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Biomedical subjects

M Mulvihill

Publications and source records attributed to M Mulvihill.

At least 37 records · Page 2Linked to original sources
PubMed1992

Acute myocardial infarction in a long-term care institution for the aged.

We reviewed the clinical characteristics and outcome of cases of acute myocardial infarction occurring from January 1, 1985, through December 31, 1987, in the population of a long-term care institution for the elderly. The total number of patients in the series was 43. Comparisons were made between those patients transferred to a general acute-care hospital and those who remained at the facility. The most common initial symptoms of acute myocardial infarction in 32 of 48 patients were, in order, dyspnea, dizziness or syncope, precordial pain, and abdominal pain. Nine (of 43) patients were asymptomatic. In the 14 (of 43) patients transferred to an acute-care hospital, cardiac failure, arrhythmias, and cardiogenic shock were much more frequent than among those retained in the long-term care facility. We concluded that a high index of suspicion for the diagnosis of acute myocardial infarction in the institutionalized elderly is indicated. Patients with mild infarction can be retained in long-term care institutions; resulting mortality from cardiac disorders should be low in adequately staffed and equipped long-term care institutions.

Aged↗
PubMed1991

Substituted judgment: how accurate are proxy predictions?

Substituted judgment has been proposed as a method of promoting the autonomy of the mentally incapacitated patient, but little is known about the accuracy of surrogate decision makers in reflecting the true wishes of patients. In this study, surrogate decision makers' views (those of primary care providers and close family members) were compared with the decisions of currently competent chronically ill elderly patients, using a hypothetic cardiopulmonary resuscitation scenario under circumstances of current health and progressive dementia. Concordance between patients and their surrogates was evaluated by assessing percent agreement, kappa coefficient (for concordance beyond chance), and directionality of discrepant responses. Most patient respondents chose to be resuscitated in both scenarios. Although patients predicted that both their physicians (90%) and family members (87%) would accurately represent their wishes, neither family members nor physicians, in fact, were able to adequately predict patients' wishes in both scenarios (kappa less than or equal to 0.3 in all scenarios; percent agreement range, 59% to 88%). Few patients had ever discussed their resuscitation preferences with either their family member (16%) or their physician (7%). These results cast doubt on the usefulness of a strict substituted judgment standard as an approach to medical decision making for patients with diminished mental capacity.

Aged↗
PubMed1991

Eliciting medical care preferences from nursing home residents.

We interviewed 44 residents of a nursing home to assess their preferences for care. Using case vignettes, we asked residents about resuscitation, hospital transfer, feeding tubes, and restraint use. Most were opposed to aggressive care unless the purpose was to enhance comfort or safety. However, sufficient diversity of opinions points to the need for advanced directives.

Advance Directives↗
PubMed1991

Refusal of tube feeding as seen from a patient advocacy organization: a comparison with landmark court cases.

OBJECTIVE: To determine how closely high court decisions regarding tube feeding are a reflection of the situations that occur in the general population. DESIGN: A retrospective review was conducted of memos recording inquiries made to the Society for the Right to Die (SRD), a patient advocacy organization. Characteristics of clients were compared to characteristics of individuals considered in landmark "right-to-die tube feeding cases during the same period of time. RESULTS: Information from 116 memos of inquiries made from 1985 through mid-1990 was compared to 20 court cases, and significant differences were identified. The average age of the SRD clients was 77.6 (+/- 18.4) years compared to 55.1 (+/- 22.8) years for the court cases (P less than 0.001). Of the clients, 79% were 70 years of age or older and 28% were 90 or older; in contrast, 7 (35%) of subjects in the court cases were 70 years of age or older, and none was over 90 (P less than 0.001). In addition, whereas 14 (70%) of the court cases dealt with individuals in a persistent vegetative state, only 17 (15%) of SRD clients carried that diagnosis (P less than 0.001), with the remainder suffering from dementia, various stages of coma, or a variety of other debilitating disorders. The sex distribution, year of inquiry or year of court decision, and geographic distribution were similar. Some states were overrepresented in both groups. CONCLUSION: High court cases may inadequately reflect the majority of situations that arise on a day-to-day basis. Elderly individuals, in particular those who are not in a persistent vegetative state, are significantly underrepresented.

Aged↗
PubMed1990

The role of medication in falls among the elderly in a long-term care facility.

