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Biomedical subjects

J P O'Sullivan

Publications and source records attributed to J P O'Sullivan.

At least 19 recordsLinked to original sources
PubMed2001

Intra- and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions.

OBJECTIVE: To examine the intra- and intertester reliability of the universal goniometer (UG) and parallelogram goniometer (PG), and to assess the criterion validity of the same instruments on subjects with knee restrictions. DESIGN: Reliability and validation study. SETTING: Radiology department at university hospital. PARTICIPANTS: Sixty subjects (34 men, 26 women; mean age, 52yr) with various knee restrictions. INTERVENTIONS: Sixteen goniometric measurements were collected per patient by 2 physical therapists. Subjects were evaluated in knee flexion and knee extension positions. To serve as a gold standard, radiographs were taken in both positions. MAIN OUTCOME MEASURES: Active knee flexion and knee extension on 2 goniometers, radiographs. Maximum active range of motion (AROM). RESULTS: The UG intratester reliability (intraclass correlation coefficients [ICCs]) was .997 in flexion and .972 to .985 in extension. The results were also high with the PG (ICC =.996,.953-.955) for flexion and extension, respectively. The intertester reliability was high for flexion (ICC =.977-.982) and for extension (ICC =.893-.926) when using the UG. For the PG, ICC results ranged from .959 to .970 for flexion and from .856 to .898 for extension. Criterion validity (r) varied from .975 to .987 for flexion and from .390 to .442 for extension with the UG, and from .976 to .985 for flexion and .423 to .514 for extension with the PG. CONCLUSION: Intra- and intertester reliability were high for both goniometers. The results for the criterion validity varied. Our study also revealed that it is preferable to use goniometry rather than visual estimations when measuring AROM. It is recommended that the same therapist take all the measurements when assessing AROM for UG and PG goniometric measurements on patients with knee restrictions.

Anthropometry↗
PubMed2000

Reduction in episodes of self harm/harm to others in severely mentally ill population through assertive outreach.

This article aims to apply the process of clinical governance to the management of patients with a major mental illness, living in the community, with a history of self harm and/or harm to others; and to design an early warning system to drive rapid intervention if patients miss a clinic appointment. This follows the recommendations of good clinical practice for this vulnerable group.

Adult↗
PubMed1999

The characteristics of false negative cervical smears--implications for the UK cervical cancer screening programme.

OBJECTIVE: To accurately determine whether there are any features of an abnormal cervical smear that predispose to the production of a false negative report, in order to gain insight into why false negative reports are issued, and to establish whether there are steps that can be taken to reduce them. DESIGN: A quantitative retrospective analysis using the AxioHOME microscope of the number, size, and spatial distribution of abnormal cells in a set of 50 slides comprising a mixture of false negative and true positive cervical smears. SETTING: Five different cytology laboratories in the United Kingdom. RESULTS: False negative smears were found to be quantitatively different from true positive smears. They contained significantly fewer abnormal cells (median number of abnormal cells for false negatives = 173, median number of abnormal cells for true positives = 1712; p < 0.004), and these were more likely to be unevenly distributed on the slide. It was possible to predict with a high degree of accuracy whether a smear was a false negative by analysing number and distribution alone (kappa = 0.57). CONCLUSIONS: False negatives are quantitatively different from true positive cervical smears. This has important implications for quality assurance in the UK cervical screening programme. More consideration needs to be given to the effectiveness of existing quality assurance measures, which need to be tailored to the preferential detection of this type of abnormal cervical smear.

Cell Count↗
PubMed1998

A case-control study of true-positive versus false-negative cervical smears in women with cervical intraepithelial neoplasia (CIN) III.

Cervical smears (n = 150) from five departments showing high-grade dyskaryosis were examined by three cytologists. All the smears came from patients with biopsy-proven CIN III. One hundred had been correctly reported (true positives) but 50 had originally been reported as negative and had been found to be positive only on review (false negatives). There were significant differences between the two sets in the characteristics of the dyskaryotic cell population. The false-negative smears tended to have fewer than 200 dyskaryotic cells. The nuclei of the dyskaryotic cells tended to have fine rather than coarse nuclear chromatin. A smear with fewer than 50 dyskaryotic cells is 26 times more likely to be reported as negative than one with more than 200 dyskaryotic cells. The results suggest that there is a type of severely dyskaryotic smear that is inherently likely to be missed on routine screening.

Case-Control Studies↗
PubMed1997

Intratester and intertester reliability and criterion validity of the parallelogram and universal goniometers for active knee flexion in healthy subjects.

