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Biomedical subjects

T J Ryan

Publications and source records attributed to T J Ryan.

At least 91 records · Page 5Linked to original sources
PubMed1997

Improving the odds in acute myocardial infarction.

Reperfusion therapy offers the best chance for reducing mortality if given as early as possible. Hence, the diagnosis of acute MI should be made, the indications for reperfusion confirmed, and the therapy started within half an hour of patient presentation to the emergency room. Later, pharmacologic measures, such as intravenous beta-blockers and ACE inhibitors, may reduce mortality even further.

Adrenergic beta-Antagonists↗
PubMed1997

A model of bovine tuberculosis control in domesticated cattle herds.

A typical strategy for disease control in domesticated animals involves regular field tests and quarantine of infected herds. This prevents disease spread beyond the herd, while slaughter of diseased animals removes the infection from within the herd. A model of bovine tuberculosis (Tb) control in cattle is examined, which includes 'test and slaughter' combined with herd isolation and vaccination. Herd status is represented by an integral equation expressing the duration of herd isolation. The current Tb situation in New Zealand is used as an example, and vaccination strategy discussed. Extrapolation of existing management strategies indicate that a vaccine of efficacy greater than 96% would be required, reaching 95% of target Tb levels within six years. These results suggest that a complementary strategy of vaccination and vector control may be more promising than vaccination alone.

Animals↗
PubMed1997

Results of directional coronary atherectomy in Northern New England. Northern New England Cardiovascular Disease Study Group.

The role of directional coronary atherectomy (DCA) in interventional cardiology remains uncertain. We report the Northern New England regional experience with DCA from 1991 to 1994. Data were collected on 11,178 patients having had an intervention on a single lesion in a single vessel (798 DCAs; 10,380 percutaneous transluminal angioplasties [PTCA]). The use of DCA increased from 1.8% of interventions in 1991 to 10% in 1994. Compared with PTCA, DCA patients were younger, more often men, had more 1-vessel disease and more coronary artery bypass surgery (CABG). DCA was more often used in the left anterior descending artery, in vein grafts, for restenoses, for subtotal occlusions, and with type A lesions. Angiographic success (96.7%) and clinical success (93%) were good. Adverse events were rare: mortality 0.9%, emergent CABG 2.2%, nonfatal myocardial infarction 2.8%. After adjusting for case-mix, there was no difference between DCA and PTCA for in-hospital mortality (odds ratio [OR] = 1.03, 95% confidence interval [CI] 0.44 to 2.43, p = 0.95) or need for emergent CABG (OR = 1.27, 95% CI 0.77 to 2.10, p = 0.34). Atherectomy patients were more likely to have a nonfatal myocardial infarction (OR = 2.0, 95% CI 1.26 to 3.20, p <0.01), to sustain an injury to the femoral or brachial artery (OR = 2.89, 95% CI 1.52 to 5.51, p <0.01), and to have a clinically successful procedure (OR = 1.37, 95% CI 1.01 to 1.88, p = 0.05). Our results support the relative safety and effectiveness of DCA as its use disseminated into the region.

Aged↗
PubMed1997

Coronary angioplasty volume-outcome relationships for hospitals and cardiologists.

OBJECTIVE: To assess the relationship between each of 2 provider volume measures (annual hospital volume and annual cardiologist volume) for percutaneous transluminal coronary angioplasty (PTCA) and 2 outcomes of PTCA (in-hospital mortality and same-stay coronary artery bypass graft [CABG] surgery). DESIGN: Cohort study, using data from January 1, 1991, through December 31, 1994, from the Coronary Angioplasty Reporting System of the New York State Department of Health. SETTING: Thirty-one hospitals in New York State in which PTCA was performed during 1991-1994. PATIENTS: All 62670 patients discharged after undergoing PTCA in these hospitals during 1991-1994. MAIN OUTCOME MEASURES: Rates of in-hospital mortality and CABG surgery during the same stay as the PTCA. RESULTS: The overall in-hospital mortality rate for patients undergoing PTCA in New York during 1991-1994 was 0.90%, and the same-stay CABG surgery rate was 3.43%. Patients undergoing PTCA in hospitals with annual PTCA volumes less than 600 experienced a significantly higher risk-adjusted in-hospital mortality rate of 0.96% (95% confidence interval [CI], 0.91%-1.01%) and risk-adjusted same-stay CABG surgery rate of 3.92% (95% CI, 3.76%-4.08%). Patients undergoing PTCA by cardiologists with annual PTCA volumes less than 75 had mortality rates of 1.03% (95% CI, 0.91%-1.17%) and same-stay CABG surgery rates of 3.93% (95% CI, 3.65%-4.24%); both of these rates were also significantly higher than the rates for all patients. Also, same-stay CABG surgery rates for patients undergoing PTCA in hospitals with annual volumes of 600 to 999 performed by cardiologists with annual volumes of 75 to 174 (2.99%; 95% CI, 2.69%-3.31 %) and 175 or more (2.84%; 95% CI, 2.57%-3.14%) were significantly lower than the overall statewide rate (3.43%). CONCLUSIONS: In New York State, both hospital PTCA volume and cardiologist PTCA volume are significantly inversely related to in-hospital mortality rate and same-stay CABG surgery rate for patients undergoing PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1997

Congestive heart failure in patients with coronary artery disease: the gender paradox.

