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Biomedical subjects

P Mullins

Publications and source records attributed to P Mullins.

33 records · Page 2Linked to original sources
PubMed1990

Obstetric risk factors: can they predict fetal mortality and morbidity?

An antepartum fetal risk score was developed and applied to 29,101 pregnancies which delivered at National Women's Hospital between January 1983 and April 1988. Twenty-one past and current obstetric and medical factors available at the onset of pregnancy or labour were weighed to obtain a risk score. The scoring system developed compared favourably with international systems. An antepartum fetal risk score of three or more was chosen to select a high risk group. These 10,859 women, 37% of the total population, identified 90% of those who had a fetal or neonatal loss. The perinatal mortality rate was 34.7/1000. Twenty-eight percent of this group had a caesarean section and 23% gave birth to a low birth weight infant. Women who had an antepartum risk score of seven or more had a perinatal mortality rate of 200/1000. The remaining women, a low risk group of 18,242 (63%), had a perinatal mortality rate of 4.1/1000. However 60% had a complicated pregnancy including 8.2% who required a caesarean section and 2.7% who gave birth to a low birth weight infant. The antepartum fetal risk score clearly identified the population at risk of fetal or neonatal loss. In addition significantly more medical intervention was provided to the high risk group. It is important to note that 60% of the low risk group had a complicated pregnancy leaving only 24% of the total population whose pregnancy was normal.

Adult↗
PubMed1984

Death from asthma in Auckland: circumstances and validation of causes.

New Zealand has experienced an epidemic of asthma deaths since 1977 with mortality rates of over 3.0/100 000 for people aged 5-34 years, more than three times the rate of comparable countries. To examine the reasons for this high mortality rate all deaths from asthma in people under 70 years in the Auckland region in 1981-82 were investigated. A total of 84 possible cases were studied and the validity of death certificates was found to be excellent for people under the age of 50 years. Fifty-three cases had usefully reversible asthma at the time of death and the mortality rate was almost four times higher in Pacific Islanders than in caucasians, with the Maori rate being intermediate. Sixty-seven percent (35) of the deaths in people with usefully reversible asthma occurred at home. In only 40% of cases had the patient reached some form of medical care. No deaths occurred in the patients admitted to hospital with the diagnosis of asthma during this period.

Adolescent↗
PubMed1983

Levamisole in primary breast cancer. A controlled study in conjunction with l-phenylalanine mustard.

Between September 1976 and May 1980, 135 patients with operable breast cancer and positive axillary nodes received l-phenylalanine mustard, adjunct to surgery, 0.15 mg/kg for five days, six weekly, and were randomised prospectively to levamisole 150 mg for three days, two weekly, or a placebo. Treatment was continued for two years or until evidence of treatment failure, whichever was the sooner. At 4 1/2 years, for all patients, there was no significant difference between the two groups (P = 0.09), but in a subgroup of women less than or equal to 50 with 1-3 positive nodes, levamisole had a negative effect (P = 0.05). Although an analysis of the same age group, independent of the nodal status, did not reach significance, there was a trend in favor of placebo (P = 0.08) which was also apparent in premenopausal women (P = 0.15). In postmenopausal patients, however, and in those with more advanced disease with four or more positive nodes, although the results also failed to reach significance the trend in these subgroups favored levamisole. The results of this study suggest that levamisole has no place in the primary therapy of breast cancer in younger women and those with more favorable disease. The value of this agent in older patients and those with more advanced primary disease, remains unproven, but the favorable trends are in accord with a number of other studies with levamisole in metastatic breast and resectable lung cancer. Retrospective analysis confined to those women who received 75% or more of the total dose of l-phenylalanine mustard showed no evidence for a dose-responsive effect of adjuvant chemotherapy on the described pattern of results.

Age Factors↗
PubMed1981

HLA types in American black juvenile diabetics strong associations with Dw3 and Dw4.

The distributions of HLA-A, -B, -C and -D antigens in 38 black American insulin-dependent juvenile diabetics were studied. Antigens A1, A2, B8 and Cw3 were slightly increased, but the corrected probability values were not statistically significant. As determined by mixed lymphocyte culture, the frequency of Dw3 was 89% in the juvenile diabetics and that of Dw4 was 42% in comparison with 14 and 8%, respectively, in the controls. The relative risks for juvenile diabetes were 52 for Dw3 (p = 10(-8) and 9 for Dw4 (p = 10(-6). Dw2 was significantly decreased in the diabetics (p equals 0.008). All of these deviations in A, B, C and D locus specificities have been previously reported by others in white juvenile diabetics. Because there are white genes in the American black gene pool and juvenile diabetes is rare in blacks in western Africa, many cases of juvenile diabetes in American blacks could be the result of genes ultimately derived from the white genes. This hypothesis is supported by the similar HLA associations in juvenile diabetes in the black and white ethnic groups.

