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D Healy

Publications and source records attributed to D Healy.

At least 37 records · Page 2Linked to original sources
PubMed2001

A tool to assess clinical signs and symptoms of localized infection in chronic wounds: development and reliability.

This paper reports on the development and testing of a tool designed to assess chronic wounds for the clinical signs and symptoms of localized infection. Thirty-one wounds were assessed by two independent nurse observers for the signs and symptoms of infection using the Clinical Signs and Symptoms Checklist. The Clinical Signs and Symptoms Checklist delineates 12 signs and symptoms of infection (i.e., pain, erythema, edema, heat, purulent exudate, serous exudate with concurrent inflammation, delayed healing, discoloration of granulation tissue, friable granulation tissue, pocketing at the base of the wound, foul odor, and wound breakdown) and their definitions. The reliability of each sign or symptom on the checklist was calculated using percent agreement and the Kappa statistic. Percent agreement ranged from 65% to 100%, and Kappa statistics ranged from 0.53 to 1.00, excluding pocketing of the wound base. The reliability estimates obtained for signs and symptoms on the Clinical Signs and Symptoms Checklist compare favorably with other data regarding interclinician agreement on wound assessment. Incorporating a structured approach to assess and monitor for wound infection, such as the Clinical Signs and Symptoms Checklist, may improve clinician skill and accuracy in identifying this condition.

Aged↗
PubMed2000

Two consecutive pregnancies during inadvertent gonadotropin-releasing hormone agonist desensitization.

OBJECTIVE: To describe two consecutive spontaneous pregnancies during luteal-phase down-regulation with a GnRH-a. DESIGN: Case report. SETTING: University-affiliated reproductive medicine unit. PATIENT(S): A 33-year-old woman with a history of failed uterine tubal reanastomosis. INTERVENTION(S): Four IVF cycles. MAIN OUTCOME MEASURE(S): Pregnancy. RESULT(S): The patient had two spontaneous pregnancies during luteal-phase down-regulation. CONCLUSION(S): Although midluteal administration of GnRH-a is not established as a treatment, there might be a beneficial effect on the endometrium via the medication's evoked gonadotropin flare.

Adult↗
PubMed2000

Should we still advise infertile couples to use (barrier) contraception before IVF down-regulation?

OBJECTIVE: To determine the outcome of spontaneous conceptions in women who received GnRH agonists during mid-luteal phase down-regulation before IVF treatment. DESIGN: Retrospective analysis of case records and study of the literature. SETTING: Two university-affiliated reproductive medicine units. PATIENT(S): Seventy-three women who conceived spontaneously after starting down-regulation with a GnRH agonist before controlled ovarian hyperstimulation. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Course and clinical outcome of pregnancies. RESULT(S): Seventy-four pregnancies occurred in 73 women who received a GnRH agonist. Of these patients, 6 (8%) had a biochemical pregnancy, 6 (8%) had an ectopic pregnancy, 21 (28%) miscarried, and 41 pregnancies resulted in successfully delivered babies; there were 2 cases of congenital abnormalities. CONCLUSION(S): These cases, together with other published data, suggest that pregnancy outcome is not adversely affected by exposure to GnRH agonist during luteal-phase down-regulation. A central register of pregnant women who received a GnRH agonist is needed.

Buserelin↗
PubMed2000

Reboxetine: its effects as measured by the Social Adaptation Self-evaluation Scale.

The determination of the outcome of treatment for depression is important both for the symptoms of depression and social functioning. The aim of this review is to evaluate the outcome of two clinical trials comparing reboxetine and fluoxetine on depressive symptoms and social functioning. These studies used both conventional measures of outcome such as the Hamilton Rating Scale for Depression (HAM-D) and the Social Adaptation Self-evaluation Scale (SASS), a patient-centred, disease non-specific scale of social functioning, which was developed for measuring social functioning in depressed people. These findings, set against a background of all studies in which antidepressants have been compared using quality of life instruments, suggest that while some patients may appear to the clinician to have recovered, they may remain less than fully well and differences in selectivity for neurotransmitter systems may play a part in the degree of wellbeing that recovered patients might expect.

Adrenergic Uptake Inhibitors↗
PubMed2000

Incidence of cancer in children born after in-vitro fertilization.

