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Biomedical subjects

J Dickinson

Publications and source records attributed to J Dickinson.

At least 37 records · Page 2Linked to original sources
PubMed1995

The changing characteristics of rural GPs.

AIM: Rural regions of Australia remain relatively underserved by general practitioners. The capacity to make sensible policy depends on a deeper understanding of who rural general practitioners are. METHOD: 454 NSW rural general practitioners were surveyed with a 65% return rate. Our sample was intentionally skewed to greater rurality. RESULTS: Women remain under represented in rural practice. 37% of our sample were aged under 40, with over 90% Australian graduates. Rural doctors continue to do significant amounts of training overseas. Some doctors in rural practice drifted there without planning, and 25% of those under 40 are intending to leave. Young doctors provide a number of procedural services to their patients, including anaesthetics and obstetrics, but this is strongly influenced by town size. Doctors with a rural upbringing are no more likely than those without a rural background to practice in more rural areas. CONCLUSION: Australian rural general practitioners are relatively young and providing a broad range of services to their patients. A number of rural practitioners have not planned for rural practice and may require further training after arrival. Australian graduates continue to train overseas, suggesting that procedural experience in Australia is inadequate. Town size is a strong predictor of procedural skills being available to patients.

Adult↗
PubMed1995

Effect of age and training schedules on balance improvement exercises using visual biofeedback.

There has been a growing popularity and success rate of balance rehabilitation programs, and this success is paralleled by the growth of technology, making available instruments that provide objective, quantitative, and immediate results. The Balance Master is such a commercially available instrument, consisting of a dual-force platform connected to a micro-computer that provides visual feedback of the centre of gravity (COG) in relation to the theoretical limits of stability. Spontaneous body sway can be measured in a static central position, or in peripheral positions around the limits of stability (peripheral sway area). The trajectory between targets can also be analyzed in terms of time (transition time) and accuracy (path error) of transition, which gives a quantitative measure of dynamic movement of the COG. This study examined the practice effect that occurs while using this instrument over repeated sessions for two schedules of training (daily and weekly) and over two age groups (20-35 years, and 60-75 years). Each group completed a series of postural exercises, with an assessment of static and dynamic postural variables before and after training, and at approximately 3 and 6 weeks post-training. Spontaneous body sway was measured with eyes open, eyes closed, and with visual feedback of the COG. No significant changes were observed in these variables as measured over the four standard assessment occasions. Peripheral sway area and path error decreased significantly for both the daily and weekly training groups from pre- to post-training, and these skills were retained over both retention tests, whereas the tendency toward decreasing transition time was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Pharmacokinetics and tolerance of the natural pentasaccharide (SR90107/Org31540) with high affinity to antithrombin III in man.

This paper reports the results of the first administration of the synthetic natural pentasaccharide with high affinity to antithrombin III (NP) in man. This study was mainly focused upon the pharmacokinetic properties and general tolerance of the compound. Subcutaneous injections of doses < 1.43 mg (1000 anti Xa IU) did not generate measurable anti-Xa activities. After subcutaneous injection of increasing doses from 1.43 to 22.9 mg (1000 to 16,000 anti-Xa IU) to young healthy volunteers, it was found that the maximal concentration (Cmax) and the area under curve (AUC) were linearly correlated to the dose, that the total plasma clearances (CI) were constant and almost 3 times lower than those of the current low molecular weight heparins. Cmax were reached between 1 h and 3 h after the injection and the half-lives (t 1/2) were remarkably constant (13.1 h to 13.9 h). During the first 24 h following the injection, around 50% of the total administered dose was recovered in the urine in an active form, indicating that kidney plays a major roles in the elimination of NP. Consistent with these results, when NP was administered to healthy elderly volunteers having a lower creatinine clearance, the half-life of the compound was longer and the clearance lower. At doses exceeding 22.9, Cmax, and AUC were slightly lower than expected, the percentage of the dose recovered in the urine and the total apparent plasma clearance increased, suggesting that the excess of NP unbound to antithrombin III was excreted faster. NP was also administered at various dosages once or twice a day for 7 days to 20 elderly volunteers. Due to the long half-life of the compound the "steady state" was obtained 2 to 3 days after the first injection at which the mean Cmax was increased 1.5 to 2 times. The general tolerance of the compound was excellent. No relevant prolongations of the prothrombin time, of the activated partial thromboplastin time or of the bleeding time were observed. A re-bleeding phenomenon of the bleeding time incision, probably related to friability of the haemostatic plug, occurred in 3 subjects treated with the highest dose regimens: single injection of 26.6 mg (20,000 anti-Xa IU) (young volunteers) and repeated injections of 11.4 mg (8,000 anti-Xa IU) once a day for 7 days (elderly volunteers). At these times, plasma NP concentrations were between 2.9 and 3.6 micrograms.ml-1 (2 and 2.5 anti-Xa IU.ml-1).

