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Biomedical subjects

C O'Donnell

Publications and source records attributed to C O'Donnell.

72 records · Page 4Linked to original sources
PubMed1990

Vasopressin release in response to intravenously injected contrast media.

We have previously reported that intravenously administered contrast media produce a rise in plasma vasopressin (antidiuretic hormone) concentrations. We have now shown that this occurs both when contrast medium is injected into a peripheral vein and when it is centrally injected into the right atrium. The peak vasopressin concentration recorded varies with the osmolality of the contrast medium. The vasopressin response was greater when contrast agent was centrally injected.

Angiography, Digital Subtraction↗
PubMed1988

Vibrio parahaemolyticus (Kanagawa-negative) wound infection in a hospital dietary employee.

Vibrio parahaemolyticus is an estuarine bacterium that is a major cause of gastroenteritis worldwide. Occasionally, this organism has also been shown to be the causative agent of wound infections. In almost all cases of gastrointestinal disease only strains that produce hemolysin ("Kanagawa-positive") are implicated. We have isolated a Kanagawa-negative strain of V. parahaemolyticus from serous wound drainage of the infected foot of a hospital dietary employee. To our knowledge, this is only the third documented case of wound infection caused by such an organism. In this instance, the potential threat of nosocomial transmission was of special concern in that the wound infection was present in a hospital food handler.

Adult↗
PubMed1988

Bedside assessment of the work of breathing.

The oxygen consumption (VO2) of healthy volunteers and patients recovering from respiratory failure in the ICU was measured by indirect calorimetry during complete mechanical (VO2vent) and spontaneous (VO2wean) ventilation. The work of breathing was calculated as the difference in VO2 between spontaneous and mechanical ventilation and expressed as a percentage of VO2vent (% delta VO2). The average % delta VO2 for eight normal healthy volunteers was 3.7 +/- 1.8%, while it was 7.7 +/- 8.8% with the Bechman and Utah metabolic carts for patients recovering from ventilatory failure who were weaned successfully from respiratory support based on clinical criteria within 24 h of their metabolic study. In patients who were not weaned successfully, the average % delta VO2 measured was 24.7 +/- 12.3%. Indirect calorimetry is a relatively simple, reliable bedside technique for determining the oxygen cost of breathing. In our sample, the oxygen cost of breathing was a reliable predictor of weaning and extubation in patients recovering from respiratory failure. This measurement may be clinically useful in identifying the patient who cannot sustain spontaneous ventilation because of excessive respiratory work.

Calorimetry, Indirect↗
PubMed1988

Evaluation of intermittent long-term negative-pressure ventilation in patients with severe chronic obstructive pulmonary disease.

We tested the hypothesis that intermittent ventilatory assistance in patients with severe chronic obstructive pulmonary disease (COPD) improves pulmonary function and exercise capacity. Twenty stable patients with severe COPD were recruited from outpatient pulmonary clinics and were randomized to use a poncho wrap, negative-pressure ventilator or to receive standard care. After 6 months, the patients receiving standard care were switched over to the ventilator and vice versa, and follow-up was continued for an additional 6 months. After 3 to 6 months of ventilator use, we observed no clinically significant improvements in FEV1, FVC, blood gas determinations, maximal inspiratory and expiratory pressures, and exercise duration. However, 11 of our patients dropped out of the study because of an inability to tolerate the ventilator, and all but one of the nine who completed the study expressed dissatisfaction with it, using it for less time (4.1 h/day) than we recommended. Musculoskeletal pain and inconvenience were the most frequently voiced complaints. Because we did not document that ventilator use actually rested the respiratory muscles in our patients and because duration of ventilator use may have been too brief, we cannot conclude that intermittent rest of respiratory muscles in patients with severe COPD fails to bring about improvement. On the other hand, our results demonstrate that the poncho wrap ventilator is poorly tolerated by patients with severe COPD in a typical outpatient setting. We suggest that future trials seek to utilize better tolerated ventilatory assist devices.

Clinical Trials as Topic↗
PubMed1988

AIDS-phobia, contact with AIDS, and AIDS-related job stress in hospital workers.

In a survey of 237 hospital workers involved in the care of AIDS patients at a major AIDS inpatient-care facility, negative attitudes toward AIDS and AIDS patients (AIDS-phobia) and AIDS-related job stress (AIDS-stress) were common. In multivariate analyses, AIDS-phobia is significantly higher among older staff, those having low contact with AIDS patients (AIDS-contact), and those holding homophobic attitudes. AIDS-phobic attitudes and low AIDS-contact can be interpreted as predicting each other. Finally, AIDS-stress is predicted by low contact with AIDS and AIDS-phobic attitudes.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Results of a prospective trial of strategies for improving oxygen utilization.