Black People↗
PubMed1980

An evaluation of the performance of laboratories in the assays of oestriol and creatinine in pregnancy urine: the national pregnancy urine survey.

The performance of clinical chemistry laboratories in New Zealand in the assays of oestriol and creatinine in pregnancy urine has been investigated. The quality of oestriol determinations in general was poor. Only seven of 20 laboratories achieved an inter-assay precision of better than 12 percent consistently through the range of oestriol levels represented by three control urines. The precision of laboratories in assaying urinary creatinine was, however, of a higher standard. Only three of 18 laboratories had precision values that could be regarded overall as unsatisfactory.

Autoanalysis↗
PubMedDate not supplied

Practice analysis of hand therapy.

In 1994, a practice analysis (role delineation study) was conducted on the profession of hand therapy. This study was conducted as a follow-up to the original study conducted by the American Society of Hand Therapists (ASHT) in 1985. A representative group of content experts developed a description of hand-therapy practice, and this description was validated using a questionnaire. The questionnaire was distributed to a random sample of 400 certified hand therapists (CHTs), of whom 50% responded. The respondents provided confirmation of the accuracy of the description of hand therapy. The survey results were used to update the test specifications for the Hand Therapy Certification Examination. The results enabled the Hand Therapy Certification Commission to improve upon its certification program by clarifying and expanding the definition of hand therapy. The 1994 findings were also compared with the results of the 1985 study.

Certification↗
PubMedDate not supplied

Heart transplantation in patients over 54 years of age with triple-drug therapy immunosuppression.

Between April 1, 1986, and December 31, 1989, 206 patients received orthotopic heart transplants with triple-drug therapy immunosuppression (cyclosporine, azathioprine, prednisone). Forty-six patients were aged 55 years or more at the time of transplantation and 160 patients were less than 55 years of age; these two groups were compared. Selection criteria and treatment regimen were the same in both groups. In our experience, although both groups had good postoperative survival, older patients had higher mortality rates early after transplantation, particularly from rejection and infection. Patients over 55 years of age had similar nonfatal rejection rates and were no more likely to have infectious episodes than younger patients. As demand for heart transplantation increases and waiting lists lengthen, the age of potential recipients should be an important factor in deciding how to allocate scarce donated organs, although age should not be exclusive.

Adult↗
PubMedDate not supplied

Prospective study of transbronchial biopsies in the management of heart-lung and single lung transplant patients.

A prospective study of 219 bronchoscopies in 54 heart-lung and in 2 single lung transplant recipients was undertaken over a 12-month period by a single operator. For histologic study, an average of 17.3 transbronchial biopsy specimens (range, 6 to 56) were taken from three lobes (or from two lobes and lingula of one lung). A further two specimens were taken for culture. The average procedure time was 14.4 minutes (SE 0.31). An estimate of the probability of rejection being missed, depending on the number of specimens taken and based on the method of Gilman and Wang, suggests 18 biopsy specimens are required to have 95% confidence of diagnosing rejection. Sensitivity for diagnosing rejection by histologic study of transbronchial biopsy specimens was 94%, and specificity was 90%. The simple grading of severity of rejection that was used was related both to the number of specimens demonstrating rejection and to the severity of graft airway mucosal inflammation seen at bronchoscopy. The major complication encountered, on 27 occasions, was bleeding of more than 100 ml. On no occasion did bleeding result in any long-term complication. Extensive transbronchial biopsy is a simple, relatively safe, and quick procedure, with a high sensitivity and specificity for diagnosing rejection and lung infection.

Adolescent↗
PubMedDate not supplied

The hand therapy certification examination: results of the first five years.

In 1991, the first Hand Therapy Certification Examination was administered to candidates throughout the United States. Since then, the examination has been given annually. The purpose of this paper is to summarize the processes that have been used to develop the examination as well as to report demographic data about the examination and certification candidates. Overall, the results of test administration have been very good. Twenty-two hundred therapists have become certified hand therapists. Eighty-five percent are occupational therapists, and 88% are female. Most candidates have practiced for ten years or less and have maintained caseloads of upper-extremity patients for three to six years. The examination has performed well. Reliability coefficients have been 0.91 or greater for each administration. The mean scores on the examination have decreased each year, from 148.4 in 1991 to 129.4 in 1995.

Certification↗