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Biomedical subjects

C Coles

Publications and source records attributed to C Coles.

At least 19 recordsLinked to original sources
PubMed2001

Community-acquired pneumonia in Christchurch and Waikato 1999-2000: microbiology and epidemiology.

AIMS: To prospectively record current epidemiology and microbiology of community-acquired pneumonia in two New Zealand centres. METHODS: Between July 1999 and 2000 all adults admitted to Christchurch and Waikato Hospitals with community-acquired pneumonia were screened for study inclusion. All those enrolled had their medical history, clinical variables, inpatient management and clinical outcomes recorded and standardised microbial diagnostic testing carried out. RESULTS: 474 participants were enrolled with a mean age of 64 years and a microbial diagnosis was made in 197 cases (42%). Streptococcus pneumoniae (14%), Haemophilus influenzae (10%) and Influenza A virus (7%), Legionella spp (4%) and Mycoplasma pneumoniae (3%) were the most commonly isolated organisms. An 'atypical' organism was diagnosed in 8% of cases compared to 30% and 23% in previous Christchurch and Waikato studies respectively. Fourteen of the 67 S pneumoniae isolates (21%) had reduced susceptibility to penicillin, all with a MIC < or = 2 microg/mL, a level of reduced susceptibility not associated with worse patient outcomes. Clinical outcome included a mean hospital stay of 6.7 days and a 6 week mortality of 6%. CONCLUSION: Although S pneumoniae was the most commonly isolated organism in this study there have been significant changes in the prevalence of atypical organisms since previous surveys. Ongoing surveillance of antibiotic resistance and variations in the prevalence of organisms causing community-acquired pneumonia is required to guide clinicians' empiric antibiotic use.

Adult↗
PubMed2001

Palliative care: a suitable setting for undergraduate interprofessional education.

Effective delivery of high-quality palliative care requires effective interprofessional teamworking by skilled health and social care professionals. Palliative care is therefore highly suitable for sowing the seeds of interprofessional teamworking in early professional education. This paper describes experiences of running undergraduate interprofessional workshops in palliative care for medical, nursing, social work, physiotherapy and occupational therapy students. These workshops are unusual in three respects: first, the involvement of family carers mean that these learning experiences are rooted in clinical reality; secondly, there is no attempt to 'tidy up' the story for the students; thirdly, unlike many undergraduate interprofessional programmes, these workshops have been sustained over several years. Evaluation of these workshops demonstrate that students value and enjoy the opportunity to work together; they find the experience moving, informative and interesting. Feedback from carers showed that they appreciated the opportunity to present their real-life experiences to students. Our evidence suggests that palliative care is a suitable subject for undergraduate interprofessional education.

Attitude of Health Personnel↗
PubMed2001

Total body irradiation using a modified standing technique: a single institution 7 year experience.

We describe a simple standing technique for delivering total body irradiation (TBI) using large horizontal fields, made possible by the off-centre installation of a non-dedicated treatment unit in a pre-existing bunker. Patients are treated using anterior and posterior fields with customized lung compensators. This technique enables the dose to the lung to be accurately calculated and modified to avoid overdose and to minimize the risk of pneumonitis. From February 1991 to December 1997, 94 patients with a variety of haematological malignancies were given fractionated TBI using this technique prior to allogenic or autologous bone marrow transplantation. Patients received a total dose of 14.4 Gy given in eight fractions over 4 days, with at least 6 h between fractions. The prescribed dose to the lungs was reduced to 12 Gy in eight fractions. The technique was well tolerated, took less than 10 min to set up and did not disrupt the daily routine use of the machine. Doses to all measured points on the trunk and head were within +/-6% of the prescribed dose. Doses to the lungs were within +/-5% of the prescribed dose. There were no early respiratory deaths in the 37 autologous transplant patients. There were 10 (17%) respiratory deaths in the 57 allogeneic transplant patients, 3 of confirmed infectious aetiology.

Adolescent↗
PubMed2000

GP selection of postgraduate education courses has implications for colleagues: messages for course providers and for those writing practice professional development plans.

