Search PubMed⌕ Search

Biomedical subjects

M Andrews

Publications and source records attributed to M Andrews.

At least 19 recordsLinked to original sources
PubMed1996

Lower limb alignment and foot angle are related to stance phase knee adduction in normal subjects: a critical analysis of the reliability of gait analysis data.

Anatomic and mechanical factors that affect loading in the knee joint can contribute to pathologic changes seen at the knee in degenerative joint disease and should be considered in treatment planning. The objectives of this study were to quantify the relationships between the alignment of the bones of the lower extremity, foot progression angle, and knee adduction moment, and to determine the reliability of our gait measurements. Gait analysis and complete radiographic evaluation of the lower extremity were performed on 11 healthy subjects. The gait measurements were recorded with an optoelectronic digitizer and a multi-component force plate. The subjects who had radiographic measurements indicative of varus alignment of the lower extremity had statistically higher peaks in knee adduction moment in early stance. Conversely, those with valgus alignment of the lower extremity had statistically lower peaks in knee adduction moment in early stance. The subjects who had a large toe-out angle and low ankle inversion moment peaks in late stance had significantly lower peaks in knee adduction moment in late stance. These significant (low to moderate) correlations suggest that the limbs with more valgus alignment and those with a toe-out gait exhibited a reduced peak adduction moment at the knee. To verify the reproducibility of the data, gait analysis testing was performed on each lower limb on 2 separate days for each subject. Analysis of variance showed that there was no significant difference between test limbs or test days for each subject. Our results suggest that the alignment of the lower limb and the foot progression angle, which can be readily measured in a clinical setting, can serve as predictors of knee joint loading in healthy individuals. These findings may have important implications for both surgical and nonsurgical treatment of abnormalities of the knee joint.

Adult↗
PubMed1996

Marked reduction in long-term cardiac deaths with aspirin after a coronary event. Multicenter Myocardial Ischemia Research Group.

OBJECTIVES: We sought to assess the role of aspirin in a precisely defined cohort with coronary disease receiving current therapy. BACKGROUND: Prior results suggest that aspirin modestly decreases cardiac mortality in patients with coronary disease. However, these findings reflect heterogeneous study conditions and earlier management strategies. METHODS: We utilized findings from the Multicenter Study of Myocardial Ischemia, which enrolled 936 subjects 1 to 6 months after an acute myocardial infarction (n = 651 [70%]) or unstable angina (n = 285 [30%]). The follow-up period averaged 23 months, with treatment determined by referring physicians. RESULTS: At enrollment, 751 patients (80%) took aspirin regularly, usually 250 to 325 mg/day. Before enrollment, 291 patients (31%) had thrombolysis, and 352 (38%) had coronary angioplasty. During follow-up, cardiac death occurred in 22 patients, all-cause mortality in 31 and cardiac death or nonfatal myocardial infarction in 70. Each of these outcomes was significantly less frequent among aspirin users. Cardiac death rate was markedly reduced: 1.6% for aspirin users and 5.4% for nonusers (p = 0.005). These differences were not explained by imbalances in predictors of postinfarction risk or therapy other than aspirin (Cox hazard ratio 0.37, p = 0.023). They persisted at least 2 years after enrollment. The difference in mortality rate was particularly prominent after thrombolysis: 0.9% for aspirin users and 8.8% for nonusers (p = 0.004). CONCLUSIONS: Reduction in cardiac deaths among aspirin users is substantially greater than that reported previously. Although derived secondarily, our findings suggest that current practice leads to situations in which aspirin exerts a long-term, life-protecting action, particularly after thrombolysis.

Aspirin↗
PubMed1996

Validity in qualitative health care research: an exploration of the impact of individual researcher perspectives within collaborative enquiry.

The authors of the present paper are a team of workers undertaking an empirical study of the definitions of quality in nursing used by National Health Service managers and others. At an early stage in that work, their concern to enhance the validity of the findings led them to participate in the exercise reported in this paper. Their purpose was to answer the question 'what is the effect of the researcher's perspective on the interpretation of the analysis of interview data?'. This paper reports an exploration of the problem of validity in qualitative enquiry and a review of published strategies for analysing interview data. It then outlines the strategy chosen by the team-the use of a framework which addresses validity in terms of adequacy of description. The experience of using this framework is described and some empirical evidence of the way that individual perspectives influence the analysis is presented. This gives rise to four principles which are considered to be of value in team working in qualitative enquiry, whether the team is a large one or consists of research student and supervisor alone. The paper concludes with practical suggestions as to how these principles may be built in to the project planning cycle.

