101
|
Hilli MA, MacRedmond R, Hollywood P, O'Neill S, Morgan R. Massive pulmonary emboli associated with olanzapine. IRISH MEDICAL JOURNAL 2008; 101:186. [PMID: 18700515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
102
|
Davis S, Papalia MA, Norman RJ, O'Neill S, Redelman M, Williamson M, Stuckey BGA, Wlodarczyk J, Gard'ner K, Humberstone A. Safety and efficacy of a testosterone metered-dose transdermal spray for treating decreased sexual satisfaction in premenopausal women: a randomized trial. Ann Intern Med 2008; 148:569-77. [PMID: 18413618 DOI: 10.7326/0003-4819-148-8-200804150-00001] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It is not known whether premenopausal women who report low sexual satisfaction and have low circulating testosterone levels will benefit from testosterone therapy. OBJECTIVE To evaluate the effects of exogenous testosterone in premenopausal women reporting diminished sexual function. DESIGN Randomized, double-blind, placebo-controlled, dose-ranging trial. SETTING 6 Australian medical centers. PATIENTS 261 women age 35 to 46 years who reported a decrease in satisfying sexual activity relative to their younger years and had a morning serum free testosterone level less than 3.8 pmol/L (<1.1 pg/mL). INTERVENTION 3 different doses of testosterone administered by a metered-dose transdermal spray for 16 weeks or placebo. MEASUREMENTS The primary outcome was the mean number of self-reported satisfactory sexual events (SSEs) over 28 days at week 16. The frequency of SSEs, total number of sexual events (every 4 weeks), scores from the modified Sabbatsberg Sexual Self-Rating Scale and the Psychological General Well-Being Index, and safety variables were also measured. RESULTS The number of SSEs increased during the treatment period in the active treatment groups and the placebo group. The mean number of SSEs over 28 days at week 16 was statistically significantly greater for women treated with the intermediate dose of testosterone therapy (one 90-microL spray) than for women treated with placebo. The least-squares mean was 2.48 versus 1.70 SSEs, respectively (event rate ratio, 1.49 [95% CI, 1.01 to 2.18]; P = 0.04). The frequency of SSEs in women treated with low and high doses of testosterone did not differ from that in women who took placebo. The rate ratios based on the least-squares mean rates of SSEs during weeks 4 to 16 for each treatment group showed statistically significant or borderline significant increases in all testosterone groups compared with the placebo group. The rate ratios for the one 56-microL spray, one 90-microL spray, and two 90-microL sprays treatment groups were 1.34 (CI, 0.97 to 1.85; P = 0.081), 1.48 (CI, 1.07 to 2.06; P = 0.018), and 1.38 (CI, 1.00 to 1.92; P = 0.052), respectively. At week 16, 95% of women treated with the one 90-microL dose had a free testosterone level less than the upper limit of the reference range for women. The most frequently reported adverse event was hypertrichosis, which was dose-related and mostly confined to the application site. No clinically relevant changes in blood test values, serum biochemical variables, or vital signs occurred. LIMITATION The study duration was short, and the placebo effect was strong. CONCLUSION A daily 90-microL dose of transdermal testosterone improves self-reported sexual satisfaction for premenopausal women with reduced libido and low serum-free testosterone levels by a mean of 0.8 SSE per month. The rate of SSEs with higher and lower testosterone doses did not differ from that with placebo.
