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Biomedical subjects

T Clarke

Publications and source records attributed to T Clarke.

70 records · Page 4Linked to original sources
PubMed1989

Dermatofibromas and arthropod bites: is there any evidence to link the two?

30 patients with dermatofibromas were questioned closely about contacts with stinging or blood-sucking arthropods before the development of their lesions. Their responses were not significantly different from those of a matched control group. 100 dermatofibromas were examined by dissection, histology, and after acid digestion of the collagenous material; no traces of arthropod skeletal tissues were found. These data are not consistent with the theory that the mechanical presence of arthropod tissues is necessarily, or even usually, a cause of dermatofibromas.

Animals↗
PubMed1989

On the effect on specificity of Thr246----Gly mutation in L-lactate dehydrogenase of Bacillus sterothermophilus.

The function of the amino acid Thr246 in L-lactate dehydrogenase from Bacillus stearothermophilus has been investigated by site-directed replacement with glycine. Kinetic experiments with a number of 2-oxo acids showed strongly reduced activity for the mutated enzyme. However, the mutant enzyme shows a relative preference for the large hydrophobic sidechains of alpha-keto acids and an even higher specific activity than the wild-type lactate dehydrogenase for the polar oxaloacetate substrate. Graphic analyses indicate that the loss of one hydrogen bond, or intrusion of water into the active site, might be responsible for the reduced activity. The kinetic results suggest that the binding modes of bulky hydrophobic or polar substrates compensate to some degree for the partially disrupted active site.

Amino Acid Sequence↗
PubMed1989

Histological changes in the urinary bladder secondary to urethral catheterisation.

The macroscopic and microscopic features of the urothelial response of the human urinary bladder to urethral catherisation are described. The catheter reaction is characterised by a predominantly eosinophilic inflammatory response producing, macroscopically, a papillary mucosal appearance termed polypoid cystitis. The severity of the epithelial inflammatory response correlates significantly with the duration of catheterisation. Urothelial dysplasia confined to the catheter reaction site was noted in 6% of cases. The possible implications of these findings are discussed.

Aged↗
PubMed1978

Experience and problems in the first six months of transcutaneous PO2 (tcPO2) monitoring in routine neonatal intensive care.

A transcutaneous oxygen monitor (Roche 5301), operated by regular intensive care nursery nurses, was used in the routine management of 47 acutely ill infants over a six month period. The monitor was helpful as a trend monitor in showing immediate changes in oxygenation but in this clinical situation lacked accuracy. The overall correlation coefficient was 0.74 with a standard error of the estimate of 2.0 kPa (15 torr). This lack of accuracy was probably due to technical problems including the need for fairly frequent precise calibrations and proper, careful application of the skin electrode. Ill infants with poor skin perfusion may also have contributed to the lowering of the correlation coefficient.

Blood Gas Analysis↗
PubMedDate not supplied

What information patients require on graduated compression stockings.

Graduated compression stockings are used prophylactically on a variety of patients within acute hospitals. Anecdotal evidence suggests patients have a limited understanding of this treatment. The aim of this qualitative study was to explore patients' experiences of compression stockings and to ascertain perceptions of their use. Information was gathered using telephone interviews from a sample of 12 adults who had been patients within the past 2 months, and who had worn compression stockings for more than 48 hours. The results showed that patients received little or no information from healthcare staff regarding compression stockings, but that they did have knowledge from other sources, such as long-haul flight advice. This raises issues of informed consent and patient empowerment and highlights the need for both verbal and written information. The information gained informed a patient information leaflet, which was developed in partnership with a patient focus group.

Adult↗
PubMedDate not supplied

Neonatal abstinence syndrome.

A 12 month review of infants admitted with neonatal abstinence syndrome to a neonatal intensive care unit was undertaken. The relationship of maternal drug abuse to symptoms, the effectiveness of pharmacologic agents in controlling symptoms and the length of inpatient stay were investigated. A retrospective review of maternal and infant records was performed. Those infants with a serial Finnegan score greater than 8 were treated. Pharmacologic treatment was oral morphine sulphate (0.2 mg 4-6 hourly), phenobarbitone (3-7 mgs/kg/day), or combination of the above. 43 infants were admitted to the hospital during the year. The average maternal age was 24.6 years, (18-34 years). Drug use volunteered by the mothers was methadone alone in 6 cases, methadone and benzodiazepines in 14, methadone and heroin and benzodiazepines in 7, methadone and heroin in 10, heroin alone in 2, and other multiple drug use including oral morphine sulphate, dothiepin and cannabis in 4. Average gestational age was 40.3 (35-42 weeks). The average birthweight was 2.81 kgs (1.89-3.91 kgs). Time to onset of withdrawal symptoms was 2.8 (1-13) days. The duration of pharmacologic treatment (oral morphine sulphate and/or phenobarbitone) was 21.8 (1-62) days. The total hospital stay for the 43 infants was 1,011 days. This study confirms that polydrug abuse is the commonest type of drug abuse in Dublin. The duration of withdrawal symptoms is loosely related to drug type, but increasing duration of symptoms is noted for infants exposed to benzodiazepines. Our experience would favour the use of morphine sulphate to treat pure opiate withdrawal symptoms. Over the 12-month period, there was an average occupancy of 3 beds per day in the paediatric department.

Adolescent↗
PubMedDate not supplied

Work-related stress among paediatric non-consultant hospital doctors.

