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Biomedical subjects

M McHugh

Publications and source records attributed to M McHugh.

At least 37 records · Page 2Linked to original sources
PubMed1996

Use of computerized morphometric analyses of endometrial hyperplasias in the prediction of coexistent cancer.

OBJECTIVE: Our purpose was to determine whether computerized morphometric analysis is predictive of coexistent cancer in uteri that show endometrial hyperplasia in curettings or biopsy specimens. STUDY DESIGN: Forty-five patients with endometrial hyperplasia and 10 patients with well-differentiated cancers diagnosed from curettings or biopsy specimens and treated by hysterectomy at Thomas Jefferson University Hospital between 1989 and 1993 were identified from the pathology department archives. Curettings were analyzed by computerized morphometric analysis at the Free University Hospital in Amsterdam. Pathologists performing the morphometric analyses were blinded to the pathologic diagnoses obtained by examining the hysterectomy specimens. The histopathologic classification of the hysterectomy specimens were used as the end point. RESULTS: Twelve of 45 patients with endometrial hyperplasia (26.7%) by preoperative histopathologic classification showed coexistent carcinoma at hysterectomy. All instances of carcinoma occurred in patients with atypical hyperplasia. Sensitivity of morphometric analysis to predict carcinoma was 100%, with a specificity of 88.5%. The positive predictive value was 83.3%, and the negative predictive value was 100%. A blinded reanalysis of the quantitative analysis in 16 patients showed good reproducibility of this technique (r = 0.93). CONCLUSIONS: Morphometric analysis is useful for predicting which patients with endometrial hyperplasia have coexistent carcinomas. Computerized morphometric analysis may be useful in therapeutic decision making for complex atypical hyperplasia.

Aged↗
PubMed1996

Establishing an interdisciplinary patient care team: collaboration at the bedside and beyond.

The authors describe how an interdisciplinary team used skills in communication and collaboration to improve patient care on a busy surgical service. A major goal was to establish and maintain continuity of care in the face of decreasing lengths of stay and increasing patient acuity. The authors share their insight about designing and supporting a successful interdisciplinary patient care team and discuss how their experiences relate to concepts such as case management and career development.

Communication↗
PubMed1995

Effect of injury on the bi-affinity alpha 1-adrenoreceptor binding in rat brain in vivo.

Focal freezing lesions in rats cause a widespread decrease of cortical glucose utilization in the lesioned hemisphere, probably as a reflection of depressed cortical activity. The noradrenergic neurotransmitter system was implicated in these alterations when it was demonstrated that prazosin, a specific norepinephrine (NE) antagonist at alpha 1-adrenergic receptors, prevented their development. In normal rat brain, specific binding of [125I]HEAT [(+/-)2-(3-[125I]iodo-4-hydroxyphenyl)-ethyl-aminomethyl-tetralone], another selective alpha 1-adrenoreceptor ligand, was demonstrated in vivo at sites consistent with the alpha 1A- and alpha 1B-adrenoreceptor subtypes. In the present study, the effect of a freezing lesion on specific binding of [125I]HEAT in rat brain in vivo was determined three days after traumatization when cortical glucose use suggested the greatest degree of functional depression. The steady-state volumes of distribution of [125I]HEAT three days after injury were significantly increased in all the cortical areas of the lesioned hemisphere, but not in the subcortical structures. Injury did not modify the binding affinities for HEAT. However, a statistically significant increase in the number of low-affinity binding sites for this ligand was demonstrated in all cortical areas of the lesioned hemisphere, but not in subcortical structures. The traumatization did not modify Bmax estimates for the high-affinity binding of HEAT. The results support the hypothesis that changes in the noradrenergic system are of functional importance in brain injury and that at least some effects of injury are mediated by alpha 1B-adrenergic receptors.

Animals↗
PubMed1995

Mandated training of professionals: a means for improving reporting of suspected child abuse.