BACKGROUND AND PURPOSE: A new parallelogram goniometer was designed by the Rehabilitation Centre of the Royal Ottawa Health Care Group in 1983. The advantage of using such a goniometer is that the clinician is not required to estimate the joint axis of rotation when taking a measurement. The parallelogram goniometer has obtained a good intratester and intertester reliability when measuring active range of motion of hip abduction on eight individuals with hip pathologies. However, the validity of the parallelogram goniometer has not been examined. The purposes of this study were to examine the intratester and intertester reliability and the criterion validity of the parallelogram and universal goniometers for active knee flexion on healthy individuals. SUBJECTS: Sixty healthy university students (44 females and 16 males; mean age of 20.6 yrs.) participated to this study. METHODS: Measurements with the universal and parallelogram goniometers were taken in two different positions, the smaller and larger angles of active knee flexion. All measurements were taken by two trained testers. A radiograph was taken in both positions to serve as the 'gold standard'. The sequence of the measurements and radiographs were randomly selected. The intra and intertester reliability of both goniometers were established by calculating the intraclass correlation coefficients (ICCs) using the repeated-measures ANOVA. The criterion validity was examined by calculating Pearson product-moment correlation coefficients (tau) between each goniometric and radiologic measurements. A 0.05 level of significance was chosen for each statistical test. RESULTS: Intratester reliability ranged from good to excellent for the small angles (ICC = 0.85 and 0.87) and the large angles (ICC = 0.91 and 0.96) when using the parallelogram goniometer. Intertester reliability was fair for the small angles of flexion (ICC = 0.43 to 0.52) and good to excellent for the large angles of flexion (ICC = 0.82 to 0.88). The parallelogram goniometer was found to have greater validity when measuring the large angles of knee flexion (r = 0.73 and 0.77) compared to the small angles of knee flexion (r = 0.33 and 0.41). Similar results of reliability and validity were obtained with the universal goniometer. CONCLUSION: The results of this study have clinical importance. The use of the parallelogram goniometer was found to be as reliable and valid as the universal goniometer when measuring active knee flexion. However, the parallelogram goniometer offered clinicians the advantages of obtaining precise angular measurements with fewer adjustments, and a faster application technique. Further studies on the parallelogram goniometer are necessary among individuals presenting with altered range of motion at different joints.

Adult↗
PubMed1996

Inter- and intra-observer variation in the reporting of cervical smears: specialist cytopathologists versus histopathologists.

One hundred and ten cervical smears were circulated to five specialist consultant cytopathologists and five consultant histopathologists. Of these smears, 100 were randomized and re-circulated. The cytopathologists reported endocervical cells and wart virus infection more frequently than the histopathologists, although neither group showed good inter-observer agreement for either assessment. Apart from smear adequacy and the presence of endocervical cells, both groups showed good intra-observer agreement in all the parameters measured. This suggests that overall individuals were applying their own personal criteria with consistency over time, although a previous study had shown considerable lack of inter-observer agreement among the histopathologists on the grade of dyskaryosis and the management recommendation. The results indicate that specialist cytopathologists bring a different viewpoint to the reporting of cervical smears than histopathologists. They also show a lack of standardization in the reporting of smears despite the guidelines issued by the British Society for Clinical Cytology.

Cytodiagnosis↗
PubMed1996

The coroner's necropsy in sudden death: an under-used source of epidemiological information.

AIMS: To determine the number of unsuspected disease processes found in a series of cases of sudden unexpected death occurring outside hospital and to enumerate how many of these were not recorded on the death certificate. METHODS: In a series of 1000 routine coroners' necropsies for sudden unexpected death, major findings that had not been known about in life were recorded. Macroscopic findings were confirmed histologically as appropriate. The deaths occurred either outside hospital or in the Accident and Emergency department before the patient could be examined. Cot deaths and decomposed bodies were excluded. RESULTS: There were 575 major findings in 532 (53.2%) subjects that had been clinically silent in life. Of these 575 findings, 277 (48.2%) were not the cause of death and so did not appear on the death certificate. Eighty per cent of the major alimentary system findings and all of the genitourinary findings were of this type. In addition, however, 30% of the major cardiovascular and 34% of the major respiratory findings were not recorded on the death certificate for this reason. CONCLUSIONS: A large amount of important epidemiological data is being lost in the operation of the coronial system. Some of this information is irrecoverable as the function of the death certificate is to provide a cause of death only. In addition, information may be being lost because the necropsy is not being performed adequately and is not subject to audit.

Adolescent↗
PubMed1994

Interobserver variation in the diagnosis and grading of dyskaryosis in cervical smears: specialist cytopathologists compared with non-specialists.

