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Biomedical subjects

M Gorman

Publications and source records attributed to M Gorman.

At least 19 recordsLinked to original sources
PubMed2003

Patient and hospital delays in acute ischaemic stroke in a Dublin teaching hospital.

A limiting factor for thrombolysis in ischaemic stroke is delayed presentation to hospital. Prolonged A&E stay and delayed rehabilitation affects care. We evaluated the delay in presentation, A&E stay and rehabilitation delivery in 117 consecutive stroke patients. The mean presentation delay was 16.0 +/- 23.7 hours. A prior history of TIA or stroke, a reduced Glascow Coma Scale and larger strokes were associated with shorter delays to presentation. Longer delays occurred in patients living alone. The mean time spent in A&E was 11 hours, those with larger strokes spent shorter time. There were significant delays in referral to, and assessment by certain rehabilitation disciplines. Delayed presentation in stroke is a barrier to thrombolysis. Increasing public awareness may reduce this delay. In addition, prolonged A&E stay and delayed rehabilitation may adversely affect management, outcome and duration of hospital stay. Further study is required to investigate the reasons and possible solutions for such deficiencies.

Aged↗
PubMed2001

Differential effects of acute ethanol treatment on cardiac contractile function in young adult and senescent mice.

It is understood that marked biochemical, molecular, and performance alterations occur in cardiovascular tissues related to aging. It is logical, therefore, that differences in the cardiovascular response to ethanol consumption, when comparing younger with older individuals, may exist. We compared the left ventricular function of 6- and 15-month-old (senescent) mice and 16-month-old (senescent) inducible nitric oxide synthase knockout mice (n=7 each) before and subsequent to acute treatment with 60% ethanol (2 g/kg, i.p.). A Millar 1.4 Fr conductance/micromanometer catheter was placed into the left ventricle of the mice for acquisition of pressure-volume loops. Heart contractile functions were significantly decreased in the senescent group, compared with findings in the younger mice. Subsequent to ethanol treatment, the younger mice showed a significant reduction in cardiac function, with a 28% decrease in cardiac index, a 29% decrease in end-systolic elastance, and a 16% decrease in preload recruitable stroke work (P<.01). Conversely, the senescent mice showed significantly increased contractile function, with a 40% increase in end-systolic elastance (P<.01) and a 19% increase in preload recruitable stroke work (P<.05). The myocardial cyclic guanosine monophosphate levels were significantly higher in the older group (P<.002), and subsequent to ethanol treatment, they were decreased by 68.5% (P<.001). Northern blot analysis demonstrated inducible nitric oxide synthase message only in senescent myocardial tissues. Moreover, the cardiac function of senescent inducible nitric oxide synthase knockout mice was comparable with that of young mice, and after ethanol treatment, cardiac function decreased significantly, just as that for young mice did, with a 26% decrease in cardiac index (P<.05) and a 23% decrease in preload recruitable stroke work (P<.01). It was concluded that the differential cardiovascular function and response to acute ethanol

Aging↗
PubMed2001

Transcranial Doppler in stroke.

Transcranial Doppler (TCD) has been extensively used in various clinical situations, and in the last two decades has established its role in the management of patients with cerebrovascular disease and stroke. Based on the Doppler principle, it uses ultrasound waves to insonate the blood vessels supplying the brain to obtain hemodynamic information. Anatomic abnormalities of vascular occlusion, stenosis and spasm can be indirectly derived. Intracranial arterial disease is an important cause of ischemic stroke and TCD can detect these with a fair amount of sensitivity and specificity. In hemodynamically significant extracranial internal carotid artery disease, TCD shows significant abnormalities in flow dynamics of the anterior circulation and abnormalities of cerebral vasomotor reactivity. A distinct advantage of TCD is the ability to monitor blood flow in a blood vessel over prolonged periods of time, which has shown microembolic signals in acute ischemic stroke, carotid artery disease, atrial fibrillation and during angiography. In acute ischemic stroke, TCD can be used to elucidate stroke mechanisms, plan and monitor treatment, and determine prognosis. In an era when stroke is increasingly being recognized as an emergency requiring immediate treatment, TCD may be capable of providing rapid information about the hemodynamic status of the cerebral circulation, within the time frame of the rather small 'therapeutic window'. TCD predicts vasospasm with a high degree of sensitivity and specificity and because of its non-invasive nature repeated assessments can be performed after subarachnoid hemorrhage.

