Ambient temperatures and potassium concentrations.
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Bias↗
Biomedical subjects
J Keenan
Publications and source records attributed to J Keenan.
The association between different patterns of hand symptoms and objective evidence of median nerve compression: a community-based survey.
OBJECTIVE: To examine the association between different patterns of hand symptoms and the presence of delayed nerve conduction in the general population. METHODS: We performed a 2-stage screening survey involving a questionnaire on current hand symptoms, and nerve conduction testing in samples of subjects with and without symptoms. Of 648 respondents to the symptom questionnaire, 212 reported hand symptoms. In all, 155 were tested for nerve conduction of sensory and motor median nerve latencies, including 40 who had reported no symptoms. Patterns of hand symptoms were compared with nerve conduction results and associations weighted back to the general population. RESULTS: The presence of any hand symptoms had only a 40% sensitivity for delayed nerve conduction on latency testing. The presence of typical symptoms of carpal tunnel syndrome had a much lower sensitivity. CONCLUSION: In a community setting, the distribution of hand symptoms does not usefully correlate with the presence of delayed nerve conduction in the median nerve.
Adult↗
Estimating the prevalence of delayed median nerve conduction in the general population.
The objectives of this study were to determine the point prevalence of neurophysiologically defined median nerve compression and associated carpal tunnel syndrome in a random sample of the general population. The design was a two-stage screening study: (i) a cross-sectional survey to estimate the point prevalence of current hand symptoms; (ii) nerve conduction testing of the median nerve in weighted samples of the survey respondents. The target study population was a random sample of 1000 adults aged between 18 and 75 yr registered with a family practice in the UK. A mailed questionnaire enquired about hand symptoms on the day and included various demographic questions. Weighted random samples were taken based on the hand symptoms reported, and the subjects were invited to attend for motor and sensory median nerve conduction testing. A neurophysiological diagnosis of median nerve compression was made based on a number of different cut-offs using published criteria. Of those receiving a questionnaire, 79% responded. A total of 250 responders were invited to attend for nerve conduction testing, of whom 155 (62%) attended. Non-response to the questionnaire and non-attendance for nerve conduction testing may have biased the prevalence estimates. After adjustment for such biases, a prevalence estimate of between 7 and 16% was obtained, varying with the different cut-offs used to define delayed median nerve conduction. Subjects over 54 yr of age had a higher prevalence than younger participants. There was no difference in prevalence estimates between men and women. The conclusion reached was that carpal tunnel syndrome, as assessed by delayed median nerve conduction, is common in the general population.
Adolescent↗
Study and modulation of human cortical excitability with transcranial magnetic stimulation.
Transcranial magnetic stimulation (TMS) can be applied in different paradigms to obtain a measure of various aspects of cortical excitability. These different TMS paradigms provide information about different neurotransmitter systems, enhance our understanding about the pathophysiology of neuropsychiatric conditions, and in the future may be helpful as a guide for pharmacological interventions. In addition, repetitive TMS (rTMS) modulates cortical excitability beyond the duration of the rTMS trains themselves. Depending on rTMS parameters, a lasting inhibition or facilitation of cortical excitability can be induced. These effects can be demonstrated neurophysiologically or by combining rTMS with neuroimaging techniques. The effects do not remain limited to the cortical area directly targeted by rTMS, but affect a wider neural network transynaptically. Modulation of cortical excitability by rTMS may in the future be useful not only as a research tool but also as a therapeutic intervention in neurology, psychiatry, and neurorehabilitation.
Cerebral Cortex↗
Is delayed nerve conduction associated with increased self-reported disability in individuals with hand symptoms? A population based study.
