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Biomedical subjects

E Sheehan

Publications and source records attributed to E Sheehan.

At least 19 recordsLinked to original sources
PubMed2005

Primary total hip replacement--a survey of current practice and identifying changing trends.

Primary total hip replacement (THR) surgery is the most commonly performed and successful reconstructive procedure in orthopaedic surgery. We performed a survey of Irish Orthopaedic consultants to elucidate current practices of primary THR in elderly and young patients and identify changing trends. There was an 83% response rate. Most respondents use a cemented THR in elderly patients. 69% use a different THR in younger patients compared to older patients. 9% refer younger patients to hip replacement specialist consultant colleagues. 70% report changing to a new implant or new technique in younger patients and 45% use a hybrid THR, 15% an uncemented THR, 15% perform hip resurfacing and 47% use different bearing surfaces. Only 17% use the Charnley hip prosthesis in younger patients. Young and active patients will place high demands on a new THR and newer techniques, implants and bearing surfaces are being adopted in the hope of better outcomes.

Arthroplasty, Replacement, Hip↗
PubMed2004

Adhesion of Staphylococcus to orthopaedic metals, an in vivo study.

This study describes a new model of biofilm study in rabbits. The primary focus of this study was to assess biofilm adhesion to orthopaedic metals in their first 48 h in a femoral intramedullary implantation model. Two previous inoculation methods i.e. that of pre- and direct inoculation were studied with two bacterial isolates namely Staphylococcus aureus and epidermidis, on titanium and stainless steel metallic implants. A method of sonication and log dilution/plating was used to assess biofilm bacteria adhering to implants. Silver coated metals were then compared with their respective control metals in the new model. The direct inoculation model gave larger and more reproducible biofilm adhesion to implanted metals. Staphylococcus epidermidis shows lower adhesion ability to metals, and biofilms adhere in greater numbers to stainless steel over titanium. Silver coated metals show no statistical difference over control metals when exposed to orthopaedic biofilms.

Animals↗
PubMed2004

Staphylococcal diaphyseal subacute osteomyelitis of the ulna in a child: an unusual cause of post-traumatic forearm swelling.

Paediatric subacute osteomyelitis (SAO) presents a diagnostic and therapeutic challenge to clinicians. Typically located in the metaphysis of long bones, diaphyseal SAO of the upper limb is rare. We present the case of a three-year-old girl referred to our fracture clinic as an occult fracture following trauma to her forearm with normal initial radiographs. Follow-up radiographs one week later showed cortical erosion of the distal ulna, while a subsequent MRI scan showed soft tissue swelling with an area of high signal in the distal ulna. A limited biopsy diagnosed staphylococcal subacute osteomyelitis of the ulna. The patient responded to high dose antibiotic therapy and made a full recovery. We present this case to highlight the high index of suspicion required to diagnose and appropriately manage this insidious condition, which may easily be confused with any number of benign and malignant bony lesions and provide a review of the relevant literature.

Anti-Bacterial Agents↗
PubMed2003

Lumbar Chance fracture associated with use of the lap belt restraint in an adolescent.

The use of the 2-point seat belt or lap belt in motor vehicles, particularly to restrain young rear seat passengers, remains an issue of some concern. The occurrence of lumbar spinal flexion-distraction injuries in lap belt restrained children and adolescents during road traffic accidents is a well known phenomenon, but is still occurring. High velocity paediatric Chance fractures are frequently associated with significant intra-abdominal trauma. We present the case of a Chance fracture sustained by a 15 year old girl, involved in a motor vehicle collision, while wearing a lap belt. We emphasise the need to develop safer seat belt designs for juvenile car passengers.

Accidents, Traffic↗
PubMed2002

Diagnosis and management of an intra-articular foreign body in the foot.

We describe a case of a small intra-articular foreign body in the foot presenting 48 hours following injury, which at operation showed early evidence of septic arthritis. It is essential to accurately localise periarticular foreign bodies in the foot and proceed to arthrotomy and debridement in all cases where there is radiological or clinical evidence to suggest intra-articular retention of a foreign body.

Child↗
PubMed1996

Attitudes toward health risks and sunbathing behavior.