Evaluation of the long-term health of children born using in-vitro fertilization (IVF) provides important information to clinicians and consumers. Until very recently, there have been no published data on the incidence of cancer in children conceived as a result of IVF, despite a number of case reports of neuroblastoma in children conceived using fertility drugs. This study used a record-linkage cohort design to investigate the incidence of cancer in children born after IVF. The study included all conceptions using assisted reproductive technologies between 1979 and 1995 at two clinics in Victoria, Australia that resulted in a live birth. Data on births were linked with a population-based cancer registry to determine the number of cases of cancer that occurred. The standardized incidence ratio (SIR) was calculated by comparing the observed number of cases to the expected number of cases. The final cohort included 5249 births. The median length of follow-up was 3 years, 9 months (range 0-15 years). In all, 4.33 cases of cancer were expected and six were observed, giving a SIR of 1.39 (95% CI 0.62-3.09). This study found that children conceived using IVF and related procedures did not have a significantly increased incidence of cancer in comparison to the general population.

Birth Weight↗
PubMed2000

Prevalence of gestational diabetes mellitus in polycystic ovarian syndrome (PCOS) patients pregnant after ovulation induction with gonadotrophins.

Our aims were: 1. To investigate if women with PCOS who become pregnant using gonadotrophins have a higher incidence of gestational diabetes mellitus (GDM) compared to spontaneously pregnant matched control women, 2. To compare the prevalence of GDM in PCOS women with that in women with hypo/eugonadotrophic hypogonadism and in unexplained infertility and 3. To investigate differences in pregnancy outcomes between the groups. This was a retrospective case-control study. Women with PCOS were matched with a control by age, BMI, and ethnicity. There were 60 women with PCOS, 11 with hypogonadotrophic hypogonadism, 6 with eugonadotrophic hypogonadism, and 12 with unexplained infertility. Control women were those who attended a major public hospital for antenatal care and delivery We found no difference in the prevalence of GDM between the PCOS (22%) and the controls (17%) or between the PCOS and other groups. Women with GDM (diet or insulin controlled) had a significantly higher BMI than women without GDM (p = 0.019). There was no difference in pregnancy outcomes between the groups. There was a significant dependence of babies' birthweight on mother's BMI (p<0.001).

Adult↗
PubMed2000

Social functioning in depression: a review.

OBJECTIVE: This article reviews the available data on social functioning in depression and provides clinical guidelines and opinion on this important and expanding field. DATA SOURCES: A MEDLINE search was conducted to identify all English-language articles (1988-1999) using the search terms depression and social functioning, depression and social adjustment, depression and psychosocial functioning, and social functioning and antidepressant. Further articles were obtained from the bibliographies of relevant articles. DATA SYNTHESIS: Depressive disorders are frequently associated with significant and pervasive impairments in social functioning, often substantially worse than those experienced by patients with other chronic medical conditions. The enormous personal, social, and economic impact of depression, due in no small part to the associated impairments in social functioning, is often underappreciated. Both pharmacologic and psychotherapeutic approaches can improve social impairments, although there is a lack of extended, randomized controlled trials in this area using consistent assessment criteria. CONCLUSION: Despite this lack, it is becoming clear that not all treatments are equally effective in relieving the impaired social functioning associated with depressive disorders. Furthermore, efficacy in relieving the core symptoms of depression does not necessarily guarantee efficacy in relieving impaired social functioning.

Adaptation, Psychological↗
PubMed2000

The case for an individual approach to the treatment of depression.

Early reports of the discovery of antidepressants in the 1950s have remained as little-known findings. Had the discovery of isoniazid, an agent with no clear action on monoamine systems, and that of reserpine, which depletes monoamines, been more widely known, then the monoamine lesion theories of depression, as proposed by Schildkraut in 1965, may not have been written. If the lesion in depression is lowered brain monoamine levels, then antidepressant agents that increase monoamine levels should work for all patients. If this were the case, optimizing treatment effect sizes with a minimum of side effects and some demonstrable specificity to depressive disorders would be possible. This is not the profile of antidepressants in clinical practice. Alternatively, if antidepressants act on constitutional types to provide appropriate therapeutic principles, then the efficacy would stem from an ability to suppress symptoms and to elicit or maintain conditions that allow recovery in a subgroup of patients who would otherwise remain nonresponsive. Current monoamine selective antidepressant principles embody "get-up-and-go" (noradrenergic) and emotional reactivity-reducing (serotonergic) principles. Different antidepressants are, therefore, likely to have different treatment effect sizes in different constitutional types. A further important aspect of antidepressant selectivity will lie in the extent to which these agents promote a sense of well-being during the maintenance phase of treatment.

