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Biomedical subjects

M Tobin

Publications and source records attributed to M Tobin.

At least 19 recordsLinked to original sources
PubMed1999

An adult system versus a Bain system: comparative ability to deliver minute ventilation to an infant lung model with pressure-limited ventilation.

UNLABELLED: We compared the efficacy of an adult circle system versus a Bain system to deliver minute ventilation (V(E)) to an infant test lung model using pressure-limited ventilation. To simulate a wide variety of potential infant clinical states, V(E) was measured with two compliances: at peak inspiratory pressures (PIP) of 20, 30, 40, and 50 cm H2O and at respiratory rates (RR) of 20, 30, 40, and 50 breaths/min. Each measurement was made three times, and their average was used for analysis. Data were analyzed using the multiple regression technique. In both normal and low-compliance lung models, V(E) was nearly identical between adult circle and Bain systems (P = 0.67 for normal compliance model, P = 0.89 for low-compliance model). V(E) positively correlated with RR (P < 0.001), PIP (P < 0.001), and lung compliance (P < 0.001). Very high PIP or RR were required to deliver V(E) to the low-compliance lung model. The adult circle system is equivalent to the Bain system in its ability to ventilate an infant test lung over a wide range of RR, PIP, and two compliances during pressure-limited ventilation. V(E) is dependent of PIP, RR, and lung compliance. With low-compliance lungs, both systems require a high PIP. We conclude that both anesthetic systems deliver ventilation over a wide range of respiratory variables during pressure-limited ventilation in infants. IMPLICATIONS: We obtained results from this infant test lung study that indicate that either an adult circle breathing system or the Bain system can reliably deliver ventilation over a wide range of respiratory variables during pressure-limited ventilation in infants.

Adult↗
PubMed1998

Mental health and general practice: improving linkages using a total quality management approach.

This paper reports on a project to implement total quality management strategies to improve the linkages between general practitioners and specialist mental health services. The project implemented a process of change and objectively assessed the success of the process. The project involved all mental health staff (n = 100) in the St George Division of Psychiatry and Mental Health. General practitioners registered with the St George Division of General Practice were invited to participate in the change process. The project showed that the attempts to engage general practitioners in the ongoing care of patients with chronic mental illness is unlikely to be successful until mental health services promote general practitioner linkages as an ongoing service goal, relevant at all levels of delivery.

Advertising↗
PubMed1998

Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS.

Because animal studies have demonstrated that mechanical ventilation at high volume and pressure can be deleterious to the lungs, limitation of airway pressure, allowing hypercapnia if necessary, is already used for ventilation of acute respiratory distress syndrome (ARDS). Whether a systematic and more drastic reduction is necessary is debatable. A multicenter randomized study was undertaken to compare a strategy aimed at limiting the end-inspiratory plateau pressure to 25 cm H2O, using tidal volume (VT) below 10 ml/kg of body weight, versus a more conventional ventilatory approach (with regard to current practice) using VT at 10 ml/kg or above and close to normal PaCO2. Both arms used a similar level of positive end-expiratory pressure. A total of 116 patients with ARDS and no organ failure other than the lung were enrolled over 32 mo in 25 centers. The two groups were similar at inclusion. Patients in the two arms were ventilated with different VT (7.1 +/- 1.3 versus 10.3 +/- 1.7 ml/kg at Day 1, p < 0.001) and plateau pressures (25.7 +/- 5. 0 versus 31.7 +/- 6.6 cm H2O at Day 1, p < 0.001), resulting in different PaCO2 (59.5 +/- 15.0 versus 41.3 +/- 7.6 mm Hg, p < 0.001) and pH (7.28 +/- 0.09 versus 7.4 +/- 0.09, p < 0.001), but a similar level of oxygenation. The new approach did not reduce mortality at Day 60 (46.6% versus 37.9% in control subjects, p = 0.38), the duration of mechanical ventilation (23.1 +/- 20.2 versus 21.4 +/- 16. 3 d, p = 0.85), the incidence of pneumothorax (14% versus 12%, p = 0. 78), or the secondary occurrence of multiple organ failure (41% versus 41%, p = 1). We conclude that no benefit could be observed with reduced VT titrated to reach plateau pressures around 25 cm H2O compared with a more conventional approach in which normocapnia was achieved with plateau pressures already below 35 cm H2O.

Adolescent↗
PubMed1998

Outcomes focused service delivery: developing an academic-management partnership.

OBJECTIVE: Current mental health policies emphasise the need for services to be integrated and to develop outcomes-based evaluation systems. An overview of the challenges faced by service managers and clinical academics who develop the appropriate financial, personnel and academic infrastructure for these tasks is presented. METHOD: By drawing on experiences within the St George Service and references to other services, we propose a model for a successful partnership between the academic and management components of a district service. RESULTS: Major logistic impediments to the development of a partnership are identified, although the long-term scientific and service delivery benefits are highlighted. Key areas within both academic practice and managerial approaches requiring transformation are discussed. CONCLUSIONS: A successful long-term partnership between management and an academic department within a district service may provide the opportunity for rapid progress in population-based service evaluation and health outcomes research.

