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Biomedical subjects

T McNamara

Publications and source records attributed to T McNamara.

36 records · Page 2Linked to original sources
PubMed1990

Early readmission of elderly patients with congestive heart failure.

Repetitive hospitalizations are a major health problem in elderly patients with chronic disease, accounting for up to one fourth of all inpatient Medicare expenditures. Congestive heart failure, one of the most common indications for hospitalization in the elderly, is also associated with a high incidence of early rehospitalization, but variables identifying patients at increased risk and an analysis of potentially remediable factors contributing to readmission have not previously been reported. We prospectively evaluated 161 patients 70 years or older that had been hospitalized with documented congestive heart failure. Hospital mortality was 13% (n = 21). Among patients discharged alive, 66 (47%) were readmitted within 90 days. Recurrent heart failure was the most common cause for readmission, occurring in 38 patients (57%). Other cardiac disorders accounted for five readmissions (8%), and noncardiac illness led to readmission in 21 cases (32%). Factors predictive of an increased probability of readmission included a prior history of heart failure, four or more admissions within the preceding 8 years, and heart failure precipitated by an acute myocardial infarction or uncontrolled hypertension (all P less than .05). Using subjective criteria, 25 first readmissions (38%) were judged possibly preventable, and 10 (15%) were judged probably preventable. Factors contributing to preventable readmissions included noncompliance with medications (15%) or diet (18%), inadequate discharge planning (15%) or follow-up (20%), failed social support system (21%), and failure to seek medical attention promptly when symptoms recurred (20%). Thus, early rehospitalization in elderly patients with congestive heart failure may be preventable in up to 50% of cases, identification of high risk patients is possible shortly after admission, and further study of nonpharmacologic interventions designed to reduce readmission frequency is justified.

Aged↗
PubMed1988

Technique and results of "higher-dose" infusion.

We experimented with thrombolytic technique in an attempt to maximize therapeutic outcome, selecting urokinase because of its proven safety and efficacy in clinical investigation. An initially "high-dose" regimen, starting at 4,000 U/min and decreasing to 1,000 U/min after restoration of antegrade blood flow, generally establishes lysis within 3-4 h--even after acute embolic or thrombolytic occlusion. It can also be used effectively and safely as a therapeutic trial. "High-dose" urokinase compares favorably with "low-dose" streptokinase and shows a lower incidence of bleeding and allergic complications.

Arterial Occlusive Diseases↗
PubMed1985

Pain control: comparison of percutaneous and operative nephrolithotomy.

Percutaneous removal of renal calculi is an effective form of therapy with less morbidity than some other operative procedures. The narcotic requirements of 21 patients treated percutaneously were compared with a comparable group of patients treated by open nephrolithotomy. Patients treated percutaneously stayed in the hospital for 8.9 days and required 6.5 doses of narcotics. Patients treated by open surgical lithotomy remained in the hospital for 11.0 days and required 21 doses of narcotics. When compared on a daily basis, patients in the open operative group required 2.7 times more doses of narcotics than patients treated percutaneously. Percutaneous nephrolithotomy appears to be significantly less painful than operative nephrolithotomy utilizing a standard flank incision as indicated by narcotic analgesic usage.

Adolescent↗
PubMed1985

Endoscopic ureteropyelostomy: opening the obliterated ureteropelvic junction with nephroscopy and flexible ureteropyeloscopy.

Endoscopic re-establishment of a totally obstructed ureteropelvic junction was accomplished in 2 patients. The combined use of rigid percutaneous nephroscopy and flexible ureteropyeloscopy provided full visualization of the obliterated segment, and allowed accurate electroincision into the ureter and placement of a wire and catheter into the lumen. This technique demonstrates the potential therapeutic applications of flexible ureteropyeloscopy and should be considered for the initial treatment of the obliterated ureteropelvic junction.

Aged↗
PubMed1975

Effects of dietary hydrochloric acid on voluntary food intake and metabolism of sheep in relation to the use of mineral acids as silage additives.

