Biomedical subjects
Publications and source records attributed to M Murphy.
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Procedural sedation and analgesia are core skills in emergency medicine. Various specialty societies have developed guidelines for procedural sedation, each reflecting the perspective of the specialty group. Emergency practitioners are most likely to embrace guidelines developed by people who understand emergency department (ED) skills, procedures, conditions, and case mix. Recognizing this, the Canadian Association of Emergency Physicians (CAEP) determined the need to establish guidelines for procedural sedation in the ED. In March, 1996, a national emergency medicine (EM) working committee, representing adult and pediatric emergency physicians, was established. This committee teleconferenced with representatives of the Canadian Anesthetic Society (CAS) to identify problems, perspectives, and controversial issues, and to define a process for guideline development. The EM committee subsequently reviewed existing literature, determined levels of evidence, and developed the document, which evolved based on feedback from the CAS and CAEP Standards Committees. The final version was approved by the CAEP Standards Committee and the CAEP Board of Directors, then submitted for peer review. These guidelines discuss the goals, definitions, and principles of ED sedation, and make recommendations for pre-sedation preparation, patient fasting, physician skills, equipment and monitoring requirements, and post-sedation care. The guidelines are aimed at non-anesthesiologists practicing part-time or full-time emergency medicine. They are applicable to ED patients receiving parenteral analgesia or sedation for painful or anxiety-provoking procedures. They are intended to increase the safety of procedural sedation in the ED.
BACKGROUND CONTEXT: Low back pain (LBP) and low back disorders (LBDs) identify a complex constellation of conditions that frustrate both diagnosis and therapy. Dynamic quantitative assessment and questionnaire instruments directed toward psychosocial and situational variables provide potentially powerful tools for determining functional pathology and potentially outcome. PURPOSE: Our goal was to independently assess clinical correlates of a trunk motion measurement device, the lumbar motion monitor (LMM). The reliability of the LMM as a clinical test was assessed by comparison with an independent medical examination and biobehavioral questionnaires. STUDY DESIGN/SETTING: There were three study components. A multispecialty physician panel that administered a structured physical examination contributed to a clinical correlation case series study. Standardized outcomes and risk identification questionnaires were administered to the case population. Finally, the LMM was administered in a customary fashion to the same population. PATIENT SAMPLE: Nineteen subjects were recruited on the basis of criteria that included symptoms of chronic recurrent low back pain. This was an employed and active, although impaired, population. Eighteen of the subjects were currently employed with limited lost work time, but chronic and recurrent pain was a common feature. OUTCOME MEASURES: Questionnaire outcome measures were both characterologic and situation based. In addition to providing diagnoses, the physician panel was also asked to offer certain qualitative assessments, such as rehabilitative potential and functional level pertinent to activities of daily living. The impact of LMM measures on physician decision making was also assessed. Trunk angular measurements were used to assess function of patients with chronic low back disorders. METHODS: Kinematic performance on the LMM was expressed as three probability scores. These were the likelihood of abnormality, the "sincerity of effort" (exacerbation or aggravation of impairment), and the likelihood of structural anatomic disease. These variables were examined against established self-report measures of pain and disability. RESULTS: The LMM and physician panels were in agreement on the presence or absence of abnormality. LMM findings tended to be more consistent with clinical history than the clinical examination. The LMM results were also generally consistent with the self-reported measures of pain and disability: a high likelihood of structural disease was associated with depression, somatization, poor health perception and diminished vitality. CONCLUSIONS: The LMM appears to be a useful assessment tool for gauging the presence of LBP and LBD. It was accurate in detecting abnormality when abnormality was determined by clinical history and physician diagnosis. The LMM's differentiation of mechanical low back disease (nonanatomically specific disorders) from structurally specific low back disease was not consistent with a parallel clinical differentiation. Larger trials in a prospective format and studies on a chronically disabled population seem warranted. In an impaired but less disabled population, elevated pain and somatization did not appear to weaken the effort during testing.
BACKGROUND: Type 2 diabetes is now recognized as a major public health concern but its burden on society is under-researched. METHODS: T(2)ARDIS was a postal survey of 1578 people with type 2 diabetes across four UK centres, incorporating measures of resource use, treatment satisfaction and health-related quality of life (HrQoL). The findings included data on the EQ-5D that enabled the HrQoL burden of the disease to be established by comparison with equivalent data for the general population and the diabetic population as a whole from the 1996 Health Survey of England. RESULTS: The results indicate a significant deficit experienced by people with type 2 diabetes vs. their age group peers in the general population. The proportion of T(2)ARDIS respondents reporting problems increases in relation to the presence of complications, and microvascular complications appear to have more impact than macrovascular complications. CONCLUSIONS: This confirms the need for treatment policies to focus on reducing the risk of such complications and hence improve patients' HrQoL.
A 6-week-old boy was referred with a generalized bullous rash since birth. Examination revealed bullous mastocytosis with initially no evidence of systemic involvement. Hepatosplenomegaly was noted at 6 months, and at 12 months he was found to have generalized lymphadenopathy. He developed bouts of vomiting associated with increased blistering. At 17 months he had sudden collapse following a brief bout of vomiting and was apneic and asystolic on arrival at the emergency department. The cause of death was attributed to massive hypotension secondary to mast cell degranulation. Although childhood mastocytosis has a favorable course in general, the subset of children with congenital bullous mastocytosis is at higher risk of sudden death and a more guarded prognosis should be given.
