Search PubMed⌕ Search

Biomedical subjects

J D Richards

Publications and source records attributed to J D Richards.

At least 37 records · Page 2Linked to original sources

Effects of discrimination by sex and race on the early careers of British medical graduates during 1981-7.

OBJECTIVE: To examine the possible effects of discrimination by sex and race on the career patterns of doctors up to six years after qualifying. DESIGN: Postal questionnaire follow up survey. PARTICIPANTS: 1572 Doctors who graduated from five British medical schools in 1981, 1983, and 1985, including 587 women and 131 doctors from ethnic minorities. MAIN OUTCOME MEASURES: Reported success rates of applications for training posts. RESULTS: Comparison of the career patterns of women and men yielded no evidence of discrimination against women in competition for posts. In contrast, there were striking differences in career patterns between graduates of native European origin and those of ethnic minority origin. Graduates from ethnic minorities reported lower success rates and more difficulty in obtaining house officer posts, registrar posts, and places in vocational training schemes in general practice. Most of this discrimination seemed to occur at the stage of shortlisting for interview. Graduates from ethnic minorities were more likely than graduates of native European origin to have experienced spells of unemployment while seeking work. They were also more likely to have changed their original choice of career because of difficulty in obtaining suitable training posts or unfavourable career prospects. CONCLUSIONS: Discrimination against ethnic minorities occurs in the competition for training posts among graduates from British medical schools. There was no evidence of discrimination against women graduates. Shortlisting procedures based on objective scoring systems may help to ensure equality of opportunity in future.

Career Mobility↗

High-dose chemotherapy and autologous bone marrow transplantation in acute myeloid leukemia.

For younger patients with acute myeloid leukemia (AML), an allogeneic transplant from a matched sibling may afford the best chance of cure. In patients who are older or without a matched sibling donor, dose intensification can be achieved with an autologous bone marrow transplant (ABMT). We report here the results of a high-dose chemotherapy regime with nonpurged ABMT in 82 adult patients in first remission of AML with a median follow-up of 31 months. The median age was 40 years (range 16 to 57 years). The median interval between remission and ABMT was 5 months (range 1 to 12 months). Twenty-eight of these patients received a second course of the same high-dose chemotherapy and ABMT. The procedure related mortality rate was 6%. The projected leukemia-free survival (LFS) at 5 years is 48% for all 82 patients and 50% for the 76 patients with no known preceding myelodysplastic syndrome. For those patients with primary AML who received a double ABMT the projected LFS is 67%. The interval between remission and ABMT did not predict for either relapse or LFS. ABMT using a multidrug chemotherapy protocol is less toxic than allogeneic BMT yet results in a similar LFS.

Adolescent↗

Hemibody irradiation. An effective second-line therapy in drug-resistance multiple myeloma.

The authors report the results of treatment of 41 patients with melphalan-resistant multiple myeloma using single half-body irradiation (HBI) or double half-body irradiation (DHBI). Patients were grouped using prognostic classification reported by the Medical Research Council. Patients in group I and II showed the best response to therapy with reduction in serum of urinary paraprotein and improvement in symptoms, most notably a marked reduction in bone pain. In these groups five patients have survived over 2 years after therapy. The therapeutic response appeared better in those patients who received DHBI as opposed to those whom treated with single HBI. Patients in group III did not achieve prolonged survival but effective relief of bone pain was a consistent finding in these patients also. Thus HBI represents an alternative to combination chemotherapy as second-line treatment of patients with melphalan-resistant multiple myeloma. A comparative study of HBI versus combination chemotherapy is now indicated to establish which therapeutic approach is most effective.

Adult↗

Renal impairment in myeloma: negative association with isoelectric point of excreted Bence-Jones protein.

The isoelectric point (pI) of the major form of Bence-Jones protein excreted by 62 patients with myeloma and six with macroglobulinaemia was measured by combining isoelectric focusing with immunoblotting techniques. The distribution of the pI values for both kappa and lambda type proteins was bimodal, most falling in the ranges 5.0-6.0 and 7.0-7.5. Plasma creatinine and creatinine clearance and the urine excretion of alpha-1-microglobulin and beta-2-microglobulin were measured in 24 of the patients. These patients, who were free of additional factors known to have an association with the development of renal impairment, were followed up for a mean period of 16 months (range three to 28 months). It was found that renal impairment was not related to the pI of the Bence-Jones protein excreted.

Alpha-Globulins↗

Effectiveness of high-dose combination chemotherapy and autologous bone marrow transplantation for patients with non-Hodgkin's lymphomas who are still responsive to conventional-dose therapy.

We commenced a study in September 1981 to investigate the role of high-dose combination chemotherapy in the management of patients with non-Hodgkin's lymphomas who had failed conventional therapy. Fifty patients with diffuse intermediate- and high-grade non-Hodgkin's lymphomas were treated with high-dose combination chemotherapy with autologous bone marrow rescue (ABMT) and have a minimum follow-up of 1 year. Twenty patients had disease that was still responsive to conventional-dose chemotherapy, 15 had achieved a partial response (PR) to first-line therapy, and five were showing PR to salvage therapy after relapse. Twelve of these patients (60%) achieved complete remission (CR) (two following boost radiotherapy) and three patients have nonprogressive masses on computed tomographic (CT) scan as the only abnormality. None of these patients died during the procedure. Twenty-nine patients had disease not responsive to chemotherapy at conventional dosages: 19 had no response to first-line therapy and 10 showed no response to salvage therapy given after relapse. Only three of these patients achieved CR, all of short duration only. Only two patients in this group remain alive more than 2 years after the procedure and both have nonprogressive abnormalities on CT scan. Nine patients (31%) died of sepsis during the procedure. In those patients with disease not responsive to conventional-dose therapy, dose escalation is associated with a high procedure-related mortality and a low response rate. In those patients who still have chemotherapy-responsive disease the response rate is high and mortality is low.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Medical indications for splenectomy.

