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Biomedical subjects

G A Fleming

Publications and source records attributed to G A Fleming.

At least 19 recordsLinked to original sources
PubMed1996

Reengineering the medical staff. Thirteen equals two.

Managed care forces were putting pressure on Athens Regional Medical Center, Inc., and its medical staff to sustain quality of care, and simultaneously tighten the budget, achieve continued improvements in efficiency, and retrain employees. To ensure its leadership position in Northeast Georgia, ARMC decided to restructure the organization to avoid a "slash and burn" crusade later. This article addresses the medical staff restructuring and how it came about. The strategy eliminated five committees and reduced 13 Medical Staff departments to two.

Blood Transfusion↗
PubMed1995

Benign intracranial hypertension in children with growth hormone deficiency treated with growth hormone.

We report 13 cases of benign intracranial hypertension (IH) in children with growth hormone (GH) deficiency treated with GH in the United States. The group consisted of eight boys and five girls, 3 to 16 years of age (median, 9 years). The interval from starting GH therapy to diagnosis of IH was 2 weeks or less in six patients, between 2 and 12 weeks in four, 8 months in one, 5 years in one, and unknown in one. Seven patients were not known to have previously described IH risk factors; the other six had at least one factor each. All patients but one had headache, nausea, vomiting, and visual changes. All had papilledema, and cerebrospinal fluid pressures were elevated (> 250 mm H2O) in all nine patients tested. The GH dosage range was 0.17 to 0.35 mg per kilogram body weight per week (median, 0.30 mg/kg per week) for the 11 patients with dosage data. After discontinuation of GH and treatment with lumbar punctures and/or medications, signs and symptoms resolved in eight children; in two of these children signs and symptoms reappeared when GH therapy was restarted. In four patients signs and symptoms resolved while GH therapy was continued; one child was treated with a ventriculoperitoneal shunt because of an arachnoid cyst, after which GH was restarted without subsequent IH. In the 12 patients with idiopathic GH deficiency the course of IH was benign, with complete resolution of all signs and symptoms. Because doses and scheduling of GH administration have changed since the introduction of recombinant GH, higher doses and increased frequency of administration may be contributing to the development of IH in some patients. We suggest beginning therapy at the lowest recommended dose, with gradual titration to higher doses, and the performance of routine funduscopic examinations during initiation of GH therapy and whenever signs or symptoms of IH develop.

Adolescent↗
PubMed1990

The relationship between medical students' locus of control and promotion of breast self-examination.

There is general agreement that medical school curricula should involve the teaching of preventive health behaviours. Locus of control is a personality variable that has been associated with health practices and may be associated with tendencies to promote health practices. Few significant relationships have been found correlating health locus of control beliefs with preventive health behaviours. This study investigated the health locus of control of medical students and their tendencies to talk about and teach breast self-examination to women patients. Women students' health locus of control and breast self-examination practices were also investigated. The authors conclude that health locus of control has little influence on the tendency of medical students to promote breast self-examination. Other factors apparently have more effect on the student doctor's tendencies to promote health practices.

Attitude of Health Personnel↗
PubMed1989

Type II hyperprolinaemia in a pedigree of Irish travellers (nomads).

We describe a study of 312 subjects in 71 families near related to a proband with type II hyperprolinaemia. The subjects were Irish travellers (nomads) among whom consanguineous marriage and high fertility are common. Thirteen additional cases of type II hyperprolinaemia were discovered; all were offspring of consanguineous unions. A further 50 subjects were found to have mild hyperprolinaemia. We found a strong association between type II hyperprolinaemia and seizures during childhood but no significant association with mental handicap. Most adults with type II hyperprolinaemia enjoyed normal health and there was no evidence that maternal hyperprolinaemia compromised fetal development. The documented association between type II hyperprolinaemia and seizures may be related to the neuromodulatory or reducing-oxidising effects of proline and pyrroline-5-carboxylate, respectively, that has been shown in vitro. Alternatively, another genetic defect closely linked to the type II hyperprolinaemia allele could be the explanation.

1-Pyrroline-5-Carboxylate Dehydrogenase↗
PubMed1989

Fluctuations in plasma pyrroline-5-carboxylate concentrations during feeding and fasting.