Collapse
|
103
|
Danbury CM, O'Neill S, Kitching A. Preoperative cardiopulmonary exercise testing. Br J Anaesth 2008; 100:726; author reply 726. [PMID: 18407947 DOI: 10.1093/bja/aen062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
104
|
O'Neill S, Danbury C, Kitching A. Salvage oesophagectomy after local failure of definitive chemoradiotherapy (Br J Surg 2007; 94: 1059-1066). Br J Surg 2007; 94:1572; author reply 1573. [PMID: 18027384 DOI: 10.1002/bjs.6088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
105
|
Harari D, Martin FC, Buttery A, O'Neill S, Hopper A. The older persons' assessment and liaison team 'OPAL': evaluation of comprehensive geriatric assessment in acute medical inpatients. Age Ageing 2007; 36:670-5. [PMID: 17656421 DOI: 10.1093/ageing/afm089] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Reducing hospital length of stay (LOS) in older acute medical inpatients is a key productivity measure. Evidence-based predictors of greater LOS may be targeted through Comprehensive Geriatric Assessment (CGA). OBJECTIVE Evaluate a novel service model for CGA screening of older acute medical inpatients linked to geriatric intervention. SETTING Urban teaching hospital. SUBJECTS Acute medical inpatients aged 70+ years. INTERVENTION Multidisciplinary CGA screening of all acute medical admissions aged 70+ years leading to (a) rapid transfer to geriatric wards or (b) case-management on general medical wards by Older Persons Assessment and Liaison team (OPAL). METHODS Prospective pre-post comparison with statistical adjustment for baseline factors, and use of national benchmarking LOS data. Pre-OPAL (n = 46) and post-OPAL (n = 49) cohorts were similarly identified as high-risk by the CGA screening tool, but only post-OPAL patients received the intervention. RESULTS Pre-OPAL, 0% fallers versus 92% post-OPAL were specifically assessed and/or referred to a falls service post-discharge. Management of delirium, chronic pain, constipation, and urinary incontinence similarly improved. Over twice as many patients were transferred to geriatric wards, with mean days from admission to transfer falling from 10 to 3. Mean LOS fell by 4 days post-OPAL. Only the OPAL intervention was associated with LOS (P = 0.023) in multiple linear regression including case-mix variables (e.g. age, function, 'geriatric giants'). Benchmarking data showed the LOS reduction to be greater than comparable hospitals. CONCLUSION CGA screening of acute medical inpatients leading to early geriatric intervention (ward-based case management, appropriate transfer to geriatric wards), improved clinical effectiveness and general hospital performance.
Collapse
|
106
|
O'Neill S, Danjoux G. Targeted pre-operative echocardiography using international guidelines may influence patients’ management and outcome. Anaesthesia 2007. [DOI: 10.1111/j.1365-2044.2006.04943_4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
107
|
Howard JR, O'Neill S, Travers C. Factors affecting sexuality in older Australian women: sexual interest, sexual arousal, relationships and sexual distress in older Australian women. Climacteric 2007; 9:355-67. [PMID: 17000584 DOI: 10.1080/13697130600961870] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the sexual behavior, sexual relationships, sexual satisfaction, sexual dysfunction and sexual distress in a population of older urban Australian women. METHOD In 2004, 474 women participating in the Longitudinal Assessment of Ageing in Women (LAW) Study completed a series of questionnaires about sexuality. They included the Short Personal Experiences Questionnaire (SPEQ), Relationship Assessment Scale (RAS), Female Sexual Distress Scale (FSDS), questions concerning past sexual abuse based on the Sex in Australia Study, and questions comparing present and past sexual interest and activity. RESULTS The percentage of women with partners ranged from 83.3% in the 40 - 49-year age group to 46.4% women in the 70 - 79-year age group. The sexual ability of partners diminished markedly with age, with only 4.8% of the partners using medication to enable erections. Only 2.5% of women reported low relationship satisfaction. The incidence of sexual distress was also low, being reported by only 5.7% of women. Younger women and women with partners had higher levels of distress than older women. Indifference to sexual frequency rose from 26.7% in women aged 40 - 49 years to 72.3% in the 70 - 79-year age group. Past sexual abuse was recalled by 22.7% of women and 11.6% recalled multiple episodes of abuse. Women who recalled abuse had lower scores for satisfaction with sexual frequency. CONCLUSIONS It appears from this study that there is a wide range of sexual experience amongst aging women, from never having had a sexual partner, to having solitary sex, to having a relationship with or without sex into the seventh decade. As women age, they experience a decrease in sexual activity, interest in sex, and distress about sex. This may be associated with the loss of intimate relationships as part of separation, divorce or bereavement. Decreased sexual activity with aging may be interpreted as a biological phenomenon (part of the aging process) or as sexual dysfunction, or it may be the result of adapting to changed circumstances.