BACKGROUND: The Department of Health's review of continuing professional development in general practice advocates setting team and individual goals. AIM: To explore how general practitioners (GPs) share learning experiences with colleagues, focusing on how GPs choose courses as one factor influencing sharing. METHOD: Interviews were conducted with 21 GPs using grounded theory methodology. The responses were coded by six researchers from psychology, education, and general practice. RESULTS: Much sharing with colleagues took place, though not always immediately following a course. GP explanations revealed four reasons for course selection that influenced the degree of sharing: 1. Attendance to meet group needs encouraged rapid sharing and could involve course attendance with colleagues. 2. Attendance to enhance 'special interests' could either encourage or inhibit sharing. 3. Attendance in pursuit of 'personal interests' peripheral to general practice did not result in sharing within the primary care team. 4. Attendance to meet personal learning needs did not involve sharing when needs were not currently shared with colleagues. CONCLUSION: Course selection and subsequent sharing have implications for course providers and those writing personal and practice professional development plans.

Curriculum↗
PubMed1999

Pulsed dye laser therapy for sun damaged skin.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of the pulsed dye laser (585 nm, 450 ms) in the treatment of sun induced wrinkles. DESIGN: Patients had one pulsed dye laser (585 nm) treatment. The treated areas were assessed by the following methods: grading of skin wrinkles at 6 weeks, 12 weeks, and 6-14 months after treatment by blinded observers and by light and electron microscopy. SETTING: An ambulatory care center at Abbott Northwestern Hospital (ANH) and the Laser & Skin Surgery Center of Northern California (LSSCNC). PATIENTS: Twenty patients were treated, half with mild to moderate and half with moderate to severe sun induced skin wrinkles. RESULTS: At last follow up 90% (9/10) of the mild to moderate wrinkles and 40% (4/10) of the treated patients with moderate to severe wrinkles had clinically observable improvement in their sun induced skin wrinkles. Histologic examinations of the treated areas showed a superficial dermal band of well organized elastin and collagen fibers replacing pre-treatment elastic tissue. Increased cellularity and mucin deposition was consistent with dermal collagen remodeling.

Adult↗
PubMed1999

Educational portfolios in the assessment of general practice trainers: reliability of assessors.

OBJECTIVES: This paper reports a project that assessed a series of portfolios assembled by a cohort of participants attending a course for prospective general practice trainers. DESIGN: The reliability of judgements about individual 'components', together with an overall global judgement about performance were studied. SETTING: NHSE South & West, King Alfred's College, Winchester and Institute of Community Studies, Bournemouth University. SUBJECTS: Eight experienced general practice trainers recruited from around Wessex, which incorporates Hampshire, Dorset, Wiltshire and the Isle of Wight. RESULTS: The reliability of individual assessor's judgements (i.e. their consistency) was moderate, but inter-rater reliability did not reach a level which could support making a safe summative judgement. The levels of reliability reached were similar to other subjective assessments and perhaps reflected individuality of personal agendas of both the assessed and the assessors, and variations in portfolio structure and content. CONCLUSIONS: Suggestions for approaches in future are made.

Education, Medical, Continuing↗
PubMed1997

Cell fate in the chick limb bud and relationship to gene expression.

We have produced detailed fate maps for mesenchyme and apical ridge of a stage 20 chick wing bud. The fate maps of the mesenchyme show that most of the wing arises from the posterior half of the bud. Subapical mesenchyme gives rise to digits. Cell populations beneath the ridge in the mid apical region fan out into the anterior tip of the handplate, while posterior cell populations extend right along the posterior margin. Subapical mesenchyme of the leg bud behaves similarly. The absence of anterior bending of posterior cell populations has implications when considering models of vertebrate limb evolution. The fatemaps of the apical ridge show that there is also a marked anterior expansion and cells that were in anterior apical ridge later become incorporated into non-ridge ectoderm along the margin of the bud. Mesenchyme and apical ridge do not expand in concert--the apical ridge extends more anteriorly. We used the fatemaps to investigate the relationship between cell lineage and elaboration of Hoxd-13 and Fgf-4 domains. Hoxd-13 and Fgf-4 are initially expressed posteriorly until about the mid-point of the early wing bud in mesenchyme and apical ridge respectively. Later in development, the genes come to be expressed throughout most of the handplate and apical ridge respectively. We found that at the proximal edge of the Hoxd-13 domain, cell populations stopped expressing the gene as development proceeded and found no evidence that the changes in extent of the domains were due to initiation of gene expression in anterior cells. Instead the changes in extent of expression fit with the fate maps and can be attributed to expansion and fanning out of cell populations initially expressing the genes.

