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Biomedical subjects

A J Reid

Publications and source records attributed to A J Reid.

14 recordsLinked to original sources
PubMed1995

Female family physicians in obstetrics: achieving personal balance.

OBJECTIVE: To describe the experiences of female family physicians who practise obstetrics in balancing professional obligations with personal and family needs, given the unique challenges that such practice poses for these physicians. DESIGN: Qualitative study. SETTING: Ontario. PARTICIPANTS: A purposefully selected sample of nine female family physicians who met the criteria of being married, having children and currently practising obstetrics. OUTCOME MEASURES: Experiences of female family physicians and their strategies in their personal, family and professional lives that enable them to continue practising obstetrics. RESULTS: All participants continued to practise obstetrics because of the pleasure they derived from it, despite the challenges of balancing the unpredictable demands of obstetrics with their personal and family needs. To continue in obstetrics, they needed to make changes in their lives, either through a gradual, evolutionary process or in response to a critical event. Alterations to work and family arrangements permitted them to meet the challenges and led to increased satisfaction. Changes included making supportive call-group arrangements, limiting work hours and the number of births attended and securing help with household duties. CONCLUSIONS: An in-depth examination, through the use of qualitative methods, showed the reasons why some female family physicians continue to practise obstetrics despite the stressful aspects of doing so. This knowledge may be useful for women who are residents or experienced clinicians and who are considering including obstetrics in their practice.

Adaptation, Psychological↗
PubMed1995

Consultation in family practice obstetrics.

PURPOSE: To examine the types of non-low-risk obstetric patients managed by family physicians in urban teaching hospitals, and to determine indications for consultation for women at low risk when labour began. METHOD: Retrospective chart review for all patients delivered by family physicians in three downtown Toronto teaching hospitals during 1 year. RESULTS: Of 1710 cases, 595 (34.8%) were classified as non-low risk, with the main indications being postdates (> 42 weeks) (19.9%); pregnancy-induced hypertension (19.3%); and premature labour (< 37 weeks) (14.8%). Of the 1115 low-risk patients, 363 (32.6%) had an intrapartum consultation, usually for failure to progress (50.1%) or fetal distress (12.7%). More than 80% of intrapartum consultations were associated with induction and augmentation of labour. CONCLUSION: Family physicians can continue to care for many non-low-risk women, usually with the help of obstetricians. Consultations were obtained for many women at low risk. We need to reevaluate whether some mandatory consultations are necessary in family practice obstetrics.

Family Practice↗
PubMed1994

Psychosocial risk factors during pregnancy. What do family physicians ask about?

OBJECTIVE: To determine whether physician characteristics affect attitudes or practices regarding assessment of psychosocial risk factors during pregnancy, and to evaluate whether an antenatal psychosocial risk factor assessment form would help family physicians. DESIGN AND SETTING: A questionnaire asking physicians to rate the importance of information on a scale of one to five was mailed to all active members of the University of Toronto Department of Family and Community Medicine's Survey Network of Attitudes and Practice (SNAP). PARTICIPANTS: A volunteer sample of physicians doing prenatal and intrapartum obstetrics who are active members of SNAP. The network is made up of full-time faculty in the University of Toronto's family practice units and teaching practice physicians (rural, suburban, and urban) who are interested in participating in research projects. MAIN OUTCOME MEASURES: Response rate was 78%. Responses of the 45 SNAP members who did not practise obstetrics were excluded; 125 of 218 questionnaires mailed were analyzed. RESULTS: Women family physicians rated the form potentially helpful more frequently than their male colleagues. Urban and suburban physicians' concerns differed from those of rural physicians. Alcohol and drug abuse, abuse in the relationship, and acceptance of the pregnancy were rated highly important by physicians. Of the physicians surveyed, 77% thought that an antenatal psychosocial risk assessment form would be of some benefit or very helpful. Only 15% indicated it would be useless or not helpful. CONCLUSION: The importance respondents accorded to risk factors showed little correspondence to the frequency of inquiry about them. The survey confirmed our plan to design an antenatal psychosocial risk factor assessment form.

