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Biomedical subjects

L Kelly

Publications and source records attributed to L Kelly.

At least 145 records · Page 8Linked to original sources
PubMed1976

Posterior cervical fusion in chidren.

Six cases of posterior cervical fusion with rib grafts in children are reported. Four of the children had sustained cervical spine injuries in accidents, and two had congenital absence of the odontoid. Three-level fusions (C1-3) were done in four children, and four-level fusions (C1-4) in two. One child died of unrelated causes 3 months after the operation. The other five children have been followed for 5 to 13 years. All are doing well and each has a remarkably supple, stable neck and no neurological deficit.

Adolescent↗
PubMedDate not supplied

Value of sentinel node biopsy in the management of breast cancer.

AIMS: To determine the rate of detection of the sentinel node using both blue dye and radioisotope, and the accuracy with which the sentinel node histology reflects the nodal status of the axilla in a series of patients with clinically node-negative breast cancer. PATIENTS AND METHODS: During a 32-month period from May 1998 to December 2000, 73 patients with clinically node-negative breast cancer underwent sentinel node biopsy immediately followed by formal axillary lymphadenectomy. The sentinel node(s) was identified using a combination of lymphoscintigraphy, blue dye and an intraoperative hand-held gamma probe. RESULTS: The mean age of the 73 patients was 58 years (range 32-83 years). Twenty-six per cent (19/73) had previous surgical/excisional biopsy. Pre-operative lymphoscintigraphy was positive in 74% (54/73) of patients. Combination of blue dye and radioisotope was better than either method in isolation for identifying the sentinel node, yielding a success rate of 96% (70/73). A total of 32 cases proved to have positive nodal disease on histological examination. In 44% (14/32) of patients, the sentinel node was the only positive node. Forty-seven per cent (15/32) of patients in whom the sentinel node was positive also had positive nodes in the axillary nodal basin. There were 3/32 false negative cases, giving a false negative rate of 9.4%. CONCLUSION: Sentinel node biopsy will have a role in the management of breast cancer. However, widespread adaptation of this technique awaits the results of prospective, randomised trials.

Adult↗
PubMedDate not supplied

Safety guidelines for radiolocalised sentinel node resection.

BACKGROUND: Sentinel node radiolocalisation procedures are associated with low levels of radiation exposure. Radioactive material is present in the operating theatre and pathology laboratory. In most hospitals there are no official regulations in place for sentinel node radiation exposure. AIM: To establish guidelines on the safety of sentinel node mapping with emphasis on the management of radioisotopes. METHODS: The current literature regarding sentinel node procedures and radiation safety was reviewed. EU and US radiation safety regulations were scrutinised. RESULTS: Personnel involved in sentinel node procedures are exposed to low levels of radiation. These levels are not high enough to require designated radiation workers in the theatre and pathology laboratory. Awareness of radiation safety and certain precautions during the procedure and processing of the specimen can further reduce levels of exposure. CONCLUSION: Although low levels of radiation exposure are associated with sentinel node procedures, awareness of radiation safety and adherence to regulations, along with close interdepartmental co-operation, are recommended for further reduction in radiation exposure and safe application of this technique.

Breast Neoplasms↗
PubMedDate not supplied

Improving caretakers' knowledge of fever management in preschool children: is it possible?

INTRODUCTION: The purpose of this study was to investigate caretakers' knowledge of the implications of fever, the appropriate method of fever management, and the effectiveness of an educational intervention directed toward improving caretakers' ability to manage their child's fever. METHOD: A descriptive, comparative study was conducted with a convenience sample of 86 caretakers. Follow-up data were obtained for 50 caretakers. Data were collected with an investigator-developed open-ended questionnaire. RESULTS: A fever of 104 degrees F was considered to be harmful by 31 subjects. However, fever as low as 100 degrees F was perceived to be harmful by eight subjects. Administration of acetaminophen was the most frequent method of treatment (84 [98%] of 86). No significant improvement in caretaker knowledge in terms of the level of fever at which to administer medication was demonstrated (chi-squared analysis, .012; df, 1; p = 0.91). Accuracy of antipyretic medication dosage was improved (chi-squared analysis, 13.13; df, 6; p = 0.04). DISCUSSION: Caretakers continue to perceive even marginal fevers can cause harm. Improvement was noted in dose accuracy after the intervention. The lack of significant improvement in caretaker knowledge regarding some aspects of fever management after the educational intervention suggests that more than a one-time educational intervention is required.

Acetaminophen↗
PubMedDate not supplied

A survey of Canadian hand therapists: demographics, roles, and educational needs.

A questionnaire was mailed to 236 occupational therapists (OTs) and physical therapists (PTs) practicing hand rehabilitation in Canada, to develop a demographic profile of practitioners, determine the scope of practice in Canada, and study educational and certification issues. The response rate was 78%, which provided an accurate profile. Sixty-two percent of respondents were OTs, 35% PTs, and 3% combined P/OTs. While 82% of respondents supported a certification process, only 13% were certified hand therapists. Forty-two percent practice with both OT and PT skills. Most respondents held bachelor's degrees and reported formal OT or PT education as their primary mode of acquiring knowledge. The high response rate indicated that commitment to and interest in the practice of hand therapy are strong in Canada. Therapists would like to see more continuing education offered in Canada, and a certification process to ensure professional standards.