Professionals who are legally required to report suspicions of child abuse and neglect to a child abuse hotline often do not do so. In 1988 the New York State Legislature passed a law requiring professionals to take a 2-hour course called Identification and Reporting Child Abuse and Maltreatment as a prerequisite for licensure. New York Society for the Prevention of Cruelty to Children has provided this training for more than 2,500 physicians, psychologists, psychiatrists, nurses, teachers, and other professionals. A question affecting training content and quality, as well as policy decisions by child welfare professionals, remains: whether failure to report is founded in professionals' ignorance of the law and procedures involved in reporting or in their inability to recognize indicators of child abuse and neglect. NYSPCC conducted a survey of 1,368 course participants to determine the extent to which information in the course was new to them. Results indicated that substantial numbers of professionals were not aware of indicators of abuse; nevertheless all professionals were more knowledgeable about abuse than they were about legal obligations and procedures for reporting. A surprising finding was that teachers were no more knowledgeable about indicators of abuse than were other professionals, though most abused children are of school age. These and other results strongly supported the need to train professionals about indicators of child abuse and about how to report them.

Child↗
PubMed1995

A 3-year epidemiological review of burn unit admissions in Dublin, Ireland: 1988-91.

A retrospective multifactorial epidemiological study of all patients admitted to the Burns Unit, St James's Hospital, Dublin during a 3-year period from January 1988 to December 1990 was undertaken. One hundred and twenty patients were admitted. All patients were aged over 14 years. The mean patient age was 48.2 years. Males accounted for 56 per cent of admissions. The mean percentage body surface area (%BSA) burned was 24.9 per cent. Flame was the cause of burns in 60 per cent of cases and produced the most extensive lesions. The home was the most common site of injury. Almost half the patients admitted from residential institutions sustained their burns in hot baths. Those aged over 60 years sustain smaller burns but are at increased risk from thermal injury. Twenty-one per cent of burns were caused by open fires used for heating the home. The mean time in hospital was 49.9 days. Twenty-three per cent of patients died as a result of their injuries. We have identified those living in residential institutions to be at increased risk from scald burns and suggest methods by which they may be protected.

Adolescent↗
PubMed1995

Local cerebral glucose utilization in stimulated rats sedated with thiopental.

BACKGROUND: Recent studies have suggested that supraspinal structures are involved in barbiturate-induced enhancement of nociceptive processing. The goal of the study was to determine whether cortical and subcortical regions involved in nociception were relatively activated or depressed by noxious stimulation during infusion of small doses of thiopental. METHODS: Local cerebral glucose utilization (LCGU) was measured with the 14C-2-deoxyglucose radioautographic technique in 14 rats. During the LCGU experiment, pressure was applied to the tail every 2 min, and the somatic motor response threshold was recorded. Seven animals received thiopental infusions to produce a steady-state plasma concentration (target concentrations of 10 micrograms/ml), and seven untreated animals served as controls. RESULTS: A steady-state plasma thiopental concentration (11.1 +/- 1.8 to 13.0 +/- 2.1 micrograms/ml) was accompanied by a decrease in the somatic motor response threshold from 277 +/- 32 g (before thiopental) to 215 +/- 41 g (P < 0.001). The somatic motor response threshold remained unchanged in the control group. Average LCGU was 29% less in the thiopental-treated animals than in the untreated controls (P < 0.001). In cortical regions associated with nociception, LCGU was relatively increased (+3% +/- 14%) during the thiopental infusion in comparison to the visual and auditory cortices (-18% +/- 13%; P < 0.001). Individual structures that showed relative changes during thiopental infusion included the nucleus accumbens (+17%, P < 0.05) and the habenula (-17%, P < 0.05). Heterogenous relative changes (P < 0.05) in LCGU were observed in the auditory system: auditory cortex (-22%), medial geniculate (-16%), lateral lemniscus (+26%), superior olive (+38%). CONCLUSIONS: Noxious stimulation during low-dose thiopental infusions relatively increased LCGU in cortical regions postulated to be responsible for processing of noxious stimuli. Nuclei in the descending pain modulating system were not relatively depressed.

