Drug misuse should always be considered in young people with impaired consciousness.
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Humans↗
Biomedical subjects
Alison Jones
Publications and source records attributed to Alison Jones.
A qualitative study of the attitudes to teamwork of graduates from a traditional and an integrated undergraduate medical course.
INTRODUCTION: In 1994 the University of Manchester medical school introduced an integrated undergraduate course using problem-based learning throughout. This study explores differences between the new and old (traditional) course graduates' attitudes to, and conceptualization of, teamwork. METHODS: Semi-structured interviews were conducted with 24 graduates of the traditional course (graduating in 1998) and 23 from the new course (1999 graduates), representing approximately 14% of graduates from each cohort. Theories were then developed from concepts emerging from the data. RESULTS: The new course graduates (NCGs) had a broader view of members of a health professional team. The NCGs believed that the medical team should provide support and were more comfortable consulting them when faced with problems. CONCLUSIONS: The new curriculum has had some impact on conceptualization and attitude to teamwork. However, further development is required if graduates are to see themselves as part of a multi-professional team.
Attitude↗
Does a new undergraduate curriculum based on Tomorrow's Doctors prepare house officers better for their first post? A qualitative study of the views of pre-registration house officers using critical incidents.
INTRODUCTION: In 1994 Manchester University introduced an integrated undergraduate medical course using problem-based learning (PBL) throughout. The study reported here explored whether there were any differences between the new course graduates (NCGs) and the traditional course graduates (TCGs) in the types of scenarios they recalled as 'critical incidents', or challenging cases, while working as pre-registration house officers (PRHOs). The focus is on differences rather than causal links. METHOD: We used semistructured interviews to generate our data. Twenty-four traditional course graduates and 23 new course graduates were interviewed approximately 3 months after starting their first PRHO placement. RESULTS: We identified 4 types of critical incidents relating to: clinical practice; limitations of competence; emotional involvement; and communication. Traditional course graduates reported difficulties in making patient management decisions, whereas the NCGs were better at dealing with uncertainty, knowing their limits and asserting their rights for support. Communication difficulties and coping with emotional involvement were common across both groups of graduates and hence remain problems in relation to being prepared for the role of a PRHO. CONCLUSIONS: Graduates of the new, integrated curriculum seemed to be much better at dealing with uncertainty, knowing their personal limits and asserting their rights for support when they felt these limits had been reached. Communication difficulties and emotional involvement remain major factors in the transition from student to PRHO.
Clinical Competence↗
A novel form of integrin dysfunction involving beta1, beta2, and beta3 integrins.
The adhesion receptors known as integrins perform key functions for hematopoietic cells. The platelet integrin alphaIIbbeta3 is critical in hemostasis, and the beta1 and beta2 integrins on leukocytes have many roles in cell-mediated immunity. Mutations in the beta2 subunit lead to integrin nonexpression and to an immune deficiency, leukocyte adhesion deficiency-1. Mutations in either the alpha or beta subunit of alphaIIbbeta3 usually lead to integrin nonexpression and a bleeding tendency termed Glanzmann thrombasthenia. Here we describe a unique patient with clinical features of both Glanzmann thrombasthenia and leukocyte adhesion deficiency-1. The patient has normal expression of beta1, beta2, and beta3 integrins, but all are dysfunctional. The key findings are that "inside-out" signaling pathways leading to integrin activation are defective and that this is associated with abnormal integrin clustering. The integrins themselves are intact and capable of function following extracellular stimulation. T cell motility is normal, as are the expression levels and electrophoretic characteristics of all cytoskeletal and signaling proteins tested, except PKC-alpha, which has enhanced expression in the patient's cells. To our knowledge, this is the first description of a dysfunction affecting three classes of integrins. We propose that it is caused by a lesion in an intracellular factor or signaling pathway essential for integrin activation in hematopoietic cells and results in lack of regulation of clustering, an essential component of integrin-mediated adhesion.
Blood Platelets↗
Building research capacity. An exploratory model of GPs' training needs and barriers to research involvement.
AIMS: To determine general practitioners' research training needs, and the barriers to involvement in research. METHOD: Semi-structured interviews with 11 GPs in rural and metropolitan South Australia, analysed using a grounded theory approach. RESULTS: General practitioners' perceptions about their research needs were limited by their own experience and focussed at an individual level. Overlapping needs and barriers emerged, categorised as: 'individual issues' (a lack of research training or experience, concepts and attitudes to research, and research interest) and 'systems issues' (funding arrangements for general practice, access to resources, opportunity for publication and the role of The Royal Australian College of General Practitioners [RACGP]). DISCUSSION: Our data provide an exploratory model that may assist in developing suitable strategies for research capacity building programs. General practitioners perceived both individual and systems solutions to building research capacity, including multifaceted interventions.
Attitude of Health Personnel↗
Case report: Survival after deliberate strychnine self-poisoning, with toxicokinetic data.
INTRODUCTION: Strychnine poisoning is uncommon, and in most severe cases, the patient dies before reaching hospital. The management of strychnine poisoning is well documented, although there are few data on the kinetics of elimination of strychnine after overdose. CASE REPORT: A 42-year-old man presented shortly after ingestion of an unknown quantity of strychnine powder. After a respiratory arrest, with intensive supportive management requiring admission to an intensive care unit, he survived. Eight serum samples were taken over the first 5 days and analysed subsequently for strychnine concentrations. RESULTS: The initial concentration at 1.5 hours after ingestion was 4.73 mg/l, falling to 0.38 mg/l at 74 hours postingestion. Serum concentrations followed a monoexponential elimination curve with a calculated elimination half-life of 12 hours. DISCUSSION AND CONCLUSION: Strychnine poisoning presents with classical features, and with early diagnosis and supportive management, the patient can survive. The initial serum concentration of 4.73 mg/l is the highest reported concentration in a patient who has survived. Previous reports of the elimination half-life have suggested it is between 10 and 16 hours, which conforms to the elimination data in our case.