Pyrroline-5-carboxylate (P5C) is the oxidized metabolite of proline. In cultured cells redox-sensitive metabolic pathways are influenced by these two amino acids. To determine whether plasma P5C levels fluctuate enough physiologically to regulate such pathways in vivo, we measured venous plasma P5C concentrations hourly for 48 h in five normal subjects while eating and in four subjects while fasting. Two fed subjects had one or more plasma P5C excursions per day exceeding 10 times the baseline level; the other fed subjects had lesser variations. These patterns suggest a relationship of plasma P5C peaks to meals. This relationship is supported by the finding of no significant P5C elevations above baseline levels in four subjects during fasting for 24 h. Despite the changes in plasma P5C concentrations, those of proline and other metabolically related amino acids were constant. The variation among subjects in the degree of plasma P5C fluctuation could not be explained by differences in total protein and caloric intake or body weight. Among plasma constituents, the large peak to basal plasma P5C excursions in some of the normal subjects we studied are matched only by those of peptide hormones.

Adult↗
PubMed1988

Teachers' perceptions concerning the relative values of personal and clinical characteristics and their influence on the assignment of students' clinical grades.

Twenty senior teachers were asked to rank, in order of influence, the seven clinical and five personal characteristics used to grade third-year medicine clerks. Seventeen perceived themselves to be more influenced by clinical characteristics when assigning grades. Independently, the actual ratings completed over a 3-year period by these same teachers were analysed to measure the congruency between their perceived and actual grading behaviour. When actually rating students only nine raters were more influenced by clinical characteristics and just one half of the teachers displayed a congruency between their perceived and actual rating behaviour. The implications of these findings are discussed.

Attitude of Health Personnel↗
PubMed1988

Increased pro-opiomelanocortin-derived peptide release in myotonic dystrophy.

The response of plasma immunoreactive (IR)-ACTH, IR-beta-endorphin (beta-END) and IR-cortisol to insulin-induced hypoglycaemia, an acute stimulus to the pituitary corticotrophs through the central nervous system, and to synthetic ovine corticotrophin-releasing hormone (CRH), a direct corticotroph stimulator, were studied in normal males and males with myotonic dystrophy. Myotonics had an increased IR-ACTH and IR-beta-END response to hypoglycaemia and an increased IR-ACTH response to CRH compared with normals. Plasma IR-cortisol response were not different in either group of subjects to both stimuli. This neuroendocrine abnormality in myotonic dystrophy may represent a manifestation of the purported specific cell membrane defect underlying the disease. This is the first report of an abnormality in proopiomelanocortin peptide release in myotonic dystrophy.

Adolescent↗
PubMed1986

The aqueous humor of rabbit contains high concentrations of pyrroline-5-carboxylate.

Accumulating evidence suggests that the interconversion of proline and pyrroline-5-carboxylate (P5C) transfers oxidizing or reducing potential within or between cells. We report here that rabbit aqueous humor contains P5C at a concentration at least 20 times that found in rabbit plasma or in biologic fluids from other animals, and, in isolated lens, P5C stimulates the activity of the pentose phosphate shunt. However, aqueous humor in other species contains P5C in the same range of concentrations as their respective plasma. The high P5C concentration in rabbit aqueous humor may be due to comparatively low levels of P5C reductase activity in ocular tissues, especially the cornea. The levels in lens epithelium, though lower in the rabbit, nevertheless could mediate the transfer of oxidizing potential from P5C and stimulate the pentose-phosphate shunt. These results suggest that the eye may serve as a convenient model for the study of proline and P5C-related transfer of reducing or oxidizing potential between tissues.

Animals↗
PubMed1985

Curriculum change in the 1980s. A report of 40 southern US medical schools.

Forty southern medical schools were surveyed to evaluate the nature and mechanisms of curricular change during 1980 to 1983. Ninety percent of schools experienced change in some aspect of curriculum. Faculty, curriculum committees, the dean, and external forces were stimuli for change. Internal self-review or self-criticism seemed to be the most important reasons for change. Proposals were considered by curriculum committees and the dean, but veto power often rested with the dean, although departmental chairmen and faculty occasionally had veto power. Types of change were divided equally between content, timing of courses, and the educational process. Half the schools stated that they had evaluated the changes or planned to do so. Thirteen of 38 changes in curriculum were in the direction of curricular innovations of the 1960s and 1970s and 25 were in the opposite direction.