Attitude of Health Personnel↗
PubMedDate not supplied

Use of capnography in the delivery room for assessment of endotracheal tube placement.

OBJECTIVE: Determine whether end-tidal CO(2) (ETCO(2)) monitoring allows for more rapid discrimination of tracheal versus esophageal intubation than standard clinical assessment during neonatal resuscitation in the delivery room. STUDY DESIGN: Endotracheal tube (ETT) placement was assessed using either a hand-held monitor that displayed graphic and quantitative ETCO(2) by an investigator not involved in the resuscitation, or using clinical parameters by the resuscitation team unaware of the ETCO(2) data. The time differences between ETCO(2) and clinical determinations of ETT placement were compared. RESULTS: Capnography correctly identified all 16 tracheal and 11 esophageal intubations performed on 16 study infants. The median times (and range) in seconds required for capnographic and clinical determination of tracheal intubation were 9 (4 to 26) vs. 35 (18 to 70), p<.001, and for esophageal intubation were 9 (4 to 17) vs. 30 (25 to 111), p=.001. CONCLUSION: Capnography allowed more rapid determination of both tracheal and unintended esophageal intubation than clinical assessment.

Apgar Score↗
PubMedDate not supplied

Comparison of scales of amino acid side chain properties by conservation during evolution of four proteins.

As the amino acid sequence of a given protein changes along the phylogenetic tree, enough of the overall folding pattern must be conserved to ensure that the protein still fulfils its biological function. Eighteen published scales which tabulate various side chain properties are compared here by computing the variance of each scale when applied to each of several protein families. The conservation of each scale of side chain properties is examined for the 20,627 residues in 60 mammalian myoglobins, 31 mammalian ribonucleases, insulin A and B chains (29 sequences each), 29 vertebrate and 28 plant cytochrome c's. Those scales which are the most highly conserved through the evolution of each protein family may well be the best predictors of protein folding patterns. The mean-area-buried scale and the optimized matching hydrophobicities scale are more conserved than other scales. An additional result is the relatively poor conservation across evolution of the Chou-Fasman secondary structure predictors.

Amino Acid Sequence↗
PubMedDate not supplied

Preventing repeat adolescent pregnancies with early adoption of the contraceptive implant.

CONTEXT: Even in intensive, adolescent-oriented programs, in which access to highly effective contraceptives is guaranteed, repeat adolescent pregnancies commonly occur. METHODS: To assess whether adoption of the contraceptive implant would lower the rate of repeat pregnancy, contraceptive use and pregnancy outcomes were tracked among 309 adolescent mothers--171 "early" implant users who began use within six months of delivery and 138 who either adopted another method or had used no method. Participants were interviewed at delivery and at six-month intervals through the second year postpartum. Multivariate logistic regression analyses were conducted to ascertain the likelihood of a repeat pregnancy within the first and second year postpartum. RESULTS: During the first year postpartum, although 7% of the early implant users had their implants removed, pregnancy rates were significantly (p < .0001) lower among early implant users (less than 1%) than among the other adolescent mothers in the sample (20%). By the end of the second year postpartum, 37% of early implant users had discontinued use. Nevertheless, their two-year pregnancy rate (12%) remained significantly lower (p < .0001) than that of the other adolescent mothers (46%). The multivariate analysis showed that early implant use was the only independent predictor of a repeat pregnancy within the first year postpartum, while early use, parity and number of risk factors for repeat pregnancy were independently associated with the likelihood of another pregnancy in the second year postpartum. CONCLUSIONS: Although early implant insertion significantly decreased the rate of rapid, repeat adolescent pregnancies, the rates of removal and of pregnancy by the end of the second year postpartum were high. Thus, health care providers need to address the motivational components of adolescent pregnancy even among those who accept ostensibly long-term methods.

Adolescent↗
PubMedDate not supplied

The value of sentinel node mapping for staging melanoma.

One of the most important prognostic features of malignant melanoma is the involvement of regional lymph nodes. Sentinel lymph node biopsy (SLNB) is increasingly used to stage melanoma in order to avoid lymph node dissection in patients who clinically have no lymph node involvement. We present a prospective study of 27 patients who underwent SLNB from November 1999. Lymphoscintigraphy was done on the day of surgery, and SLNB guided by blue dye and/or gamma probe performed. A sentinel node was identified in all 27 patients, mean age 46 years. The mean Breslow thickness was 1.63mm. Excision of 1-3 sentinel nodes (mean 1.5) was performed. In 3/27 patients metastatic disease was detected in the sentinel node, 2 patients had therapeutic lymph node dissections, and one had chemotherapy. There were no major complications. SLNB is a valuable technique for staging melanoma, however impact on overall survival requires longer follow up.

Adolescent↗
PubMedDate not supplied

Treatment for alteration in oral mucosa related to chemotherapy.

Possibly one of the most painful and difficult side effects of chemoradiotherapy is stomatitis. Early intervention to limit its severity and aggressive treatment to prevent related complications such as infection and hemorrhage are essential.

Adolescent↗