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Biomedical subjects

J Bligh

Publications and source records attributed to J Bligh.

At least 73 records · Page 4Linked to original sources
PubMed1995

Problem-based learning in medicine: an introduction.

Problem-based learning is an innovative and challenging approach to medical education--innovative because it is a new way of using clinical material to help students learn, and challenging because it requires the medical teacher to use facilitating and supporting skills rather than didactic, directive ones. For the student, problem-based learning emphasises the application of knowledge and skills to the solution of problems rather than the recall of facts. It is an approach much favoured by curriculum planners in new and more progressive medical schools. This paper describes the educational basis of problem-based learning and gives an example of how it operates in undergraduate medical education.

Education, Medical, Undergraduate↗
PubMed1995

The changing context of undergraduate medical education.

It has long been recognised that intensive efforts are needed to reform medical education in order to meet the future needs of populations worldwide. Pressure for changes to the organisation, content and delivery of both undergraduate and postgraduate medical education has greatly increased in the last two decades. The experience of innovative medical schools, the emergence of learner-centred teaching methods and the implications of health-care reforms in North America and Britain are major factors influencing calls for change. The pace of change has accelerated to such an extent in recent years that progress towards widespread reform appears to be more attainable than ever before. This article provides an overview of the changing context of health-care, some patterns of existing medical education and some strategies for change.

Curriculum↗
PubMed1995

The clinical skills unit.

Clinical skills units offer exciting and innovative ways of learning about clinical skills. Links between theoretical knowledge and clinical practice are appropriate for both undergraduate and postgraduate training. Students and doctors can practice and acquire technical and examination skills in a standardised and protected environment without being concerned about the distress such learning may cause real patients. Models and simulators used in skills units are being developed to keep pace with demand, with a corresponding increase in standards of quality and durability. As undergraduate medical courses respond to the demands of modern clinical practice the use of such facilities will increase. This paper describes the functions of skills units and provides practical examples of educational strategies in use.

Attitude of Health Personnel↗
PubMed1995

Current prescribing in primary care in the UK. Effects of the indicative prescribing scheme and GP fundholding.

The costs of drugs prescribed in primary care in the UK continue to rise despite a variety of government initiatives. Two of the major initiatives are considered here in detail: the Indicative Prescribing Scheme (IPS), and general practitioner (GP) fundholding, both of which began in 1991. Other more recent initiatives are also described, including the selected list, the Pharmaceutical Pricing Regulatory Scheme and the move to relicense drugs for nonprescription sale. The IPS has generally failed to control the rise in drug costs because of unrealistic targets, organisational difficulties (including the lack of adequate data to set budgets properly) and because there was neither incentive nor penalty to encourage compliance on the part of the GP. The IPS stresses cost containment, and makes little allowance for the consideration of quality of appropriateness of prescribing. Despite this disappointment, the IPS is continuing, and the future of the scheme is discussed here. GP fundholding, in contrast, has reduced the rate of rise of drug costs in participating GP practices, although it has not actually reduced drug costs. There have been a number of studies of this model, which are discussed here. The clear financial incentive to fundholders encourages them to restrain drug costs. Attempts to extend similar incentives to nonfundholding GPs are also described. Although there is a commitment on the part of the government to encourage and make use of data about economic evaluations of drug therapy and other medical interventions, so far the emphasis has been exclusively on cost containment. In this paper, we consider possible mechanisms by which this might be improved.

Cost-Benefit Analysis↗
PubMed1995

Oncocytic metaplasia of bile duct epithelium in hepatic GVHD.

A 15-year-old female underwent matched unrelated BMT for chemotherapy resistant ALL. She died 3 months later from septicaemia complicating grade IV GVHD. Light and electron microscopic examination of the post-mortem liver confirmed GVHD and showed oncocytic metaplasia of interlobular bile duct epithelium. We report that oncocytic metaplasia of bile duct epithelium is part of the pathological spectrum of hepatic GVHD.

Adolescent↗
PubMed1994

Clinical pharmacology and therapeutics in undergraduate medical education in the UK: current status.