Adult↗
PubMed1993

Echocolonoscopy--an indispensable procedure before and after transanal endoscopic microsurgery.

As a refinement of the widely practised intraluminal sonography, echocolonoscopy represents a breakthrough in preoperative staging and post-operative follow-up of rectal tumor patients. Enabling colonoscopy and intraluminal sonography to be performed in one session, optical control with the Olympus echocolonoscope also prevents inaccurate endosonographic diagnosis caused by tangential cuts or mistaken interpretation of faeces adhering to the mucosa. In the era of transanal endoscopic microsurgery, echocolonoscopy acquires enhanced importance as a pre- and post-operative tool.

Anal Canal↗
PubMed1989

Differences in intrapartum obstetric care provided to women at low risk by family physicians and obstetricians.

To determine differences in practice style and to examine maternal and neonatal outcomes, we reviewed the hospital charts of 1115 women admitted by family physicians and 1250 women admitted by obstetricians who gave birth at one of three teaching hospitals in Toronto between April 1985 and March 1986. All the women in the two groups were categorized retrospectively as being at low risk at the onset of labour on the basis of their prenatal records and their admission histories and physical examination results. There were higher proportions of younger women and women of lower socioeconomic status in the family physician group than in the obstetrician group (p less than 0.001). The rates of interventions, including artificial rupture of the membranes, induction, augmentation, low forceps plus vacuum extraction, episiotomy and epidural anesthesia, were all higher in the obstetrician group. The mean birth weight and the cesarean section rate were the same in the two groups. Differences in labour and delivery outcomes between the two groups, including a higher rate of spontaneous vaginal delivery for the family physicians, reflected a more "expectant" practice style by family doctors. However, there were no significant differences in the rates of maternal or neonatal complications. A practice style characterized by a higher rate of interventions was not associated with improved maternal or newborn outcome in this low-risk setting.

Adult↗
PubMed1988

The differential expression of genes for the PSE-4 beta-lactamase in Pseudomonas aeruginosa and the Enterobacteriaceae.

The PSE-4 beta-lactamase has been identified, for the first time, in two non-pseudomonal strains. The gene in Klebsiella pneumoniae 241 (dal1) was located on a plasmid (pUK700) and was freely transferable to other enterobacterial strains and Pseudomonas aeruginosa. On the other hand, the gene in Enterobacter cloacae A113 (dal2) could only be transferred in the presence of a mobilizing plasmid. When both these genes were transferred within the Enterobacteriaceae, the beta-lactamase produced was slightly different from the prototype 'Dalgleish' PSE-4 enzyme. However, when dal1 and dal2 were transferred to P. aeruginosa the enzyme expressed was identical to this prototype enzyme. In addition, both these genes expressed higher levels of PSE-4 beta-lactamase production in P. aeruginosa than found in the Enterobacteriaceae. Thus it appears that the biochemical properties of the PSE-4 gene products from dal1 and dal2 are host-modified.

Enterobacteriaceae↗
PubMed1988

Cephaloridine resistance in gram-negative bacteria isolated in Scotland.

The incidence of cephaloridine resistance (minimum inhibitory concentration, MIC greater than 8 mg L-1) in isolates from urinary tract infections was 45.1% in Glasgow, 22.6% in Dundee and 25.9% in Edinburgh. The incidence of ampicillin resistance (MIC greater than 8 mg L-1) was even higher:- being 45.2% in Dundee and 48.5% in Edinburgh. In Glasgow, the incidence was 71.9% which is the highest proportion of ampicillin resistance reported in the United Kingdom. The cephaloridine resistant strains were examined for beta-lactamase production. Amongst these strains 50.8% produced only a chromosomal beta-lactamase, whereas 47.9% produced beta-lactamases which were potentially plasmid-mediated on the basis of biochemical tests. Only 1% of the resistant strains produced no detectable beta-lactamase.

Ampicillin Resistance↗
PubMed1987

Ampicillin resistance in Haemophilus influenzae: identification of resistance mechanisms.