1. In Expt I, a pelleted grass-meal diet was supplemented with hydrochloric acid, added to the grass pellets before feeding, at five levels from 0 to 628 mmol/kg dry matter (DM). Each diet was offered ad lib. for 21 d to five sheep in a 5 x 5 Latin-square design. 2. Voluntary food intake decreased rectilinearly with increasing HCl supplementation (P less than 0.001), to 42% of the control value for sheep on the high-HCl diet. The decrease in food intake was related both to dietary pH and to the extent of metabolic acidosis induced by the HCl treatment. Although the pH of rumen fluid decreased slightly with increasing HCl supplementation, effects of the HCl treatment on volatile fatty acid concentrations in rumen fluid were not significant (P greater than 0.05). 3. In Expt 2, palatability and metabolic effects of dietary HCl were studied by comparing its effect when mixed into the pelleted grass meal before feeding, with and without a supplement of an equivalent amount of sodium bicarbonate given intraruminally, or when HCl was given intraruminally while the sheep consumed pelleted grass meal alone. Each of the three treatments was given at two levels of HCl, 280 and 560 mmol/kg DM. At each level of dietary HCl supplementation, the three treatments and the control diet (pelleted grass meal alone) were each given to four sheep, in a Latin-square design, for 11 d. 4. At the low level of supplementation, HCl, when mixed into the pelleted grass meal, reduced food intake by 17%, this effect was not altered by NaHCO3 supplementation, but when HCl was given intraruminally food intake was not reduced. At the high level of HCl supplementation, food intake was reduced by about 40% by each method of HCl supplementation; and NaHCO3 supplementation did not appreciably alter the effect of HCl on food intake, but prevented metabolic acidosis associated with the HCl treatments. Food intakes for the low-HCl treatments were significantly higher than those for the high-HCl treatments (P less than 0.01) and the level of dietary HCl x treatment interaction was also significant (P less than 0.01). DM digestibility, and the pH and volatile fatty acid concentrations of rumen fluid were not significantly affected by the different treatments. 5. It is concluded that at a low level of HCl supplementation the adverse effects of dietary HCl on voluntary food intake of sheep is determined by palatability associated with low dietary pH, whereas at a high level of HCl supplementation the effect is determined by palatability and by a metabolic response.

Acidosis↗
PubMed1975

A study of the effectiveness of calcined magnesite as a neutralizing agent for hydrochloric acid in the diet of sheep.

1. Five experimental diets were offered ad lib. for 21 d to five sheep in a 5 x 5 Latin-square design experiment as follows: pelleted grass meal alone (control); pelleted grass meal plus hydrochloric acid (470 mmol/kg dry matter (OM); pelleted grass meal plus 470 mmol HCl/kg DM and either an equivalent amount of calcined magnesite (MgO) (235 mmol/kg DM) or twice the amount (470 mmol MgO/kg DM); pelleted grass meal plus 470 mmol MgO/kg DM. 2. MgO supplementation partly prevented the reduction in food intake caused by HCl, being more effective at the low than at the high level. When fed alone, the high level of MgO had a slight adverse effect on food intake. 3. There was no significant treatment effect on either the pH or volatile fatty acid concentrations of rumen fluid. MgO supplementation was only slightly effective in preventing the metabolic acidosis caused by HCl supplementation, as indicated by blood and urine acid-base measurements. 4. With the MgO-supplemented diets, values for the faecal and urinary excretion of magnesium were approximately 70 and 10% respectively of Mg intake and were not significantly affected by HCl supplementation. For rumen fluid, the water-soluble Mg concentration as a percentage of the total Mg concentration was similar for each treatment, approximately 90%. For faeces, the corresponding value was also similar for each treatment, approximately 30%. 5. MgO supplementation altered the effect of dietary HCl on faecal calcium excretion and on the balance of Ca, but did not alter its effect on urinary Ca excretion. 6. It is concluded that the beneficial effect of MgO supplementation on the intake of the HCl-treated diet was related more to its influence on dietary pH than on conditions in the rumen or the acid-base balance of the sheep.