This case-control study examines the relationship between falls and drug use in elderly residents of a long-term care facility. The drug use and functional status of 57 first-time fallers were compared retrospectively with those of 90 residents who had never fallen. Fallers were taking significantly more drugs than controls. Hypnotic/anxiolytics and cardiac drugs carried a twofold increase in the risk of falling. Fallers were restrained less often, were more often ambulatory, and had been at the institution for a shorter time than controls. Previous studies have failed to use control groups or have selected controls by length of stay, possibly introducing bias into the results. A large prospective study is needed to determine whether these results are generalizable to the elderly institutionalized population as a whole.

Accidents↗
PubMed1989

Indicators of social risk for poor adjustment to nursing home placement.

In an attempt to identify indicators of risk for psychosocial maladjustment in new nursing home residents, we evaluated the first-year course of 88 new nursing home residents. These 88 study patients constituted all the new residents admitted in 1987 to the Kingsbridge Center of the Jewish Home and Hospital for Aged, Bronx, NY, and assigned to the health-related floors (indicating less serious impairments). Social work intake and progress notes were abstracted to evaluate their utility in identifying indicators of risk for medical and psychosocial maladjustment among these patients. Patients admitted from home fared worse (had more medical visits) than those admitted from hospitals. Lack of additional findings suggests that more uniform and structured intake and progress assessments be made.

Activities of Daily Living↗
PubMed1987

Normal trunk muscle strength and endurance in women and the effect of exercises and electrical stimulation. Part 1: Normal endurance and trunk muscle strength in 101 women.

The lack of trunk muscle strength and endurance has frequently been cited as a suspected factor in the etiology of low-back pain. Several investigators have suggested that asymptomatic patients have stronger trunk muscles than patients with low-back pain. People who are physically fit appear to have a decreased incidence of low-back pain. Increased trunk muscle endurance also have been observed to decrease the incidence of low-back pain. The objective evaluation of the strength and endurance of trunk musculature may, therefore, be significant. Part 1 of this study was designed to develop a reproducible strength-endurance screening procedure and to establish normal isometric-isokinetic trunk muscle strength and endurance parameters for women. This study showed that isometric trunk flexion varied from 19-109 Nm and trunk extension from 38-168 Nm. Peak values for isokinetic trunk flexion at two speeds (30 degrees per second and 60 degrees per second) varied from 17-191 Nm and isokinetic trunk extension from 14-208 Nm. The average endurance time for trunk extensors tested with the Sorensen test was 196 seconds.

Adolescent↗
PubMed1987

Normal trunk muscle strength and endurance in women and the effect of exercises and electrical stimulation. Part 2: Comparative analysis of electrical stimulation and exercises to increase trunk muscle strength and endurance.

Several studies have shown positive correlations between muscle strength, flexibility, and the frequency of low-back pain. Weak trunk musculature and decreased endurance have thereby come to be identified as significant risk factors in the development of occupational back problems. Because it is widely accepted that exercise plays an important role in the conservative treatment and prevention of low-back pain, the goals of most rehabilitative programs involves improving the strength and endurance of the low-back pain patient. Whereas electrical stimulation has been shown to increase the muscle strength of the lower extremities, this effect has not been demonstrated for the trunk muscles. Part 2 is a prospective controlled study designed to document and to compare objectively the effects of electrical stimulation and exercise on trunk muscle strength. A total of 117 healthy women were divided randomly into four groups. Two groups received electrical stimulation with different electrical parameters, one group received exercises, and one group acted as a control group. The results showed that low-frequency electrical stimulation and exercises significantly (P less than .05) increased isokinetic back-muscle strength compared to the control and medium-high-frequency electrical stimulation groups. Both types of electrical stimulation, however, significantly increased (P less than .05) the endurance in the back muscles compared with the control and the exercise groups. This study showed that electrical stimulation may be a valuable treatment in the early care of low-back pain patients in maintaining and increasing strength and endurance of back muscles when a more active exercise program is too painful to perform.

Adolescent↗
PubMed1987

Delirium: a test of the Diagnostic and Statistical Manual III criteria on medical inpatients.