Curriculum↗
PubMed1985

Criteria for selection of future physicians.

Academic achievement correlates poorly with clinical performance of physicians, so it is probably more important to select college students for medical school admission who will be superior physicians than to select those who will be excellent medical students. Before such selection criteria can be developed, a valid description of a superior physician must be determined. The relative importance of 87 characteristics of a superior physician, based on a previously published list, was determined by asking medical school faculty members to rate them. The resulting description of a superior physician is valid, because it correlated very highly (r = 0.87, p less than 0.001) with the published ratings of the same characteristics from decades earlier in another part of the country, and because it was constant across many subgroups. The faculty was also asked to rate how easily each characteristic could be taught, and those ratings were validated by high correlations across several subgroups. The importance and the teachability ratings were combined into a nonteachable-important index (NTII) that provides a rank order of traits that are important but cannot be taught easily. These are the characteristics that should be used in selecting future physicians.

Character↗
PubMed1984

Pyrroline-5-carboxylate in human plasma.

Pyrroline-5-carboxylate is the intermediate in the interconversions of proline, ornithine, and glutamate. Recent studies have suggested that pyrroline-5-carboxylate has regulatory properties in a wide range of tissues. Physiologic studies in humans have been limited by the unavailability of a sufficiently sensitive assay for this compound. Until now pyrroline-5-carboxylate has not been detectable in plasma of normal humans or even in plasma of patients with type II hyperprolinemia. We now report a method for measuring pyrroline-5-carboxylate made possible by a preparation of purified Escherichia coli pyrroline-5-carboxylate reductase. This method is more sensitive than currently available methods by two or three logs and is applicable for all biologic fluids. We have quantitated pyrroline-5-carboxylate in normal plasma, urine, and saliva. In addition, we have found pyrroline-5-carboxylate levels 10x to 20x normal in two patients with type II hyperprolinemia. The ability to measure physiologic concentrations of pyrroline-5-carboxylate now enables further characterization of its role as a regulatory molecule.

Chromatography, Ion Exchange↗
PubMed1984

Malaria control with residual fenitrothion in Central Java, Indonesia: an operational-scale trial using both full and selective coverage treatments.

An operational-scale trial, using residual fenitrothion, for control of malaria was carried out in Central Java, Indonesia, from 1980 to 1982. Two areas, each comprising about 70 km(2) and a population of about 50 000, were treated with fenitrothion (40% water dispersible powder) at a target dosage of 2 g/m(2) for 3 cycles at 6-monthly intervals. One area was treated with full coverage (i.e., the interiors of houses and cattle shelters were sprayed to a height of 3 m) for 2 cycles, followed by a third cycle with selective coverage (i.e., the interiors of houses were sprayed with one 75 cm horizontal swath between 10 cm and 85 cm from the floor while the cattle shelters were sprayed to a height of 3 m). The other area was treated for 3 cycles with only selective coverage. While both treatment methods reduced malaria rates and vector populations to very low levels, the full coverage treatment was more rapidly effective and also reduced the Plasmodium falciparum index. However, the selective coverage treatment was 68% less expensive than full coverage and greatly reduced the degree of cholinesterase depressions among the spraymen. The trial also showed that a dosage of 1 g/m(2) with full coverage was nearly as effective as the 2 g/m(2) dosage.

Animals↗
PubMed1984

A survey on the 'premedical syndrome'.

The "premedical syndrome" has been widely discussed but only anecdotally described. To learn whether the syndrome exists in the South Carolina schools and which traits compose it, the authors surveyed faculty members and students of 13 undergraduate colleges in the state. Premedical students were perceived as differing from nonpremedical students in being excessively competitive, academically, overspecialized , overachieving , more highly motivated, more highly self-disciplined, goal-oriented, and proud of their career choice. The perception by students and faculty members of the premedical syndrome may have important effects on the undergraduate curriculum and students' choices of major areas of study. Only 3 percent of the premedical students who responded to the survey were majoring in the liberal arts, and only 9 percent of the nonpremedical students were majoring in the natural sciences. These data suggest that the natural science departments in U.S. colleges may have become training grounds for premedical students to the exclusion of others. Modification of medical school admissions policies may be able to reverse some features of the premedical syndrome and some of its effects.

Achievement↗