1. Medical undergraduate education is currently undergoing major changes in the UK in response to calls for the development of a core curriculum. Teaching in clinical pharmacology and therapeutics will also change to meet these demands. A postal survey was conducted to assess the current status of teaching in these subjects. 2. A questionnaire based on previous similar surveys conducted elsewhere was sent to departments or individuals in 27 medical schools in the UK; 22 (81%) replied. 3. Departmental priorities were defined as (in order): clinical research, undergraduate teaching, basic scientific research and clinical service provision. No change in these priorities in the future was foreseen by respondents. 4. Teaching methods were for the most part traditional, with the lecture as the most widely used and important technique. Specific clinical teaching was conducted by some and was considered very important by them. Teaching by problem solving was much less common. 5. Respondents were asked for free text comments; many of the remarks suggested dissatisfaction with the resources and time currently available for teaching in clinical pharmacology and therapeutics. Some expressed significant concerns that their teaching commitment would be reduced further by the development of the core curriculum.

Education, Medical, Undergraduate↗
PubMed1994

Clinical pharmacology and therapeutics in undergraduate medical education in the UK: the future.

1. Changes in undergraduate medical education will involve the development of a core curriculum of material of essential knowledge and of the skills for self directed learning both as a student and a postgraduate. A survey of departments or individuals teaching clinical pharmacology and therapeutics was conducted to consider what a core curriculum in these subjects might contain and how changes in the school curriculum would affect teaching in the future. 2. A questionnaire was developed based on an American consensus statement on the core curriculum in clinical pharmacology and therapeutics. Freetext answers were encouraged. Twenty-seven medical schools were surveyed; 21 (78%) replied. 3. Items of core knowledge (as defined by the American statement) were generally rated important or very important. The most important were considered to be (in order): prescribing for the elderly, management of overdose and adverse drug reactions. All of these were widely taught (85-100%). The least important items were the efficacy and toxicity of nonprescription drugs (taught by 35%) and the process of drug development and approval (taught nevertheless by 95%). 4. Core skills were generally rated less important, and less often taught. It was felt by many respondents that these skills, as defined, were excessively detailed for British undergraduates and more appropriate for postgraduate education. 5. Core attitudes were rated as being of intermediate importance, but not widely taught as it was felt that these could best be inculcated by example rather than formal teaching. Again, many felt that these attitudes were inappropriate for a UK core curriculum.(ABSTRACT TRUNCATED AT 250 WORDS)

Curriculum↗
PubMed1992

The UK indicative prescribing scheme: background and operation.

The cost of drugs in the UK has increased at a rate of 4% above inflation over the last ten years. Prescribing in general practice accounts for 80% of the total drugs bill. Within general practice, there is considerable variation in individual prescribing frequency and costs, reflecting demographic, morbidity and professional influences. Recognition that much prescribing is unnecessary and wasteful of resources which may be better used elsewhere in the NHS is a major force behind recent radical changes to the organisation of British general practice. This paper describes the background, implementation and first year of the Indicative Prescribing Scheme (IPS). The IPS is an initiative of the Department of Health in the United Kingdom that aims to introduce greater accountability for, and control over, the costs of prescribing in general practice. Previous attempts to control the costs of drugs to the NHS included efforts to control price, demand, availability; encouraging generic prescribing; and educational initiatives. The IPS was introduced to place downward pressure on expenditure on drugs by improving the quality of prescribing and by eliminating wasteful prescribing. The scheme hinges around the setting of 'indicative prescribing amounts' for each general practice. Practitioners are expected to operate within these guidelines and are provided with regular financial summaries to help them gauge their progress. Additionally, Family Health Service Authorities (the new administrative and managerial body with responsibility for the day-to-day running of primary care services) have engaged medical and pharmaceutical advisers to provide support and information to assist general practitioners with their prescribing. The first year of the scheme has been one of establishment and consolidation. It is too early to judge whether it will be a success. After initial resistance, many doctors are adopting the principles of the scheme and are critically reviewing their prescribing. Greater awareness of the content and influences on prescribing in primary care and of the resource implications for the rest of the NHS of rational prescribing has encouraged dialogue between hospital clinicians, managers and general practitioners.

Budgets↗
PubMed1989

The increased oxygen uptake upon immersion. The raised external pressure could be a causative factor.