Although 10% to 15% of patients admitted to acute care hospitals are in a state of delirium, few patients are given this diagnosis by their clinician. We field-tested the Diagnostic and Statistical Manual III (DSM-III) criteria for diagnosing delirium on 133 consecutively admitted patients to an acute medical ward. Twenty patients were delirious using DSM-III criteria, 19 more patients than were reported by the primary clinician. Seven delirious patients were less than 65 years of age (range, 32 to 64 years). Sixty-five percent of patients with delirium died, whereas significantly fewer (3.3%) of patients without delirium died (P less than .0001). We found that delirium could be readily and reliably detected (kappa coefficient of agreement = 0.62 for interrater reliability) using the DSM-III criteria. Clinicians should routinely screen hospitalized patients of all ages using DSM-III criteria to identify delirious patients for an immediate evaluation and treatment.

Adult↗
PubMed1985

Forensic aspects of fraternity hazing.

Although the news media has occasionally reported deaths and injuries related to fraternity hazing in the past, little, if any, attention has been given to the subject in the medical literature. In light of the medicolegal implications surrounding many of these incidents, it is important that medical examiners be aware of the problem. One hundred sixty-eight (168) cases of injuries and deaths related to fraternity hazing activities occurring in the past 60 years in the United States have been collected from secondary sources. A descriptive statistical analysis of the data is presented.

Adolescent↗
PubMed1985

ALS and pet exposure.

To examine animal exposure in ALS patients, a case-control study was undertaken on 40 ALS patients and 40 closely matched controls. Exposure to pets of any kind and to small dogs in the period from birth until 10 years before onset of ALS symptoms was significantly increased. Affected men showed a trend toward increased exposure to neurologically ill pets, but there was no significant difference when male and female cases were grouped. No differences between ALS cases and controls were observed in exposure to any other single animal species. There may be a link between ALS and exposure to house pets.

Adult↗
PubMed1984

Blood glucose discrimination training with insulin-dependent diabetics: a clinical note.

Two insulin-dependent diabetic adults were exposed to a blood glucose discrimination training program. Following baseline, during which subjects estimated their blood glucose levels twice daily, subjects received immediate feedback regarding the accuracy of their estimates. The procedure resulted in a large increase in accuracy of blood glucose level estimation. The implications of the findings were discussed.

Adult↗
PubMed1982

Age distribution of right- and left-sided colorectal cancers.

The age distributions in different anatomic areas of the colorectum were compared in 410 patients. The average age for patients with right-sided cancers (71.3 yr) was significantly higher than that for patients with left-sided cancers (67.5 yr). In addition, there was a significantly higher percentage of patients over the age of 70 (mean age of the whole group) in the right colon group as compared with the left colon group. It was concluded that the older age distribution of right-sided cancers might be explained by the delayed effect of an environmental carcinogen in a population with a longer life expectancy.

Adenocarcinoma↗
PubMed1980

Parity and prognosis in breast cancer.

Analysis of five-year disease-free survival rates in 608 women with operable breast cancer revealed that the reproductive history is a significant prognostic determinant. Overall parous women had a significantly higher cumulative five-year disease-free survival rate (60%), compared to the nulliparous (46%) (z = 2.5, p = 0.012). Significant differences were also noted when gravidity in addition to parity was taken as the determinant. The corresponding disease-free survival rates were 61% and 50%, respectively (z = 1.98, p = 0.048). Five-year survival rates were influenced in a similar manner by these variables but the observed differences were less significant. The trend toward higher survival rates in parous and gravidae women were noted in all tumor stages but achieved statistical significance only in stage III. The findings indicate that parity and gravidity affect not only the risk of breast cancer development but also the subsequent course of the disease. Parity seems to be a strong risk and prognostic factor than gravidity.

Breast Neoplasms↗
PubMed1980

Association between estrogen receptors and weight in women with breast cancer.

A significant association between body weight and estrogen receptor protein (ERP) was noted in 83 women with primary and metastatic breast cancer. Thirteen of 34 (54%) women with weight greater than 150 lb had low or absent receptor protein (less than 10 femtomoles/mg of cytoplasmic protein) compared to 15 of 59 (25%) women with weight less than 150 lb (P less than 0.025). The observed association was stronger in the group of 62 postmenopausal women (P less than 0.01). The findings suggest that the endocrine and metabolic milieu in women with increased weight favors autonomous growth of breast cancer, and adjuvant treatment in this group should be planned accordingly.

Body Weight↗