OBJECTIVE: To determine whether, in individuals in the general population with hand symptoms, there is a greater level of disability in those with objective evidence of delayed nerve conduction. METHODS: A 19 item disability schedule relevant to hand function was developed for this survey. Subjects included 71 individual respondents to a random population survey who reported pain, tingling, numbness, or loss of sensation in the hands during an interview and who agreed to have nerve conduction studies. They were divided into those with (10) and without (61) delayed median nerve conduction. RESULTS: Those with delayed conduction were more likely to report disability for 14 of the 19 items assessed. Half those with delayed conduction reported disability in 7 or more items, compared with 18% of those with normal conduction (chi-squared = 7.49, p = 0.006). Disability items that showed the greatest disparity between the 2 groups were those that relied on hand, although not specifically fine hand, movements. CONCLUSION: Individuals with hand symptoms in the general population who have objective evidence of delayed nerve conduction have a greater degree of self-reported disability than those with normal conduction.
Carpal Tunnel Syndrome↗
Orthopaedic pre-operative assessment: a two-year experience in 5,000 patients.
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Aged↗
Disability. All systems go.
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Communication Devices for People with Disabilities↗
Psychological effects of continuation versus discontinuation of hormone replacement therapy by estrogen implants: a placebo-controlled study.
There is conflicting evidence regarding the effects of hormone replacement therapy (HRT) with estrogens on psychological and psychiatric symptoms of menopause. Forty women already attending a menopause clinic for continuing HRT by estrogen implants were studied in a randomized, double-blind, placebo-controlled study of estrogen reimplantation versus implantation of a placebo preparation. Assessment included self rating with visual analog scales, standardized psychological and menopause rating scales (Hospital Anxiety and Depression Scale, Self-Concept Questionnaire, Cognitive Failures Questionnaire, Greene Menopause Index), and interview with the Present State Examination. No difference in outcome with regard to either psychological or psychiatric symptoms was found 2 months after entry to the study between the women who received an active implant and those who received a placebo implant, in spite of the former group having a significant rise in estradiol levels. The only effect of HRT on physical symptoms was a nonsignificant reduction in flushes. Psychiatric morbidity of the study population was high with nearly half being "psychiatric cases" according to the Present State Examination at both initial assessment and follow-up. At entry to the study nearly all the women had levels of estradiol in the premenopausal range and four had supraphysiological levels. It appears likely that women were returning requesting a new implant because of symptoms related to nonhormonal factors. Women receiving continuing HRT for menopausal symptoms should be reassessed both for hormonal status and current psychosocial factors when they present with recurrent symptoms, especially those of a psychological or psychiatric nature.
Adult↗
The anthropometric assessment of dysmorphic features in schizophrenia as an index of its developmental origins.
BACKGROUND: Evidence suggests that schizophrenia may be a disorder with origins in early intrauterine mal-development. We have constructed a comprehensive anthropometric scale for the evaluation of dysmorphic features as an index of the nature and timing of developmental disturbance. METHOD: A detailed set of craniofacial and bodily measures was compiled and applied to 174 patients with schizophrenia and 80 matched control subjects. RESULTS: Patients had significantly higher scores on this scale and displayed multiple anomalies of the craniofacial region with an overall narrowing and elongation of the mid-face and lower face. Twelve craniofacial anomalies independently distinguished patients from controls and these variables correctly classified 95% of patients and 80% of control subjects. CONCLUSIONS: This new scale, while procedurally more exacting than the Waldrop scale, more clearly defines the topography of anomalies previously suspected in individuals with schizophrenia. These findings constitute direct evidence for disturbed craniofacial development in schizophrenia and indicate origins in the foetal period during which the characteristic human facial pattern evolves in close association with brain differentiation.
Abnormalities, Multiple↗
Management of idiopathic carpal tunnel syndrome (ICTS): a survey of rheumatologists' practice and proposed guidelines.
This questionnaire survey was undertaken to study the approaches to diagnosis and management of idiopathic carpal tunnel syndrome by rheumatologists. Analysis of the completed questionnaires (81% response) showed variations in availability and referral for electrophysiological tests (EMG), initial choice of treatment (depending on patient's age and occupation, duration of symptoms, severity of clinical and EMG findings) and decompression surgery. This led the authors to propose guidelines in the management of this common condition.
