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Biomedical subjects

G McIlwaine

Publications and source records attributed to G McIlwaine.

At least 19 recordsLinked to original sources
PubMed2005

Interventions for idiopathic intracranial hypertension.

BACKGROUND: Idiopathic intracranial hypertension occurs throughout the world with an estimated incidence of one to three per 100,000 population per year. It occurs most commonly in obese young women but the cause is unknown. It presents a significant threat to sight and is associated with severe morbidity, in the form of headaches in most cases. Several different treatments have been proposed ranging from relatively conservative measures such as diuretic therapy to more invasive treatments such as optic nerve sheath fenestration, stenting of cerebral venous sinuses, or lumbo-peritoneal shunting. OBJECTIVES: The objective of this review was to assess the effects of various forms of treatment for idiopathic intracranial hypertension with a view to producing an evidence-based treatment strategy. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Group Trials Register, on The Cochrane Library (Issue 4, 2004), MEDLINE (1966 to January 2005) and EMBASE (1980 to January 2005). SELECTION CRITERIA: We included only randomised controlled trials in which any intervention used to treat idiopathic intracranial hypertension had been compared to placebo or to another form of treatment in people with a clinical diagnosis of idiopathic intracranial hypertension. DATA COLLECTION AND ANALYSIS: Both authors independently assessed the search results for trials to be included in the review. Discrepancies were resolved by discussion. Since no trials met our inclusion criteria, no assessment of quality or meta-analysis was undertaken. MAIN RESULTS: No randomised controlled trials were found that met the inclusion criteria. AUTHORS' CONCLUSIONS: There is insufficient information to generate an evidence-based management strategy for idiopathic intracranial hypertension. There is inadequate information regarding which treatments are truly beneficial and which are potentially harmful. Properly designed and executed trials are needed.

Humans↗
PubMed2004

Delayed diagnosis of HIV infection in ophthalmic practice.

The introduction of potent antiretroviral drug combinations has transformed human immunodeficiency virus/acquired immunodeficiency disease syndrome (HIV/AIDS) from an intractable and rapidly fatal disease to a chronic manageable illness with prolonged life survival for many patients. This paper discusses the ophthalmic and medical histories of two young female patients who presented with 'atypical' optic neuropathy and toxoplasma gondii retinochoroiditis and were later found to be HIV infected. We discuss the need for increased vigilance in the ophthalmic community for suspecting HIV infection to allow optimal management of the ophthalmic and systemic manifestations of the disease spectrum associated with HIV/AIDS.

Adult↗
PubMed2002

Interventions for idiopathic intracranial hypertension.

BACKGROUND: Idiopathic intracranial hypertension (IIH) occurs throughout the world with an estimated incidence of one to three per 100,000 population per year. It occurs most commonly in obese young women, but the cause is unknown. It presents a significant threat to sight and is associated with severe morbidity in the form of headaches in the majority of cases. Several different treatments have been proposed, ranging from relatively conservative measures such as diuretic therapy to more invasive treatments such as optic nerve sheath fenestration or lumbo-peritoneal shunting. OBJECTIVES: The aim of this review is to assess the evidence from controlled trials looking at the various treatments used for idiopathic intracranial hypertension with a view to producing an evidence-based treatment strategy. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register - CENTRAL/CCTR (which contains the Cochrane Eyes and Vision Group specialised register) on the Cochrane Library Issue 2, 2002, MEDLINE (1966 to March 2002) and EMBASE (1980 to February 2002). SELECTION CRITERIA: We included only randomised controlled trials in which any intervention used to treat idiopathic intracranial hypertension had been compared to placebo or to another form of treatment in people with a clinical diagnosis of idiopathic intracranial hypertension. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the search results for trials to be included in the review. Discrepancies were resolved by discussion. Since no trials met our inclusion criteria, no assessment of quality or meta-analysis was undertaken. MAIN RESULTS: No randomised controlled trials were found that met the inclusion criteria. REVIEWER'S CONCLUSIONS: There is insufficient information to generate an evidence-based management strategy for idiopathic intracranial hypertension. Of the various treatments available, there is inadequate information regarding which are truly beneficial and which are potentially harmful. Properly designed and executed trials are needed.

