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Biomedical subjects

M McCarthy

Publications and source records attributed to M McCarthy.

At least 253 records · Page 14Linked to original sources
PubMed1995

Dying from cancer: results of a national population-based investigation.

OBJECTIVE: To describe the quality of care received in the last year of life by people who die from cancer, focusing particularly on symptom control, communication with health professionals, and care in the community. DESIGN: Interview survey of family members or others who knew about the last year of life of a random sample of people who died in the UK in 1990, based upon methods used in nationally representative surveys by Cartwright in 1969, and Cartwright and Seale in 1987. SETTING: Twenty district health authorities from a range of inner city, outer urban and rural settings. Although self-selected, districts were nationally representative in terms of social characteristics and on many indicators of health service provision and usage. PARTICIPANTS: Interviews were obtained for 2074 cancer deaths out of a random sample of 2915, a 71% response rate. MAIN RESULTS: At some stage in the last year of life, 88% were reported to have been in pain, 66% were said to have found it to be 'very distressing', and 61% to have experienced it in their last week. Treatment that only partially controlled the pain, if at all, was said to have been received by 47% of those treated for pain by their GPs and by 35% of hospital patients. Other common symptoms experienced by more than half the sample in their last year were loss of appetite, constipation, dry mouth or thirst, vomiting or nausea, breathlessness, low mood, and sleeplessness. Half of the respondents (51%) were unable to get all the information they wanted about the patient's medical condition when they wanted it. Relatives bore the brunt of caring for 81% of the sample. Of respondents who had helped to care for the deceased, 65% said that their activities had been at least fairly restricted, but 53% had found it rewarding. District nurses had helped 60% of the deceased, 20% had had a home help, and 9% had received 'meals on wheels'. More help with activities of daily living was reported to have been needed by 31%; 24% were reported to have needed more help with domestic chores; 25% were reported to have needed more financial help, and 29% were reported to have needed either more care from district nurses (if had some) or some care (if had none). CONCLUSION: There is still some way to go before all dying cancer patients receive high quality care. Education in the principles of palliative care is needed at all levels of the NHS if high standards are to be reached. In addition, adequate resources are required to meet the social and health care needs of cancer patients at home. There is, as yet, no room for complacency about the care of dying cancer patients.

Adolescent↗
PubMed1995

Media components influence viral gene expression assays in human fetal astrocyte cultures.

In vitro neurovirological studies of viral infectivity or viral gene expression may be confounded by the multiple neural cell types and/or fibroblast contamination present in early passage cultures prepared from dissociated human central nervous system (CNS) tissue. We have developed highly enriched astrocyte cultures for neurovirological study by culturing in a serum-free defined medium, B16, supplemented with basic fibroblast growth factor (FGF-2). Subculture in this medium selects against fibroblast proliferation and favors sustained proliferation of a highly enriched glial fibrillary acidic protein (GFAP)-positive cell population. These astrocytes support productive replication of cytomegalovirus (CMV) and transient expression of transfected CMV and human immunodeficiency virus type 1 (HIV-1) viral promoters. By comparison, CNS cultures developed in standard serum-containing medium initially contain predominantly astrocytes, but show increasing contamination with fibroblasts with sequential passage. These cultures support CMV viral synthesis in both fibroblasts and astrocytes, cell types distinguishable only by immunostaining for cell specific antigen. CMV or HIV-1 promoter activities, quantitated by transient gene expression assays, are distinctly lower in CNS cultures maintained in serum-containing medium.

Astrocytes↗
PubMed1995

Family planning, managed care, and rural America.

Within the United States, rural residents encounter a greater number of barriers in accessing health care services than their urban counterparts. In general, rural Americans have less access to both family planning services and managed care delivery systems. Given the rapid changes in health care, we reviewed the implications for the provision and integration of family planning and managed care services in rural areas, where there is limited experience in establishing working relationships between those services. In many instances, family planning services are well established in rural areas where managed care has not yet penetrated. Our case study in Minnesota suggests that, although managed care and family planning services are developing in rural areas, there is little evidence of collaboration. Several innovative and successful family planning projects do exist in rural areas, however, and serve as models of successful population-based programs that could work well with health plans. Although this study concentrated on the provision and utilization of subsidized family planning services, there is a compelling need for further work to determine accurately where rural residents are accessing such services and how the expansion of managed care will affect the delivery of reproductive health care.

Family Planning Services↗
PubMed1994

"Starwars" for AIDS.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1994

US "AIDS czar" quits.