Community Mental Health Services↗
PubMed1998

Defining the role of the consultant psychiatrist in a public mental health service.

OBJECTIVE: The aim of this paper is to clarify elements of the role of a psychiatrist working in the public sector. METHOD: The relevant literature was examined to help clarify some of the reasons psychiatrists have been leaving the public sector and to help define the key roles of a psychiatrist working in the public sector. RESULTS: Two principal roles for the consultant psychiatrist in the public sector are identified: the psychiatrist as a clinician and the psychiatrist as a manager. The management role is contrasted with the role as an administrator and important differences between these roles are identified. The management role includes planning, advocacy and managing human resources. The importance of professional development in the career path for the newly qualified psychiatrist is discussed. CONCLUSIONS: The role of the psychiatrist in public sector psychiatry is a challenging and exciting one. Psychiatrists will start to return to the public sector when they recognise this new role for the consultant psychiatrist. This will be to the advantage of public sector psychiatry in general and to the job satisfaction of psychiatrists. The key features of the clinical role are the demonstration of sophisticated clinical skills, providing clinical leadership via supervision, being accountable for patient care and providing consultant opinion on complex clinical problems.

Attitude of Health Personnel↗
PubMed1997

Increasing general practitioner skills with patients with serious mental illness.

This report describes a clinical training program designed to increase general practitioner involvement with a public mental health service. The program involved one half-day clinical session per week and one two-hour formal training seminar per month, over a six-month period. Prior to training, participants demonstrated major clinical and theoretical skill deficits when assessing patients with serious mental illnesses. While specific knowledge of psychiatry increased by the end of the training program, little change in clinical interview skills was evident. Current initiatives to enhance general practitioner involvement in mental health care may be hampered if these skill deficits are not directly addressed in relevant shared care programs.

Attitude of Health Personnel↗
PubMed1997

Using action research to facilitate organisational change in mental health service delivery.

OBJECTIVE: To report how well a particular mental health service was responding to National and State mental health policies by emphasising community-based clinical care for patients. METHOD: The method involved analysis and action in response to information obtained from a consecutive sample of 100 people admitted to a psychiatric hospital ward from a geographical catchment area. RESULTS: It was found that community mental health staff were working without adequate support and were not able to effectively implement early intervention and relapse prevention strategies. Concern about these findings led to organisational change using action research methodology and some of these changes are discussed. CONCLUSIONS: Such methodology was a useful tool to identify and achieve organisational change in psychiatric services.

Australia↗
PubMed1996

Normal saline i.v. fluid load decreases uterine activity in active labour.

This study was designed to observe the effects of i.v. fluid infusion on uterine activity during normal labour in women receiving an extradural block. Thirty-four women in spontaneous labour at term gestation were allocated randomly and prospectively to one of three i.v. pre-extradural fluid load groups: group A, no fluid load; group B, normal saline 500 ml; and group C, normal saline 1000 ml. Continuous internal measurement of uterine activity was observed before, during and after fluid infusion and extradural block. In groups A and B, uterine activity did not change. In group C, uterine activity decreased after infusion of saline (P < 0.01) and returned to baseline over the next 20 min. Extradural block was not associated with a change in uterine activity. Hypotension was not increased in the group that received no fluid preload.

Adolescent↗
PubMed1996

Psychosocial problems faced during absorption of Russian-speaking new immigrants into Israel: a systematic approach.

The problems faced by immigrants during the absorption process are multidimensional and require a systematic approach. According to the authors' theoretical perspective and clinical experience, two main principles determine the "facets" of absorption: search activity and self-esteem. The paper begins with a definition of search activity and its relationship to self-esteem and then discusses intrapsychic and environmental blocks to search activity and their effect on self-esteem. The paper concludes with a therapeutic approach toward restoration of search activity and self-esteem.

Acculturation↗
PubMed1995

When does palliative care begin? A needs assessment of cancer patients with recurrent disease.

This cross-sectional study compared the prevalence and intensity of needs expressed by cancer patients at the time of first recurrence (n = 75) with those of patients at the time of disease progression (n = 75). On a 72-item Likert-type scale participants rated from "none" to "very much" the severity of physical symptoms; emotional, psychological, and social problems; and difficulties with activities of daily living. The progressive disease group reported more problems than the first recurrence group in 11 of 24 (47%, p < 0.05) symptom-related questions. The progressive disease group also expressed greater needs in 19% of the function-related questions. There were no differences in reported psychological problems, responses to recurrence, or greatest concern between the two groups. These results support the need for palliative care throughout the entire course of illness.

Adult↗
PubMed1995

The psychosocial morbidity of breast cancer patients with lymphoedema.