Antidepressive Agents↗
PubMed1999

Risk of cancer after use of fertility drugs with in-vitro fertilisation.

BACKGROUND: We investigated the incidence of invasive cancer of the breast, ovary, and uterus in a cohort of patients who had undergone in-vitro-fertilisation (IVF) treatment and examined whether cause of infertility or exposure to fertility drugs to induce superovulation was associated with an increased cancer risk. METHOD: Ten Australian IVF clinics provided data for women who had been referred for IVF before Jan 1, 1994. The frequencies of invasive breast, ovarian, and uterine cancer were assessed by record linkage to population-based cancer registries and the national death index. The observed number of cancers was compared with the expected number calculated by application of age-standardised general-population cancer rates to the cohort. Standardised incidence ratios (SIRs) were derived from the ratio of observed to expected cases. FINDINGS: The cohort consisted of 29,700 women: 20,656 were exposed to fertility drugs and 9044 were not. 143 breast cancers, 13 ovarian cancers, and 12 cancers of the uterus occurred among these women. For breast and ovarian cancer the incidence was no greater than expected (SIR 0.91 [95% CI 0.74-1.13] for breast cancer and 0.88 [0.42-1.84] for ovarian cancer in the exposed group and 0.95 [0.73-1.23] for breast cancer and 1.16 [0.52-2.59] for ovarian cancer in the unexposed group). The incidence of uterine cancer was no higher than expected in the exposed group (1.09 [0.45-2.61]) but was significantly higher in the unexposed group (2.47 [1.18-5.18]). Women with unexplained infertility had significantly more cancers of the ovary and uterus than expected (2.64 [1.10-6.35] and 4.59 [1.91-11.0], whole cohort). Analysis of cancer incidence within 12 months of exposure to fertility drugs with IVF showed that incidence was significantly higher than expected for breast and uterine cancer (1.96 [1.22-3.15] and 4.96 [1.24-19.8]). INTERPRETATION: Women who have been exposed to fertility drugs with IVF seem to have a transient increase in the risk of having breast or uterine cancer diagnosed in the first year after treatment, though the incidence overall is no greater than expected. Unexplained infertility was associated with an increased risk of a diagnosis of ovarian or uterine cancer.

Adult↗
PubMed1999

Does growth hormone-releasing factor assist follicular development in poor responder patients undergoing ovarian stimulation for in-vitro fertilization?

Treatment with growth hormone-releasing factor (GRF) has been reported to improve the ovarian response to gonadotrophins in women who respond poorly to ovarian stimulation during in-vitro fertilization (IVF). The efficacy and tolerability of GRF were studied in a randomized, double-blind, placebo-controlled trial involving 196 patients. Following down-regulation with a gonadotrophin-releasing hormone agonist (GnRHa), patients were randomized to receive GRF (500 microg twice daily; n = 96) or placebo (n = 100) in addition to follicle stimulating hormone (FSH); treatment was continued until human chorionic gonadotrophin was given, or for a maximum of 14 days. GRF had no significant effect on the mean number of follicles with a diameter of >/=16 mm (GRF: 3.26 +/- 2.29; placebo: 3.27 +/- 2.30; P = 0.95), the number of FSH ampoules required to achieve ovarian stimulation (GRF: 55.2 +/- 16. 4; placebo: 54.9 +/- 17.2; P = 0.50), or on secondary measures of ovarian response and treatment outcome. There were, however, significant increases in circulating growth hormone (GH) and insulin-like growth factor (IGF)-1 concentrations. GRF was well tolerated. It is concluded that, despite producing significant increases in GH and IGF-1, concomitant treatment with GRF does not improve the ovarian response to FSH in poorly responsive women undergoing IVF.

Adolescent↗
PubMed1999

The three faces of the antidepressants: a critical commentary on the clinical-economic context of diagnosis.