UNLABELLED: We prospectively investigated strategies for assuring that oxygen was provided to patients hospitalized in our institution, according to standard indications (Blue Cross/Blue Shield Medical Necessity Guidelines). METHOD: After a baseline observation period (Phase I) during which no specific interventions were made, therapists were informed that appropriate oxygen utilization was an administrative goal and a department priority, and intensive instruction and case review were provided by the Technical and Medical Directors (Phase II). In Phase III, therapists were encouraged to continue to assure that guidelines were met, but instruction, discussion, and review ceased, and the Technical Director assumed responsibility for all oxygen therapy decisions. Finally, all concerted policing activity by the Technical Director ceased (Phase IV). RESULTS: The total number of patients and percentage of patients with no indications for therapy fell progressively through Phases II and III and returned almost to baseline after policing activities were discontinued in Phase IV. CONCLUSIONS: We believe that it is unlikely that any department can sustain the educational and supervisory input necessary to assure optimal conformance to published standards for oxygen therapy when all members are involved. Therefore, assigning one qualified person to manage oxygen therapy may be more successful than other approaches. Requiring all therapists to monitor conformance to standards for low-flow oxygen therapy is time consuming and less effective and limits the time that can be spent caring for patients with problems that respond favorably to other forms of respiratory therapy.

Blue Cross Blue Shield Insurance Plans↗
PubMed1987

Viral infection of the lower respiratory tract.

This article describes the epidemiology, transmission, and pathophysiology of viral infection of the lower respiratory tract. Current approaches to diagnosis, treatment, and prevention also are discussed.

Humans↗
PubMed1984

Physical fitness of New Zealand army personnel; correlation between field tests and direct laboratory assessments--anaerobic threshold and maximum O2 uptake.

Performance in two field tests was compared with maximum oxygen uptake (V02max) and anaerobic threshold in 42 male army staff. V02max was measured directly during incremental treadmill exercise. Anaerobic threshold was determined simultaneously from changes in ventilation and gas-exchange. The time to run 2.4 km and the distance covered in 12 minutes were each measured within a week of the laboratory assessments. V02max ranged from 39.8 to 66.0 ml kg-1min-1 with a mean of 50.8 ml kg-1 min-1 (SD 6.2) for the group. Mean anaerobic threshold was 30.7 ml kg-1min-1 (SD 5.5). These values compare favourably with those for other military populations. The time to run 2.4 km averaged 616 s (SD 60) for the group while the mean distance covered in 12 minutes was 2.78 km (SD 0.25). The time for the 2.4 km run showed a significant inverse correlation with both V02max (r = 0.83) and anaerobic threshold (r = 0.81). The linear correlations between 12 min run distance and V02max (r = 0.72) or anaerobic threshold (r = 0.70) were lower. V02max and anaerobic threshold may be justifiably estimated using such field tests.

Adult↗
PubMedDate not supplied

Correlation between LUTS (AUA-SS) and erectile dysfunction (SHIM) in an age-matched racially diverse male population: data from the Prostate Cancer Awareness Week (PCAW).

The relationship between lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia and sexual health in men participating in a national multicenter screening program was studied. A total of 12 679 men were screened for prostate cancer in the year 2003. Of these, 6641 men had completed both the American Urological Association Symptom Score (AUA-SS) and the Sexual Health Inventory for Men (SHIM) questionnaires. We assessed the apparent effect of comorbidities (ischemic heart disease, hypertension, hypercholesteremia and diabetes), smoking habits and testosterone level on the overall sexual health. Age and race were also assessed as factors affecting the SHIM score. We used a general linear multivariable regression analysis to express the effect of these variables on the sexual health in these men adjusting for the apparent effect of LUTS. The mean and median age of the population was 58.4 +/- 9.8 and 58 y, respectively. The median AUA-SS was 4/25 (mean=5.7 +/- 5.3) and SHIM score was 19/25 (mean=16.3 +/- 5.9). Of the men, 4948 (75%) were Caucasian and 1154 (17%) were from African-American racial origin. A high AUA-SS appears to have a negative effect on the overall sexual health (P<0.05) after adjusting for all other confounding factors. As expected, age showed a significant inverse correlation with SHIM score (P<0.05). Caucasian men on average appear to have a significantly higher SHIM score by 6.5 points when compared to African-American men after adjusting for age, comorbidities, smoking habits, and AUA-SS (P<0.05). However, with increasing age, the difference in SHIM score diminishes between the two groups. Further, smoking and comorbidities were strong predictors of poor sexual health performance. Interestingly, hypogonadism (testosterone <300 ng/dl) was not a significant risk factor (P=0.104) when adjusting for all other variables. Nonetheless, in a univariate analysis, testosterone levels significantly correlated with reported SHIM scores (P<0.05). The overall sexual health in aging men is substantially affected not only by age, but by the severity of their urinary symptoms after adjusting for the most common known risk factors, suggesting perhaps a common underlying pathophysiology. Moreover, race appears to constitute another neglected potential risk factor, which should be investigated further in future studies.