Animals↗
PubMed1996

Undergraduate education and palliative care.

The undergraduate education of health professionals has legitimately broad but ultimately conflicting aims. There is a need to reformulate how professionals work, think and learn, and for this analysis to inform undergraduate programmes. Palliative care is not strongly placed politically to influence these developments, yet the contribution it can make is enormous, through allowing students the opportunity to experience what it does and to reflect on that experience.

Curriculum↗
PubMed1995

Educating the health care team.

How can health professional teams provide patient-centred care in the treatment of chronic disease? What education and training is needed to achieve this? Patient-centred care means helping people living with a condition make informed choices to maximise their quality of life. The health professional's role is to facilitate, to ensure patients and those around them take effective and appropriate self-management of the condition. To achieve this, high quality team working is needed amongst people who do not interact in the course of their day-to-day work. Education for this should begin with students, expand when staff are newly qualified, become a feature of specialist training, and extend through continuing professional development. A unified philosophy and strategy then is needed for life-long professional education and training. Generalised principles are proposed for what should happen and who can best provide it, and these can be widely applied in many fields of health professional education.

Chronic Disease↗
PubMed1995

The impact of conjugate vaccine on carriage of Haemophilus influenzae type b.

Conjugate vaccines against Haemophilus influenzae type b (Hib) may modify Hib pharyngeal colonization. Hib colonization was compared in 371 infants and their families. In Oxfordshire, infants received PRP-T (polyribosylribitol phosphate conjugated to tetanus toxoid) and in Buckinghamshire they did not (controls). Infants were followed at 6, 9, and 12 months of age. Also, 6 unvaccinated Hib carriers were vaccinated and followed for 6 weeks. Hib acquisition was lower in vaccinees than controls (P < .01). During surveillance, 1.5% of vaccinees and 6.3% of controls carried Hib (P = .04). Among those with family Hib exposure, the carriage rates were 8.7% and 38.5% (P = .07), respectively. Hiv carriage rates were lower among vaccinees' unvaccinated siblings. Giving conjugate vaccine to a child carrying Hib did not rapidly terminate carriage. Thus, a primary means by which herd immunity to Hib is induced in a vaccinated population may be through reduction or delay in the initial acquisition of Hib.

Bacterial Capsules↗
PubMed1995

Rewarming hypothermic postanesthesia patients: a comparison between a water coil warming blanket and a forced-air warming blanket.

The warming effects of a Blanketrol water coil-heated hypothermia blanket and a Bair Hugger forced-warm air warming blanket were compared. Thirty-two patients admitted to the PACU with temperatures 34.4 degrees C (94 degrees F) or lower were assigned to treatment with the Blanketrol (Cincinnati Sub-Zero Products, Cincinnati, OH) or the Bair Hugger (Augustine Medical, Eden Prairie, MN) in alternating fashion, and treatment continued until the patients' temperatures reached 36.1 degrees C (97 degrees F). Every half hour each patient's temperature was measured using a tympanic temperature device and recorded on the data collection sheet. Analysis of the findings showed that the forced-air warming blanket warmed patients to 36.1 degrees C (97 degrees F) or higher significantly faster than the water coil-heated blanket (P < .001).

Adult↗
PubMed1994

Clinical, histologic, and ultrastructural evaluation of tattoos treated with three laser systems.

We examined the response of tattoo pigments treated with three commercially available lasers: Q-switched ruby, Q-Switched neodynium:yttrium,aluminum,garnet (Nd:YAG), and the alexandrite. Tattoos applied to hairless guinea pigs and treated with the aforementioned lasers were evaluated clinically, histologically, and ultrastructurally. Clinical evaluation showed red brown, dark brown, and orange pigment responded best to the Nd:YAG laser (1064 nm). The alexandrite laser was most effective for removing blue and green pigment, the Q-switched ruby laser was most effective for removing purple and violet pigment, and the Nd:YAG laser (532 nm) removed red pigment the best. Black pigment was lightened equally with the Nd:YAG laser (1064 nm) and (532 nm) and the alexandrite laser (755 nm). No clinical scarring was observed; however, some colors turned black after treatment. Histologic and ultrastructural examination showed epidermal and dermal damage to be most evident after treatment with the Nd:YAG laser. Our study shows that certain tattoo pigments respond better to different laser systems.

Aluminum Oxide↗