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Biomedical subjects

J F Wilson

Publications and source records attributed to J F Wilson.

At least 55 records · Page 3Linked to original sources
PubMed1998

Nitric oxide enhances the inotropic response to beta-adrenergic stimulation in the isolated guinea-pig heart.

Nitric oxide (NO) exerts several effects on myocardial contraction, including enhancement of relaxation and diastolic function, modulation of beta-adrenergic inotropic responses, and inotropic effects in the absence of agonist pre-stimulation. Different effects have been observed in different species and preparations, and it is unclear whether they are species- or preparation-specific, or whether they represent a range of responses that can manifest in most mammalian species. We therefore examined the effects of NO on the inotropic response to beta-adrenergic stimulation in the isolated guinea-pig heart, a species in which we have previously shown that NO enhances basal left ventricular (LV) relaxation and modulates the Frank-Starling response. Isolated ejecting hearts were perfused with Krebs buffer at constant placed heart rate (1 microM) indomethacin, 37 degrees C, constant loading conditions), and high fidelity LV pressure was monitored by an apical 2 F Millar catheter. All hearts were initially treated with dobutamine (0.1 microM) and then, once the peak inotropic and chronotropic response had been established, with either (a) no further treatment (n = 6), (b) the NO donor sodium nitroprusside (1 microM, n = 6; 10 microM, n = 6), or (c) the specific agonist for NO release, substance P (0.1 microM, n = 6). Dobutamine (0.1 microM) produced a rapid positive inotropic and chronotropic response, associated with a fall in LV end-diastolic pressure (LVEDP) and a rise in coronary flow. The positive inotropic effect of dobutamine declined over 20-28 minutes, while the chronotropic response persisted over this period. Low dose sodium nitroprusside (1 microM) delayed the decline in the inotropic response to dobutamine and exaggerated the fall in LVEDP. Similar effects were observed with substance P (0.1 microM). In contrast, a higher dose of sodium nitroprusside (10 microM) did not alter the response to dobutamine. These data indicate that "low dose" NO augments the inotropic response to beta-adrenergic stimulation in the isolated ejecting guinea-pig heart, in addition to its previously reported effects on basal LV relaxation in the same preparation.

Adrenergic beta-Agonists↗
PubMed1998

Personality and social competency following unilateral stroke.

Neuropsychological research indicates that the left hemisphere plays a dominant role in verbal production and processing, while the right hemisphere plays a dominant role in nonverbal production and processing. This study sought to examine the effects of such differential hemispheric specialization on personality and social competency. Ten left hemisphere damaged (LHD) stroke patients, 11 right hemisphere damaged (RHD) stroke patients, and 7 neurologically normal (NHD) patients were videotaped while engaging in social interaction with their spouse and an interviewer. Segments of the interactions were independently coded by two observers. Patients and spouses were rated with respect to their level of social competency and the extent to which they were characterized by 10 personality adjectives (e.g., outgoing, warm). Ratings for the personality items were summed to create an aggregate score. Analysis of these scores revealed both LHD and RHD patients to have lower (i.e., more negative) mean scores than NHD patients, suggesting that stroke patients as a whole were seen as socially impaired. Analysis of the socially competent item revealed particular LHD deficits; LHD patients were seen as less socially competent than both RHD and NHD patients. Spouses of LHD, RHD, and NHD patients, in contrast, did not differ in observer-rated social behavior.

Cerebrovascular Disorders↗
PubMed1998

Physical symptoms, distress, and breast cancer risk perceptions in women with benign breast problems.

Physical symptoms, general and breast cancer-specific distress, and perceived breast cancer risk were assessed in 66 women with benign breast problems (BBP) and 66 age-matched healthy comparison (HC) women. BBP women reported significantly greater worry about breast cancer than HC women. Breast symptom incidence and breast cancer risk perceptions were found to mediate group differences in breast cancer worry. Hierarchical regression analyses indicated that perceptions of control over a potential breast cancer prognosis moderate the impact of breast symptoms on reports of breast cancer worry. Implications for risk counseling with BBP women are discussed.

Adult↗
PubMed1998

Comparing fourth-year medical students with faculty in the teaching of physical examination skills to first-year students.

PURPOSE: To see whether fourth-year medical students can teach the physical examination to first-year students as effectively as can faculty preceptors. METHOD: Ninety-three first-year students studying the physical examination were randomly assigned to one of ten fourth-year student preceptors or one of 15 faculty preceptors. Test results and course evaluations were compared by type of preceptor. Fourth-year student preceptors were surveyed regarding their experience. RESULTS: The mean test scores did not differ between the first-year students with fourth-year student preceptors and those with faculty preceptors. The first-year students rated the fourth-year student preceptors higher than they did the faculty preceptors. The fourth-year students rated their experience favorably. CONCLUSION: A select group of fourth-year medical students provides a successful alternative to faculty in the teaching of the physical examination to first-year students.

Attitude↗
PubMed1998

The effect at one teaching hospital of interns' workloads on the satisfaction of their patients.