Depression was infrequently diagnosed before the advent of the antidepressants but has now apparently become a major public health problem. National campaigns are organized aimed at increasing recognition of the condition and at commencing treatment for sufferers. Implicit in these approaches is the premise that treatment will necessarily reduce disability and ultimately lower suicide rates. This is by no means certain. The treatment effect size of many antidepressants is modest, the burden of side effects they produce has never been established, and data on the quality of life during treatment is absent. It remains possible that mild depressive disorders confer a protective effect against suicide and that injudicious or unmonitored treatment may increase that risk. In their concern to help patients, physicians appear to have systematically overlooked the risks they expose patients to as part of their therapeutic effort to minimize the risks posed by the patient's condition. Their propensity to overlook the risks posed by therapy may stem in part from the availability of antidepressant treatments on prescription only. Remedying this situation will require first of all a recognition of the biases that prescription-only status introduces into therapeutics. Current pharmacological and neuroscientific developments have the potential to make alternative health care frameworks possible. Whether these alternatives are adopted will probably depend on the capacity of all interested parties to reform the present arrangements. Future concepts of depressive disorders will probably reflect the regulatory arrangements adopted.

Antidepressive Agents↗
PubMed1999

Modern antioestrogens and the coming revolution in women's health care.

This review will focus on antioestrogens and selective oestrogen receptor modulators (SERMS). The more traditional SERMS, clomiphene citrate and tamoxifen, will be reviewed along with such modern drugs as raloxifene and faslodex, with emphasis upon their actions on breast, uterus, bone and lipids. The future potential of these medications, in the management of oestrogen-dependent gynaecological conditions such as endometriosis, dysfunctional uterine bleeding, fibroids and breast cancer will be discussed.

Bone and Bones↗
PubMed1999

Suicide in the course of the treatment of depression.

Five different mechanisms have been proposed whereby antidepressant treatment might lead to suicide: first by simply ameliorating depressions more rapidly; second by an action intrinsic to the specific antidepressant effects; third by toxicity in overdose; fourth by side-effects of specific antidepressants; and finally by virtue of treatment inefficacy. Evidence from randomized control trials (RCT), controlled case studies and epidemiological studies on this question is reviewed and it is concluded that antidepressants can be implicated in some cases of suicide during treatment. Modifications of clinical trial methods and pharmacogenetic studies would yield a richer data set to explore this issue further.

Animals↗
PubMed1999

Pharmacological stress diathesis syndromes.

Recent descriptions of discontinuation syndromes following treatment with antidepressants and antipsychotics, in some cases long lasting, challenge both public and scientific models of addiction and drug dependence. Antipsychotic and antidepressant drug dependencies point to a need to identify predisposing constitutional and personality factors in the patient, pharmacological risk factors in the drug and aspects of therapeutic style that may contribute to the development of stress syndromes. The stress syndromes following antipsychotics also point to the probable existence of a range of syndromes emerging within treatment. The characteristics of these need to be established.

Antidepressive Agents↗
PubMed1999

Clinical trials and legal jeopardy.

On neither side of the Atlantic have research ethics committees found a satisfactory way of ensuring that all serious side-effects of new treatments being studied are noted and reported to them, without being deluged in reports of minor adverse events. The author of the following paper is probably the leading historian of psychopharmacology: he discusses the issue, and its implications for RECs, in the light of the serious side-effects of the new generation of SSR antidepressants.

Antidepressive Agents↗
PubMed1998

The clinical pharmacologic profile of reboxetine: does it involve the putative neurobiological substrates of wellbeing?

Following a review of the clinical trials of reboxetine, a new nonadrenegic reuptake inhibitor antidepressant, this paper presents a heuristic theoretical framework to better understand selective antidepressant action. For over three decades, the dominant views of antidepressant action have seen these agents active across all constitutional types and regardless of social setting. An increasing number of studies using quality of life methods are at odds with this view. This paper summarizes several of these studies, along with two studies of the effects of reboxetine on the quality of life, which reveal differential effects of selective agents that demand alternative explanations to the conventional monoamine theories. The authors submit that any revisions in our understanding of what is happening will have to pay attention to temperamental inputs that antedate affective episodes and to the sense of wellbeing and level of residual symptoms patients have on treatment after the acute phase of their illness has remitted. Obviously much more research needs to be done in this area. This invited paper sketches out, in very general terms, some provocative possibilities of how future understanding of antidepressants, temperament and their neurobiologic substrates could lead to better matching of specific antidepressants to specific temperament types.

Adolescent↗