Sunbathing confers the benefits of looking and feeling good but presents the long-term risk of skin cancer. In a disguised experiment exploring attitudes toward sunbathing by British adults, participants were asked to rate their willingness to take a hypothetical new drug (with different levels of risk) that would make them look and feel good. One aspect of the resulting risk profiles was significantly related to a positive attitude to open-air sunbathing but not to sunbed use, possibly because it was erroneously thought that using a sunbed is not risky. The well-established finding that women are more cautious was confirmed; the risk function for men was curvilinear, in contrast to women, who were willing to increase their risk linearly over their lifetime.

Adolescent↗
PubMed1995

Parent satisfaction with services in an emergency department located at a paediatric teaching hospital.

OBJECTIVE: To evaluate parents' satisfaction with the services provided in an emergency department located at a paediatric hospital. METHODOLOGY: A descriptive study in which the parents of children with non-life-threatening illnesses attending an emergency department completed a questionnaire describing their satisfaction with services in the department. RESULTS: The majority of parents were satisfied with the services provided. However, less satisfied parents reported having to wait significantly longer before receiving medical attention than satisfied parents. Consistent with this finding, 77% of less satisfied parents reported that staff did not attend to their children's needs quickly enough and 62% felt that there were insufficient staff available to provide help. Twenty-nine per cent of the less satisfied parents reported that they did not know what was required for the ongoing care of their children after their discharge from the emergency department. CONCLUSIONS: In order to address the concerns of less satisfied parents, emergency departments need to give careful attention to the maintenance of reasonable waiting times, the provision of adequate staffing, and the quality of staff-parent communication. Addressing these issues may improve the ongoing care of children after their discharge from emergency departments.

Adolescent↗
PubMed1993

Basilic vein transposition: an underused autologous alternative to prosthetic dialysis angioaccess.

PURPOSE: Provision of lifelong angioaccess for hemodialysis generally requires multiple procedures. To extend the availability of each extremity as an access site, we have used the transposed basilic vein for fistula construction since 1988. Our purpose is to present our initial experience, with follow-up of 30 months. METHODS: We have used the transposed proximal basilic vein in 65 procedures to construct an autogenous arteriovenous fistula (AVF) to the brachial artery in 58 patients without suitable superficial venous anatomy. There were 25 males and 33 females, with a mean age of 47 years (range 10 to 77). The basilic vein transposition was the initial angioaccess procedure in only 25% of cases and secondary in 75%. Three additional patients underwent exploration of an inadequate basilic vein with subsequent prosthetic grafting. RESULTS: There were no operative deaths. Two postoperative complications included a wound infection and a transient steal syndrome. The actuarial life-table patency rate for all successfully completed AVFs was 49% at 30 months. Late revisions with continued patency were required in 11 cases, including repair of a focal stenosis in six, pseudoaneurysm resection in two, and thrombectomy in one. Sixty-seven percent of patients who required subsequent prosthetic grafting for a failed basilic vein AVF had an ipsilateral procedure. Patient preference for the opposite arm was the usual indication for contralateral grafting in the remainder. CONCLUSIONS: The transposed basilic vein AVF was technically feasible in 95% of cases, can frequently be performed in patients with multiple previous access procedures, does not compromise the arm for future prosthetic grafting, and has a long-term patency rate that is comparable to more traditional autologous AVFs. This underused procedure should be considered before placement of polytetrafluoroethylene graft for long-term angioaccess.

Adolescent↗
PubMed1992

Calmodulin-specific monoclonal antibodies inhibit DNA replication in mammalian cells.

The involvement of calmodulin in the proliferation of Chinese hamster embryo fibroblast cells has been studied with a specific monoclonal antibody to calmodulin. We observed that calmodulin levels increase 2-fold in the late G1 period in these cells, and this coincides with the increase in DNA polymerase alpha activity as the cells progress synchronously from a quiescent state in the G1 to the S phase. However, there is a concurrent 10-fold enhancement of thymidine kinase activity, which is tightly coupled to the entry of cells into the S phase. Incubation of permeabilized S-phase cells with calmodulin-specific murine monoclonal antibody resulted in a dose-dependent inhibition of DNA replication. This inhibitory effect of anti-calmodulin antibodies on DNA replication is completely reversed by the addition of exogenously purified calmodulin. These observations provide evidence for the involvement of calmodulin in DNA replication and, therefore, in cell proliferation during the S phase.

Animals↗
PubMed1992

The effectiveness of adherence intervention in a colon cancer prevention field trial.

