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Biomedical subjects

C Maloney

Publications and source records attributed to C Maloney.

35 records · Page 2Linked to original sources
PubMed1980

Early results with composite strut caged ball prostheses.

The Starr-Edwards model 6400/10 mitral and 2400/10 aortic valve prostheses incorporate metallic tracks on the inner aspects of cloth-covered struts in an attempt to preserve the favorable thromboembolic performance of cloth-covered valves while avoiding the risk of cloth wear. Two hundred severity operative survivors of mitral valve replacement with the model 6400/10 prosthesis, all on continuous anticoagulant therapy, have been followed up for a mean period of 2.3 (maximal 6) years. The late survival rate is 91 percent and the removal-free rate is 94 percent at 5 years. The rate of embolism (mean +/- standard error of the mean) is 4.6 +/- 0.9 percent per patient-year. Significant bleeding complications occurred at a rate of 1.0 +/- 0.2 percent per patient-year; there were no deaths. Two hundred forty operative survivors of aortic valve replacement with a model 2400/10 prosthesis, all on continuous anticoagulant therapy, have been followed up for a mean of 2.0 (maximal 7) years. The 5 year survival rate is 84 percent and the removal-free rate is 98 percent. Embolism occurred at a rate of 3.3 +/- 0.8 percnet per patient-year. Hemorrhagic complications occurred at a rate of 2.1 +/- 0.6 percent per patient-year; there were three families. Cloth wear and hemolysis have not been significant problems with this prosthesis, and the rates of thromboembolism are comparable with those reported for xenograft bioprostheses. The composite strut (track) valve prosthesis is a durable alternative to tissue valves in patients who are able to tolerate anticoagulant therapy.

Aortic Valve↗
PubMed1979

Biotransformation and elimination of digoxin with normal and minimal renal function.

Six subjects with normal renal function (NRF) and 6 patients with minimal renal function (MRF) on 3 times weekly hemodialysis received 150 muCi3H-digoxin-12 alpha orally. Serial urine collections were made for five days or more. Digoxin and metabolites were separated using diethylaminoethyl Sephadex LH-20 column chromatography. Mean cumulative percentages of the ingested radioactivity excreted over five days in NRF and MRF groups were: digoin, 54.5% and 14.7%; bis-digitoxoside of digoxigenin, 2.0% and 0.59%; mono-digitoxoside, 0.8% and 0.19%; digoxigenin, 0.25% and 0.03%; and dihydrodigoxin, 0.3% and 0.03%. Half-lives based on the mean rates of disappearance from urine comparing NRF and MRF groups were: for digoxin 40 hr and 120 hr; for bis-digitoxoside, 11.5 hr and 46 hr; for mono-digitoxoside, 8.5 hr and 12 hr; for digoxigenin, 2 hr and 7.5 hr; and for dihydrodigoxin, 1.2 hr and 7.0 hr. Considering the relationships of the five-day cumulative excretion and half-lives of digoxin and metabolites in the NRF and MRF groups, it appears unlikely that there is a major alteration in the biotransformation of digoxin in advanced renal failure when there appears to be a shift from renal to slower biliary excretion.

Adult↗
PubMedDate not supplied

Effect of exercise on perceived quality of life of individuals with Parkinson's disease.

The purpose of this study was to determine if individuals with Parkinson's disease (PD) who completed an 8-week, supervised PoleStriding exercise program would undergo significant improvements in cognitive skills, activities of daily living, motor function, and quality of life. The Unified Parkinson's Disease Rating Scale (UPDRS) and the Parkinson's Disease Questionnaire (PDQ-39) were used to measure functional independence. Six male volunteers (72.7+/-3.7 years of age) performed PoleStriding exercise three times per week for 37+/-3 minutes. Differences in the participants' pre- and post-training scores on the UPDRS and PDQ-39 were analyzed using the Wilcoxin Signed Ranks Test. A statistically significant improvement occurred in the UPDRS (P<0.026) and PDQ-39 (P<0.028) scores following the moderate-intensity exercise intervention. The results of this nonrandomized clinical trial indicate that an 8-week individualized PoleStriding exercise program increases perceived functional independence and quality of life in individuals with PD.

Activities of Daily Living↗
PubMedDate not supplied

Pulmonary function testing in spinal cord injury: effects of abdominal muscle stimulation.

The purpose of this study was to assess the effects of applying transcutaneous electrical stimulation to paralyzed abdominal muscles during pulmonary function testing (PFT) of individuals with spinal cord injury (SCI). Ten male subjects with anatomical level of SCI between C5-T7 were studied. Subjects performed PFTs with and without electrical stimulation delivered to the abdominal muscles. Subjects with the lowest percentage of predicted expiratory volumes and flows demonstrated the greatest improvement when electrical stimulation was delivered during forced expiration. The overall increases seen in percent of predicted for the study sample were 23 percent for forced vital capacity (FVC), 16 percent for forced expiratory flow in 1 s (FEV1), and 22 percent for peak expiratory flow rate (PEF). Contractions of paralyzed expiratory muscles in response to electrical stimulation during the performance of PFT maneuvers can significantly improve FVC, FEV1, and PEF in some individuals with SCI.

