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Biomedical subjects

M Donnelly

Publications and source records attributed to M Donnelly.

At least 37 records · Page 2Linked to original sources
PubMed2001

Decision-making for mentally incompetent people: the empty formula of best interests?

This paper considers the way in which the best interests test has been used in making health care decisions for mentally incompetent individuals in the Irish and English Courts where this is the test of choice. It looks in brief at the development of the test and the way in which the House of Lords has "de-theorised" the question of best interests in cases such as Re F (Mental Patient: Sterilisation) and Airedale N.H.S. Trust v. Bland, leaving little in the way of assistance for lower courts. The test adopted by the Irish courts has also lacked a strong theoretical underpinning. However, the existence of a written constitution has meant that there has at least been recognition of the role of rights in determinations such as In Re a Ward of Court. Having noted the inadequacies in the current test as it is applied, the article then considers the question of whether the best interests test has been inadequately applied or whether it is fatally flawed and should be dispensed with as a method of making determinations for mentally incompetent people. The article looks at two alternatives to the best interests test; namely, purely rights based decision making and substituted judgment. Both will be seen to be flawed and it will be argued that the best interests test should be maintained but that a more careful theoretical and analytical approach is required.

Decision Making↗
PubMed2000

Rocuronium anaphylaxis and multiple neuromuscular blocking drug sensitivities.

PURPOSE: To report a case of anaphylaxis to rocuronium and the sensitivities to multiple neuromuscular blocking drugs in a patient with no previous exposure to this group of drugs. We describe the current recommendations for both intraoperative and postoperative testing of these patients. CLINICAL FEATURES: A 36-yr-old man was admitted for repair of a ruptured Achilles tendon. Following induction of general anesthesia with fentanyl and propofol, 60 mg of rocuronium were given to facilitate tracheal intubation. He immediately became profoundly hypotensive with impalpable pulses, and blood pressure could not be recorded. Airway pressure increased markedly, and hand ventilation of the lungs became very difficult. His airway was secured and he was successfully resuscitated with 3 mg epinephrine and three litres crystalloid and colloid intravenous fluid therapy. His recovery in the intensive care unit was uneventful and the operation was performed four days later under spinal anesthesia. Subsequent skin prick testing, performed six weeks later, demonstrated strong positive weal and flare reactions to rocuronium, vecuronium and pancuronium, and some cross-reactivity with the benzylisoquinolinium group of muscle relaxants. CONCLUSION: Muscle relaxants are responsible for 61.6% of cases of anaphylaxis during general anesthesia. Cross-reactivity is common, as this group of drugs share a quaternary ammonium group. It is mandatory that patients be tested for both the agent responsible and cross-reactivity following an anaphylactic response. We suggest a protocol for investigation of suspected anaphylaxis.

Achilles Tendon↗
PubMed2000

Cross-domain adaptation reveals that a common mechanism computes stereoscopic (cyclopean) and luminance plaid motion.

Across three experiments, this study investigated the visual processing of moving stereoscopic plaid patterns (plaids created with cyclopean components defined by moving binocular disparity embedded in a dynamic random-dot stereogram). Results showed that adaptation to a moving stereoscopic plaid or its components affected the perceived coherence of a luminance test plaid, and vice versa. Cross-domain adaptation suggests that stereoscopic and luminance motion signals feed into a common pattern-motion mechanism, consistent with the idea that stereoscopic motion signals are computed early in the motion processing stream.

Adaptation, Ocular↗
PubMed2000

How well do elderly people complete individualised quality of life measures: an exploratory study.

This research note describes and discusses a study which investigated the feasibility of using an individualised approach to measure the quality of life (QoL) of a sample of older people who were in receipt of an early hospital discharge service. Most participants (86%) were able to identify areas of their lives which were important to them, rate their level of functioning on each of these areas and rank their life areas in order of importance. However, 39% were unable to quantify the relative importance of each area of life. Indeed, the majority (57%) of participants who were over 75 years old could not complete this 'weighting' or evaluative stage. The results suggest that the phenomenological approach to measuring QoL may be employed successfully with older people but that the 'weighting' system used by existing individualised QoL measures needs to be refined, especially when assessing people over 75.

Aged↗
PubMed2000

The use of EMLA reduces the pain associated with digital ring block for ingrowing toenail correction.