Collapse
|
108
|
O'Neill S, Andreotti M, de Simone V. [Semantic dementia, a many-worded disorder]. Rev Neurol 2006; 43:685-9. [PMID: 17133330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Semantic dementia is a progressive, relatively selective disorder affecting the semantic system with involvement of the verbal and non-verbal functions. The clinical picture is well characterised despite the confusion that may be generated by the different ways of classifying it. AIM. To determine the clinical, neurolinguistic, imaging and pathological features of this progressive language disorder. DEVELOPMENT Evaluation of language reveals above all the existence of semantic paraphasias, disorders affecting the comprehension of isolated words and surface dyslexia. Flow of speech, complex syntactic comprehension and grammar are preserved. Both episodic and autobiographic memory are close to normality. Both the clinical signs and symptoms and imaging studies agree on the fact that the most heavily affected area is the anteroinferomedial region of the temporal lobe on a bilateral scale but with predominance of the left-hand side. Pathologically, in most cases positive intraneuronal ubiquitin inclusions are observed like those described in motor neuron diseases. CONCLUSIONS Semantic dementia constitutes a diagnosis challenge, mainly from the neuropsychological point of view. Further advances towards reaching a diagnosis would allow us to determine which area is mainly affected and, in the future, to find an effective treatment for this progressive, degenerative disorder.
Collapse
|
109
|
Baessler K, O'Neill S, Maher CF. Prävalenz, Inzidenz, Progression und Regression des Genitalprolapses in der Normalpopulation: Ergebnisse einer 5-jährigen longitudinalen Studie. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
110
|
Shifren JL, Davis SR, Moreau M, Waldbaum A, Bouchard C, DeRogatis L, Derzko C, Bearnson P, Kakos N, O'Neill S, Levine S, Wekselman K, Buch A, Rodenberg C, Kroll R. Testosterone patch for the treatment of hypoactive sexual desire disorder in naturally menopausal women. Menopause 2006; 13:770-9. [PMID: 16932240 DOI: 10.1097/01.gme.0000243567.32828.99] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of a testosterone patch for the treatment of women with hypoactive sexual desire disorder after natural menopause. DESIGN A multicenter, randomized, double-blind, placebo-controlled, parallel-group trial was conducted in naturally menopausal women with hypoactive sexual desire disorder receiving a stable dose of oral estrogen with or without progestin (N = 549). Women were randomized to receive testosterone 300 microg/day or placebo patches twice weekly for 24 weeks. The primary efficacy measure was change from baseline in frequency of total satisfying sexual activity over a 4-week period (weeks 21-24). RESULTS A total of 483 women (88%) were included in the primary analysis population (those with baseline sex hormone binding globulin levels < or = 160 nmol/L). The change from baseline in number of total satisfying sexual episodes was significantly greater for testosterone compared with placebo (participants with baseline sex hormone binding globulin levels < or = 160 nmol/L, mean change of 2.1 +/- 0.28 versus 0.5 +/- 0.23 episodes/4 weeks; P < 0.0001; intent-to-treat population, mean change from baseline of 1.9 +/- 0.26 versus 0.5 +/- 0.21 episodes/4 weeks, P < 0.0001). Testosterone also produced statistically significant improvements compared with placebo in all secondary efficacy measures, including sexual desire and personal distress. The testosterone patch was well tolerated. CONCLUSIONS Testosterone patch treatment increased the frequency of satisfying sexual activity and sexual desire, decreased personal distress, and was well tolerated in naturally menopausal women with hypoactive sexual desire disorder.