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Acquired Immunodeficiency Syndrome↗
PubMed1994

Deaths of cyclists in London 1985-92: the hazards of road traffic.

OBJECTIVE: To determine the characteristics of cyclists and vehicles involved in fatal cycling accidents. DESIGN: Analysis of data routinely collected by police for each accident from January 1985 to December 1992 and held in a national master file (Stats 19) by the Department of Transport. SETTING: Greater London, which comprises inner London (12 boroughs and the City of London) and outer London (20 boroughs). SUBJECTS: 178 cyclists who died (78 in inner London and 100 in outer London; age range 3-88). MAIN OUTCOME MEASURES: Associations between characteristics of cyclists, type of vehicle involved, and place of accident. RESULTS: Motor vehicles were involved in 173 deaths. Heavy goods vehicles were involved in 75 deaths (30/100 (30%) in outer London and 45/78 (58%) in inner London); cars in 74 (54/100) (54%) in outer London and 20/78 (26%) in inner London); light goods vehicles in 12/178 (7%); and buses in 6/178 (3%). Thirty five of the people who died were children aged < or = 16. Female cyclists were especially at risk from heavy goods vehicles in inner London (22 deaths), while male cyclists were especially at risk from cars in outer London (50 deaths). DISCUSSION: Cyclists who died in urban areas are more likely to be adults than children. In inner London, in relation to their traffic volume, heavy goods vehicles are estimated to cause 30 times as many cyclists' deaths as cars and five times as many as buses. Until the factors leading to this excess risk are understood, a ban on heavy goods vehicles in urban areas should be considered.

Accidents, Traffic↗
PubMed1994

HIV and cancer.

Explore the source record for details and available documents.

AIDS-Related Opportunistic Infections↗
PubMed1994

Disadvantage in physically disabled adults: an assessment of the causation and selection hypotheses.

An area survey of West Beirut provided the opportunity to study whether disadvantage among people with physical disabilities is attributed to social class of origin (causation) or is due to the social consequences of disability (selection and drift). Adults who were disabled from poliomyelitis in childhood were compared to West Beirut residents and to age and sex matched sibling controls. The typical finding of a substantially greater proportion of disabled people in the lower social class groups was noted. Their fathers were also over-represented in the lower social classes but to a lesser extent in the skilled manual group. The occupational mobility processes, both inter-generational and intra-generational, pointed to a trend towards skilled labor for disabled groups from all social classes, a finding different from the general population trends. Selection (failure to reach or keep expected position) was noted in the lower social classes while the downward drift (movement from higher to lower social class) for the disabled persons was seen in the upper social classes. Both the causation and the selection-drift hypotheses were supported by the findings.

Adult↗
PubMed1994

Are bereaved family members a valid proxy for a patient's assessment of dying?

OBJECTIVE: To compare assessments made retrospectively by bereaved family members (or the nearest carer to the patient) with assessments made before death by palliative staff and, where available, by patients themselves or the family member. METHODS: SETTING--two palliative care support teams. ASSESSMENTS--were recorded prospectively by team staff, patients and their family members for consecutive patients referred, and then were recorded retrospectively by family members during interview seven months after bereavement. MEASURES--seven items each rated 0 (best) to 4 (worst) using standard definitions. The rater was asked to average the severity over one week. ANALYSIS--ratings were tested for percentage agreement, for Cohen's Kappa (which controls for chance agreement) and for Spearman correlations. RESULTS: Staff ratings and family members' retrospective ratings, which described the last week of life, were available for 35 patients. Six patients and seven family members had also been interviewed shortly before the patient's death. The main problems identified by all raters were similar: family anxiety, symptom control, patient anxiety and pain control. For three items, practical aid, wasted time and communication, agreement was good--all cases except one were equal or within one score. However, problems were rarely identified for these items. For the other four items: pain control, other symptom control, family anxiety and patient anxiety, there was little agreement, Cohen's Kappa ranged 0.05-0.22. Agreement for one item (patient anxiety) was significantly improved if a patient had died at home. Comparison of ratings made by the family members before the death and seven months after bereavement suggests that family members alter their assessments during bereavement. CONCLUSION: Retrospective assessments by bereaved family members may be valid for some items related to service provision, but not as the sole assessment of a patient's pain, symptoms or anxiety. We suggest that studies which rely on these retrospective ratings should assess the validity of their responses and record more information about the mood and grief of the family member.

Anxiety↗
PubMed1994

Emulsified anterior chamber silicone oil and glaucoma.