Acidosis↗
PubMedDate not supplied

Evaluating a support group for perinatal loss.

PURPOSE: This study attempted to determine if a support group intervention makes a difference in grief reactions of parents who have experienced a perinatal loss, and describes what parents perceived as being helpful and not helpful in handling the loss. DESIGN: A cross-sectional, retrospective, two-group research design was used. The independent variable was having attended or not having attended a perinatal loss support group. METHODS: A convenience sample of 121 participants (n = 67 in support groups; n = 51 not in support groups) was obtained from a mail survey to families who were on a perinatal loss support newsletter mailing list. The participants completed the Hogan Grief Reactions Checklist and a demographic questionnaire. RESULTS: There were no statistically significant differences in parents' grief reaction scores between the two groups, but there were some differences in grief scores by gender and ethnicity. In both groups, the parents perceived their spouse, their extended families, and their friends as "most helpful." Physicians were perceived as "least helpful." CLINICAL IMPLICATIONS: Grief is very individual, and not all individuals may benefit from a support group. When suggesting a support group or any intervention, timing and a caring approach are essential.

Adult↗
PubMedDate not supplied

Four maxillary incisors: a case report.

This case report describes the dentofacial morphology and treatment of a 9-year-old female who presented with four maxillary incisors, and a combination of rare oral and cervical vertebral anomalies. The patient had a Class II division I malocclusion which was complicated by the presence of supernumerary permanent teeth: two supplemental maxillary central incisors, and a supplemental mandibular central incisor. She also had abnormalities of the cervical vertebrae, which were symptom-free. In addition, a number of surgical procedures had been performed in early childhood to treat a benign oral teratoma, cleft tongue, and an isolated cleft of the secondary palate. The dental treatment involved the extraction of the two most centrally placed maxillary central incisors, and the alignment of the maxillary arch with fixed orthodontic appliances.

Abnormalities, Multiple↗
PubMedDate not supplied

Facial developmental vascular anomalies.

Developmental vascular anomalies of the head and neck may give rise to profound esthetic problems that are a challenge to treat. These vascular anomalies may also be of significance in dentistry, particularly where extractions have to be carried out. This brief report describes a number of children who presented with different variations of these anomalies.

Adolescent↗
PubMedDate not supplied

Focal dermal hypoplasia (Goltz-Gorlin) syndrome with taurodontism.

This paper is a case report of a 10-year-old girl with focal dermal hypoplasia (FDH) who presented for dental care. She displayed many of the well-documented oral features associated with this syndrome. Additionally, she had taurodontism of a permanent mandibular molar. Although taurodontism affected only one tooth in this patient, the presentation of taurodontism with FDH has not been reported previously.

Child↗
PubMedDate not supplied

Gorlin-Goltz: what's in a name?

This paper describes the clinical features of two very distinct syndromes with similar names: Gorlin-Goltz and Goltz-Gorlin Syndromes. A case report is presented that highlights the differences between these syndromes. To avoid errors in diagnosis because of the similarity in names, the authors caution that, based on additional information now available, the preferred names should be Focal Dermal Hypoplasia syndrome for Goltz-Gorlin syndrome and Nevoid Basal Cell Carcinoma syndrome for Gorlin-Goltz syndrome.

Basal Cell Nevus Syndrome↗
PubMedDate not supplied

A solitary maxillary central incisor treated orthodontically: a case report.

The presentation of a solitary maxillary central incisor is reported and its association with other congenital abnormalities discussed. It is an important finding for dental health professionals, since it may indicate the presence of other significant midline congenital abnormalities. It may also indicate the presence of associated disorders that profoundly affect growth and development and which, once identified, may be treated.

Heart Defects, Congenital↗