Humans↗
PubMed1998

Is a rising caesarean section rate inevitable?

OBJECTIVE: To determine the indications for singleton caesarean sections in Scotland in 1994. DESIGN: Prospective survey of singleton caesarean sections using information provided by clinicians entering data onto a computer in labour wards. SETTING: Twenty-three consultant-led obstetric units in Scotland. POPULATION: Women undergoing caesarean section in participating Scottish maternity units during 1994. RESULTS: Using routinely collected data it was found that the caesarean section rate varied by maternal age, parity, gestation, history of previous section and hospital of delivery, but there was no difference by area of deprivation. 87.4% (8369/9573) of Scottish caesarean sections were included in the survey of which 8098 were in women with singleton pregnancies. Most singleton caesarean sections were undertaken in primiparae (50.5%), 31.2% were in women with a history of previous section and 18.3% were in multiparous women who had not had a previous section; 38.9% of the operations were elective, 13.9% were emergencies before labour and 47.2% were emergencies during labour. Four main indications--elective section for breech presentation (10.7% of all sections); emergency caesarean section before labour because of fetal problems (2.8%); emergency caesarean section during labour for fetal distress and/or failure to progress (30.3%); repeat section for reasons other than above (16.2%) accounted for 60% of all caesarean sections in women with no other recorded complications. 7.7% of all singleton caesarean sections (19.8% of elective operations) were associated with maternal request for the operation. DISCUSSION: The survey has identified why caesarean sections are performed by Scottish obstetricians and highlighted some areas where there would be scope to increase the vaginal delivery rate. Before this can be attempted, agreement must be reached by clinicians about effective management of particular problems. Women also need to have ready access to evidenced-based information about caesarean section.

Algorithms↗
PubMed1997

Comparison of the efficacy of diclofenac and betamethasone following strabismus surgery.

AIMS: To compare the relative antiinflammatory potency and safety of topical diclofenac-gentamicin with betamethasone-neomycin following strabismus surgery. METHODS: A single centre, single observer, prospective, randomised, and double masked clinical trial of 25 children undergoing bilateral symmetrical horizontal strabismus surgery was carried out. One eye received diclofenac-gentamicin and the contralateral eye received betamethasone-neomycin; both treatments were instilled four times a day for 4 weeks postoperatively. Ocular inflammation was assessed at 1 and 4 weeks postoperatively, objectively by comparison with a photographic chart and subjectively by questionnaire. RESULTS: There was no statistically significant difference in the rate of resolution of the inflammatory response between each group at both visits. CONCLUSION: Diclofenac appears to be as effective as betamethasone in controlling postoperative inflammation following strabismus surgery and may offer a safer alternative to the use of topical steroids.

Anti-Bacterial Agents↗
PubMed1997

The neonatal consequences and neonatal cost of reducing the number of embryos transferred following IVF.

This clinical audit project examined the effects of change of policy between 1990 and 1993 transferring an average two (maximum three for particular cases) embryos to women undergoing IVF in the West of Scotland programme. All women who achieved clinical pregnancy in 1990 (92 women) and 1993 (93 women) as a result of the IVF programme were included in the study. The hospital records of women via the programme were analysed. The results of the study showed that there was a significant reduction in the rate of multiple pregnancy, preterm birth and low birth weight babies in the 1993 group (new policy). The cost of neonatal intensive care in 1993 for babies born following IVF was about nine times lower than that in 1990 (old policy). This study concluded that a policy of transferring two embryos (or three for particular cases) to women in an IVF programme, had improved the perinatal outcome and reduced the cost of the neonatal service for those babies.

Chi-Square Distribution↗
PubMed1996

Randomised, controlled trial of efficacy of midwife-managed care.