Collapse
|
111
|
O'Neill S, Greenberg RK, Haddad F, Resch T, Sereika J, Katz E. A Prospective Analysis of Fenestrated Endovascular Grafting: Intermediate-term Outcomes. Eur J Vasc Endovasc Surg 2006; 32:115-23. [PMID: 16580236 DOI: 10.1016/j.ejvs.2006.01.015] [Citation(s) in RCA: 233] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Accepted: 01/25/2006] [Indexed: 11/21/2022]
Abstract
PURPOSE To assess the intermediate-term outcomes following fenestrated grafting for juxtarenal aneurysms. MATERIALS AND METHODS A prospective trial was conducted on patients with short proximal necks, who were considered to be high-risk for open repair and unacceptable for conventional endovascular repair. Devices were designed from reconstructed CT data. Follow-up studies included CT, duplex ultrasound, and KUB and occurred at hospital discharge, 1, 6, and 12 months and annually thereafter. RESULTS One hundred and nineteen patients were treated (2001-2005). Mean age and aneurysm size were 75 years and 65 mm, respectively, and 82% were male. A total of 302 visceral vessels were inferior to the fabric seal (a mean of 2.5 vessels per patient), with the most common design incorporating two renal arteries and the SMA (58%). All prostheses were implanted successfully without any acute visceral artery loss. The mean follow-up was 19 months (0-42 months). One patient died within 30 days of device implantation. Kaplan-Meier estimates of survival at 1, 12, 24, and 36 months are 0.99, 0.92, 0.83 and 0.79. There were no ruptures or conversions. Pre-discharge imaging noted 11 type I and type III endoleaks. The 30-day endoleak rate was 10% (all type II). Aneurysm sac size decreased (>5 mm) in 51, 79 and 77% at 6, 12 and 24 months, respectively. One patient had sac enlargement within the first year, associated with a persistent type II endoleak. In-stent stenoses occurred in 12 renal arteries and one SMA. Six renal arteries and the SMA stenosis were treated and two renal stenoses are awaiting treatment. Ten of 231 stented renal arteries occluded (three prior to discharge), one of which was recanalized. One component separation was treated with an extension at 2 years. CONCLUSIONS The placement of endovascular prostheses with graft material incorporating the visceral arteries is safe and appears to be effective at preventing rupture. Continued follow-up to assess the long-term benefit, aneurysm sac behavior and effect of stenting upon the visceral ostia remains critical.
Collapse
|
112
|
Roche M, Redmond RM, O'Neill S, Smyth E. A case of multiple cerebral abscesses due to infection with Cladophialophora bantiana. J Infect 2005; 51:e285-8. [PMID: 15908005 DOI: 10.1016/j.jinf.2005.02.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Accepted: 02/28/2005] [Indexed: 10/25/2022]
Abstract
Cladophialophora bantiana is a highly neurotropic fungus which has been reported to cause a variety of infections in the immunocompromised and transplant populations. We describe a case of multiple cerebral abscesses caused by this dematiaceous fungus in a patient with probable Duncan's syndrome. The patient also had extensive extra-cerebral disease, which is unusual for infection with this organism. We discuss previously described cases of infection with Cladophialophora bantiana, and review the current and evolving treatment options.
Collapse
|
113
|
Hanna K, Day A, O'Neill S, Patterson C, Lyons-Wall P. Does scientific evidence support the use of non-prescription supplements for treatment of acute menopausal symptoms such as hot flushes? Nutr Diet 2005. [DOI: 10.1111/j.1747-0080.2005.00022.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
114
|
O'Neill S, MacLennan A, Bass S, Diamond T, Ebeling P, Findlay D, Flicker L, Markwell A, Nowson C, Pocock N, Sambrook P, Singh MF. Guidelines for the management of postmenopausal osteoporosis for GPs. AUSTRALIAN FAMILY PHYSICIAN 2004; 33:910-9. [PMID: 15584331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND Since the last series of guidelines on the management of osteoporosis from Osteoporosis Australia was published in Australian Family Physician (October 2002), there have been further advances in our understanding of the treatment involved in both the prevention of bone loss and the management of established osteoporosis. OBJECTIVE This article provides updated guidelines for the management of postmenopausal osteoporosis to assist general practitioners identify those women at risk, and reviews current treatment strategies. DISCUSSION Osteoporosis and its associated problems are major health concerns in Australia, especially with an aging population. While important principles of management are still considered to be maximising peak bone mass and preventing postmenopausal bone loss, new clinical trial data about drugs such as the bisphosphonates, raloxifene and oestrogen have recently become available and the relative role of various agents is gradually becoming clearer. The use of long term hormone therapy has mixed risks and benefits that requires individual patient counselling.