Animals↗
PubMed1994

Quality circles: one organization's experience.

Decentralization of quality assurance activity or total quality management (TQM) is a goal set by many health services. Effective and efficient use of available resources is usually the goal. This article describes the efforts of one organization to decentralize its nursing quality assurance program. Quality circles provided forums for an increasing acceptance by ward-based nurses of their role in establishing quality as central to nursing practice. This emphasis on local group processes has helped staff to work with each other to solve problems related to the work of nursing.

Attitude of Health Personnel↗
PubMed1994

Implementation of a collaborative quality assessment program.

The authors describe a collaborative quality assessment program between the department of anesthesia and critical care and the department of nursing. Data were collected on patient outcomes and were presented, through case reviews, at monthly quality assessment rounds. The program has been successful in stimulating important discussions between physicians and nurses about patient care.

Aged↗
PubMed1994

Symptom relief and quality of life after stenting for malignant bile duct obstruction.

Palliative treatment is appropriate for most patients with cancer of the head of pancreas. Insertion of a biliary stent relieves jaundice and pruritus but it is not known if stenting affects other symptoms or changes the quality of life. Nineteen patients have completed a standard questionnaire to assess symptom relief and quality of life after stent insertion. After stenting there was complete relief of jaundice and pruritus. Furthermore, there was also considerable improvement in anorexia and indigestion. All patients had anorexia before stent insertion, this was moderate/severe in 13 (68.4%). Anorexia was significantly better (p < 0.01) a week after stenting and this benefit was maintained at 12 weeks (p < 0.01). Sixteen (84.2%) patients complained of indigestion before stenting, moderate/severe in 11 (57.9%). This was significantly better (p < 0.01) a week after stenting with complete relief in six at eight weeks (p < 0.01). Fifteen (78.9%) felt that their mood was good/very good before stent insertion and this was unchanged even at the 12 week assessment. A similar result was obtained for physical health and level of activity. In conclusion stent insertion not only relieves jaundice and pruritus in these patients but also improves other symptoms and quality of life. The considerable improvement in appetite after stenting was of particular benefit.

Affect↗
PubMed1993

Acute electrical stimulation increases extramyocardial collateral blood flow after a cardiomyoplasty.

We hypothesized that acute electrical stimulation of a latissimus dorsi cardiomyoplasty would augment the collateral blood flow delivered by the skeletal muscle to the heart. This hypothesis was tested in an animal model (13 goats) of coronary artery disease. Six weeks after a cardiomyoplasty was performed, myocardial collateral blood flow derived from the latissimus dorsi muscle was measured with colored microspheres when the muscle was at rest and during electrical stimulation of the thoracodorsal nerve at 1.25 Hz. The area at risk for ischemia averaged 13.37 +/- 2.08 g (mean +/- standard error), or 18.4% of left ventricular mass (n = 13). At rest, significant skeletal muscle-derived collaterals developed in 9 animals, and formed predominantly to chronic ischemic myocardium (mean +/- standard error, 0.07 +/- 0.02 mL.g-1 x min-1; n = 9), rather than infarct (0.03 +/- 0.02 mL.g-1 x min-1; n = 5), or normal myocardium (0.0005 +/- 0.0001 mL.g-1 x min-1; n = 9). Stimulation increased skeletal muscle-derived collateral blood flow to chronic ischemic areas to 0.38 +/- 0.09 mL.g-1 x min-1 (n = 9) (p < 0.05). During stimulation, the collateral flow was greater in the epicardium (0.46 +/- 0.11 mL.g-1 x min-1) than in endocardium (0.14 +/- 0.09 mL.g-1.min-1) (p < 0.05). This study demonstrates that electrical stimulation of a latissimus dorsi cardiomyoplasty increases extramyocardial collateral blood flow to chronic ischemic myocardium.

Animals↗
PubMed1993

Bupivacaine and Kaltostat reduces post-operative donor site pain.