Abdominal Muscles↗
PubMedDate not supplied

Implementation of a nursing home urinary incontinence management program with and without tolterodine.

OBJECTIVE: To evaluate the implementation of a nursing home urinary incontinence management program. DESIGN: A prospective field trial of the program incorporating practice guidelines and principles of continuous quality improvement. SETTING: Five nursing homes in New York, Virginia, and Georgia PARTICIPANTS: One hundred fifty-one residents identified as being incontinent of urine and who met inclusion criteria for ongoing participation in the program. INTERVENTION: Key multidisciplinary staff from the five nursing homes were trained in the program and assumed responsibility for implementing it in their facilities. The program consisted of a clinical assessment, toileting protocols, and the addition of the antimuscarinic drug tolterodine in selected residents who did not respond well to toileting alone. Data on dryness rates during the 60-day toileting protocols, collected by nursing home staff, were analyzed on a weekly basis by an overall project coordinator who sent data back to the nursing homes in an easy-to-read graphical format. MEASURES: (1) The dryness rate, defined as the number of times the resident was dry divided by the number of times the resident was checked (every 2 hours from 7 a.m. to 7 p.m.); and (2) adverse events (eg, dry mouth, increased confusion, need for dosage reduction). RESULTS: Of 645 residents in the 5 nursing homes, 377 (58%) were identified as incontinent of urine, of whom 151 (40%) were placed on an ongoing toileting program. Of these 151 residents, 48 (32%) were prescribed tolterodine, and 117 (78%) completed the 60-day trial. The initial dryness rate was 57%, and for the group as a whole remained essentially unchanged (increase in dryness 1%, P = 0.50). Among 50 clinically stable residents on a toileting program alone, the increase in the dryness rate was 16% (P = 0.001), and for 31 clinically stable residents prescribed tolterodine, the increase in the dryness rate was 29% (P = 0.012). Two residents had their dosage of tolterodine reduced because of dry mouth and nausea,one resident was taken off the drug because of increased pain in the back and legs and increased confusion. CONCLUSIONS: Overall, this program resulted in significant increases in dryness rates for clinically stable incontinent nursing home residents. These residents represented 22% of the total number of residents identified as incontinent in the five participating nursing homes. Tolterodine was prescribed for approximately one-third of incontinent residents as a supplement to a toileting program, and was well tolerated. Nursing homes should be encouraged to implement similar urinary incontinence programs, target toileting protocols to the most responsive residents, and maintain the program using principles of continuous quality improvement.

Journal Article↗
PubMedDate not supplied

Effect of local conjugated estrogens on vaginal pH in elderly women.

OBJECTIVE: The decline in estrogens during and after menopause is associated with an increase in vaginal pH and an increased susceptibility to urinary tract infections (UTIs). Decreased vaginal pH following short-term treatment with topical estrogens may reduce the incidence of such infections. This study was undertaken to evaluate the effect of low-dose, topical conjugated estrogens vaginal cream (CEVC) on vaginal pH in older, postmenopausal women. DESIGN: We conducted a retrospective analysis of initial and follow-up evaluations of older, postmenopausal women residing in 19 long-term care facilities who were referred to Seton Health System's Incontinence Treatment Center between January 2, 1997, and June 13, 1998. Patients were untreated or were administered conjugated estrogens intravaginally (0.5 g/d, 3 days per week). SETTING: Incontinence Treatment Center, Seton Health System. PARTICIPANTS: Two hundred fifty-eight postmenopausal women (mean age 83 years), residents of skilled nursing facilities, who were diagnosed with urinary incontinence, were included in the study. MEASUREMENTS: Measurements included age, CEVC treatment, vaginal pH, and history of UTIs or hysterectomy. RESULTS: In the CEVC-treated women, vaginal pH was reduced from a mean of 7.41 +/- 0.71 to 6.80 +/- 0.70 after 6 weeks (n = 213; P = 0.0001). No differences in vaginal pH were observed in untreated women (n = 45). Continuation of CEVC treatment for an additional 6 weeks (n = 93) resulted in further decreases in vaginal pH (P = 0.017). Women who discontinued treatment after 6 weeks maintained a lower vaginal pH for 6 weeks (P = 0.0004), and there was no significant difference between groups at Week 12. CONCLUSIONS: Low-dose CEVC for 6 and 12 weeks reduces vaginal pH in older women residing in long-term care facilities. The decreased vaginal pH following short-term treatment with topical estrogens may reduce the incidence of recurrent UTIs.

Journal Article↗