Adult↗
PubMedDate not supplied

Hyaluronic acid-dependent pericellular matrices in fetal fibroblasts: implication for scar-free wound repair.

Fetal fibroblasts are intrinsically different from postnatal fibroblasts. We studied the differences in expression, size, and assembly of pericellular matrices in human fetal and postnatal fibroblasts, as well as the effect of fetal fibroblast-conditioned media as a source of migration stimulating factor on pericellular matrix formation. Fibroblasts in their fifth to fifteenth passages were cultured for 24 hours before analysis. Streptomyces hyaluronidase (0.1 U/ml), monoclonal mouse anti-human CD-44std, or anti-human CD-4 antibodies were added and incubated for 1 hour (at 4 degrees and 37 degrees C) before analysis of the pericellular matrices with the use of a particle exclusion technique. The pericellular matrix/cell body ratio of fetal fibroblasts was significantly larger than that of newborn (p < 0.002) and adult (p < 0.001) fibroblasts. Hyaluronidase disrupted the pericellular matrices in all three cell lines. Assembly of the pericellular matrices was blocked by anti-human CD-44std antibody but not by anti-human CD-4 antibody at both 4 degrees and 37 degrees C. Incubation of fibroblast cell lines in fetal fibroblast-conditioned media did not increase pericellular matrix/cell body ratio but did increase the percentage of fibroblasts expressing a detectable pericellular matrix in adult (p < 0.01), newborn (p < 0.001), and fetal (p < 0.005) fibroblasts. We conclude that fibroblasts produce hyaluronic acid-dependent pericellular matrices which require interaction with a hyaluronic acid-binding protein for assembly. Large pericellular matrices are one intrinsic factor characterizing a unique fetal fibroblast phenotype.

Journal Article↗
PubMedDate not supplied

The BRENDA model: a psychosocial addiction model to identify and treat alcohol disorders in elders.

Studies have shown that up to 10% of the elderly drink daily and as much as 4% have alcoholism. Although many elders visit a primary care provider, the problem frequently is overlooked or misdiagnosed. We have found that primary care-based nursing is an effective treatment for older adults with alcoholism. In this article, we introduce the BRENDA model and show its effectiveness in retaining older adults in treatment. BRENDA involves biopsychosocial assessment, reporting the assessment to the patient, an empathetic approach, identified and stated patient needs, direct advice to stop or decrease alcohol consumption, and assessment of the compliance with or outcome of the direct advice. We also describe the utility of the BRENDA model for the pharmacotherapeutic treatment of addiction in late life.

Aged↗
PubMedDate not supplied

Motor accident and workers' compensation insurance design for high-quality health outcomes and cost containment.

This paper studies scheme structure and information concerning rehabilitation outcome for claimants under the NSW Motor Accidents Scheme and the NSW Workers' Compensation Scheme. It argues that to ensure effective rehabilitation there is a need for consistent, national accident schemes which provide services regardless of fault. In general, health outcomes will be improved if dispute resolution and estimation of level of disability occur in a context which avoids adversarialism. On the other hand, negligence could best be punished and compensation provided to victims as a result of prosecution for breach of duty of care under the relevant protective legislation. Other vital elements in injury prevention and rehabilitation are more effective risk management, worker representation and information provision at the workplace level. Comparable performance measures for rehabilitation and other service providers are also necessary for the attainment of quality management and evidence-based medicine.

Accidents, Traffic↗
PubMedDate not supplied

Magnetic resonance imaging and late-onset epilepsy.

The value of magnetic resonance imaging (MRI) in investigation of patients with late-onset epilepsy has not been studied systematically. We evaluated prospectively the usefulness of MRI in 50 patients with late-onset epilepsy in whom a computed tomography (CT) scan was normal (32), did not allow a definitive diagnosis to be made (12), or showed irrelevant lesions (6). Patients were assessed clinically and had an EEG, and CT and MRI scans were reported by one neuroradiologist blinded to clinical and laboratory data. Of the 32 patients with a normal CT scan, MRI was normal in 20, showed irrelevant ischemic lesions in 8, and showed the cause of seizures in 4 patients. Of the 12 patients with nondiagnostic CT, MRI clarified the diagnosis in 5 and was normal in 2 patients. In 6 patients, both scans showed irrelevant ischemic lesions, and in 1 patient MRI showed a relevant additional lesion. The incidence of MRI-detected white matter ischemic lesions was no greater than in an age- and sex-matched group of subjects without seizures. MRI was diagnostic in 32% of the patients with partial seizures and/or focal EEG findings, as compared with 0% of patients without focal features (p less than 0.01). We conclude that MRI is useful in investigation of patients with late-onset epilepsy with focal features.

Adult↗