Anti-Inflammatory Agents, Non-Steroidal↗
Diagnostic test comparisons in patients with deep venous thrombosis.
UNLABELLED: New diagnostic modalities are often judged relative to accepted standard procedures. These comparisons are influenced by the accuracy of the standard test and the prevalence of disease in the study population. We evaluated the importance of these factors in the assessment of antifibrin scintigraphy when used to detect deep venous thrombosis. METHODS: Scintigraphy is compared to contrast venography in two populations of patients with different disease prevalence. We calculate the sensitivity and specificity by limb site (calf, knee, thigh) and the overall diagnosis for each modality. The sensitivity and specificity results obtained using venography as a gold standard are compared to those obtained using a maximum likelihood statistical procedure that does not require comparison to a standard test. RESULTS: A significant variation in the apparent sensitivity, specificity and accuracy is found for antifibrin scintigraphy as related to limb site, disease prevalence and use of a gold standard. The value of antifibrin scintigraphy sensitivity (84.7%) and specificity (75.8%) predicted by the maximum likelihood analysis are substantially higher than those obtained from the estimates based on the use of venography as a gold standard for both high and low disease prevalence populations. The sensitivities and specificities of antifibrin scintigraphy (84.7% and 75.8%, respectively) and venography (71.7% and 80.7%, respectively) are comparable for the combined study group of 268 patients. CONCLUSION: To obtain unbiased evaluations of a new diagnostic modality, it is essential to take into account the errors of the standard reference test and disease prevalence in the study population. The results of our analysis suggest that it may not be appropriate to use contrast venography as a gold standard in the assessment of new diagnostic imaging procedures for DVT.
Antibodies, Monoclonal↗
Replacement of transferrin by simple iron compounds for MDCK cells grown and subcultured in serum-free medium.
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Animals↗
The Japanese Tea Ceremony and stress management.
When people attend a Japanese Tea Ceremony, they often remark that it had a calming effect on them. The Tea Ceremony can be much more than that, however. Serious practitioners of tea develop a mind set and body control that enables them to transform tension-producing details of everyday life into moments of beauty, meaningfulness and tranquility. This effect comes from ritualizing ordinary chores and giving them an esthetic dimension and a noble motivation. Such discipline of mind and body also enables tea people to concentrate solely on the present moment, thereby shutting out worries about the past and anxieties about the future.
Ceremonial Behavior↗
Raynaud's phenomenon in idiopathic carpal tunnel syndrome.
Both carpal tunnel syndrome and Raynaud's phenomonon are common conditions in the general population. These two different conditions frequently cause similar symptoms such as tingling, numbness, and "deadness of the fingers". They may also co-exist for instance in scleroderma or rheumatoid arthritis. In order to study the association, if any, between these two conditions, we studied 93 patients with idiopathic carpal tunnel syndrome confirmed in electro-physiological tests with 57 control subjects, for the presence of Raynaud's phenomenon by means of a previously validated questionnaire. Raynaud's phenomenon was detected significantly more frequently (P = 0.002) in patients with idiopathic carpal tunnel syndrome (36%) compared to control subjects (12%). Thus there appears to be an association between these two conditions. The mechanism for this is not clear. Sympathetic dysfunction may play a part. Practitioners should be aware of the similarity of the symptoms and the possibility that the two conditions may co-exist.
Adult↗
Bush knife multiple flexor tendon injuries in Western Province.
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Hand Injuries↗
Cardiac involvement in seatbelt-related and direct sternal trauma: a prospective study and management implications.