PURPOSE: This retrospective study was undertaken to assess the occurrence of postoperative anterior chamber emulsified silicone oil after intravitreal instillation and to examine the relation between such emulsification and new postoperative glaucoma. METHODS: Forty-eight consecutive eyes received intravitreal silicone oil, were followed for at least 1 year, and were evaluated postoperatively by gonioscopy on at least one occasion. Eight eyes received 1000 cs oil, and 40 eyes received 5000 cs oil from which low molecular weight contaminants were removed. All aphakic and pseudophakic eyes received an inferior iridectomy. Oil was removed in 19% of eyes during follow-up. RESULTS: Fifty-six percent of eyes manifested anterior chamber emulsified oil postoperatively. The oil was typically identified only on gonioscopy. This complication developed in 50% of eyes receiving 1000 cs oil and 58% of eyes receiving highly homogeneous 5000 cs oil. Of the 48 eyes, new postoperative glaucoma best explained by interval angle oil emulsification developed in 5 (10%). CONCLUSION: Anterior chamber oil emulsification occurred frequently, despite inferior peripheral iridectomy in aphakic or pseudophakic eyes and the use of highly purified, higher viscosity oil in 83% of eyes. In this series, new glaucoma in the setting of angle oil emulsification only developed in 10% of eyes. The glaucoma was managed medically in four of five patients.

Adolescent↗
PubMed1994

Idiopathic sclerosing inflammation of the orbit. A distinct clinicopathologic entity.

BACKGROUND: Idiopathic sclerosing inflammation of the orbit is a poorly delineated, fibrosing, immune-mediated entity resulting in significant ocular disability. To characterize this process and propose more specific and effective therapy, clinical and pathologic findings in 16 cases are reviewed. METHODS: The clinical records of 16 patients with biopsy-proven disease were retrospectively reviewed to determine demographic and clinical features, radiologic features, course, management, and outcome. These findings were correlated with pathologic features to describe this unique entity. Immunohistologic characteristics were compared with those of a clinically and histopathologically similar process, retroperitoneal fibrosis. RESULTS: The study included 11 male and 5 female patients, ranging in age from 8 to 81 years. Disease onset was usually unilateral (14/16) and chronic (11/15), with two distinct anatomic presentations, lacrimal (11/16) and apical (3/16), characterized by infiltration (15/16), mass effect (12/16), and visual loss (3/16). The most common signs and symptoms were dull pain (13/16), proptosis (11/16), mild inflammation (11/16), restricted motility (9/16), swelling (9/16), and diplopia (8/16). Two features, a sparse, chronic inflammatory infiltrate, the immunopathologic characteristics of which suggested a cell-mediated process, and a desmoplastic stroma of early onset, dominated the pathologic picture. Treatment with corticosteroids (11/16), radiotherapy for steroid failures (8/11), and observation alone (3/16) was inadequate, resulting in blindness in 3/16 cases, restricted movement in 10/16, and complete resolution in only 2/16 patients. CONCLUSION: Idiopathic sclerosing inflammation of the orbit is a unique clinicopathologic entity, similar to retroperitoneal fibrosis, that is characterized by primary, chronic, and immunologically mediated fibrosis, poor response to corticosteroid treatment or radiotherapy, and frequent visual disability. Early and aggressive immunosuppressive therapy is recommended.

Adolescent↗
PubMed1994

Definitions and determinants of handicap in people with disabilities.

Researchers have made a distinction between disability and its social and psychological consequences, now known as handicap, both conceptually and in terms of intervention. More work is needed in standardizing and refining the assessment of handicap and in highlighting risk factors for its development. Epidemiology has major contributions to make in understanding handicap in both aging and young populations. Data on the prevalence and incidence of handicap are scarce and difficult to obtain. Efforts are needed in the following areas: 1) contributing to the methodology of handicap assessment through the provision of valid and reliable scales; 2) defining and identifying risk factors for handicap formation, which underscores the need for analytic studies in this regard; 3) understanding the dynamics of these factors in the production of disadvantage, which calls for more qualitative and in-depth interviews with persons with handicaps; and 4) formulating critical points of intervention at the personal and community levels for handicap prevention. Such efforts will assist policy-makers in formulating appropriate and acceptable policies for safeguarding the opportunities of people with disabilities, ensuring their optimal participation in society, and enabling them to lead independent and self-sufficient lives. Efforts to evaluate the effect of legislation, both existing and recent, on handicap development are also called for. These efforts may help to reduce the gap between disabled and nondisabled people and improve the quality of life for people with disabilities and their families.

Activities of Daily Living↗