.

Amoxicillin↗
PubMedDate not supplied

Willingness to pay: a valid and reliable measure of health state preference?

The development of methods to measure willingness to pay (WTP) has renewed interest in cost-benefit analysis (CBA) for the economic evaluation of health care programs. The authors studied the construct validity and test-retest reliability of WTP as a measure of health state preferences in a survey of 102 persons (mean age 62 years; 54% male) who had chronic lung disease (forced expiratory volume < 70%). Interview measurements included self-reported symptoms, the oxygen-cost diagram for dyspnea, Short-Form 36 for general health status, rating scale and standard gamble for value and utility of current health state relative to death and healthy lung functioning, and WTP for a hypothetical intervention offering a 99% chance of healthy lung functioning and a 1% chance of death. WTP was elicited by a simple bidding game. To test for starting-point bias, the respondents were randomly assigned to one of five starting bids. All health status and preference measurements except WTP (controlling for income) showed significant (p < 0.05) difference between disease-severity groups (mild/moderate/severe). WTP was significantly (p = 0.01) associated with household income, but other health status and preference measure were not. The measure most highly correlated with WTP was standard gamble (r = -0.46). There was no association between starting bid and mean WTP adjusted for income and health status. The test-retest reliability of WTP was acceptable (r = 0.66) but lower than that for the standard gamble (r = 0.82).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

When do the "dollars" make sense? Toward a conceptual framework for contingent valuation studies in health care.

There is growing interest in the application of cost-benefit analysis (CBA) as a technique for the economic evaluation of health care programs. A distinguishing feature of CBA is that costs and benefits are expressed in the same units of value--typically money. A popular method for estimating money values for health care programs is the use of willingness-to-pay (or accept) survey techniques known as contingent valuation. This paper presents a conceptual framework to help in the interpretation or design of contingent valuation studies in health care. To be consistent with the theory upon which CBA is built, the authors consider what types of questions should be asked of what populations. They conclude that studies undertaking contingent valuation should distinguish between compensating variation and equivalent variation, and recognize that respondents can be gainers or losers in utility and therefore should be asked willingness-to-pay (or accept) questions as appropriate. Current critical-appraisal guidance in the health care literature for CBA is poor and unlikely to offer useful demarcation between good and bad CBA studies. More work is needed exploring whether recently issued guidelines for contingent valuation in environment damage assessment are applicable to health care studies.

Attitude to Health↗
PubMedDate not supplied

Reproduction of radicular symptoms by paraspinal muscle EMG needling.

With a frequency of 0.3-0.5%, patients who had cervical and lumbosacral radiculopathies had their symptoms of radicular pain or paresthesia reproduced during needling of the paraspinal muscles at the level of the lesion. The occurrence of the patient's symptoms during paraspinal EMG needling is an insensitive but specific diagnostic sign which helps establish the level of a root lesion.

Action Potentials↗