Brain Ischemia↗
PubMed2001

Development and evaluation of a moral distress scale.

AIM OF THE STUDY: This methodological research developed and evaluated the moral distress scale from 1994 to 1997. BACKGROUND/RATIONALE: Although nurses confront moral questions in their practice daily, few instruments are available to measure moral concepts. The methodological design used a convenience sample consisted of 214 nurses from several Unites States hospitals. The framework guiding the development of the moral distress scale (MDS) included Jameton's conceptualization of moral distress, House and Rizzo's role conflict theory, and Rokeach's value theory. Items for the MDS were developed from research on the moral problems that nurses confront in hospital practice. The MDS consists of 32 items in a 7-point Likert format; a higher score reflects a higher level of normal distress. RESULTS: Mean scores on each item ranged from 3.9 to 5.5, indicating moderately high levels of moral distress. The item with the highest mean score (M=5.47) was working where the number of staff is so low that care is inadequate. Factor analysis yielded three factors: individual responsibility, not in the patient's best interest, and deception. No demographic or professional variables were related to moral distress. Fifteen percent of the nurses had resigned a position in the past because of moral distress. CONCLUSION: The results support the reliability and validity of the MDS.

Adult↗
PubMed2001

Comparison of tumor necrosis factor-alpha effect on the expression of iNOS in macrophage and cardiac myocytes.

Proinflammatory cytokines, including tumor necrosis factor-alpha (TNF-alpha), are elevated during cardiopulmonary bypass (CPB), heart failure, and inflammatory cardiac and systemic diseases. Elevated TNF-alpha has been linked to diminished cardiac function, decreased systemic vascular resistance, as well as renal and pulmonary dysfunction. It is understood that myocardial tissues can express TNF-alpha, which results in the induction of inducible nitric oxide synthase (iNOS) leading to a significant decline in cardiac function and other direct effects. The hypothesis of this study was to determine if TNF-alpha would stimulate iNOS and its product nitric oxide (NO) similarly in immortalized macrophage and cardiac myocytes. Cultured macrophages (RAW 264.7) and cardiac myocytes (HL-1) were placed into two treatment groups and a control. The treatments included: (1) TNF-alpha and lipopolysaccharide (LPS); and (2) LPS, TNF-alpha, interleukin-1beta (IL-1beta) and interferon-gamma (IFN-gamma) incubated for 8 h. The macrophage expression of iNOS increased by 365% (p < 0.01) and its product, NO, increased proportionally. The expression of iNOS in the cardiac myocyte did not increase with TNF-alpha and LPS. However, with the addition of IFN-alpha and IL-1beta iNOS increased to 140% of control (p < 0.05). Myocyte cGMP and NO did not increase significantly with TNF-alpha treatment. This study suggests that HL-1 myocyte iNOS cannot be induced by TNF-alpha, unlike macrophage iNOS. Furthermore, the resultant cardiac dysfunction, secondary to proinflammatory cytokines effects, is regulated via diverse pathways.

Animals↗
PubMed2000

Senescent ventricular dysfunction: issues related to cardiopulmonary bypass.

The mean age of the open-heart surgical patient is increasing every year. Therefore, it is logical to define the aging-related changes in cardiovascular function. This study set forth to define the major molecular and performance alterations that occur in the left ventricle related to advanced aging or senescence. In the human, vascular pathologies usually accompany left ventricular dysfunction. The aim of this study was to associate the altered left ventricular mechanics with molecular pathways in mice who lacked these associated vascular pathologies. This study compared the left ventricular function of two groups of mice (N = 20 each), 6 months old and 16 months old (senescent). The mice were anesthetized with urethane and alpha-chloralose, and a Millar 1.4 Fr. conductance micromanometer catheter was placed into the left ventricle for acquisition of pressure-volume loops. Heart tissues were collected immediately for analysis of cGMP concentrations. The cardiac index, preload recruitable stroke work, and the slope (Ees) of the end-systolic pressure volume relationship were significantly less in the senescent group compared to the young mice. It was concluded that the aged heart has significantly reduced systolic and diastolic dysfunction compared to the young heart function and that this dysfunction may be related to pathways leading to increased myocardial cGMP concentrations.