BACKGROUND: Adherence interventions were implemented in a 1-year community-based colon cancer prevention clinical trial (n = 110) using wheat bran fiber and calcium dietary supplements. The adherence promotion strategy was guided by a theoretical model. METHODS: The adherence intervention contains both a generalized portion given to all participants and an individualized portion given to marginal (50-74% intake) and low (under 50% intake) adherers. A regression model was employed to assess the effectiveness of the interventions both at the first intervention and at subsequent times. RESULTS: The Health Behavior in Cancer Prevention Model-based adherence promotion intervention was associated with retention of participants, both during the run-in period and after randomization (P = 0.05); and maximization of the percentage of the 13.5-g recommended fiber supplement consumed during the trial (92.5%). The positive effects of the adherence intervention were greater with first-time nonadherers and the control group than with the experimental group. The high-fiber group had notably more biological GI effects from the increased fiber intake, more preexisting comorbidities, and lower perceived cognitive and physical health status. CONCLUSIONS: Randomized participants had excellent adherence overall. Retention rates in the trial were better than would be expected without the adherence intervention, especially among those participants who may have been at higher risk for dropping out of the study. This suggests that a systematic, theoretically based adherence strategy should be further tested in clinical trial settings in which lower adherence is a problem.

Aged↗
PubMed1992

Reasons related to adherence in community-based field studies.

This study identified participants' reasons for good, marginal or poor adherence, or withdrawing from community-based clinical studies using a dietary and/or drug intervention. Adults aged 48-75 years participated in one of three studies related to decreasing colon polyp recurrence. Qualitative data from progress notes (N = 675) and end-of-study evaluations (N = 87) were coded using constant comparative analysis with 100% content validity panel agreement. Most common reasons for non-adherence were barriers such as side-effects, interference with vacation plans, unrelated illness, forgetting and competing outside stressors. Participation motivators were benefits such as altruism, medical benefits, free service and staff rapport. Findings supported the Health Behavior in Cancer Prevention model-based approach to adherence interventions and provided directions for adherence promotion in future community-based clinical studies.

Aged↗
PubMed1991

Epidural versus general anesthesia for infrainguinal arterial reconstruction.

A prospective evaluation of 213 consecutive infrainguinal bypass procedures was performed to determine the effect of anesthesia technique on the postoperative complication rate. Limb salvage was the indication for surgery in 92% of cases. No significant differences were observed in age, sex, indication for surgery, presence of cardiovascular and pulmonary risk factors, American Society of Anesthesiologists classification, or Goldman scores between patients receiving epidural anesthesia and those receiving general endotracheal anesthesia. Epidural anesthesia was used for 96 procedures and general endotracheal anesthesia was used in 117 cases. Cardiac complications for the epidural anesthesia and general endotracheal anesthesia groups, respectively, included a mortality rate of 5% versus 3%, nonfatal infarctions in 6% versus 7%, and reversible cardiac events in 14% versus 16%. A high-risk subgroup of 69 patients (American Surgical Association classes IV and V or Goldman score greater than 10 points) also had no significant difference in outcome between epidural anesthesia and general endotracheal anesthesia. Major noncardiac complications occurred in an additional 8% of each group. Regional and general anesthesia therefore produce equivalent cardiovascular risk for infrainguinal arterial reconstruction. These results suggest that indicated operations should not be postponed or avoided for patients either requiring or requesting general anesthesia. Furthermore, other investigations of cardiac risk in vascular surgery do not require a uniform anesthetic technique for valid interpretation of results.

Aged↗
PubMed1991

MCMI-II report style and bias: profile and validity scales analyses.

This study examines the behavior of the Millon Clinical Multiaxial Inventory-II (MCMI-II) in the face of various response styles and biases. The profiles and validity configurations of eight different test-taking styles were analyzed. Four hundred MCMI-II inventories (50 for each of the following categories) were administered or generated to produce the following: (a) normal endorsement by subjects, (b) fake good for administrative reasons, (c) fake good for clinical reasons, (d) fake bad administratively, (e) fake bad clinically, (f) 50% true/50% false computer generated, (g) 95% true computer generated, and (h) 95% false computer generated. Good statistical and clinically relevant separation of the profiles was found for normal, fake good, fake bad, and the randomly generated profiles with 44% of the variance predicted. The percentage of profiles identified by validity scales, however, was modest.

Adult↗