There have been many reports of Non-Consultant Hospital Doctors (NCHDs) deciding to leave hospital medicine in pursuit of a career with better hours and lifestyle such as general practice. It is not known, however, how widespread feelings of dissatisfaction are in paediatrics and whether work-related stress is a contributing factor. A postal survey of NCHDs in paediatric posts throughout the country was conducted in November 2000. Data collected included demographic and personal details. NCHDs were also asked their level of stress in relation to their daily work, patient-care, hospital environment and dealing with other staff members using an incremental scale from 1 to 5 (5 most stressed). 69% (71/103) of the questionnaires were returned. Equal numbers of males and females responded (48% vs 52%). 51% (36/71) of the NCHDs were registrars; 51% (36/71) were working within Dublin. More than three-quarters had graduated from a European Union (EU) medical school (77%, 55/71). While the majority (79%, 56/71) were either satisfied or very satisfied with paediatrics as their chosen specialty, 79% (56/71) admitted to work-related stress causing job dissatisfaction with 71% (50/71) having experienced 3 or more stressful situations in the previous week. 56% (41/71) graded their occupational stress level at 4 or 5. Routine non-medical work and poor job prospects were the main factors causing job dissatisfaction. With regard to daily duties, the situations causing stress were acute emergency situations (51%, 36/71), being solely responsible for patients when on-call (52%, 19/36) and making decisions after a night on-call (76%, 50/67). The general attitudes of nursing staff were stressful to 40% (28/71) with 39% (27/71) stating having a difference of opinion with a nurse at least once every week. Relating to consultants was moderately stressful to 26% (19/71) and very stressful to 4% (3/71). Uncomfortable sleeping quarters and having insufficient time for meals were noted to be at least moderately stressful (stress levels 3 to 5) for 70% (50/71) and 92% (65/71) respectively. 59% (42/71) felt that their social life was greatly affected by their work. 68% (48/71) have considered leaving paediatrics with almost half (48%, 23/48) considering this seriously or very seriously. More than half stated that their alternative career choice would be general practice (61%, 29/48). The results of our survey show that work-related stress is common among paediatric NCHDs and is associated mainly with long working hours, sub-optimal on-call conditions, and dealing with very ill patients.

Female↗
PubMedDate not supplied

Childhood drowning: review of the literature and clinical implications.

In children the risk of submersion is highest in those under 5 years of age and in male adolescents 15-19 years of age. This review examines the research literature that identifies factors related to drownings and near drownings, strategies to prevent these occurrences, and suggestions for primary prevention and associated nursing interventions.

Adolescent↗
PubMedDate not supplied

The Dublin outcome for low birth-weight infants.

This report describes outcomes for all infants with birth weight 501-1750 grams born in the three major maternity hospitals in Dublin between 1.1.90 to 31.12.91. 37,958 mothers delivered 38,498 infants during this period, consisting of approximately 36% of all deliveries in Ireland. 633 (1.6%) of all infants born weighed 501-1750 grms. 102 (16%) were stillborn and 28 of the 531 live born infants had lethal malformations. 30% of women received two or more doses of antenatal steroids before delivery and a highly significant negative correlation occurred between the need for ventilation after birth and antenatal steroids. 56.4% of babies were delivered by caesarean section as compared with 10.8% of the hospital population. Of 503 liveborn infants without lethal malformation. 426 (85%) survived to 28 days and 419 (83%) to discharge home. 15% were growth retarded. 46% of infants were ventilated, mean duration of ventilation was 7 days. 25% of infants had an intraventricular haemorrhage, 10% necrotising enterocolitis and 19% culture proven sepsis. 15% of survivors developed broncho pulmonary dysplasia and 12% retinopathy of prematurity. This paper describes important information for mortality, morbidity and interventions among a large population of low birth weight infants in Ireland and can be used as a basis against which to compare future alterations in practice. It demonstrates a clear benefit for antenatal steroids in decreasing the need for ventilation and the importance of ensuring their utilisation antenatally where possible.

Female↗
PubMedDate not supplied

Suboptimal compliance with periconceptual folic acid in an Irish hospital population.

Awareness of and compliance with periconceptual folate was measured by questionnaire in our antenatal and infertility populations. Awareness was somewhat better in the private antenatal and infertility patients, but compliance was universally very poor. A substantial proportion of pregnancies were planned, and therefore there is potential for a much higher level of compliance.

Attitude to Health↗
PubMedDate not supplied

The prevalence of chemical substance and alcohol abuse in an obstetric population in Dublin.

OBJECTIVE: To determine the prevalence of illicit drug abuse and alcohol use in an obstetric population based in an urban maternity hospital. SETTING: A collaborative study between the Rotunda Hospital, Dublin and the Irish National Drug Advisory & Treatment Centre. DESIGN: A prospective study consisting of anonymous, unlinked urine testing of 504 'first visit' antenatal patients and a separate group of 515 patients six weeks after delivery. METHODS & OUTCOME MEASURES: Toxicological screening using enzyme-linked immunoassay techniques, with all positive samples being reanalysed. Drug histories were taken and samples were tested for alcohol and six of the most commonly abused drugs. The pre- and postnatal prevalence of abuse was matched with demographic data. RESULTS: The prevalence of chemical substance misuse in the antenatal population was 2.8% and 5.6% in the postnatal population. Substances identified included benzodiazepines, cannabis, amphetamines, opiates and cocaine. Less than 2% of samples tested positive for alcohol. None of the women yielding positive samples had been pre-identified on the basis of history. A significant proportion of the women were in the high risk categories with regard to age and socio-economic status. CONCLUSION: The prevalence of drug misuse antenatally was nearly 3% and postnatally almost 6%. Substance abusers in pregnancy are more likely to be single, unemployed, and to have had a previous pregnancy.

Adult↗