AIMS: To compare the assessment of dyskaryosis in cervical smears made by specialist consultant cytopathologists and consultant general histopathologists. METHODS: One hundred and ten cervical smears were circulated to 10 observers from five district general hospital histopathology departments and five major departments of cytopathology. Their responses were analysed by five consultant general histopathologists and five consultant specialist cytopathologists. In 54 of the 110 cases, the histology of a corresponding cervical biopsy specimen was compared with the smear assessments. RESULTS: Specialist cytopathologists were more consistent than non-specialists when diagnosing and grading dyskaryosis. They chose the higher grades of dyskaryosis more frequently than the non-specialists. The cytopathologists recommended referral for colposcopy more frequently, but if they asked for a repeat smear, they wanted it done within three months more frequently than the histopathologists. The specialists were more frequently in agreement with the biopsy grade of intra-epithelial neoplasia than the non-specialists, whose smear diagnoses tended to underestimate the severity of the histopathological abnormality. CONCLUSIONS: This study has shown major differences between specialist and non-specialist cytopathologists in the diagnosis and grading of cervical smears and in the recommended management of patients with abnormal smears. These differences may result in uneven clinical management of women with smear abnormalities. It is therefore important to explore possible strategies for standardising the reporting of cervical smears, such as centralisation of screening services, accreditation in cytopathology for non-specialist consultants, and the value of participation in external quality assessment schemes.

Female↗
PubMed1993

Bone banking: from Tamworth Base Hospital to Royal Newcastle Hospital.

During the first 6 months of 1992, orthopaedic surgeons at Tamworth Base Hospital were involved in a feasibility study using allograft bone and donating femoral heads to Royal Newcastle Hospital Bone Bank. The two hospitals being separated by 300 km meant that storage, packaging and transportation had to be refined in order to ensure sterility and safe delivery of the bone. This study was undertaken because of the growing need for allograft bone in revision hip arthroplasty at Tamworth Base Hospital. This need for allograft bone has been expressed by other country based orthopaedic surgeons and will only increase during the next few years as primary hip prostheses age and revision hip surgery continues to advance.

Australia↗
PubMed1990

Reporting cervical intra-epithelial neoplasia (CIN): intra- and interpathologist variation and factors associated with disagreement.

Eight histopathologists, based at different hospitals, who had previously examined 100 consecutive colposcopic cervical biopsies were circulated with the results of the initial study. The slides were then 'reblinded' and re-examined by the pathologists who, as before, assigned them into one of six diagnostic categories. The degree of interpathologist agreement for the seven observers who returned usable responses was characterized by kappa statistics and compared to the corresponding figures for the same observers from the previous study. Although some of the observers showed significant alterations in their diagnostic practices there was persistent poor agreement for CIN 1 and 2, mediocre agreement for CIN 3 and excellent agreement for invasive carcinoma. Intra-observer agreement was consistently better than inter-observer agreement for each of the diagnostic categories. Significant differences were found among observers in the degree of intra-observer variability. The 20 cases in which there was most disagreement were re-examined by one of the authors who compared these with 20 biopsies which caused little disagreement. Disagreement was considered to be associated with florid papilloma-virus changes, basal cell hyperplasia and severe inflammation in varying combinations. On the basis of these findings we suggest changes in the terminology of CIN lesions.

Carcinoma in Situ↗
PubMed1989

Observer variation in histopathological diagnosis and grading of cervical intraepithelial neoplasia.

To assess the variability among histopathologists in diagnosing and grading cervical intraepithelial neoplasia eight experienced histopathologists based at different hospitals examined the same set of 100 consecutive colposcopic cervical biopsy specimens and assigned them into one of six diagnostic categories. These were normal squamous epithelium, non-neoplastic squamous proliferations, cervical intraepithelial neoplasia grades I, II, and III, and other. The histopathologists were given currently accepted criteria for diagnosing and grading cervical intraepithelial neoplasia and asked to mark their degree of confidence about their decision on a visual linear analogue scale provided. The degree of agreement between the histopathologists was characterised by kappa statistics, which showed an overall poor agreement (unweighted kappa 0.358). Agreement between observers was excellent for invasive lesions, moderately good for cervical intraepithelial neoplasia grade III, and poor for cervical intraepithelial neoplasia grades I and II (unweighted kappa 0.832, 0.496, 0.172, and 0.175, respectively); the kappa value for all grades of cervical intraepithelial neoplasia taken together was 0.660. The most important source of disagreement lay in the distinction of reactive squamous proliferations from cervical intraepithelial neoplasia grade I. The histopathologists were confident in diagnosing cervical intraepithelial neoplasia grade III and invasive carcinoma (other) but not as confident in diagnosing cervical intraepithelial neoplasia grades I and II and glandular atypia (other). Experienced histopathologists show considerable interobserver variability in grading cervical intraepithelial neoplasia and more importantly in distinguishing between reactive squamous proliferations and cervical intraepithelial neoplasia grade I. It is suggested that the three grade division of cervical intraepithelial neoplasia should be abandoned and a borderline category introduced that entails follow up without treatment.