A prospective double blind controlled trial was carried out to examine the differences in post-operative split skin graft donor site pain between sites dressed with three differently treated types of dressing; a dry calcium alginate dressing (Kaltostat Britcair), a saline moistened Kaltostat dressing and a bupivacaine hydrochloride (0.5%) moistened Kaltostat dressing. There was a significant reduction in post-operative pain in the Kaltostat and bupivacaine group (group 3) at 24 and 48 h when compared to the other two groups (p < 0.04). There was no difference in ease of removal of dressings or the quality of wound healing on day 10 between the three groups. This study demonstrates a significant reduction in post-operative pain in bupivacaine soaked Kaltostat without reducing the beneficial effects of Kaltostat on donor site healing and we recommend its use in clinical practice.

Adult↗
PubMed1993

Limitations of liability insurance.

In the unfortunate event that you are sued for malpractice, the following suggestions could maximize the benefits of your professional liability insurance policy: Do not contact the claimant, because any statements you make can be used against you in a suit. Provide the insurer with as much information as possible. Monitor the case regularly by contacting the insurance adjuster assigned to the case and request copies of all documents generated. Communicate your feelings with the company about defending or settling the case. If you completely violated a standard of care such as giving an IV push medication to the wrong patient because of failure to check the patient's name bracelet, try to settle this case out of court. A jury would not likely be sympathetic to a nurse who injured a patient in this manner. Review the entire medical record and discuss your analysis with your attorney. Remember, as a policyholder, you have the right to demand that your claim be handled by a competent, professional lawyer. Unlike other professionals, attorneys are not required to have national certification. Defendants have the right to ask assigned attorneys about their malpractice experience. Does the attorney have a working knowledge of the procedures and technical jargon concerning the case? How many similar cases has the attorney handled? You have a right to these answers.

Critical Care↗
PubMed1992

Variations in dorsomedial hand innervation. Electrodiagnostic implications.

Sensory potentials recorded from the dorsal cutaneous branch of the ulnar nerve (DCUN) help localize ulnar nerve lesions. This conduction technique was first described by Jabre in 1980. Abnormalities detected with this technique in control populations are commonly attributed to local trauma. Anatomic variations of cutaneous innervation to the dorsum of the hand, however, have been described. We recorded DCUN responses using both the normal DCUN stimulation point and a secondary site of stimulation at the radial aspect of the forearm in 44 patients. Eleven patients demonstrated a low-amplitude DCUN response. Four of the 11 patients demonstrated sensory potentials obtained from the routine recording site of the DCUN with radial stimulation. We conclude that an abnormal DCUN response may represent anomalous innervation. To avoid some errors in localization, radial forearm stimulation should be performed whenever the DCUN response is abnormal.

Adult↗
PubMed1992

After a cardiomyoplasty, collaterals from skeletal muscle form to chronic ischemic myocardium.

We measured the collateral formation between skeletal muscle and the heart after a latissimus dorsi cardiomyoplasty in an animal model that contained normal, chronic ischemic, and infarcted myocardium. The area at risk for ischemia was 27.0 +/- 3.2% of the left ventricular mass (n = 10, mean +/- SE). In five animals the risk area developed predominantly into chronic ischemic myocardium; in five others the risk area became an infarct. The collateral blood flow from the skeletal muscle to chronic ischemic myocardium (6.05 +/- 1.36 ml/100 g/min, n = 5) was higher than flow to the infarct (0.46 +/- 0.31 ml/100 g/min, n = 5). The collateral blood flow to normal myocardium was minimal (0.04 +/- 0.01 ml/100 g/min). The collateral blood flow appeared to be concentrated in the outer half of the left ventricular wall, with the epicardium having a higher skeletal muscle derived collateral blood flow than endocardium (p < 0.05). We conclude that after a cardiomyoplasty a collateral blood flow, which approaches clinical significance, is preferentially established between skeletal muscle and chronic ischemic myocardium. Enhancement of this collateral blood flow might provide a means to revascularize patients with presently inoperable coronary disease.

Animals↗