The study set out to assess the incidence and consequences of pericardial and myocardial involvement in seatbelt-related sternal injury. Comparison was made with that from direct sternal trauma and implications for patient management were examined. The study was designed as a prospective sequential single centre study of 60 patients, from a total of 63 consecutive admissions over a 13 month period, admitted with blunt central chest trauma or multiple injuries involving the torso. Clinical status, correlated with echocardiographic, ECG and cardiac enzyme abnormalities were the main outcome measures. The study showed that 25% of 32 patients with seatbelt-related chest injury and 30% of 10 patients with multiple injuries had clinically unsuspected pericardial effusions detected by echocardiography. Pericardial effusion was not associated with an adverse outcome in the seatbelt-related injuries. Abnormalities of ECG or CK-MB isoenzyme levels were non-specific and did not correlate with the presence of pericardial effusion. From these data it is concluded that seatbelt-related sternal trauma is usually relatively benign. Echocardiography detects unsuspected pericardial effusion in a significant minority but ECG and cardiac enzyme estimations are of limited value. The routine admission to hospital of all patients with isolated seatbelt-related sternal trauma for cardiological monitoring is unnecessary. Inpatient treatment should be reserved for patients whose clinical condition, social circumstances or other injuries necessitate admission.
Accidents, Traffic↗
Biochemical features in patients with their first acute inferior myocardial infarction.
Sixty eight patients with their first acute inferior myocardial infarction were studied within 24 h of the onset of chest pain by vectorcardiography and biochemical indicators. Patients were divided into three groups according to the vectorcardiographic findings: Group 1 (31 patients with inferior myocardial infarction); Group 2 (26 patients with inferior myocardial infarction and right ventricular involvement); and Group 3 (11 patients with inferior-posterior infarction). Biochemical studies showed that the tendency for the magnitude of enzyme release varied with the site inferior-posterior > inferior+right ventricular > inferior groups. However, the differences between inferior and inferior plus right-ventricular groups were not significant. This suggests that the left ventricle dominates enzyme release regardless, with or without right ventricular involvement in patients with acute inferior myocardial infarction. When the enzyme levels in inferior and inferior-posterior myocardial infarction are compared, the HBDH and CK-MB were significantly higher (2P < 0.02 and 2P < 0.05 respectively). This confirms that when the vectorcardiographic QRS loop changes are large, more enzyme is released during acute myocardial infarction.
Acute Disease↗
Evaluation of a prototype expiratory-phase aerosol controller during simulated pediatric volume-controlled ventilation.
BACKGROUND: Some methods of administering aerosolized medications during volume-controlled ventilation require adjustment of ventilator settings to avoid inadvertent increases in tidal volume (VT). Our bench evaluation of an expiratory-phase aerosol controller (EXPAC) sought to determine the differences (1) in aerosol delivery between continuous and EXPAC nebulization in pediatric and neonatal ventilator circuits and (2) in delivered VT with a 30-cm vs a 213-cm nebulizer supply line. DESCRIPTION OF DEVICE: An electrically powered EXPAC linked to the VIP Bird ventilator by a fiberoptic cable and driven by flow from an integral blender was developed to our performance specifications. EVALUATION METHODS: In Phase 1, VT was measured at the patient connection under 3 conditions: (1) no nebulizer in-line, (2) a dry in-line nebulizer driven by EXPAC with a 30-cm supply line, and (3) Condition 2 with a 213-cm supply line. In Phase 2, we measured the aerosol delivered to a filter placed between the patient connector and the test lung. Aerosol delivery = filter wet weight-filter dry weight. RESULTS: (1) When EXPAC was operated according to manufacturer's recommendations, no significant differences were found between VTS measured with EXPAC plus the 30-cm line and with no nebulizer in-line. VT increased significantly (p = 0.0001, 1-way ANOVA) in both circuits with the 213-cm supply line. (2) Mean (SD) aerosol delivery at the patient connection of the pediatric circuit was 1.5 (0.002)% with EXPAC and 1.7 (0.003)% with continuous nebulization (p = 0.23, t test) and of the neonatal circuit 1.6 (0.002)% with EXPAC and 1.5 (0.002)% with continuous nebulization (p = 0.45, t test). CONCLUSIONS: EXPAC eliminated need for adjustment of ventilator settings and according to our data was as effective as continuous nebulization for delivering aerosol to the patient connection.
Administration, Inhalation↗