Collapse
MESH Headings
- Absorptiometry, Photon
- Aged
- Antihypertensive Agents/therapeutic use
- Benzothiadiazines
- Biomarkers/blood
- Bone Diseases, Metabolic/complications
- Bone Diseases, Metabolic/diagnosis
- Bone Diseases, Metabolic/therapy
- Calcium/therapeutic use
- Diphosphonates/therapeutic use
- Diuretics
- Drug Therapy, Combination
- Estrogen Replacement Therapy/methods
- Family Practice/methods
- Family Practice/standards
- Female
- Fractures, Bone/etiology
- Fractures, Bone/prevention & control
- Humans
- Middle Aged
- Organometallic Compounds/therapeutic use
- Osteoporosis, Postmenopausal/blood
- Osteoporosis, Postmenopausal/complications
- Osteoporosis, Postmenopausal/diagnosis
- Osteoporosis, Postmenopausal/therapy
- Parathyroid Hormone/therapeutic use
- Risk Factors
- Selective Estrogen Receptor Modulators/therapeutic use
- Sodium Chloride Symporter Inhibitors/therapeutic use
- Thiophenes/therapeutic use
- Vitamin D/therapeutic use
Collapse
|
115
|
O'Neill S, Parkin I, Clark J, Mills A, Elliott N. Photocatalytically Activeγ-WO3 Films from Atmospheric Pressure CVD of WOCl4 with Ethyl Acetate or Ethanol. ACTA ACUST UNITED AC 2004. [DOI: 10.1002/cvde.200304167] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
116
|
Greenberg RK, Haulon S, O'Neill S, Lyden S, Ouriel K. Primary Endovascular Repair of Juxtarenal Aneurysms with Fenestrated Endovascular Grafting. Eur J Vasc Endovasc Surg 2004; 27:484-91. [PMID: 15079770 DOI: 10.1016/j.ejvs.2004.02.015] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate outcomes of an endovascular graft incorporating the visceral aortic segment with graft material in the setting of juxtarenal aneurysms. MATERIALS AND METHODS A prospective analysis of patients undergoing implantation of an endovascular device with graft material proximal to the renal arteries was conducted. All patients were deemed unacceptable candidates for open surgical repair and had proximal neck length=<10 mm, or =<15 mm with a compromising morphology (funnel or thrombus). Fenestrations were customized to accommodate aortic branch anatomy based upon CT and intravascular ultrasound data. Selective visceral ostia were treated with balloon expandable stents following endograft deployment. All patients were evaluated with CT, duplex ultrasound, and abdominal radiograph at discharge, 1, 6, 12 and 24 months. RESULTS A total of 32 patients were enrolled in the trial. Short proximal necks (3-10 mm) were present in 22, and 10 had necks 10-15 mm in length with concomitant angulation or thrombus compromising neck quality. Endograft design included bifurcated (30) and aortic tube (2) systems. A total of 83 visceral vessels were incorporated (mean of 2.6 per patient). These most commonly included both renal arteries and the SMA. All prostheses were implanted successfully without the acute loss of any visceral arteries. The mean follow-up was 9.2 months (range 0-24 months). One patient died within 30 days of device implantation and hypogastric bypass following the development of aspiration pneumonia. Three early (<30 days) and three late secondary interventions were performed. The 30-day endoleak rate was 6.5%. The aneurysm sac decreased greater than 5 mm in 58% of patients at 6 months and in 75% of patients at 12 months. One patient, with a persistent type II endoleak had 5 mm of sac growth over 12 months. Six patients had transient or permanent elevation of serum creatinine (>30% from baseline), with one requiring hemodialysis. Of the 83 vessels incorporated, three late stenoses (all successfully treated with an endovascular approach) and two renal occlusions were detected during follow-up. Three patients died of unrelated causes during the follow-up period. CONCLUSIONS The placement of endovascular prostheses with graft material incorporating the visceral arteries is technically feasible. The incidence of endoleaks is exceptionally low. It remains critical to follow the status of stented visceral vessels, and establish the long-term efficacy of this type of repair.
Collapse
|
117
|
Thompson B, MacAuley D, McNally O, O'Neill S. Defining the sports medicine specialist in the United Kingdom: a Delphi study. Br J Sports Med 2004; 38:214-7. [PMID: 15039262 PMCID: PMC1724767 DOI: 10.1136/bjsm.2003.004689] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To define the role and responsibilities of the sports medicine specialist using a recognised research technique. METHODS A Delphi technique was employed using anonymous postal questionnaires sent to a random sample of 300 members of the British Association of Sport and Exercise Medicine. The questionnaire of 300 putative attributes was developed in a pilot study and the Delphi technique used allowed participants to modify their responses according to the responses of other participants. RESULTS There was a 53% response to both rounds of the study with 75.6% of the respondents being male, 39% having a higher qualification in sports medicine, and 45.6% being general practitioners. Some 86.3% strongly agreed that sport and exercise medicine should be a recognised speciality and 90% strongly agreed that it should be available on the National Health Service (NHS). The most important specialist attributes were orthopaedic and soft tissue medicine (83.6% strongly agreed) and emergency medical management (79.7% strongly agreed). More than 75% of respondents did not agree that either research or personal playing experience were relevant. CONCLUSION Sports and exercise medicine is an evolving speciality in the United Kingdom. We believe this is the first systematic attempt to define the role and responsibilities of the sports medicine specialist and the findings are of relevance to the future development of a career pathway.