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The biological, social and reproductive characteristics of women who have had twins were compared with those of other parous women using questionnaire data gathered for a prospective cohort study of women aged 35 and over on the island of Guernsey. Data for 97 mothers of twins and 4026 other parous women were available for analysis. The two groups were similar in height, first degree family history of breast cancer, use of hormone replacement therapy or other hormones, age at menarche, length of menstrual cycle and age at first and last birth. The mothers of twins were slightly heavier, more likely to smoke and consume more caffeine, less likely to have used oral contraceptives in the past, slightly younger when reaching the menopause and had a larger number of pregnancies. Adjustment for age did not alter these results. This study does not provide evidence that mothers of twins differ markedly from other parous women across a range of characteristics that might be associated with twinning or associated with breast cancer risk.
Community-dwelling, nondemented older people (60-70 years) with reported memory complaints were randomly assigned to either a memory-handbook (MHB) group (n = 20) or a placebo group (n = 20). The MHB group members were given a self-contained memory handbook and were individually trained on two of the handbook's sections that related to (a) remembering a person's name and (b) prospective memory, for approximately 30 minutes each. The placebo group was given an instructional pamphlet with a description of three list-learning mnemonics as a placebo treatment. Subjects were tested before and after the intervention. When compared with the placebo group, the MHB group members significantly improved their performance on a face-naming task and a strategies knowledge questionnaire, but not on the prospective memory measures, when compared with the placebo group. In addition, the MHB group showed a significant advantage on an everyday memory diary that was filled out by all subjects following the intervention. Following the study, the placebo group was also given the memory handbook, and both groups were then assessed on their knowledge and use of strategies by questionnaire at a 4-month follow-up. At this time the MHB group appeared to maintain most of its original gains, while the placebo group made some improvement.
A single nucleotide polymorphism (SNP) in the Taq1A site near the DRD2 gene has been associated in several studies with smoking behaviour. We genotyped 732 current smokers (241 low, one to nine cigarettes a day, 250 mid, 10-19 cigarettes, 241 high, 20+cigarettes) and 243 never-smokers at this site (C32806T), to test for effects on smoking initiation and amount of tobacco consumed. No significant association between minor allele frequency and smoking status was detected. Multiple regression analysis including DRD2 genotype, sex, age and alcohol consumption as predictors showed that level of cigarette consumption was associated with sex (p=0.003) and age (p=0.002) but not with alcohol consumption (p=0.25) or DRD2 genotype (p=0.76).
To elucidate the nature of the relationship between infant mortality in China and a variety of covariates using data from the 2/1000 Chinese Fertility Survey, we use a logistic regression model where the covariates are transformed with the help of Alternating Conditional Expectation (ACE) algorithm. This approach is used to overcome the general problem in multivariate regression analysis of coding the independent variables so that relationship between independent variables and response variables is best described, rather than coding such variables in an arbitrary way. The study demonstrates the procedures and usefulness of the ACE guided transformation in multivariate analysis. The transformed covariates are then used to estimate the effects of a series of socioeconomic and demographic factors collected in the study of infant death in China. The study shows that after appropriate transformations, all the demographic and socioeconomic variables selected have statistically significant and direct influence on infant death.
The relationship between fertility of parents and children has been designated as "weak" by most investigators. This paper reviews the evidence over the past century and argues that, even allowing for problems with available data sources, the relationship was probably close to zero for pre-transitional populations. However, over time, the relationship has tended to become more substantial and is now of a similar order of magnitude in developed countries as other widely used explanatory variables. Possible mechanisms for the observed relationship are discussed, especially the roles of socialization and inherited factors. The types of data used are compared to the scientific questions posed, and the limitations of the common comparison of married-mother/married-daughter pairs are considered. Finally, some evidence from recent large-scale surveys in Britain and the United States is presented to show changes over recent periods and the relative effects of sibship size of fathers and mothers.
Construction of oxygen-hemoglobin DISSOCIATION CURVES BASED ON EXTRACELLULAR PH and using blood tonometered with 5 per cent CO2, is misleading under certain experimental conditions. These include the presence in blood of poorly penetrating non-ionic molecules like sucrose of poorly penetrating anionic aompounds like radiographic contrast materials. False conclusions regarding the position of the oxygen-hemoglobin dissociation curve can result because of the disturbance of the normal pH gradient between plasma and red cell induced by such chemicals.
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Between January 1987 and December 1990, 179 patients (131 men, 48 women) infected with human immunodeficiency virus type 1 (HIV-1) were admitted 408 times to St James's Hospital, Dublin. One hundred and thirty-two (73.7%) patients were intravenous drug users. The commonest cause of admission was bacterial lower respiratory tract infection (84 patients, 21%). At the time of study 95 (53%) patients fulfilled Centers for Disease Control (CDC) criteria for stage IV disease. HIV antibody status in 26 of these patients with stage IV disease was unknown prior to their admission to hospital with symptomatic disease. Pneumocystis carinii pneumonia was the most frequent stage IV defining diagnosis. The mean length of hospital stay for patients with CDC stage II/III and stage IV disease was 8.5 (median 7) and 13.5 (median 8) days respectively.