The incidence and mechanisms of ampicillin resistance (MIC greater than 1 mg/l) were investigated in 105 clinical isolates of Haemophilus influenzae collected in Edinburgh during 1983/4. Fifteen (14.3%) ampicillin-resistant strains were identified and these were non-serotypable and comprised six biotypes. Isoelectric focusing and beta-lactamase-inhibition studies demonstrated that production of the TEM-1 beta-lactamase was the principal mechanism of resistance in nine (60%) strains. Radiolabelling revealed that one beta-lactamase-positive strain also had an unusual penicillin-binding protein (PBP) profit. No beta-lactamase activity was detected in the other six (40%) ampicillin-resistant strains. Two beta-lactamase-negative ampicillin-resistant strains had atypical PBP profiles. SDS-PAGE analysis showed that four beta-lactamase-negative ampicillin-resistant strains, including one with altered PBPs, exhibited outer membrane protein profiles which differed from those of sensitive strains of the same biotype. The ampicillin-resistance mechanism of the remaining strain could not be determined. Thus, several resistance mechanisms, either acting individually or in combination, are implicated in ampicillin resistance in H. influenzae.

Ampicillin↗
PubMed1986

Plasmid penicillin resistance in Vibrio cholerae: identification of new beta-lactamase SAR-1.

Two strains of Vibrio cholerae biotype El Tor, isolated in Tanzania, possessed a single IncC resistance plasmid of 113 kilobases. Both plasmids encoded the production of a novel beta-lactamase, SAR-1, which was 33,700 daltons in size and was able to hydrolyze carbenicillin as well as penicillin G. The SAR-1 beta-lactamase was quite distinct from all other plasmid beta-lactamases by virtue of its unusually low isoelectric point and a combination of its size, substrate profile, and inhibition properties. This enzyme is only the second beta-lactamase identified in V. cholerae species and the first to be reported in V. cholerae strains isolated in Southern Africa.

Ampicillin↗
PubMed1985

Night-time sleep EEG changes following body heating in a warm bath.

Six healthy female volunteers (22-24 years), physically untrained (unfit), sat in baths of warm or cool water for 90 min, between 14.30 h and 17.30 h, on separate occasions. In the former condition (HOT), rectal temperature (Tr) rose by an average of 1.8 degrees C, and in the latter (COOL), a thermoneutral condition, there was a nil Tr change. All-night sleep EEGs were monitored after both occasions and on baseline nights. Following COOL, there was no significant change in any sleep parameter. After HOT there were significant increases in: sleepiness at bed-time, slow wave sleep, and stage 4 sleep. REM sleep was reduced, particularly in the first REM sleep period.

Adult↗
PubMed1982

Wegener's granulomatosis and the respiratory system.

Wegener's granulomatosis is a disease characterized by necrotizing vasculitis of the upper and lower respiratory tracts, necrotizing glomerulonephritis, and varying degrees of disseminated small vessel vasculitis. Patients can present to an otolaryngologist head and neck surgeon with ear, nose, throat, lung, orbit, salivary gland, or cutaneous lesions. The disease is variable in its presentation and progression. Tissue biopsies may be non-diagnostic even in the presence of active disease. Although the disease was rapidly fatal as recently at 1970, it can now be effectively treated. This paper reviews the diagnosis and management of Wegener's granulomatosis at a major university hospital between 1965 and 1979. during this period there was a significant evolution of treatment methods.

Adult↗
PubMed1975

Letter: CUSO.

Explore the source record for details and available documents.

Canada↗
PubMedDate not supplied

The influence of the high-risk care environment on the practice of low-risk obstetrics.

This retrospective chart review compared the intervention rates in 2,365 low-risk obstetric patients at three urban teaching hospitals, two of which were high-risk, perinatal referral centers. The third cared for mostly low-risk patients. The hypothesis was that rates of intervention in low-risk pregnancies would be higher in the high-risk care environment. Family physicians at the perinatal referral centers performed significantly more artificial rupture of membranes, epidural blocks, augmentations of labor, and episiotomies on their low-risk patients than did those at the low-risk hospital. This trend was also found for obstetricians but did not reach statistical significance. Thus, the conclusion was drawn that caring for low-risk patients in a high-risk care environment is associated with a higher intervention rate by family physicians. Factors that may contribute to this finding are discussed.

Adult↗