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Biomedical subjects

M Kiernan

Publications and source records attributed to M Kiernan.

50 records · Page 3Linked to original sources
PubMed1986

Observer variation in the classification of mammographic parenchymal patterns.

Wolfe has described different cancer risks associated with a classification of four patterns of the breast parenchyma on mammography, but there is however little information available on the ability of radiologists to agree on the classification of the different patterns. We have assessed inter-rater agreement on the assignment of films to one of the four mammographic patterns described by Wolfe. One hundred xeromammograms were selected, copied and distributed to 10 radiologists who were experts in mammography. Films were classified according to the presence or absence of several radiological signs, according to diagnosis and recommendation, and according to mammographic pattern. Agreement was assessed after correction for agreement expected by chance, using the Kappa statistic. In general, high levels of agreement were found for the classification of mammographic pattern. Agreement on the classification of mammographic pattern was substantially greater than agreement for any other feature of mammographic interpretation, including diagnosis and recommendation.

Breast Neoplasms↗
PubMed1986

The use of intravenous immunoglobulin (endobulin) in patients with immune thrombocytopenia.

Six adults were treated for chronic immune thrombocytopenia (ITP) with high dose intravenous immunoglobulin (ENDOBULIN). Five patients were evaluable. In four patients the platelet associated IgG (PAIgG) levels were increased. All four responded to i.v. Ig and two subsequently underwent splenectomy. One patient had normal PAIgG and had no response to i.v. Ig. Endobulin is useful in the treatment of chronic ITP and is followed in some patients by a prolonged response. High levels of PAIgG may predict a favourable outcome.

Adult↗
PubMed1982

Observer variation in the interpretation of xeromammograms.

We have examined variation in the interpretation of xeromammograms among radiologists designated to take part in a Canadian multicenter randomized controlled trial of screening for breast cancer. Radiologists read 100 xeromammograms comprising 10 histologically proved cancers, 40 benign abnormalities, and 50 normal films. Radiologists' opinions differed widely on the frequency of suspected or identified cancer. The diagnostic category "suspicion of cancer" or "cancer" was selected by radiologists for 10-55% of the films, and biopsy or aspiration was recommended for 21 to 53% of patients whose films were examined. Agreement on specific diagnostic categories was greatest for the diagnosis of cancer; agreement was least for the diagnosis of benign abnormalities and intermediate for the diagnosis of normality. Known cancers were in general correctly identified. These results indicate a need for development of methods to reduce observer variation in a interpretation of xeromammograms while preserving diagnostic sensitivity and validity. Results also emphasize the importance of developing strategies to ensure quality control in multicenter trials.

Breast Neoplasms↗
PubMed1980

Properties of fetal and adult red blood cell arginase: a possible prenatal diagnostic test for arginase deficiency.

Prenatal diagnosis of inborn errors of metabolism has been possible only if the enzyme affected is expressed in amniotic fluid cells grown in culture. Arginase is essentially undetectable in normal human fibroblasts, amniotic fluid, and amniotic fluid cells but is present in high amounts in red blood cells. It is absent in the red blood cells of patients with liver arginase deficiency. The properties of the enzyme in the red cells of healthy children and adults were compared to those of the enzyme obtained from cord blood red cells of 13--20-week fetuses obtained at hysterotomy. The activities, heavy metal requirements, heat stability, pH optimum, kinetic properties, and reaction with anti-arginase antibody were examined. Both enzyme species were either identical or substantially similar by all criteria. The adult and fetal enzymes are, therefore, probably determined by the same structural gene. Fetal red cells obtained during amniocentesis and amnioscopy should then be a suitable tissue to use to make the prenatal diagnosis of arginase deficiency.

Arginase↗
PubMed1977

Evaluation of rapid polarographic method for determining tocopherols in vegetable oils and oil-based products.

A polarographic procedure for the determination of the tocopherols in vegetable oils was compared to a conventional gas-liquid chromatographic procedure. The polarographic method is 2-3 times more precise and more rapid, which is an important advantage for monitoring the nutritional value of processing conditions of vegetable oil-based products. Attempts to establish the validity of apparently slightly higher values for alpha- and gamma-tocopherols obtained by polarography has implicated the gas chromatography or derivative formation rather than the extensive prior manipulation of the sample for chromatography as the source of error. Essentially the same results were obtained for alpha-tocopherol, regardless of the technique used. However, more variable results which were product dependent were obtained for gamma- and delta-tocopherols when gas-liquid chromatography was used.

Chromatography, Gas↗
PubMedDate not supplied

Cardiac rehabilitation services in Ireland: the impact of a coordinated national development strategy.

BACKGROUND: The national Cardiovascular Health Strategy including specific plans for cardiac rehabilitation was launched in Ireland in 1999. A survey of cardiac rehabilitation services was conducted in 2003 to evaluate progress on service provision. AIM: To establish levels of service provision, service formats and geographic distribution of cardiac rehabilitation services in 2003 and compare them with the status pre-Strategy (1998). METHOD: All hospitals in Ireland (n = 39) admitting cardiac patients to a coronary or intensive care unit were surveyed by postal questionnaire. RESULTS: All hospitals provided information and all reported providing Phase I cardiac rehabilitation. Seventy-seven per cent (30 of 39) provided Phase III rehabilitation in 2003 (i.e. outpatient cardiac rehabilitation services) compared with 29% (12 of 41) in 1998. Of those hospitals currently without programmes, 78% (seven of nine) had plans in place for programme establishment. All programmes had trained cardiac rehabilitation coordinators, multidisciplinary teams and multiple components as recommended in the Strategy. In 82% of hospitals, intervention was provided at Phase II (immediate post-discharge period) while 26% of hospitals provided intervention at Phase IV (long-term maintenance period). CONCLUSIONS: There have been substantial achievements towards the Cardiovascular Health Strategy target of providing cardiac rehabilitation services for all relevant hospitals in Ireland over the past five years. Service provision of cardiac rehabilitation can benefit from collective efforts made across centres to encourage the prioritisation of cardiac rehabilitation in national health policy initiatives.

Ambulatory Care Facilities↗
PubMedDate not supplied

Common problems with wound care: infection with HIV.

The issue of the care required by wounded patients infected with human immunodeficiency virus should be addressed by all nursing personnel. The virus can be transmitted through blood, blood products or wound exudate. Promotion of universal precautions should greatly minimise the risk. The patient's infection status is not always known and the problem may not be a major wound but an associated condition.

HIV Infections↗
PubMedDate not supplied

Pressure sores: adopting the principles of risk management.

This article examines the continuing problem of pressure sores in the NHS from a purchasing and a providing manager's perspective. Risk management and the need for clinical effectiveness in treatment and prevention strategies are discussed. Reporting systems are advocated as a means to estimate risk and to form a store of information that will enable a response to made when problem areas are identified. Nursing advice and input into the contracting process is vital. The need for purchasers and NHS managers to work together to ensure that effective interventions are implemented to reduce both the financial burden on the NHS and the physiological insult offered to patients is stressed.

Health Policy↗
PubMedDate not supplied

Know how--i.v. insertion sites.

Patients receiving intravenous therapy are at risk of developing an infection at the insertion site. Careful monitoring of the length of time a catheter is in situ, and ensuring that only sterile dressings are used and that they do not allow accumulation of moisture at the insertion site, will reduce the rate of complications.

Bacteremia↗