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Biomedical subjects

M H Kelly

Publications and source records attributed to M H Kelly.

25 records · Page 2Linked to original sources
PubMed1988

Use of laboratory services and communication of results to patients in an urban practice: an audit.

The pattern of investigations in an urban practice of 4200 patients was monitored over an eight-week period. An assessment was made of the characteristics of patients who sought the results of their investigations.During the study period there were 1522 consultations and 186 investigations were carried out on 155 patients. More females were investigated than males (3.4:1) with most tests among 31-40 year old women. At the end of the study period only 95 patients (61.3%) knew the results of their tests and of 34 abnormal results nine were not relayed to patients. The probability of a patient collecting a result was not influenced by the patient's age or sex, the reason for carrying out the test or the instructions given by the doctor for collection of the result. Abnormal test results were more likely to be collected than normal results.These findings suggest that many practice systems of relaying information to patients need modifying. Whose responsibility it should be to pass on the results of patients' investigations is discussed.

Adolescent↗
PubMed1977

Transmissible gastroenteritis: sodium transport and the intestinal epithelium during the course of viral enteritis.

Sodium transport, mucosal structure, and epithelial enzymes were studied in piglets killed 10, 25, 40, 72, or 144 hr after infection with a standard dose of transmissible gastroenteritis virus. Glucose-stimulated Na transport measured in short-circuited jejunal epithelium and suspensions of villous enterocytes became progressively more abnormal during the first 40 hr, but recovered completely by 144 hr. As Na transport deteriorated, jejunal mucosal villi shortened and crypts deepened; cells isolated from the villi became more crypt-like in their enzyme profile, with high levels of thymidine kinase and low levels of sucrase activity 40 hr after infection. At 40 hr, when diarrhea is severe, little if any virus has been found in the epithelium. Our data suggest that the relatively undifferentiated crypt type enterocytes on the villi constitute an important determinant of altered Na transport and diarrhea in this invasive viral enteritis.

Animals↗
PubMed1974

Transmissible gastroenteritis. Mechanisms responsible for diarrhea in an acute viral enteritis in piglets.

We studied 3-wk-old piglets 40 h after experimental infection with transmissible gastroenteritis (TGE) virus to identify the mechanisms of diarrhea in this disease and to better understand infectious diarrhea in humans. Using continuous segmental marker perfusion in four regions along the gut, we found significant increases in net intraluminal accumulation of water and electrolytes only in the proximal jejunum, the region infected by the virus. In this jejunal segment studied in vivo, unidirectional sodium flux, extracellular fluid (ECF) to lumen, significantly increased, lumen to ECF significantly decreased, compared with matchfed littermates. The standard perfusate rendered hypertonic by adding mannitol (450 mosmol/kg), in the same segment of normal pigs, caused only an increase in ECF to lumen flux of sodium. TGE did not alter gross villous structure or intraluminal bacteria, bile salts, lactate, pH, or osmolality. Epithelial cell migration was accelerated in the jejunum of infected pigs. Isolated in suspension, these cells from TGE pigs exhibited increased active and passive sodium efflux, cells from mannitol-perfused pigs exhibited only increased active sodium efflux. In this viral enteritis, altered sodium transport occurring in the jejunum, the region of the intestine infected appears to be associated with defective epithelial cell function. The precise nature of the abnormalities in sodium transport, their relationship to disturbances of transport of other solutes, and to virus epithelial cell interaction remain to be defined.

Animals↗
PubMedDate not supplied

Evaluation of fiscal and treatment outcomes in major joint replacement.

The market demand for major arthroplasty procedures is increasing. This descriptive comparative study was conducted to examine clinical and fiscal outcomes in total joint arthroplasty patients discharged either to home or to a subacute unit. The post-acute care setting was self-selected by patients after information was provided on both options. The Self-Administered Joint Rating Questionnaire served as the primary data collection tool. Age, health status, and living alone were significant factors in post-acute care site selection. Although there were no significant differences in clinical outcomes between the two groups, overall costs were substantially different. Opportunities to maintain outcome status, while reducing total costs, in the subacute group are discussed.

Activities of Daily Living↗
PubMedDate not supplied

Total joint arthroplasty: a comparison of postacute settings on patient functional outcomes.

PURPOSE: This descriptive comparative study was conducted to examine functional outcomes of total joint arthroplasty patients discharged to subacute rehabilitation programs compared with those of patients discharged directly home with home physical therapy follow-up. SAMPLE: This study used a convenience sample of 96 patients having total joint arthroplasty performed by one physician within one institution. The postacute care setting was self-selected by the patients after information was provided on both options. METHODS: A patient self-evaluation questionnaire was administered preoperatively and at 1 month and 3 months after surgery. A total functional score was obtained by combining the four subscores of the questionnaire/tool: subjective, pain, walking, and activities of daily living. Quantitative data on length of stay and cost were collected for each rehabilitative site. FINDING: All patients improved significantly over time in all subscores and in total score. There was no statistically significant difference in scores between the home and the subacute group. There was a significant difference in the mean total cost of the joint replacement for the subjects who went to the subacute unit ($24,144) compared to those who went directly home ($16,918). The groups were significantly different demographically, with the subacute group being older (age > 72), and likely to have comorbidities and to live alone. CONCLUSION: The majority of total joint replacement patients can achieve acceptable functional outcomes in a reasonable length of time at home with physical therapy supervision. Rehabilitation in a subacute facility may be most useful for the elderly patient with comorbidities, particularly those who live alone.

Activities of Daily Living↗