BACKGROUND: Midwife-managed programmes of care are being widely implemented although there has been little investigation of their efficacy. We have compared midwife-managed care with shared care (ie, care divided among midwives, hospital doctors, and general practitioners) in terms of clinical efficacy and women's satisfaction. METHODS: We carried out a randomised controlled trial of 1299 pregnant women who had no adverse characteristics at booking (consent rate 81.9%). 648 women were assigned midwife-managed care and 651 shared care. The research hypothesis was that compared with shared care, midwife-managed care would produce fewer interventions, similar (or more favourable) outcomes, similar complications, and greater satisfaction with care. Data were collected by retrospective review of case records and self-report questionnaires. Analysis was by intention to treat. FINDINGS: Interventions were similar in the two groups or lower with midwife-managed care. For example, women in the midwife-managed group were less likely than women in shared care to have induction of labour (146 [23.9%] vs 199 [33.3%]; 95% CI for difference 4.4-14.5). Women in the midwife-managed group were more likely to have an intact perineum and less likely to have had an episiotomy (p = 0.02), with no significant difference in perineal tears. Complication rates were similar. Overall, 32.8% of women were permanently transferred from midwife-managed care (28.7% for clinical reasons, 3.7% for non-clinical reasons). Women in both groups reported satisfaction with their care but the midwife-managed group were significantly more satisfied with their antenatal (difference in mean scores 0.48 [95% CI 0.41-0.55]), intrapartum (0.28 [0.18-0.37]), hospital-based postnatal care (0.57 [0.45-0.70]), and home-based postnatal care (0.33 [0.25-0.42]). INTERPRETATION: We conclude that midwife-managed care for healthy women, integrated within existing services, is clinically effective and enhances women's satisfaction with maternity care.

Adult↗
PubMed1995

The health status and health needs of Chinese population in Glasgow.

This cross sectional study explored the health problems and health needs in the local Chinese community in Glasgow. Several data collection methods have been used in this study, including face-to-face and telephone structured interviews, postal and hand delivered questionnaires. A total of 800 questionnaires were processed, and 493 were completed, giving an overall response rate 61.6%. The results from the present survey indicated that the health status of Chinese residents in Glasgow is poorer than that of the local population. The most important findings of the study is that the Chinese community in Glasgow underuse health services, and unmet health needs exist in the community. The main barrier to effective use of present health services and benefit from the health promotion and health education programmes is language difficulties. Following discussion with the local community, options for improving the health services for the Chinese community in Glasgow were obtained. The findings of the study have implications for health service purchaser/providers of health care to the Chinese population generally in Scotland.

Adolescent↗
PubMed1994

Is antenatal care apportioned according to obstetric risk? The Scottish antenatal care study.

A retrospective cohort study of case records of antenatal care was carried out to describe and compare antenatal services in Scotland according to type of hospital and risk category of women. The study took place at 15 randomly selected maternity hospitals which were divided into teaching hospitals (n = 5), rural catchment hospitals (n = 2), and district general hospitals divided by size as those with 1000-1699 deliveries per year (n = 4), and those with > or = 1700 deliveries per year (n = 4). The subjects were 3574 (87.7 per cent) of 4069 eligible women who delivered in the last quarter of 1989 at these hospitals. Of those 3574, 19 per cent (675) were considered to be high risk at booking, 64 per cent (2899) continued low risk throughout their pregnancy and the remaining 17 per cent (608) changed from low risk to high risk during pregnancy. The main outcome measures were the number, timing, location and supervision of antenatal visits and antenatal admissions in relation to hospital types and obstetric risk categories, and adverse pregnancy outcomes in relation to risk categories. It was found that 97 per cent of all women had care shared by general practitioner (GP) and hospital specialist agreement. The majority (64 per cent) of antenatal visits took place away from the hospital of delivery, with GPs responsible for the largest proportion of all antenatal visits (43.5 per cent) compared with specialist hospital doctors (36 per cent) and midwives (11.5 per cent). Wide variations in the use of different personnel groups to deliver antenatal care were observed between hospitals, particularly in the use of midwives to supervise visits (4-34 per cent). The median number of antenatal visits was 14 (mean 13.9, SD 3.9). Within hospital types the differences in the mean number of antenatal visits between the three risk categories were small (one to two visits) and the direction inconsistent. In all types of hospital, outset high-risk women and those who changed to high risk were more likely to have hospital admission than those who continued as low risk. Significantly more women in the high-risk categories experienced adverse pregnancy outcomes than women who continued at low risk.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