Treatment of ingrowing toenail is commonly performed under local anaesthesia with a digital ring block. Ring block can be associated with significant pain, caused by needle insertion and deposition of the local anaesthetic agent. EMLA, a topical anaesthetic cream, is widely used to alleviate the pain of venepuncture. The aim of this study was to investigate whether the discomfort of digital block could be reduced by prior application of EMLA. Fifty-five patients who were scheduled for ingrowing toenail under local anaesthesia were randomized into two groups. In Group 1 (n = 30), EMLA was applied around the base of the affected hallux for at least 1 h before ring block. In Group 2 (n = 25), a placebo cream was used. In this double-blind study, patients assessed the pain caused by a standardized ring block using 100-mm visual analogue pain score. The mean visual analogue pain score in Group 1 was 28.1 and 50.1 in Group 2 (P < 0.0001). We conclude that EMLA significantly reduces the pain associated with digital ring block.

Adolescent↗
PubMed2000

Improving hand hygiene in community healthcare settings: the impact of research and clinical collaboration.

Observation of nursing activities and bacteriological studies undertaken with a sample of nurses employed in a community NHS trust indicated that considerable scope for cross infection existed during domiciliary visits. Poor conditions in patients' homes compromised nurses' ability to perform hand hygiene effectively, increasing risks. A clinical trial indicated that carriage of medically significant bacteria likely to contribute to cross infection could be reduced by applying an antiseptic cream which exhibited residual effectiveness. An audit of hand hygiene throughout the inner city trust indicated the need to pay greater attention to hand hygiene, especially during home nursing visits. The situation was less acute in a rural trust where a second audit was performed for comparative purposes. The motivation of clinical staff to improve hand hygiene precautions was high.

Anti-Infective Agents, Local↗
PubMed2000

Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women.

OBJECTIVES: There is a paucity of long term studies on exercise training in elderly women. The purpose of this study was to investigate the effects of one year of progressive resistance exercise (PRE) on dynamic muscular strength and the relations to bone mineral density (BMD) in elderly women. METHODS: Forty four healthy sedentary women (mean age 68.8 years) volunteered for this study and were randomly assigned to either an exercise group or a control group. The exercise group were involved in three one hour sessions a week for 52 weeks of supervised PRE to strengthen the large muscle groups of the body, while the control group were instructed to continue their normal lifestyle. The exercise circuit included three sets of eight repetitions at 75% of one repetition maximum focused on the large muscle groups. BMD was measured by dual energy x ray absoptiometry (Lunar DPX) at the lumbar spine and at three sites in the proximal femur. Other selected parameters of physical fitness were also measured. RESULTS: Statistical analyses (analysis of covariance) showed significant strength gains (p < 0.01) in bilateral bench press (> 29%), bilateral leg press (> 19%), and unilateral biceps curl (> 20%). No significant difference between groups was evident in body weight, grip strength, flexibility, waist to hip ratio, or the sum of eight skinfolds. Significant relations (p < 0.05) were recorded between dynamic leg strength and the BMD of the femoral neck, Ward's triangle, and the lumbar spine. CONCLUSIONS: Significant strength changes, after one year of PRE, were evident in elderly women, and the muscle increases may parallel changes in BMD; however, correlation coefficients were moderate.

Aged↗
PubMed2000

Measuring the health related quality of life of people with ischaemic heart disease.

OBJECTIVES: To inform researchers and clinicians about the most appropriate generic and disease specific measures of health related quality of life for use among people with ischaemic heart disease. METHODS: MEDLINE and BIDS were searched for research papers which contained a report of at least one of the three most common generic instruments or at least one of the five disease specific instruments used with ischaemic heart disease patients. Evidence for the validity, reliability, and sensitivity of these instruments was critically appraised. RESULTS: Of the three generic measures-the Nottingham health profile, sickness impact profile, and short form 36 (SF-36)-the SF-36 appears to offer the most reliable, valid, and sensitive assessment of quality of life. However, a few of the SF-36 subscales lack a sufficient degree of sensitivity to detect change in a patient's clinical condition. According to the best available evidence, the quality of life after myocardial infarction questionnaire should be preferred to the Seattle angina questionnaire, the quality of life index cardiac version, the angina pectoris quality of life questionnaire, and the summary index. Overall, research on disease specific measures is sparse compared to the number of studies which have investigated generic measures. CONCLUSIONS: An assessment of the quality of life of people with ischaemic heart disease should comprise a disease specific measure in addition to a generic measure. The SF-36 and the quality of life after myocardial infarction questionnaire (version 2) are the most appropriate currently available generic and disease specific measures of health related quality of life, respectively. Further research into the measurement of health related quality of life of people with ischaemic heart disease is required in order to address the problems (such as lack of sensitivity to detect change) identified by the review.