Collapse
|
118
|
Abstract
OBJECTIVE To report an unusual penetrating stab injury of the spinal cord. DESIGN Case report of a 13-year-old boy who sustained cervical trauma following an accident while playing. SETTING Spinal Cord Injuries Unit, Musgrave Park Hospital, Belfast, UK. CASE REPORT Mechanism of injury was by a spear-like electric fence post entering the neck. Initial neurological examination revealed tetraplegia with C4 sensory level. Magnetic resonance imaging (MRI) of spinal cord demonstrates the penetrating injury. CONCLUSION No ligamentous instability was demonstrated. In the absence of this, the penetrating injury by a short blade thrown at speed was felt to be responsible for the subsequent injury and resulting outcome at discharge of C4 American Spinal Injury Association (ASIA) grade D tetraplegia.
Collapse
|
119
|
O'Neill S. Anti-arrhythmic actions of polyunsaturated fatty acids in cardiac muscle exerted via the sarcoplasmic reticulum. Biochem Soc Trans 2003; 31:939-42. [PMID: 14505453 DOI: 10.1042/bst0310939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiac arrhythmias can be triggered from ischaemic cardiac muscle due to the damage inflicted on individual myocytes. During an ischaemic episode free fatty acids accumulate in the ischaemic tissue. The importance of these fatty acids lies in the apparent ability of some classes of fatty acid to protect against cardiac arrhythmias. As cardiac sudden death is a likely cause of death in patients who have suffered an initial ischaemic insult, protection against such arrhythmias may be of crucial importance. The following review discusses how this protection may be produced, dealing specifically with changes in electrophysiological properties of cells and intracellular calcium regulation.
Collapse
|
120
|
O'Neill S. The struggle for black equality comes to Charleston: the hospital strike of 1969. THE PROCEEDINGS OF THE SOUTH CAROLINA HISTORICAL ASSOCIATION. SOUTH CAROLINA HISTORICAL ASSOCIATION 2003:82-91. [PMID: 12862096 DOI: 10.18130/v3ps73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
121
|
Ambros IM, Benard J, Boavida M, Bown N, Caron H, Combaret V, Couturier J, Darnfors C, Delattre O, Freeman-Edward J, Gambini C, Gross N, Hattinger CM, Luegmayr A, Lunec J, Martinsson T, Mazzocco K, Navarro S, Noguera R, O'Neill S, Potschger U, Rumpler S, Speleman F, Tonini GP, Valent A, Van Roy N, Amann G, De Bernardi B, Kogner P, Ladenstein R, Michon J, Pearson ADJ, Ambros PF. Quality assessment of genetic markers used for therapy stratification. J Clin Oncol 2003; 21:2077-84. [PMID: 12775732 DOI: 10.1200/jco.2003.03.025] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Therapy stratification based on genetic markers is becoming increasingly important, which makes commitment to the highest possible reliability of the involved markers mandatory. In neuroblastic tumors, amplification of the MYCN gene is an unequivocal marker that indicates aggressive tumor behavior and is consequently used for therapy stratification. To guarantee reliable and standardized quality of genetic features, a quality-assessment study was initiated by the European Neuroblastoma Quality Assessment (ENQUA; connected to International Society of Pediatric Oncology) Group. MATERIALS AND METHODS One hundred thirty-seven coded specimens from 17 tumors were analyzed in 11 European national/regional reference laboratories using molecular techniques, in situ hybridization, and flow and image cytometry. Tumor samples with divergent results were re-evaluated. RESULTS Three hundred fifty-two investigations were performed, which resulted in 23 divergent findings, 17 of which were judged as errors after re-evaluation. MYCN analyses determined by Southern blot and in situ hybridization led to 3.7% and 4% of errors, respectively. Tumor cell content was not indicated in 32% of the samples, and 11% of seemingly correct MYCN results were based on the investigation of normal cells (eg, Schwann cells). Thirty-eight investigations were considered nonassessable. CONCLUSION This study demonstrated the importance of revealing the difficulties and limitations for each technique and problems in interpreting results, which are crucial for therapeutic decisions. Moreover, it led to the formulation of guidelines that are applicable to all kinds of tumors and that contain the standardization of techniques, including the exact determination of the tumor cell content. Finally, the group has developed a common terminology for molecular-genetic results.