Adolescent↗
PubMed1994

Use of personal medical records for research purposes.

The established practice of doctors using medical records for research purposes is threatened by the recent proposed guidelines from the Department of Health, the BMA, and the European Commission. The European Commission has proposed that explicit consent should be obtained from each patient before his or her medical records can be used; the proposals from the Department of Health and the BMA would require all research that needs access to personal medical records to be submitted to an ethics committee. We believe that these proposals would seriously impair an entire category of research and suggest therefore that another set of guidelines, proposed by a Royal College of Physicians' working group, should be used to modify the proposals. The guidelines of the working group encourage the use of medical records for research and ensure that such use can be made in a confidential manner without causing harm.

Biomedical Research↗
PubMed1994

The core content of a generalist curriculum for general internal medicine, family practice, and pediatrics.

The authors analyzed the educational content of the curricula developed for teaching in the generalist disciplines of pediatrics, family medicine, and general internal medicine. Fifteen educational components that constitute the core content shared by the three generalist disciplines are identified, described, and referenced. Tailoring the generalist curriculum for students and residents at the different stages of learning is reviewed, along with the refinement of the curriculum to meet the special needs of each generalist discipline. The success of a generalist curriculum will ultimately be measured by generalist career choices, quality of care, and both patient and professional satisfaction. The curricular determinants of success require institutional commitment to an educational philosophy that embraces the generalist disciplines, a core curriculum that provides education and training that are correlated with the demands of clinical practice, and generalist faculty who serve as role models, mentors, and teachers.

Adult↗
PubMed1993

Order effects and the weighting process in workload assessment.

Operators controlling a power grid were subjects in a mental workload experiment in which they performed their normal tasks under simulated quiet and busy conditions. Workload was assessed using the NASA Task-Load Index (TLX). It was found that there were significant differences between the two conditions, but there were no order effects. The value of the weighting procedure was assessed by correlating unweighted and weighted workload ratings. Although the correlations were high, they were not perfect, indicating some value for weighting the dimensions of the TLX. Large individual differences were observed in perceived workload.

Journal Article↗
PubMed1993

Effectiveness of screening for prostate cancer.

In this, our second article, we assess the value of screening for prostate cancer. There is insufficient evidence to recommend for or against routine digital rectal examination as an effective screening test for prostate cancer in asymptomatic men. It is recommended that tumour markers, such as prostate specific antigen, and transrectal ultrasound are not used for routine screening purposes.

Adult↗
PubMed1993

Testicular cancer. How effective is screening?

This article appraises the value of screening for testicular cancer using rigorous criteria. Testicular cancer is very rare and no benefit from self-examination has been demonstrated. There is insufficient evidence for routine screening in asymptomatic men or for educating patients to perform periodic testicular self-examination. A further article by Dr Sladden and Dr Dickinson will examine the value of screening for cancer of the prostate.

Adolescent↗
PubMed1993

Split skin injuries.

Explore the source record for details and available documents.

Dermatologic Surgical Procedures↗
PubMed1992

Medical management of ocular malakoplakia.

A 14-year-old girl had a granulomatous conjunctival lesion, proven histologically to be malakoplakia. This is the first reported case of malakoplakia arising from conjunctiva, although three others have involved the ocular adnexa. Malakoplakia is a rare disease often associated with immunodeficiency and is characterized by the presence of intracellular inclusions and organisms due to deficient intracellular bacteriolysis. Medical management is difficult because an effective antibacterial agent requires three properties: activity against the organism involved, good intracellular penetration, and the capacity to maintain its effectiveness in the intracellular milieu. Escherichia coli was isolated from a biopsy specimen and from conjunctival swabs. Treatment with systemic ciprofloxacin, which has good intracellular penetration and activity, led to rapid resolution of the lesion. This is the first report concerning the successful use of this drug to treat malakoplakia of any organ.

Adolescent↗