The spleen, whether anatomically and physiologically normal or diseased, may significantly worsen the clinical picture in a variety of medical disorders. However, splenectomy should be undertaken only after a careful balancing of the short- and long-term risks and potential benefits to the patient, which are discussed in the following review.

Humans↗

ACE inhibitors.

Explore the source record for details and available documents.

Adult↗

Granulocytic sarcoma of the small intestine preceding acute myelomonocytic leukemia with abnormal eosinophils and inv(16).

We report a case of preleukemic granulocytic sarcoma of the small intestine preceding the development of acute myelomonocytic leukemia with abnormal eosinophils and inversion of chromosome 16, inv(16)(p13q22). A literature review suggests that this is a recurring cytogenetic-clinicopathologic association and carries a favorable prognosis, especially if treated aggressively with antileukemic therapy at the time of diagnosis.

Chromosome Inversion↗

Atypical mycobacterial infection in alpha interferon-treated hairy cell leukaemia.

A patient whose hairy cell leukaemia had begun to respond to alpha interferon therapy developed overt atypical mycobacterial infection. This eventually responded to combination antimicrobial therapy. The clinical difficulties involved in this unique case included difficulty in isolation of the organism, failure of an empirical trial of antituberculous therapy and false attribution of the patient's infective symptoms to alpha interferon.

Aged↗

Use of teicoplanin for Hickman catheter associated staphylococcal infection in immunosuppressed patients.

Antibiotic-resistant coagulase-negative staphylococci are a frequent cause of infection in indwelling central venous (Hickman) catheters. Teicoplanin has been evaluated in the treatment of 19 immunosuppressed patients with staphylococcal Hickman catheter infections, nine of whom were septicaemic. All infections were eradicated, with minimal side effects. In 16 cases, the catheter was retained until no longer required. Two recurrent infections were eradicated by a second course of teicoplanin. We conclude that teicoplanin is an effective and well-tolerated antibiotic in the treatment of Hickman catheter infections in immunosuppressed patients.

Anti-Bacterial Agents↗

Automated leucocyte differential counts in chronic lymphocytic and hairy-cell leukaemias: a comparison of the Hemalog D, H6000 and Coulter S Plus IV.

The automated peripheral blood differential counts produced by the Hemalog D, H6000 and Coulter S Plus IV were analysed and compared in 30 cases of chronic lymphocytic leukaemia (CLL) and 12 cases of hairy-cell leukaemia. All three machines were reliable in identifying CLL and HCL as a 'lymphocytosis' and in estimating neutrophil numbers in the disease. The Hemalog D and H6000 produced accurate monocyte counts in the two diseases, but the Coulter S Plus IV was unreliable in this regard since large lymphoid cells were identified as monocytes. The Haemalog D and H6000 were comparable in consistently identifying modestly raised large unstained cells (LUCs) in CLL. The Hemalog D, but not the H6000, was able to distinguish HCL from CLL on the basis of markedly raised LUCs.

Automation↗

Management of multiple myeloma.

This article reviews the diagnostic approach to a patient with suspected multiple myeloma. Studies of chemotherapeutic regimens are reviewed and the alternative therapeutic options available at different stages of disease progression are discussed. These include newer modalities of treatment such as hemi-body irradiation as second-line therapy, bone marrow transplantation in plateau-phase and the role of alpha interferon.

Antineoplastic Combined Chemotherapy Protocols↗

Autologous bone marrow transplantation for patients with acute myeloid leukaemia and acute lymphoblastic leukaemia--a comparison.

Forty-two patients with acute leukaemia were treated with autologous bone marrow transplantation (ABMT) using a combination chemotherapy protocol for bone marrow ablation. The response to high-dose chemotherapy and ABMT and its associated morbidity and mortality have been compared in 24 patients with acute myeloid leukaemia (AML) and 18 patients with acute lymphoblastic leukaemia (ALL). In 16 patients with AML treated with ABMT during first complete remission (CR), ten patients (62.5%) remain in unmaintained remission; median follow up is 32 months. In eight patients with ALL treated in first CR, only one remains in remission 32 months post-ABMT, with three patients dying non-leukaemic deaths. Fourteen of 18 patients (AML and ALL) treated after first remission have died of recurrent leukaemia, two died non-leukaemic deaths and two remain well 31 and 55 months post-ABMT; both have ALL. The length of hospital stay and the amount of blood product support were similar in both groups. Haematological recovery post-ABMT was delayed in patients with AML compared to patients with ALL but this difference was not significant. Rapidly progressive lung infection was thought to be the cause of four early deaths (4/18) in patients with ALL but none in patients with AML. Severe gram-negative infections were significantly more common in patients with AML.

Adolescent↗

Autologous bone marrow transplantation following high dose chemotherapy for the treatment of adult patients with acute myeloid leukaemia.

24 adult patients with acute myeloid leukaemia (AML) were treated with intensive chemotherapy followed by autologous marrow rescue. The procedure was repeated twice in eight patients. 11 of 16 patients treated in first remission continue in first unmaintained remission (9-54 months, median 17 months). Eight patients treated at relapse or second remission have relapsed again and died within 14 months of their first autologous bone marrow transplant (ABMT). This form of intensification therapy would appear valuable for adult AML patients in first remission.

Adult↗