PURPOSE: To explore whether the amount of workload of first-year residents (interns) affects the satisfaction of their patients. METHOD: The authors collected data from January through May 1995 for 145 patients admitted to Lexinton Veterans Affairs Medical Center with the primary diagnosis of chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). Workload was measured as the number of other patients for whom the intern had primary responsibility on the day of the studied patient's admission. A questionnaire measured the patients' satisfaction on the day of discharge. The authors analyzed the data using Pearson correlation and multiple linear regression. RESULTS: For the 89 patients with COPD (controlling for patient age, severity of illness, and sex of intern), greater workloads for their interns was a significant predictor of decreased patients' satisfaction (p = .001). No association was found for the 56 patients with CHF. CONCLUSION: Interns' workloads on the day their patients are admitted can influence their patients' subsequent satisfaction.

APACHE↗
PubMed1998

An audit of therapeutic drug monitoring service provision by laboratories participating in an external quality assessment scheme.

Therapeutic drug monitoring services were investigated in a questionnaire sent to all subscribers to the United Kingdom National External Quality Assessment Scheme for Therapeutic Drug Assays. Questions were posed on assay availability and use, target ranges, and reporting procedures for digoxin, lithium, phenytoin, phenobarbitone, carbamazepine, theophylline, and valproic acid. One hundred fifty-seven laboratories replied and, except for lithium, 45% reported in mass units, 34% in molar units, and 22% a mixture of mass and molar units. Target ranges for lithium, digoxin, carbamazepine, and phenobarbitone were highly variable but ranges for phenytoin, theophylline, and valproic acid were more consistent. Immunoassay was the most popular methodology although high-performance liquid chromatography was commonly used for anticonvulsants. Paper copies of results were provided by 93% of laboratories, 40% reported by telephone, 12% by fax, and 28% by computer. Additional data, mainly dose, time of last dose, and duration of therapy were requested by 55% to 67% of laboratories. Grades of staff authorizing results ranged from nurses to senior consultants, and collaboration with pharmacists occurred in 26% of laboratories. Most laboratories provided a daily analytical service and 73% offered a 24-hour emergency service. This audit unexpectedly identified use of a wide range of target concentrations, particularly for digoxin and lithium.

Drug Monitoring↗
PubMed1998

A randomized trial of providing house staff with patient social history information. Effect on patient outcomes.

The purpose of this project was to assess if providing physicians (house staff) with routine comprehensive social history information on their patients will improve patient outcomes. Comprehensive social history information was gathered over a 5-month period on 134 consecutive patients. Patients were randomized to have social history information provided or not provided to the resident physician caring for them. Outcomes of interest were: patient satisfaction, length of stay, and early unplanned readmission. Analysis was with analysis of covariance, controlling for patient severity of illness and amount of social history information documented by the house officer. Outcomes were the same for patients for whom house staff were provided social history information versus those for whom the information was not provided. The authors conclude that providing house staff with routine comprehensive social history information did not influence patient outcomes.

Aged↗
PubMed1998

Quantitation of carboxyhaemoglobin in blood: external quality assessment of techniques.

The performance of four dedicated carbon monoxide (CO)-oximeters (AVL, Chiron, IL, Radiometer), spectrophotometry with and without dithionite, spectrophotometry by second derivative, and the Whitehead and Worthington precipitation technique for the measurement of carboxyhaemoglobin in blood was compared by a mean of 136 participants in the United Kingdom National External Quality Assessment Scheme in 21 samples formulated to contain from 4% to 48% carboxyhaemoglobin. The dedicated instruments and spectrophotometry by second derivative were of significantly higher precision than the other techniques, producing fewer measurements rejected as being > 3 standard deviations from the sample mean and having a lower standard deviation for non-rejected measurements. The AVL instrument and spectrophotometry by second derivative had a significant positive bias compared to the other techniques. The Whitehead and Worthington method was of an unacceptably low precision.

Carbon Monoxide Poisoning↗
PubMed1998

Sexing of human and other primate DNA.

We present a rapid and simple method for the sexing of human and other primate DNA. Homologous introns from the X- and Y-linked zinc finger protein genes (ZFX and ZFY) are PCR amplified with one primer pair. An Alu element insertion in the ZFX intron results in a size difference in the amplicons which is resolved by agarose gel electrophoresis.

Animals↗
PubMed1997

Hair analysis as a potential index of therapeutic compliance in the treatment of epilepsy.

Twenty-three patients resident at the Chalfont Centre for Epilepsy, who have been prescribed carbamazepine either as monotherapy or in combination with other antiepileptic drugs have been monitored for a period of 6 months. Monthly hair samples along with concomitant plasma samples have been collected over this period and the 1 cm from scalp hair sections and the plasma concentrations of carbamazepine measured. The relationship between dose, hair and plasma concentrations have been assessed as well as the monthly variability in the concentration of carbamazepine in both matrices.

Anticonvulsants↗
PubMed1997

Clinical indications for brachytherapy.

Brachytherapy, or placing radioactive sources either temporarily or permanently into or near a malignant tumor, is a long-established cancer treatment method. During the past 25 years, brachytherapy has become safer and more versatile than earlier radium therapy, and its indications have increased dramatically during this period. One estimate is that at least 5-10% of all patients needing radiation therapy require brachytherapy. The site-specific clinical indications and methods for brachytherapy implementation are described.

