Search PubMed⌕ Search

Biomedical subjects

M Coffey

Publications and source records attributed to M Coffey.

51 records · Page 3Linked to original sources
PubMed1989

Rheumatoid factors in cystic fibrosis: associations with disease manifestations and recurrent bacterial infections.

Serum IgM and IgA rheumatoid factor (RF) levels were measured by ELISA in 71 adolescent and adult patients with cystic fibrosis (CF) and 69 control subjects. IgM RF values from 15 (21%) CF patients greater than 2 s.d. of control subjects (P less than 0.001). Elevated IgM RF values were significantly associated with worse spirometric measurements of pulmonary function (P less than 0.01) and with more frequent exacerbations of respiratory tract infection (P less than 0.001). A characteristic episodic arthropathy occurred in 27% of IgM RF positive patients, compared with 4% of IgM RF negative patients (P = 0.015). IgA RF values from 26 (37%) CF patients were elevated (P less than 0.001). Pulmonary function was significantly worse in patients with elevated IgA RF values (P less than 0.001). However, IgA RF was not associated with exacerbations of respiratory tract infection or episodic arthropathy. Both IgM and IgA RF values correlated significantly with their corresponding Ig levels, suggesting that RF synthesis was the result of polyclonal B cell activation. It is concluded that serum IgM RF values in CF are associated with worse lung disease and recurring bacterial antigenic stimulation. IgM RF may contribute to the development of arthropathy in some patients. Induction of IgA RF synthesis and its pathogenic potential may differ from IgM RF.

Adolescent↗
PubMed1987

Upper airway obstruction during sleep in normal subjects after selective topical oropharyngeal anesthesia.

Previous animal studies support the presence of an upper airway reflex mechanism that when blocked by topical anesthesia of the upper airway results in upper airway occlusion. We sought a similar reflex mechanism in humans. Nine normal male volunteers 20 to 28 yr of age underwent 3 successive overnight sleep studies: a control study (C); a study in which selective topical oropharyngeal anesthesia (OPA) was achieved prior to sleep using a 10% lidocaine spray and 0.25% bupivocaine solution; a study in which selective nasal anesthesia (NA) was achieved prior to sleep using a mixture of 2% lidocaine and 0.25% bupivocaine solutions instilled into the nose while the nasal airway was positioned as the most dependent part of the upper airway. Total sleep times were similar during the 3 study nights as were the amounts of slow-wave and rapid-eye-movement (REM) sleep. Obstructive apneas and hypopneas (OAH) differed significantly between the 3 study nights [13(3.8), mean (SEM), during OPA as compared to 3(1.8) during C and 7(2.5) during NA; p less than 0.01 by ANOVA] and were most frequent during REM sleep. Total apneas and hypopneas also differed significantly between the 3 study nights [19(3.9) during OPA as compared to 8(2.1) during C and 14(3.9) during NA; p less than 0.01 by ANOVA]. Movement arousals terminating periods of abnormal respiration also differed significantly [21(6.1) during OPA as compared to 12(3.6) during C and 14(4.6) during NA; p less than 0.05 by ANOVA]. No subject, however, developed clinically significant sleep apnea or significant oxygen desaturation during sleep.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Ventilation and gas exchange during sleep in patients with interstitial lung disease.

Ventilation and gas exchange during overnight sleep was studied in a group of seven patients with severe interstitial lung disease (mean vital capacity 50%, mean diffusing capacity 46% predicted), to see whether clinically significant oxygen desaturation occurred. Patients with a history of loud snoring or clinically significant airflow obstruction were excluded. Sleep was fragmented in these patients, but all achieved rapid eye movement (REM) sleep. All patients showed episodes of oxygen desaturation during sleep--mean (SEM) awake arterial oxygen saturation (SaO2) was 92.9% (0.3%) compared with a mean minimum SaO2 during sleep of 83.2% (2.1%) (p less than 0.01). These episodes were, however, transient, and mean SaO2 showed only a slight fall between wakefulness and sleep (non-REM 91.5%, REM 90.4%; NS). Furthermore, SaO2 during non-REM sleep correlated well (p less than 0.001) with SaO2 during wakefulness. Respiratory frequency showed a significant fall between wakefulness and sleep--21.1 (1.8) versus 17.3 (1.5) breaths per minute (p less than 0.02). Our data suggest that nocturnal oxygen treatment need not be considered in patients with interstitial lung disease unless the level of oxygenation while they are awake indicates the need for such treatment.