Age Factors↗
PubMed1999

Integrating the Kuramoto-Sivashinsky equation in polar coordinates: application of the distributed approximating functional approach.

An algorithm is presented to integrate nonlinear partial differential equations, which is particularly useful when accurate estimation of spatial derivatives is required. It is based on an analytic approximation method, referred to as distributed approximating functionals (DAF's), which can be used to estimate a function and a finite number of derivatives with a specified accuracy. As an application, the Kuramoto-Sivashinsky (KS) equation is integrated in polar coordinates. Its integration requires accurate estimation of spatial derivatives, particularly close to the origin. Several stationary and nonstationary solutions of the KS equation are presented, and compared with analogous states observed in the combustion front of a circular burner. A two-ring, nonuniform counter-rotating state has been obtained in a KS model simulation of such a burner.

Journal Article↗
PubMed1999

"Telestroke" : the application of telemedicine for stroke.

BACKGROUND: Time is of the essence for effective intervention in acute ischemic stroke. Efforts including stroke teams that are "on call" around-the-clock are emerging to reduce the time from emergency room arrival to evaluation and treatment. SUMMARY OF COMMENT: Based on the results of the NINDS rt-PA Stroke Trial, which demonstrated both clinical effectiveness in reducing neurological deficits and disability and cost savings to health care systems, many community hospitals and managed-care organizations are exploring methods to enhance and expedite acute stroke care in their local communities. Only a small fraction of acute stroke victims is currently treated with thrombolytics (<1.5% nationally), and few benefit from the expertise and experience of the stroke teams. It is essential to develop new paradigms to improve acute stroke care in all settings, rural and urban. Rapid linkages to expert stroke care can help the underserved areas. Telemedicine for stroke, "Telestroke, " uses state-of-the-art video telecommunications that may be a potential solution and may maximize the number of patients given effective acute stroke treatment across the country and across the world. Telestroke could facilitate remote cerebrovascular specialty consults from virtually any location within minutes of attempted contact, adding greater expertise to the care of any individual patient. This model also has the potential to enhance patient entry into clinical trials. Telestroke would enhance stroke education through the use of Internet-based interactives for health-care professionals and patients. Education would be facilitated through the creation of telecommunication-linked classes providing interactive information on stroke care and prevention to places where they are otherwise not available. Health-care professionals will gain experience and expertise through the interaction with a remote expert--telementoring. Telestroke provides an excellent medium for data collection and an unprecedented opportunity for quality assurance. Monitoring of an entire tele-interaction can offer real-time assessments, which can then be analyzed in-depth at a later date for unique insights into health-care delivery. Prehospital use of telemedicine for stroke is already being piloted, linking patients in the ambulance to the emergency department. Legal and economic parameters must be established for telemedicine in the areas of reimbursement, liability, malpractice insurance, licensing, and credentialing. Issues of protection of privacy and confidentiality, informed consent, product liability, and industry standards must be addressed to facilitate the use of this new and potentially useful technology. CONCLUSIONS: Computer-based technology can now be used to integrate electronic medical information, clinical assessment tools, neuroradiology, laboratory data, and clinical pathways to bring state-of-the-art expert stroke care to underserved areas.

Acute Disease↗
PubMed1998

Results of aortic valve replacement for aortic stenosis with relatively low transvalvular pressure gradients.

Fifty-two patients with low gradient critical aortic stenosis who underwent aortic valve replacement were found to have a perioperative mortality of 11% and an 8-year actuarial survival of only 29%. No hemodynamic variables, including valvular resistance, predicted long-term outcome, and the only clinical variable that predicted long-term survival was the absence of coronary artery disease.

Aged↗
PubMed1998

Aspergillus fungal mass detected by transesophageal echocardiography.

Cardiac fungal infections have become more prevalent and are being diagnosed with increasing frequency. The most common infective organism is Candida albicans, followed by Aspergillus fumigatus and Cryptococcus. Cardiac involvement is usually associated with endocarditis, myocarditis, pericarditis, or intracardiac fungal mass. Early diagnosis is imperative, as these patients have poor outcome once there is cardiac involvement. In this report we describe a patient in whom an intracardiac mass was detected with transesophageal echocardiography and confirmed to be aspergillus fungal ball at surgery.

Adult↗