Biliary Tract Neoplasms↗
PubMed1997

Are fourth-year medical students effective teachers of the physical examination to first-year medical students?

OBJECTIVE: To determine if fourth-year medical students are as effective as faculty in teaching the physical examination to first-year medical students. DESIGN: Stratified randomization of the first-year students. SETTING: A public medical school. PARTICIPANTS: All 100 first-year medical students in one medical school class were randomly assigned (controlling for gender) to either a faculty or a fourth-year student preceptor for the Physical Examination Module. MAIN RESULTS: The first-year students of faculty preceptors scored no differently on the written examination than the students of the fourth-year medical student preceptors (82.8% vs 80.3%, p = .09) and no differently on a standardized patient practical examination (95.5% vs 95.4%, p = .92). Also, the first-year students rated the two groups of preceptors similarly on an evaluation form, with faculty rated higher on six items and the student preceptors rated higher on six items (all p > .10). The fourth-year student preceptors rated the experience favorably. CONCLUSIONS: Fourth-year medical students were as successful as faculty in teaching first-year medical students the physical examination as measured by first-year student's performances on objective measures and ratings of teaching effectiveness.

Adult↗
PubMed1997

Effects of pregnancy, sucrose, and various low-protein diets on the eating behavior of rats.

To assess the effects of various low-protein diets on the eating behavior of female rats, 280 rats were assigned to one of 20 groups, according to a 5 x 2 x 2 (Protein Level x Pregnancy x Sugar) design. Each rat was offered one of five isocaloric, soy-based diets: 25%, 8%, 4%, 2% or 1% protein diet. The subjects' intakes and weights were recorded daily for 3 weeks. Protein content of the diet, pregnancy, and the presence of dietary sucrose all had significant effects on diet, sucrose, and protein intake. By the third week of the experiment, pregnant rats offered 1%, 2% or 4% protein diets consumed significantly less of their diet than did their nonpregnant controls, whereas pregnant rats in the 25% protein group consumed significantly more of their diet than did nonpregnant controls. The eating behavior of the rats offered the 8% protein diet was most affected by the presence of dietary sucrose. Pregnant rats in the 8% protein group consumed less of their diet than did nonpregnant controls when sucrose was also offered, but they consumed more of their diet than did nonpregnant controls when sucrose was not offered. A learned food aversion is probably the best explanation for the severe reduction of diet intake observed in pregnant rats in all of the 1%, 2%, and 4% protein groups, as well as in pregnant rats offered the 8% protein diet and sucrose.

Animals↗
PubMed1997

Internal medicine residency training and outcomes.

OBJECTIVE: To review the impact of the clinical education of internal medicine residents on patients' outcomes. DATA SOURCES AND STUDY SELECTION: English-language studies of the relation between internal medicine housestaff training and patients' outcomes were systematically identified by a MEDLINE search and from bibliographies and reference lists of recently published articles. MAIN RESULTS: We hypothesized that the primary impact of internal medicine residency training on patients' outcomes would be the result of: (1) the inexperience of the residents; (2) the heavy workload these inexperienced residents are expected to manage: or (3) some structural feature of the internal medicine teaching services, such as the discontinuity of patient care inherent in night float systems and the fact that residents rotate to different services each month. We also hypothesized that residents may in may ways provide superior care, and many actually improve certain patient outcomes. Housestaff inexperience, workload, and structural features that promote discontinuity have been shown to affect especially outcomes of resource utilization, length of stay, and patient satisfaction. No study has demonstrated that internal medicine residents contribute to excess patient morbidity or mortality. However, the published studies in this area are for the most part retrospective and were conducted 10 to 15 years ago. The full extent of the untoward (or the beneficial) effects of internal medicine residency training on patients' outcomes is unknown. CONCLUSIONS: Multisite, prospective studies would remedy the deficiencies in the published research in this area and would yield the most valid insight into the range and extent of the effects of housestaff training on patients' outcomes. In the absence of such studies and in a rapidly changing managed care environment, academic medical centers and departments of medicine need to be aware of those aspects of the clinical education of residents that are most likely to affect patients' outcomes.

Clinical Competence↗
PubMed1997

Intern call structure and patient satisfaction.

Our institution has instituted "short-call" and "nightfloat" systems to reduce the number of admissions to the traditional "long-call" housestaff. However, the nightfloat system introduces increased discontinuity to patient care, and interns may spend less time with short-call patients because they are nor required to spend the night on-call. Discontinuity and less time spent with patients may result in decreased patient satisfaction. Over a 6-month period, data were collected on 145 consecutive patients admitted to a teaching Veterans Affairs Medical Center with the primary diagnoses of congestive heart failure and chronic obstructive pulmonary disease. We found that patients admitted to either short-call or nightfloat interns were significantly less satisfied with their care than patients admitted to long-call housestaff, controlling for intern gender, patient age, and patient severity of illness (p = 0.02). Residency program directors need to realize that changes in the structure of teaching environment may have an impact on patient satisfaction.

APACHE↗