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Biomedical subjects

M Geary

Publications and source records attributed to M Geary.

At least 55 records · Page 3Linked to original sources
PubMed1998

Childhood influences on adult disease.

There is increasing evidence that events in fetal and infant life can 'programme' the function of a number of organ systems. These changes may lead to the evolution of adult illnesses, e.g. hypertension and coronary artery disease. In addition many children with chronic illness survive into adulthood so that these diseases and/or their treatment may pose problems for health professionals involved in their care.

Adult↗
PubMed1997

Isolated choroid plexus cysts and association with fetal aneuploidy in an unselected population.

We sought to determine the relationship between an isolated choroid plexus cyst diagnosed antenatally and fetal aneuploidy in an unselected population at a district general hospital. Over a 5-year period all women attending for a detailed anomaly scan at 18-20 weeks' gestation were screened for evidence of a fetal choroid plexus cyst. All cases of choroid plexus cyst were recorded prospectively. The size, position and number of the cysts were noted and associated abnormalities seen on ultrasound were also recorded. Cases of choroid plexus cyst associated with fetal aneuploidy were noted. A total of 13,690 women were screened, and 84 cases of choroid plexus cyst were identified (0.6%). Of these, 41% underwent prenatal karyotyping by amniocentesis; 78 of 84 cases (93%) were isolated. Six had other markers for aneuploidy, and three of these fetuses had trisomy 18. All cases of isolated choroid plexus cyst resulted in chromosomally normal neonates. This was confirmed by either normal antenatal karyotype or postnatal examination by the pediatricians. The size, position and number of cysts did not appear to influence the risk of aneuploidy. We conclude that the risk of aneuploidy for a case of isolated choroid plexus cyst in an unselected population appears to be very low, and in this series was 0%. In this setting, we suggest detailed ultrasound examination is essential, rather than routine karyotyping.

Adolescent↗
PubMed1997

Psychoeducational workshops for elderly patients with recurrent major depression and their families.

OBJECTIVE: This report details an extension of the use of psychoeducational workshops with psychiatric patients and their families to families of elderly patients with recurrent unipolar late-life depression. METHODS: Subjects were 132 participants in a study of maintenance therapies for late-life depression and their 182 family members and significant others who accepted invitations to single-session family workshops. Participants provided feedback on their satisfaction with the content and quality of the workshops. Associations between workshop attendance, preworkshop demographic and clinical characteristics, treatment adherence, and outcome were explored through comparisons between 108 patients who attended workshops and 24 patients who declined the workshop invitation. RESULTS: Favorable feedback from participants suggested that the extension of the workshops to families of elderly patients with depression was successful. Workshop attendance was associated with a lower rate of dropout during continuation treatment. CONCLUSIONS: Results associating workshop refusal and treatment dropout, as well as the overall treatment compliance and retention rates in this randomized clinical trial involving geriatric patients, support the need for further study of factors relating to elderly patients' willingness to engage in family-centered interventions.

Aged↗
PubMed1997

Maternal satisfaction with management in labour and preference for mode of delivery.

The aim of this study was to assess women's level of satisfaction with management during labour and to ascertain their preference for mode of delivery. The basis for the findings was the cross-sectional anonymous questionnaire survey of 520 women at a Dublin obstetric hospital. Visual analogue scales were used to assess degree of satisfaction. The response rate was 63% (520 of 830). 98.5% of women had hoped for a vaginal delivery and 1.5% for a Cesarean section. All primiparas had wanted a vaginal delivery. The majority of women were satisfied with their care in labour (65% had a score of > or = 7). Factors significantly associated with high levels of satisfaction were good analgesia during labour (particularly epidural), vaginal delivery, adequate preparation for labour and if personal wishes were listened to by staff. Almost all women have a preference for vaginal delivery. Satisfaction with care in labour is significantly influenced by vaginal delivery, empathetic communication by staff and good analgesia in labour.

Analgesia, Obstetrical↗
PubMed1997

Comparison of liveborn and stillborn low birthweight babies and analysis of aetiological factors.