Collapse
|
122
|
Ramm RE, Rainbird AJ, Khoo S, O'Neill S, Scalia GM. Age-dependent changes in diastolic function by echocardiography in 138 healthy peri-menopausal women — preliminary findings of the five year women's longitudinal health study. Heart Lung Circ 2003. [DOI: 10.1046/j.1443-9506.2003.03234.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
123
|
McCoy ML, Devitt T, Clay R, Davis KE, Dincin J, Pavick D, O'Neill S. Gaining insight: who benefits from residential, integrated treatment for people with dual diagnoses? Psychiatr Rehabil J 2003; 27:140-50. [PMID: 14653547 DOI: 10.2975/27.2003.140.150] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This retrospective study examines 18-month outcomes for 38 participants in an urban, residential integrated treatment (IT) program, and whether residents experienced different treatment benefits. Informed by an ACT team approach, the program emphasized harm reduction and motivational interventions. The design is naturalistic, and outcomes are self-comparisons over time reported in the aggregate. Repeated measurements with three standardized scales tracked stage of treatment and extent of alcohol and drug use. Outcomes analyses reveal advancements in stage of treatment and significant reductions in use of alcohol and drugs. Participants also worked more and were hospitalized less.
Collapse
|
124
|
O'Neill S, Sambrook P, Diamond T, Ebeling P, Ferris L, Flicker L, Findlay D, Singh MF, Lord S, MacLennan A, Markwell A, Nowson C, Pocock N, Williamson M. Guidelines for the treatment of postmenopausal osteoporosis for general practitioners. AUSTRALIAN FAMILY PHYSICIAN 2002; 31:921-8. [PMID: 12404830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
BACKGROUND Osteoporosis Australia has been committed to the education of general practitioners and the community with a series of updated guidelines on the management of osteoporosis. Since the last series was published in Australian Family Physician (August 2000), there have been further advances in our understanding of the treatments involved in both prevention of bone loss and the management of established osteoporosis. OBJECTIVE This article represents updated guidelines for the treatment of postmenopausal osteoporosis to assist GPs identify those women at risk and to review current treatment strategies. DISCUSSION Osteoporosis and its associated problems are major health concerns in Australia, especially with an aging population. While important principles of management are still considered to be maximising peak bone mass and preventing postmenopausal bone loss, new clinical trial data about drugs such as the bisphosphonates, raloxifene and oestrogen have recently become available and the relative role of various agents is gradually becoming clearer. The use of long term hormone replacement therapy has mixed risks and benefits that requires individual patient counselling.
Collapse
|
125
|
Madigan SM, O'Neill S, Clarke J, L'Estrange F, MacAuley DC. Assessing the dietetic needs of different patient groups receiving enteral tube feeding in primary care. J Hum Nutr Diet 2002; 15:179-84. [PMID: 12028512 DOI: 10.1046/j.1365-277x.2002.00361.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To examine the nature of all contacts between adult tube-fed patients and the dietetic service and to refine the current dietetic protocols to reflect the findings of the study with a view to improving patient care. METHODS All adult patients referred to the Community Nutrition and Dietetic Service within a 6-month period were included in the study. Using a proforma developed from a retrospective case-note analysis, data were collected on the complications that prompted more frequent contacts than the department protocol. Data were analysed using the Statistical Package for the Social Sciences. RESULTS The most common indication for home enteral feeding in this group of adult patients was a swallowing disorder resulting from a cerebrovascular accident (59.5%) followed by cancer (21.5%). There was a trend for cancer patients to need more intervention compared with those patients with other medical conditions. A significant difference was observed in the total contacts and telephone calls given to those patients in there own homes (P=0.019) and there was a trend towards more domicilary visits with this group. CONCLUSIONS The department protocols have been revised to include a planned review within 2-6 weeks of initial dietetic assessment in the community for those patients who were identified to have the greatest need. More intensive dietetic monitoring has clear implications for dietetic services in the community.
Collapse
|