Biopsy↗
PubMed1988

Low power interstitial Nd YAG laser photocoagulation in normal and neoplastic rat colon.

The effects of low power (1-2 Watts), long exposure (30-400 seconds), interstitial Nd YAG laser therapy on dimethylhydrazine induced rat colonic neoplasms and normal rat colon have been studied. After a single exposure with appropriate laser parameters, dimethylhydrazine induced rat colonic neoplasms underwent coagulative necrosis, sloughed off over a four day period, and left an ulcer which healed within 28 days. Inadequate laser energy resulted in incomplete tumour necrosis whilst excessive laser power or energy increased the likelihood of perforation. Treatment of normal colon with 1 Watt for 30 seconds or longer resulted in coagulative damage which healed by granulation. Mean colonic bursting pressures were significantly decreased one hour after treatment with 1 Watt for 75 or 100 seconds compared with untreated colon (p less than 0.05 and p less than 0.001 respectively) but not in colon treated with 1 Watt for 30 or 50 seconds. In animals treated with 1 Watt for 100 seconds mean bursting pressures were significantly lower than untreated animals when the animals were killed two, four, and seven days after lasering (p less than 0.001 in each case) but not in animals killed at 11, 17, or 21 days. The technique may be of value in the treatment of some inoperable colorectal cancers and sessile polyps in man.

Animals↗
PubMed1987

Biological effects of intrahepatic neodymium:yttrium-aluminum-garnet laser photocoagulation in rats.

The effects of low-power neodymium:yttrium-aluminum-garnet laser light delivered intrahepatically in normal rats have been studied. Power settings of 0.5-2.0 W and exposures of 50-2400 s produced well-defined, highly reproducible necrotic lesions of up to 16 mm in diameter. The diameter of the necrotic lesions depended upon both the power setting and total energy delivered. Histologic examination showed coagulative necrosis that healed by granulation with a small residual fibrous nodule by 60 days. Microthermocouples embedded within the liver indicated temperatures of up to 100 degrees C close to the fiber tip for the higher power settings, and temperatures at the periphery of the necrotic zones were consistent with tissue damage by a purely thermal effect. Radiologic examination of photocoagulated lobes of liver in which arterial tree had been filled with a radiopaque polymer demonstrated loss of all small and some large vessels in the treated area. The technique could be used to induce necrosis of intrahepatic and other tumors.

Aluminum↗
PubMed1986

Nature of the bleeding vessel in recurrently bleeding gastric ulcers.

An unselected consecutive series of 826 patients admitted for acute upper gastrointestinal bleeding underwent urgent endoscopy. Peptic ulcers were found in 402 (49%). Of the 329 ulcer craters that could be fully examined, visible vessels were identified in 156 (47%), other stigmata of recent hemorrhage in 66, and no stigmata of recent hemorrhage in 107. One hundred twenty-nine patients with stigmata of recent hemorrhage (93 of whom had visible vessels) randomly allocated to no endoscopic treatment were observed for evidence of further bleeding. Fifty-four of the 93 patients (58%) with visible vessels rebled, compared with 2 of 36 (6%) with other stigmata of recent hemorrhage. No patient without stigmata of recent hemorrhage rebled. Twenty-seven patients in whom a visible vessel in a gastric ulcer was identified at endoscopy underwent urgent partial gastrectomy because of recurrent bleeding. The vessel identified at endoscopy was found in 26 of 27 resection specimens (96%). The arterial vessel wall protruded above the surface of the ulcer crater in 10 specimens, and clot in continuity with a breach in the vessel wall protruded in a further 10 specimens. Postoperative angiography, when technically possible, showed that the breached artery ran across the base of the ulcer in all of these specimens. Pathological changes were common in the bleeding artery and included arteritis in 24 of 29 (83%) eroded arteries found in these specimens, with aneurysmal dilatation in 14 of 27 (52%) bleeding points that could be fully examined. The ulcer had penetrated to serosa in 13 specimens (45%). The bleeding artery had a mean external diameter of 0.7 mm with a range of 0.1-1.8 mm. This study provides new information about the nature of the bleeding vessel in gastric ulcers, and some of this information is relevant in planning studies of endoscopic therapy for bleeding peptic ulcers. It validates the endoscopic identification of a visible vessel, and confirms that such identification has a high predictive value for the development of recurrent hemorrhage.

Arteries↗