Communication↗
PubMed1996

Problem-based learning in an undergraduate nursing programme: a case study.

Over the past 15 years, the 'theory-practice gap' has been a recurrent theme in the nurse education literature. Numerous explanations are put forward for its existence, along with many suggestions as to how the apparent divide can be bridged. A key component of nursing practice is problem-solving but not all nurses are competent at finding suitable solutions to the problems they face in practice settings. Therefore ways of developing learner proficiency in problem-solving is crucial and should occupy a substantial part of teacher activity. One recent educational method for promoting problem-solving skills is problem-based learning [PBL] using the hypothetico-deductive technique. This approach encourages students to work through problem situations, generating hypotheses and testing these against the relevant literature and personal experience. The process itself is seen as the essential element in developing problem-solving skills, so that when the students are qualified they can apply the same methods to patient care. This paper explores the use of the PBL approach with a group of 11 fourth-year undergraduate students. The method employed was a case study design using observation as the main data collection technique. Subsequent analysis focused on: (a) practice; (b) teaching method; (c) knowledge attainment; and (d) the role of the teacher.

Clinical Competence↗
PubMed1996

Dichotic listening to speech: VA-CD data from elderly subjects.

The Department of Veterans Affairs (VA) compact disc (VA-CD) Tonal and Speech Materials for Auditory Perceptual Assessment, Disc 1.0 contains three dichotic speech tests. Two of them, namely, dichotic digits and dichotic synthetic sentences, are tasks that are easily and accurately performed by young normal listeners. The third test, dichotic nonsense syllables, is a more difficult task for normal listeners to perform well. Few data have been gathered from use of the VA-CD with subjects other than young adults with normal hearing sensitivity. This account is about 19 elderly patients with hearing loss in a VA long-term care facility and how they performed on the trio of dichotic tasks on the disc. The digits, sentences, and syllables were presented at 80 dB SPL in a dichotic format requiring two responses to each trial. Trials using syllables were also done at 90 dB SPL to quantify the effects of hearing loss. Digits were recognized better than sentences; both were recognized better than syllables, and this was true for both ears. Compared to results from young listeners, correct responsiveness for older people was most reduced on the syllable task, but performance on dichotic sentences was also reduced. The results corroborate previous reports that suggest that many aging auditory systems do not process dichotic nonsense syllables as well as younger ones. The results also suggest that the dichotic procedures on the VA-CD provide a useful continuum of difficulty for the clinician and investigator.

Aged↗
PubMed1995

The relationship between the index of orthodontic treatment need and consensus opinion of a panel of 74 dentists.

This study looked at the aesthetic and dental health components of the index of orthodontic treatment need in relation to peer assessment of dental health and aesthetic need (panel of 74 dentists). The dental health component had a Spearmans correlation coefficient of +0.64 and the aesthetic component +0.86 when compared with the mean subjective opinion of 74 dentists. It has been proposed to have three categories for both the dental health and aesthetic components in accordance with consensus opinion. The panel of 74 examiners were more likely to regard aesthetics as a greater need for treatment than dental health.

Attitude of Health Personnel↗
PubMed1995

Calibration of dentists in the use of occlusal indices.

Dentists' opinions as to both need for and outcome of orthodontic treatment show wide variation. Within the profession there is an opportunity to reduce subjective bias and standardise criteria by the use of occlusal indices. The results of this study demonstrate that a group of dentists can easily be trained to record the Aesthetic and Dental Health Components of the Index of Orthodontic Treatment Need and the PAR index to a satisfactory level.

Bias↗
PubMed1995

Transcultural nursing: transforming the curriculum.

More than three decades have passed since Leininger established the field of transcultural nursing as a research based specialty which is recognized around the world as an essential and formal area of study and practice. When the importance of culture to nursing was first articulated by Leininger in the early 1950s, knowledge and awareness of these cultural influences were largely unknown and unrecognized in nursing education. The typical 1950s nursing curricula were soundly rooted in biophysical medical content, technical skills, tasks, and practices with no mention of cultural influences. Few nursing faculty had formal academic preparation in the social sciences, and Leininger was the first professional nurse with doctoral preparation in anthropology.

Curriculum↗
PubMed1995

Discontinued orthodontic treatment in the general dental services of England and Wales (1990-1991).

Relevant feature of a sample of discontinued treatments were investigated, including status at the start and at the time of discontinuation. In a comparison between two discontinued groups, those patients who simply failed to return tended to have lower pretreatment PAR scores, and were more likely to have received non-extraction treatments in which removable appliances were employed. However, when discontinued treatments were compared to completed treatments undertaken in 1987/8, the completed cases were only reduced by two further PAR points.