To determine whether the increased prevalence of congestive heart failure in women compared with men undergoing diagnostic cardiac catheterization is the result of a difference in the left ventricular pressure/volume relation, we retrospectively compared the clinical characteristics, left ventricular ejection fraction, and end-diastolic pressure and volume in 586 women and 1081 men undergoing diagnostic coronary angiography and left ventriculography. In comparison with men, women were older (63 vs 60 years; p = 0.0001) and had more hypertension (41% vs 31%; p = 0.0001), diabetes (18% vs 12%; p = 0.003), and symptoms of congestive heart failure (13% vs 10%; p = 0.05). In spite of this, women had a better mean left ventricular ejection fraction (61% vs 56%; p = 0.0001) and less prevalent three-vessel disease (23% vs 34%; p = 0.0001). Left ventricular end-diastolic volume index was smaller in women compared with men (73 vs 79 ml/m2; p = 0.0001) in spite of having similar left ventricular end-diastolic pressure. When patients were stratified according to left ventricular end-diastolic pressure, women had a significantly smaller end-diastolic volume than men did when left ventricular end-diastolic pressure was > or = 18 mm Hg (74 vs 86 ml/m2; p = 0.0001). In a multivariate analysis, female sex remained an independent predictor of congestive heart failure (odds ratio 1.72, 95% confidence interval 1.11 to 2.66, p = 0.02). This study suggests that diastolic dysfunction is one mechanism for the paradox of more frequent heart failure symptoms in spite of better preserved left ventricular systolic function in women. Sex appears to influence the pattern of myocardial dysfunction in patients with known or suspected coronary artery disease, but the basis for this observation remains speculative.

Coronary Disease↗
PubMed1997

Donor attitudes about exporting and importing blood.

BACKGROUND: The movement of blood among different areas of the United States and the collection of more blood than is needed locally in some areas are increasing. Little is known of donors' attitudes about this blood resource sharing. STUDY DESIGN AND METHODS: One thousand donors from five regions of the American Red Cross Blood Services were surveyed by telephone. Demographic information about the donors and the regions was obtained, and the donors were asked to describe their attitudes about blood resource sharing as well as other blood donation-related issues. RESULTS: Donors are not very knowledgeable about whether their community is self-sufficient in its blood supply. In regions that import blood, 29 to 43 percent of donors believed that enough blood was collected to meet all local needs, and, in regions that export blood, only 22 to 24 percent of donors believed that more than enough blood was collected. About three-fourths of the donors believed it acceptable to send their blood to other communities if it is needed there. However, this attitude was based on the premise that all local needs would be met first. Only 4 percent of donors would be less willing to donate if their blood was being sent to another community. CONCLUSION: Donors are not very aware of blood resource sharing but are willing, under certain circumstances, to donate blood for use outside their local communities.

Blood Banks↗
PubMed1997

The effectiveness of acne treatment: an assessment by patients of the outcome of therapy.

The impact of acne on quality of life can be profound. Although treatment improves the clinical features of acne, there is little information on its benefit from the patients' point of view. In this study, patients with acne referred to a dermatology clinic were sent questionnaires before being seen, and 4 and 12 months afterwards. Clinical severity was assessed by a dermatologist at baseline and at 4 months. Quality of life was assessed by patients using the Short Form 36 instrument (SF-36), the Dermatology Life Quality Index (DLQI), Rosenberg's measure of self-esteem and the General Health Questionnaire (GHQ-28). Of 90 available patients, 79 (89%) returned at least one follow-up questionnaire. The clinical acne grade improved substantially with treatment. There were also significant improvements either at 4 or 12 months in the DLQI, self-esteem. GHQ-28 and all five dimensions of the SF-36 that were impaired at baseline. Quality of life continued to improve between the 4- and 12-month follow-up questionnaires. Clinical and patient-assessed outcomes were significantly better in patients treated with isotretinoin. The study showed that disability caused by acne can be largely reversed by effective treatment. It also showed that patient-assessed measures of outcome can respond to changes over time and discriminate between treatments differing in effectiveness.

Acne Vulgaris↗
PubMed1997

Pain in venous leg ulcers.

A prospective study was conducted to assess the prevalence, severity and diagnostic utility of pain in patients with venous leg ulcers. A semi-structured questionnaire was completed by 140 consecutive patients in two specialist centres caring for patients with leg ulcers. A high proportion (64%) of the 94 patients with ulcers of purely venous aetiology reported severe pain; 50% of these patients were taking either mild analgesia or none at all. In 10 of 72 cases, leg elevation made the pain worse. Venous ulcers are painful. Pain in three distinct locations was reported by patients-within ulcers, around ulcers and elsewhere in the leg. The presence of severe pain does not necessarily indicate arterial disease or infection. Pain is, in general, inadequately controlled in these patients.

Adult↗
PubMed1997

Management of acute myocardial infarction. Synopsis of ACC and AHA practice guidelines. American College of Cardiology and American Heart Association.

The average time that elapses from a patient's first awareness of heart attack symptoms to start-up of specific reperfusion therapy is currently 4 hours. The National Heart Attack Alert Program wants to see this time reduced to 2 hours. Such dispatch would surely benefit patients, because when it comes to thrombolytic therapy, the sooner the better. Dr Ryan summarizes the new recommendations for handling patients with acute myocardial infarction rapidly and efficiently, from the 911 call and transport to the emergency department, through the important first 24 hours of hospitalization, to hospital discharge and long-term management.

Angioplasty, Balloon, Coronary↗