Health Status Indicators↗
PubMed2000

Brain areas involved in perception of biological motion.

These experiments use functional magnetic resonance imaging (fMRI) to reveal neural activity uniquely associated with perception of biological motion. We isolated brain areas activated during the viewing of point-light figures, then compared those areas to regions known to be involved in coherent-motion perception and kinetic-boundary perception. Coherent motion activated a region matching previous reports of human MT/MST complex located on the temporo-parieto-occipital junction. Kinetic boundaries activated a region posterior and adjacent to human MT previously identified as the kinetic-occipital (KO) region or the lateral-occipital (LO) complex. The pattern of activation during viewing of biological motion was located within a small region on the ventral bank of the occipital extent of the superior-temporal sulcus (STS). This region is located lateral and anterior to human MT/MST, and anterior to KO. Among our observers, we localized this region more frequently in the right hemisphere than in the left. This was true regardless of whether the point-light figures were presented in the right or left hemifield. A small region in the medial cerebellum was also active when observers viewed biological-motion sequences. Consistent with earlier neuroimaging and single-unit studies, this pattern of results points to the existence of neural mechanisms specialized for analysis of the kinematics defining biological motion.

Adult↗
PubMed2000

Laryngeal tuberculosis: an important diagnosis.

The incidence of laryngeal tuberculosis is increasing worldwide. To ensure early diagnosis it is important for physicians and otolaryngologists to recognize its cardinal signs and symptoms. We present two recent cases of laryngeal tuberculosis that presented to our department. We outline potential pitfalls in diagnosis, and highlight the importance of obtaining a tissue diagnosis. The literature is reviewed, and the treatment options outlined.

Bronchoscopy↗
PubMed2000

Selecting a measure of health related quality of life.

Quality of life is becoming recognized increasingly as an important outcome measure which needs to be considered by social workers. However, there does not appear to be a clear consensus about the definition of quality of life. In addition, social workers are likely to experience difficulties choosing and applying an appropriate instrument with which to measure quality of life because of the many available instruments purporting to assess quality of life. This paper discusses the definition of health-related quality of life and explains the main measurement properties of an instrument that must be appraised when considering whether or not an instrument is appropriate. The paper will assist social workers to make an informed choice about measures of health-related quality of life.

Health Status Indicators↗
PubMed1999

Antibiotic prophylaxis post-tonsillectomy: is it of benefit?

The decision to prescribe antibiotics post-tonsillectomy still remains controversial. However, recent changing trends in the tonsillar tissue microflora have been widely reported, with Haemophilus influenzae, Staphylococcus aureus and anaerobic organisms all being implicated. All of the above are beta-lactamase producers and thus render lactamase prone antibiotics inactive. We compared two groups of children, one on Amoxycillin and clavulanic acid (a lactamase stable antibiotic with anaerobic cover) for 1 week post tonsillectomy--Group A (N = 44), and another group on no treatment--Group B (N = 34). We compared tonsillar core, surface and postoperative tonsillar fossae bacteriological profiles in the two groups. The tonsil core pathogens included H. influenzae (64%) of which 9.5% were beta-lactamase producers, Streptococcus viridans (55.9%), S. aureus (37%) of which 86% were beta-lactamase producers, and anaerobes which were found in 25% of samples. We found that there was considerably less morbidity in those children receiving postoperative antibiotics compared to those who did not, as judged by the amount of analgesia consumed (p = 0.379), time to resumption of normal diet (p = 0.0072) and pain analogue scores (p = 0.0006). We feel that treating children who have undergone tonsillectomy with amoxycillin and clavulanic acid significantly reduces postoperative morbidity.

Amoxicillin↗
PubMed1999

The stereoscopic (cyclopean) motion aftereffect is selective for spatial frequency and orientation of disparity modulation.

Across two experiments, this study investigated the spatial frequency tuning and orientation tuning (both in the disparity domain) of the stereoscopic (cyclopean) motion aftereffect. In Experiment 1, observers adapted to a moving stereoscopic grating of a given cyclopean spatial frequency and tested for the motion aftereffect with a static grating of the same or different spatial frequency. Robust motion aftereffects were induced only when the spatial frequency of the adapt and test stimuli was the same. In Experiment 2, observers adapted to a moving stereoscopic grating of a given cyclopean orientation and tested for the motion aftereffect with a static grating of the same or different orientation. Robust motion aftereffects were induced only when the orientation of the adapt and test stimuli was the same. Together, these results suggest that the stereoscopic motion aftereffect is tuned for cyclopean spatial frequency and orientation which, in turn, suggest that the stereoscopic motion aftereffect is mediated by low-level oriented spatial-frequency mechanisms.

