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Biomedical subjects

D Metcalfe

Publications and source records attributed to D Metcalfe.

At least 19 recordsLinked to original sources
PubMed2000

Diabetes mellitus and the rate of cognitive ageing.

OBJECTIVES: There is some evidence that besides affecting peripheral neural function diabetes may also cause more widespread changes in the central nervous system which reduce cognitive efficiency and so, also, independence and quality of life. The present study explores whether diabetes mellitus is a compounding factor in average declines in cognitive performance observed in old age. DESIGN: A sample of diabetics and controls were compared on a battery of cognitive tasks previously used in cognitive ageing research. METHODS: Thirty-three insulin dependent (IDDM), 135 non-insulin dependent (NIDDM) diabetics and 2191 non-diabetics aged between 50 and 91 years were compared on two tests of general intellectual ability, and on three tests of verbal memory. RESULTS: Overall, the combined IDDM and NIDDM groups had significantly lower average scores than the controls group on all cognitive tasks. Detailed analyses revealed most cognitive impairment for the NIDDM sub-group whose condition was managed by hypoglycaemic drugs, slightly less for those managed by diet, and no impairment for the IDDM group. These effects were independent of age, depression, socio-economic status, and presence of other illnesses. CONCLUSIONS: Together with other recent studies these data emphasize the need for early detection and effective management of diabetes in older patients.

Age Factors↗
PubMed1999

Mastocytosis: diverse presentations and outcomes.

Within the general category of mastocytosis lies an array of clinical presentations with differing prognostic implications. We report 3 cases of systemic mastocytosis distinguished by novel aspects of the disease. Case 1 documents the first successful orthotopic liver transplantation in a patient with mastocytosis; case 2 depicts a potential hereditary component of mastocytosis; and case 3 documents the progression of mastocytosis with hematologic abnormality to mast cell leukemia. Future investigations, such as the early definition of c-kit receptor mutations, may provide additional insight as to the molecular basis for this heterogeneous disease and guidance for prognostic implications and targeted therapies.

Adult↗
PubMed1999

The core content of the undergraduate curriculum in Manchester.

AIM: To identify the core content for the new undergraduate medical curriculum in Manchester. METHOD: The initial step was to produce a list of 'index clinical situations' (ICSs), for which a newly graduated doctor must have a required level of competence. Using repeated consultation with consultants and general practitioners involved in medical education in the North-West of England, a list of 215 ICSs was agreed. Specialists and generalists were then asked to identify the components of the knowledge base and the performance (skills) base for each ICS. The knowledge base was divided into technical (biomedical facts/concepts) and contextual (effect/management of disease within the individual, family and society) domains. The performance base was divided into intellectual (problem solving and decision making) and interpersonal (history, examination, communication and procedural skills) domains. RESULTS: Forty specialties were consulted and 11,021 items (defined as a piece of knowledge, a concept or a skill) were identified. There was considerable overlap in the items listed, such that when the returns for each ICS were amalgamated, the 215 ICSs contained 6434 items with a mean of 34 +/- 14.2 per situation (range 6-85). UTILISATION: We have used the defined ICSs in the design of the trigger material used in the weekly problem-based learning sessions. Over 4 years almost all (207/215, 96%) of the ICS are covered, with many being revisited at several points in the curriculum.

Competency-Based Education↗
PubMed1995

Bone marrow-derived murine mast cells migrate, but do not degranulate, in response to chemokines.

We have determined that several chemokines induce mast cell migration in vitro. This directed migration is dependent on the presence of particular extracellular matrix proteins and the activation status of the cells. Mast cell haptotactic responses were observed in response to various chemokines on vitronectin-, laminin-, and fibronectin-coated filters. Unstimulated mast cells were chemoattracted only by monocyte chemotactic protein-1 and RANTES on vitronectin-coated and, to a lesser extent, laminin-coated filters, whereas IgE-activated mast cells migrated in response to monocyte chemotactic protein-1, regulated on activation normal T expressed and secreted, platelet factor-4, and macrophage inflammatory protein-1 alpha on all three matrix proteins. No significant migration was observed on collagen type IV-coated or uncoated filters. Mast cell migration in response to chemokines on extracellular matrices and its enhancement by IgE-dependent activation provide a mechanism by which cells may be drawn to sites of inflammation. Chemokine-induced mast cell recruitment may be particularly relevant in host defense responses to parasitic infections, allergic reactions, Jones-Mote reactions, and in wound healing.

Animals↗
PubMed1994

GPs and managers. What the doctors saw.

Low morale among many GPs was the trigger for a survey which examined the causes of communication breakdowns and misunderstandings. Mollie McBride and colleagues outline the results.

Administrative Personnel↗
PubMed1992

London after Tomlinson. Care in the capital: what needs to be done.

One of the aims of the Tomlinson report is to shift more care from the secondary to the primary sector in London. But the primary sector is already underresourced and overloaded. The capital has a heterogeneous population which often makes inappropriate demands on general practitioners. Many premises are inadequate and there are insufficient support staff. David Metcalfe emphasises that London is special and that the shift will not become a reality unless these problems are tackled. He suggests the establishment of different models of practice centres which could treat some of the patients who now go to accident and emergency departments. Some would be the night emergency service base, some would have primary care beds, and each would have a different mix of specialist support.

Health Resources↗
PubMed1990

Splenectomy in the management of systemic mast cell disease.

The records of 26 patients with systemic mast cell disease (SMCD) treated during the past decade at the National Institutes of Health were reviewed to determine the role of splenectomy in the management of SMCD. Seventeen (65%) patients had indolent SMCD, manifested primarily by urticaria pigmentosa and mast cell infiltration of the skin, bone marrow, or gastrointestinal tract. None of these patients underwent splenectomy. These patients required only symptomatic therapy. Nine (35%) patients, including those with associated hematologic disorders and those with a lymphoma-like illness termed lymphadenopathic mastocytosis with eosinophilia, had aggressive SMCD. Five of nine patients with aggressive SMCD underwent splenectomy. Of the five patients with splenectomy, three were alive at the time of this report, whereas none of the four who did not have a splenectomy was still alive. Length of survival without splenectomy was 26 months. With splenectomy, length of survival at the time of this report was 34 months. Patients without splenectomy died of bleeding caused by severe thrombocytopenia. Patients with splenectomy appeared better able to tolerate chemotherapy. We thus conclude that while splenectomy is of no value in the management of indolent mastocytosis, it should be considered in patients with aggressive SMCD.

Adult↗
PubMed1989

Requirements for technology. As seen by providers of primary health care.

This article is concerned with principles that might help to ensure that procedures and tools used in primary care are appropriate to people's needs and expectations. It urges attention, not first to technology, but to the broad range of purposes served by primary care and to the relevance of procedures to them. Other criteria for ensuring appropriateness are also proposed.

Decision Making↗
PubMed1984

Clustering diagnoses: a method of interpreting morbidity data.

Detailed classification of morbidity data provides problems in large-scale surveys in general practice: a balance between precise diagnosis and realistic uncertainty must be maintained, and it can be hard to detect the overall pattern when a large number of rubrics is involved. This paper reports the development of a system of clustered diagnoses in which similar diagnoses are linked together in homogeneous clusters. The system is based on the RCGP codes and is compatible with ICHPPC-2. The aim was not to produce another classification of morbidity but to use the system to apply to data already coded using a specific primary code.

Diagnosis↗
PubMed1982

Food allergy.

Explore the source record for details and available documents.

Double-Blind Method↗