A retrospective study was performed at a tertiary maternity hospital, to define the incidence of low birthweight (LBW) and its associated risk factors in term liveborn infants and in term stillbirths, to ascertain the antenatal detection rate in each and to assess the role of ultrasound in antenatal detection. One hundred and ninety-four term liveborn LBW infants and twenty stillborn LBW infants were studied. Fifty-six percent of the liveborn infants were detected antenatally compared to 5% of the stillborn LBW infants. Previous LBW, the extremes of maternal age, cigarette smoking and pre-eclampsia were the main risk factors for the development of LBW, not all of which were present to the same extent in each group. Ultrasound scanning antenatally increases the detection rate. Knowledge of abnormal growth antenatally significantly increases obstetric intervention. Detection of LBW antenatally remains difficult. The main risk factors for LBW were similar in both groups.

Adult↗
PubMed1997

Accelerating response in geriatric depression: a pilot study combining sleep deprivation and paroxetine.

Elderly depressed patients often require an average of 12 weeks of pharmacotherapy before attaining remission. The delay between treatment initiation and remission may decrease compliance and prolongs suffering; hence, interventions that decrease the time to onset of antidepressant activity are needed. Our objective was to evaluate, in an open trial, the use of one night of total sleep deprivation combined with paroxetine to accelerate antidepressant response in elderly patients. Thirteen elderly patients with major depression were sleep-deprived for one night and started paroxetine on the night of recovery sleep. Patients were followed for twelve weeks, and clinical improvement was rated using the 17-item Hamilton Depression Rating Scale and a version of the Hamilton modified for sleep deprivation studies. 8/13 (62%) patients experienced significant improvement of depressive symptoms by 2 weeks. Within 12 weeks 11/13 (85%) patients responded to the combination of sleep deprivation and paroxetine. Median response time was 2 weeks. Clinical response at 12 weeks was correlated with changes in Sleep Deprivation Depression Rating Scale Scores between baseline and recovery sleep. In an open trial, the combined use of total sleep deprivation and paroxetine appears to be an effective method for speeding the onset of clinical antidepressant activity in geriatric depression and for improving early recognition of non-response.

Aged↗
PubMed1996

Prolonged labor in nulliparas: lessons from the active management of labor.

OBJECTIVE: To define factors causing prolonged labor in nulliparous women undergoing active management of labor. METHODS: We included all nulliparas delivered during 1990-1994 with spontaneous onset of labor lasting more than 12 hours, singleton gestation, cephalic presentation, and labor at greater than 37 weeks. Each patient was matched with the next nulliparous woman who delivered with a labor lasting less than 12 hours and who fulfilled the same inclusion criteria. Subjects were managed according to the previously described active management of labor protocol from The National Maternity Hospital, Dublin. RESULTS: In the 5-year period, 9018 nulliparas met inclusion criteria, with 147 (1.6%) having prolonged labor. Prolonged labor was due to inefficient uterine action in 65%, persistent occipitoposterior position in 24%, and cephalopelvic disproportion in 11% of cases. Univariate analysis showed statistically significant (P < .05) differences in maternal body mass index, cervical dilation on admission, oxytocin use, epidural use, placement of epidural at less than 2 cm of dilation, and birth weight between these study groups. On multivariate conditional logistic regression analysis, the following were significant independent predictors for having a prolonged labor (odds ratios with 95% confidence intervals presented): 3.1 (1.3-7.3) for cervical dilation less than 2 cm on admission, 42.7 (7.5-242.0) for early epidural placement, 5.1 (1.9-13.7) for epidural placement at greater than or equal to 2 cm, and 10.2 (3.6-29.4) for birth weight greater than 4000 g. CONCLUSION: Less-advanced cervical dilation on admission and epidural use, especially when placed early, are strongly associated with prolonged labor.

Adult↗
PubMed1996

Multiple and massive arteriovenous malformations in pregnancy.

Arteriovenous malformations (AVM) are rare in the reproductive years of life. There is a paucity of data regarding AVMs in pregnancy. Pregnancy can influence both the development and the progression of AVMs. The tendency to bleed is unpredictable. Many AVMs undergo spontaneous postpartum regression. We report on a 30-year old primipara with multiple generalised AVMs, both congenital and acquired, and a massive congenital AVM involving her entire right upper limb and shoulder girdle. Magnetic resonance imaging suggested there were AVMs in both the pelvis and the lower abdominal wall. The main management dilemma was mode of delivery. A trial of vaginal delivery was successful after spontaneous onset at term. The patient had a series of significant postpartum haemorrhages, warranting blood transfusion.

Adult↗