Adaptation, Physiological↗
PubMed1999

An international outbreak of Vero cytotoxin-producing Escherichia coli O157 infection amongst tourists; a challenge for the European infectious disease surveillance network.

In March 1997, an outbreak of Vero cytotoxin-producing Escherichia coli O157 (VTEC) infection occurred amongst holidaymakers returning from Fuerteventura, Canary Islands. For the investigation, a confirmed case was an individual staying in Fuerteventura during March 1997, with either E. coli O157 VTEC isolated in stool, HUS or serological evidence of recent infection; a probable case was an individual with bloody diarrhoea without laboratory confirmation. Local and Europe-wide active case finding was undertaken through national centres, Salm-Net and the European Programme of Intervention Epidemiology, followed by a case-control study. Fourteen confirmed and one probable case were identified from England (7), Finland (5), Wales (1), Sweden (1) and Denmark (1) staying in four hotels. Three of the four hotels were supplied with water from a private well which appeared to be the probable vehicle of transmission. The case-control study showed illness was associated with consumption of raw vegetables (OR 8.4, 95% CI 1-5-48.2) which may have been washed in well water. This investigation shows the importance of international collaboration in the detection and investigation of clusters of enteric infection.

Adolescent↗
PubMed1999

An unusual complication of minitracheostomy.

A 72-year-old woman had a minitracheostomy inserted for sputum retention. This was undertaken by a relatively junior resident who opted to use an early model minitracheostomy kit Minitrach II. The following day the patients condition deteriorated and intubation was warranted, at which time it was apparent to senior staff that the minitracheostomy had been malpositioned. Ten days later, formal tracheostomy was performed under general anaesthesia. After incision, an abscess in the thyroid gland was found. Histology subsequently revealed a Hurthle cell tumour of the thyroid. Thyroid abscess is exceedingly rare. It typically occurs in abnormal thyroid tissue and with a focus on infection. The combination of Hurthle cell adenoma and a foreign body (the minitracheostomy) was evidently causative in this instance. This complication of minitracheostomy insertion has not to our knowledge, previously been reported.

Abscess↗
PubMed1999

Factors associated with exercise adherence among older adults. An individual perspective.

This paper reviews the literature concerning factors at the individual level associated with regular exercise among older adults. Twenty-seven cross-sectional and 14 prospective/longitudinal studies met the inclusion criteria of a mean participant age of 65 years or older. The findings are summarised by demographics, exercise experience, exercise knowledge, physiological factors, psychological factors, activity preferences and perceived social influences. In general, education and exercise history correlate positively with regular exercise, while perceived physical frailty and poor health may provide the greatest barrier to exercise adoption and adherence in the elderly. Social-cognitive theories identify several constructs that correlate with the regular exercise behaviour of older adults, such as exercise attitude, perceived behavioural control/self-efficacy, perceived social support and perceived benefits/barriers to continued activity. As well, stage modelling may provide additional information about the readiness for regular exercise behaviour among older adults. However, relatively few studies among older adults exist compared with middle-aged and younger adults. Further, the majority of current research consists of cross-sectional designs or short prospective exercise trials among motivated volunteers that may lack external validity. Future research utilising longitudinal and prospective designs with representative samples of older adults will provide a better understanding of significant causal associations between individual factors and regular exercise behaviour.

Aged↗
PubMed1999

Are HIV lookbacks worthwhile? Outcome of an exercise to notify patients treated by an HIV infected health care worker. Incident Management Teams.

This report describes the management and outcome of one of the largest exercises undertaken in the United Kingdom to notify patients exposed to an HIV infected health care worker. Eighty-six per cent (1597/1852) of patients on whom the infected junior doctor in obstetrics and gynaecology had performed surgical procedures were contacted and 1180 women (64% of those exposed) elected to be tested. None was found to be positive. Of those tested, 651 had undergone procedures classified as 'higher risk' and 529 'low risk' procedures. These data provide further evidence that the overall risk of transmission from an infected health care worker to patients is likely to be very low. HIV lookbacks may be worthwhile but we consider that it would be justifiable to notify and offer HIV testing only to patients who have undergone higher risk procedures. The estimated cost to the NHS of this exercise exceeded 200,000 Pounds.

Disease Notification↗