Adolescent↗
PubMed1995

Developing a philosophy for nursing practice.

Establishing a nursing philosophy is the first step in achieving an integrated approach to nursing care provision. A nursing philosophy should reflect the beliefs and values of the whole nursing team. It should be realistic and manifested through nursing action. Implementing change in professional practice requires thorough planning. This encompasses identifying and involving the target group and selecting the most appropriate strategy.

Humans↗
PubMed1994

Dentists variation in the determination of orthodontic treatment need.

The criteria that dentists use to judge the need for orthodontic treatment are not clear. This study investigates variation in dentists' perception of orthodontic treatment need. Seventy-four dentists were asked to assess 320 dental casts in relation to aesthetic and dental health need. The results of this investigation revealed that the panel was divided as what constituted a need for orthodontic treatment on dental health grounds. It is suggested that one method of achieving a more uniform evaluation of orthodontic treatment need is the use of an occlusal index. Until an occlusal index is accepted and used by the profession, the distortion of need and demand for orthodontic treatment by dentists' unequal perceptions will continue.

Attitude of Health Personnel↗
PubMed1994

Use of the Index of Orthodontic Treatment Need (IOTN) in assessing the need for orthodontic treatment pre- and post-appliance therapy.

The Index of Orthodontic Treatment Need (IOTN) was used to assess the need for orthodontic treatment before and after treatment, on a systematic sample of 1225 cases. On the whole, full upper and lower fixed appliances brought about a greater improvement in Aesthetics and Dental Health Components compared to other appliance techniques, and were less likely to make the occlusion worse. It was found that certain occlusal traits were more likely to be successfully treated than others. A common problem resulting from treatment was the development of a cross-bite.

Dental Health Surveys↗
PubMed1994

A preliminary comparison of the DPB's grading of completed orthodontic cases with the PAR Index.

The PAR (Peer Assessment Rating) Index was compared to the grading system currently in use for completed orthodontic cases at the Dental Practice Board of England and Wales. Forty completed cases were graded by the two systems, which were compared for their intra- and inter-examiner reliability, as well as for their agreement and disparity in judging outcomes of cases. The implications of the results on the monitoring of standards in the General Dental Services are discussed.

Confounding Factors, Epidemiologic↗
PubMed1993

Orthodontics in the general dental service of England and Wales: a critical assessment of standards.

Out of a sample of 1210 orthodontic patients treated within the General Dental Services in England and Wales, a high proportion showed no improvement. Upper and lower fixed appliances had the greatest influence on the outcome of treatment in terms of aesthetics, dental health need and standards. When treatment was analysed according to the appliance used, there were no statistically significant differences in the standard of treatment undertaken by specialist orthodontists and general dental practitioners. Methods for improving British orthodontic standards are considered.

Analysis of Variance↗
PubMed1993

Consultant opinion on orthodontic treatment plans used by dental practitioners: a pilot study.

Prior to 1987, dental practitioners in England and Wales intending to carry out all but the simplest orthodontic treatment within the National Health Service, were required to submit pretreatment study models, details of the orthodontic assessment and the proposed treatment plan to the Dental Estimates Board prior to starting treatment. Models taken at the end of treatment were required by the Board to enable payment to be made. In this pilot study, the acceptability of orthodontic treatment plans used by practitioners working in the General Dental Services was assessed by eight hospital consultants, using information about 40 cases submitted to the Dental Estimates Board in 1987/88. All consultants considered a high proportion of plans to be unacceptable, but agreement between the consultants was variable and some agreed with one another on very few plans. A single scorer used the weighted PAR (Peer Assessment Rating) index to assess the degree of departure from normal occlusion of both pre- and post-treatment models. Using accepted standards, only nine cases were greatly improved (PAR reduction > 70%) and the mean percentage reduction in PAR score was low. Consultant opinion on the appropriateness of treatment planning was not related to the outcome of orthodontic treatment.

Clinical Competence↗
PubMed1993

Osgood-Schlatter's disease complicating anterior cruciate ligament reconstruction.

Osgood-Schlatter's disease (OSD) is generally felt to be a benign self-limited disorder. In a small number of patients a symptomatic free bone ossicle persists at the tibial insertion of the patellar tendon. We report the case of a collegiate soccer player with a history of OSD who sustained an acute rupture of his anterior cruciate ligament (ACL). The presence of a free bone ossicle in his patellar tendon necessitated modification of our routine approach to ACL reconstruction. Awareness of the potential for patellar tendon graft problems in patients with previous OSD will allow surgeons to plan alternative reconstructive techniques based on the specific needs of the patient.

Adult↗