Adult↗
Factors predicting communication about the diagnosis of maternal breast cancer to children.
OBJECTIVE: To identify factors influencing mothers' communication with their children about their diagnosis and initial treatment. DESIGN: Cross-sectional cohort. SETTING: Two breast cancer treatment centres. SUBJECTS: Thirty-two women with Stage I or Stage II breast cancer with 56 school-aged children. MAIN OUTCOME MEASURES: Semistructured interview regarding timing and extent of communication with children from the time that a problem was first identified to initial treatment, and children's reactions. RESULTS: Children were most likely to be told about their mother's illness after the diagnosis had been confirmed by biopsy but a minority were told nothing until after surgery and some nothing at all. The information children received did not necessarily include mention of cancer. Predictors of communication were child age, with older children being told earlier and more information, and maternal education, with children of more highly educated mothers being told less. Child gender was not related to communication. CONCLUSION: Mothers who are being investigated for breast cancer are likely to benefit from the opportunity to consult a supportive professional about communication with their children during all stages of their diagnosis and treatment, but particularly early on in the investigation when they are more reluctant to initiate discussions with their children. At later points, those with children of varying ages may need specific advice on ways to discuss their illness in relation to children's understanding.
Adolescent↗
Perceptions of how well graduates are prepared for the role of pre-registration house officer: a comparison of outcomes from a traditional and an integrated PBL curriculum.
INTRODUCTION: Most medical schools in the UK have been engaged in major curriculum reform based on their premises of what might improve undergraduate medical education. In 1994 the course at the medical school of the University of Manchester changed to an integrated course using problem-based learning throughout and with increased emphasis on community-based medical education. This study explores whether the new curriculum has produced any differences in perceptions of how well graduates are prepared for the role of pre-registration house officer. METHODS: A postal questionnaire was used to survey 1998 Manchester graduates (traditional course) and 1999 Manchester graduates (new course), three months into their first pre-registration house officer placement. A similar questionnaire was sent to the educational supervisors who were supervising the graduates. The questionnaire was designed to measure perceptions of levels of preparedness for the role of pre-registration house officer, using a list of broad areas of competence and specific skills listed in the General Medical Council's 'The New Doctor'. RESULTS: Graduates rated the new course significantly more effective for 12 of the 19 broad competences and eight of the 13 specific skills that were listed. The 'new' graduates rated their understanding of disease processes lower than the 'traditional' graduates, but there was no difference in the ratings given by the educational supervisors for this. Overall the educational supervisors rated the new course as better preparing graduates in five of the competences. CONCLUSIONS: Overall, the evaluation shows that a major change in curriculum approach has changed the profile of the perceived preparedness of graduates for entering professional practice.
Clinical Competence↗
A model of how students link problem-based learning with clinical experience through "elaboration".
PURPOSE: In 1994, the medical school at the University of Manchester introduced a new integrated course that uses problem-based learning (PBL) throughout the clinical clerkships as the major approach for delivery of the core curriculum. This study explored how students linked PBL and clinical experiences. METHOD: All third- and fourth-year students were asked to respond to an open-ended question on the end-of-module course evaluation. Their responses were analyzed and grouped into themes. The authors also conducted three focus groups of third-year students and a further three focus groups of fourth-year students to explore how students viewed the links between PBL and clinical experiences. The discussions were taped and subsequently analyzed by the researchers independently. RESULTS: The authors found that the students used clinical experience as a means of elaborating their knowledge either at the time of encountering an appropriate patient (outside the group) or by bringing their experiences back to the PBL group for discussion (inside the group). Major facilitators of elaboration were the match between the clinical clerkship and the content of the PBL case, the role of the tutor, and the self-directedness of the student. A theoretical model of how students linked PBL with their clinical experience was derived based on a cognitive psychological approach to learning. CONCLUSIONS: The model will be of benefit as the authors try to improve the course for those students who were unable to use their clinical experiences to achieve the goals of their PBL discussions.
Clinical Clerkship↗
Recent advances in the management of poisoning.
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Antidepressive Agents, Tricyclic↗
Over-the-counter analgesics: a toxicology perspective.
The decision to use any analgesic is a balance of benefit and risk. In the case of analgesics, it is important to balance the therapeutic benefit against both the risk in therapeutic use and the risk (and ease of treatment) in overdose. Paracetamol in therapeutic dose carries little risk of adverse events. Less than 0.1% of the estimated 30 million paracetamol users in the United Kingdom attend hospital with a paracetamol overdose each year, and approximately 200 people die, most of whom presented late or did not receive antidote, N-acetylcysteine, within 12 hours. Nonsteriodal anti-inflammatory drugs (NSAIDs) have greater adverse effects in therapeutic use than paracetamol but also have a lower incidence of severe features or death in overdose. There is no antidote available for NSAID poisoning. Aspirin carries both significant adverse effects in therapeutic dose and a substantial risk in overdose, for which there is no antidote. Its risk-benefit profile is probably the poorest of all analgesics currently available over-the-counter (OTC); this is reflected in current trends both in analgesic use and overdose figures. Although a number of options to reduce deaths from poisoning by OTC analgesics have been considered, few are practical, and all must take account of the public health benefits provided by these drugs. A perspective should be retained that the vast majority of the population in Australia, the United States, the United Kingdom, and Denmark derive therapeutic benefit from OTC analgesics and do not take them in overdose. The majority of those who do take overdoses come to little or no harm. Management of serious poisoning by paracetamol, aspirin, or NSAIDs remains a medical challenge.
Acetaminophen↗