Humans↗
PubMedDate not supplied

Supervised discharge: concerns about the new powers for nurses.

The introduction of the Mental Health (Patients in the Community) Act 1995 has been the cause of much concern, although there has been little published debate from nurses. This article discusses key elements of the Act, including the power to 'take and convey', resourcing community care, the principle of reciprocity and the use of coercion to gain therapeutic cooperation. American literature suggests that the way community psychiatric nurses feel about using the power to 'take and convey' and coercion is the determining factor in the successful implementation of this act.

Community Health Nursing↗
PubMedDate not supplied

Psychosis and medication: strategies for improving adherence.

The development of traditional anti-psychotic medication has led to improvements in the care of mentally ill people. These medications have been the mainstay of drug treatment for schizophrenia for many years. In recent years, however, the advent of so-called 'atypical' anti-psychotics has enabled patients to be treated without experiencing the range of severe side-effects associated with traditional medicines. Ensuring mentally ill patients take prescribed treatment is seen as an important element of the work of mental health nurses. Adopting approaches which are non-adversarial may provide better outcomes than straightforward advice giving. A combination of psycho-education and a technique known as brief motivational interviewing could provide a useful starting point for nurses. Whether such approaches will be supported given recent declarations on policy intentions remains to be seen.

Antipsychotic Agents↗
PubMedDate not supplied

Cystic fibrosis in adolescents and adults.

A cystic fibrosis (CF) clinic for adults was established in 1977. We have reviewed the data on 164 patients who attended between 1977 and 1989. Twenty four patients had died, 11 being over 20 years of age at the time of death. Of the 140 patients still alive, 61% were male and 53% were aged over 20 years. Only 55% were diagnosed by one year and 88% by ten years. Almost all patients had respiratory symptoms and sputum culture yielded pseudomonas species in 69%. Other respiratory problems included major haemoptysis and pneumothorax, each in 10%. We found a wide range of respiratory impairment among older patients. Among 33 patients aged over 23 years, the mean (+/-S.D.) percent predicted FEV1 and FVC were 53.3% (+/- 18%) and 71.4 (+/- 20%) respectively. Mean weight in this group was 92.5% (+/- 14) of predicted. Malabsorption occurred in most patients and meconium ileus equivalent occurred in 34%. Other complications were clinical hepatomegaly (16%), diabetes mellitus (9%) and arthropathy (20%). Most patients were taking continuous antibiotics by mouth (89%) and by nebuliser (48%), beta-2 agonists by inhaler (57%) and oral steroids (29%). Almost all were taking multivitamins, pancreatic replacement therapy and multiple nutritional supplements. The number of CF "bed days" grew 12 fold since 1979 and the mean stay in hospital was double the hospital mean. The economic impact was such that over 1/4 of the annual hospital antibiotic budget was expended on CF patients.

Adolescent↗
PubMedDate not supplied

Supervision registers and mental health problems.

This paper considers the implications of the introduction of supervision registers for people with severe mental illnesses. It discusses concerns expressed by the medical profession and mental health charities. Nurses' reticence in entering the debate is noted as well as how supervision registers are interpreted in practice and the potential problems or benefits of the policy. The impact of power relationships in psychiatry are discussed in the light of the introduction of supervision registers. Finally, the implications for future practice and health-care delivery systems are highlighted.

Aftercare↗
PubMedDate not supplied

Supervised discharge.

Explore the source record for details and available documents.

Continuity of Patient Care↗