The principal cause of the immediate transient elevation in ventilation (VE, L.min-1) and oxygen uptake (VO2, L.min-1), when a human subject is immersed in cold water is considered to be the stimulation of cutaneous cold receptors. The present study demonstrates that the initial VE and VO2 responses are comprised of a thermogenic and a hydrostatic component. The peak values in VE reached (mean +/- SD) 66.8 +/- 22.3, 53.9 +/- 38.1, 32.2 +/- 15.4, 22.5 +/- 3.6, 19.5 +/- 4.6 L.min-1 during the first minute of immersion in 10 degrees, 15 degrees, 20 degrees, 28 degrees and 40 degrees C water, respectively. Similarly, peaks (mean +/- SD) in VO2 of 1.22 +/- 0.25, 1.01 +/- 0.32, 0.98 +/- 0.39, 0.81 +/- 0.09, and 0.78 +/- 0.26 L.O2.min-1, were reached when subjects were immersed in 10 degrees, 15 degrees, 20 degrees, 28 degrees, and 40 degrees C water. It is concluded that the observed increases in VO2 during the first minute of immersion are partly due to the increased hydrostatic pressure causing a shift of venous blood towards the thoracic region, and a transient increase in the uptake of oxygen into the blood.

Body Temperature↗
PubMed1989

Core threshold temperatures for sweating.

To detect shifts in the threshold core temperature (Tc) for sweating caused by particular nonthermal stresses, it is necessary to stabilize or standardize all other environmental and physiological variables which cause such shifts. It is, however, difficult to cause progressive changes in Tc without also causing changes in skin temperature (Tsk). This study compares the technique of body warming by immersion in water at 40 degrees C, and subsequent body cooling in water at 28 degrees C, to determine the core threshold for sweating, with one by which Tc was raised by cycling exercise in air at 20 degrees C, and then lowered by immersion in water at 28 degrees C. The first of these procedures involved considerable shifts in Tsk upon immersion in water at 40 degrees C, and again upon transfer to water at 28 degrees C; the second procedure caused only small changes in Tsk. The onset of sweating at a lower esophageal temperature (Tes) during immersion in water at 40 degrees C (36.9 +/- 0.1 degrees C) than during exercise (37.4 +/- 0.3 degree C) is attributed to the high Tsk since Tes was then unchanged. Likewise, the rapid decline in the sweat rate during immersion at 28 degrees C had the same time course to extinction after the pretreatments. This related more to the Tsk, which was common, than to the levels or rates of change of Tes, which both differed between techniques. Tes fell most rapidly, and thus sweating was extinguished at a lower Tes, following 40 degrees C immersion than following exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Air↗
PubMed1981

Amino acids as central synaptic transmitters or modulators in mammalian thermoregulation.

Of the amino acids that affect the activity of central neurons, aspartate and glutamate (which exert generally excitatory influences) and glycine, taurine, and gamma-aminobutyric acid (GABA) (which generally exert inhibitory influences) are the strongest neurotransmitter candidates. As with other putative transmitter substances, their effects on body temperature when injected into the cerebral ventricles or the preoptic hypothalamus tend to vary within and between species. These effects are uninterpretable without accompanying information regarding effector activity changes and the influences of dose and ambient temperature. Observations necessary for analysis of apparent action have been made in studies of the effects of intracerebroventricular injections of these amino acids into sheep. Aspartate and glutamate have similar excitatory effects on the neural pathways that activate both heat production and heat loss effectors. Glycine appears to be without effect.

Amino Acids↗
PubMed1980

Diuretic effect of intraventricular and intravenous infusions of noradrenaline in conscious sheep.

Infusion of noradrenaline at rates between 32-160 nmol.min-1 for 30 min into one lateral cerebral ventricle of conscious sheep caused a diuresis which was accompanied by negative solute-free water reabsorption and which lasted for 90-120 min. The range of noradrenaline infusion rates used reflects differences between individual animals in the rate of infusion necessry to cause diuresis. Intracerebroventricular (ICV) infusion of noradrenaline at half the diuretic rate caused no significant changes in urine flow. The diuresis induced by ICV noradrenaline infusion was prevented by concurrent ICV administration of the alpha-adrenergic antagonist, phentolamine, but was not prevented by concurrent ICV administration of the beta antagonist, propranolol, or by concurrent intravenous infusion of phentolamine. Intravenous infusion of noradrenaline at rates that were diuretic by ICV infusion caused a diuresis of approximately 30 min duration which coincided with the period of intravenous noradrenaline infusion. This diuresis was prevented by concurrent intravenous infusion of phentolamine. These results were interpreted as indicating that the higher rates of ICV infusion of noradrenaline caused the prolonged water diuresis by acting at a site in the brain and, thereby, inhibiting the release of endogenous vasopressin. ICV infusion of noradrenaline at all rates was followed by a reduction in mean arterial blood pressure and pulse pressure with variable changes in heart rate and by depression of the rates of renal clearance of PAH, potassium and total solute.

Animals↗