Lymphoedema is a problem for many women after treatment for breast cancer, leading to physical, psychosocial, and psychological problems, which have been acknowledged but are poorly understood. This article discusses the findings of two studies that used the Psychosocial Adjustment to Illness Scale to examine the psychosocial morbidity of patients with breast cancer with lymphoedema. Women with lymphoedema were found to experience increased psychosocial maladjustment and psychological morbidity to their disease and lymphoedema when compared with a group of patients with breast cancer who did not have lymphoedema. These difficulties were not related to the degree of swelling present and persisted after 6 months of specialised treatment to the swollen arm. The findings indicate that the development of lymphoedema in patients with breast cancer carries psychosocial and psychological implications that should be acknowledged and addressed at an early stage by a trained health-care professional.

Adaptation, Psychological↗
PubMed1994

Safety and diagnostic yield of noninvasive ventricular stimulation performed via tiered therapy implantable defibrillators.

Extensive electrophysiological testing is critical for the effective utilization of sophisticated tachycardia detection and termination algorithms available in tiered therapy ICDs. To evaluate the safety and diagnostic yield of electrophysiological testing via noninvasive ventricular stimulation, we performed 294 electrophysiological studies in 154 patients (age 65 +/- 10; left ventricular ejection fraction 0.36 +/- 0.15) with tiered therapy ICDs. Stimulation was performed under methohexital anesthesia. A total of 918 sustained ventricular tachyarrhythmias were induced (3.1 +/- 2.5 per procedure): monomorphic VT, 550; ventricular flutter, 74; and VF, 246. The results of invasive and noninvasive programmed stimulation were compared for 79 patients who had both studies under similar treatment. Overall concordance was 83%, and did not differ significantly between patients who had the noninvasive stimulation via epicardial or endocardial pacing leads. VF could be induced in 206 of 257 studies (82%), and it was less likely to be induced in patients on amiodarone (74% vs 85%; P = 0.02), or beta blockers (55% vs 83%; P = 0.017). No patient presented a serious complication. Minor complications occurred during 39 studies: transient laryngospasm in 1, unintended delivery of an ICD shock to a conscious patient in 4; induction of sustained atrial fibrillation in 8; need for external rescue defibrillation shocks in 13; and delivery of inappropriate shocks for supraventricular rhythms in 14 studies. Noninvasive ventricular stimulation performed under methohexital anesthesia is safe. Its diagnostic yield compares favorably with that of conventional electrophysiological studies. VF can be induced in a majority of patients. There is good correlation between invasive and noninvasive programmed stimulation for induction of VT. Noninvasive ventricular stimulation may emerge as standard procedure for the initial programming and follow-up of ICDs.

Aged↗
PubMed1994

Anesthetic considerations for the pediatric plastic surgical patient.

An understanding of the anesthesiologist's concerns during pediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Prior to surgery, the child's history is obtained and physical examination is performed. The condition of the airway is the primary concern. Preoperative medication is usually given by oral routes to avoid injections. Induction intubation, maintenance, and emergence are discussed. Specific postanesthesia care is described. Special precautions are given for children having surgical repair of craniofacial anomalies. Cleft lip and palate and mandibular advancement are described.

Age Factors↗
PubMed1993

Doppler echocardiographic evidence of left ventricular diastolic dysfunction in ankylosing spondylitis.

Although cardiac involvement in the form of conduction abnormalities or aortic regurgitation occurs in 5 to 10% of patients with ankylosing spondylitis, few studies have assessed left ventricular (LV) function. This study assesses the prevalence of both systolic and diastolic LV dysfunction and other cardiac abnormalities in patients with ankylosing spondylitis who have no clinical cardiac manifestations. Fifty-nine patients (49 men and 10 women, mean age 42 +/- 10 years) underwent full clinical examination, electrocardiography, 24-hour Holter monitoring and 2-dimensional, M-mode and Doppler echocardiography. Mean disease duration was 17 +/- 9 years (range 1 to 42). Seventeen patients had evidence of noncardiac extraarticular manifestations. Precordial examination was normal in all. An age- and sex-matched control group of 44 healthy subjects was also studied. On echocardiography, abnormal LV diastolic function was detected in 12 patients (20%). Prolonged isovolumic relaxation time, prolonged deceleration time, reduced rate of descent of flow velocity in early diastole (EF slope) and reversal of the early and late peak transmitral diastolic flow velocities (E/A ratio) were noted in 9 patients. In 3 patients there was an increased E/A ratio, reduced deceleration time and increased EF slope. Mild aortic regurgitation and mitral regurgitation was seen in 1 and 3 patients, respectively. No abnormalities of left atrial size, LV systolic or diastolic dimensions or wall thicknesses were noted. There was no correlation between the presence of LV diastolic dysfunction and age, disease severity, disease duration, or the presence of extraarticular manifestations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