Biomedical subjects
Publications and source records attributed to J Hoare.
Costing half as much as inpatient treatment, with good results and advantages to patients, day surgery might be expected to be more widespread than it is. Purchasers may be those who push for more by specifying targets for day surgery for certain procedures. How can managers respond?
Minimally invasive therapy is a new and important development in medicine. With minimal disruption to the patient's body or way of life, outcomes are at least as effective and procedures are safer than conventional surgery. But there are clear implications for management on costs, and organisational and strategic issues.
Explore the source record for details and available documents.
Electrical resistance rosette strain gauges bonded directly to the surface of the midshaft of the normal canine tibia were utilized to study the effect of the AO external skeletal fixator on the magnitude and orientation of the peak strain values recorded during locomotion. The application of the fixator in a single lateral bar configuration resulted in a significant decrease in surface bone strain magnitude but in only minor changes in the orientation of those strains. However, in only one of three dogs tested did the addition of a second external connecting bar result in significant further decreases in bone strain.
The paper describes electrical circuitry which replaces a mechanical brake, for perturbation of the contractile load of the legs during pedalling. The turning flywheel of an ergometer is connected to an alternator, with the electrical load provided by a power resistor connected across the output terminals. A 12-V battery provides the field current. Through variable resistors the field current is altered under microprocessor control, providing different steady-state loads when pedalling and also sudden transient changes of load. The point of change in load in the movement cycle can be accurately selected. The ergometer is instrumented for accurate measurement of pedal crank position, crank angular velocity and reaction force at the foot, to provide a physical description of the evoked steady states and transients, using microprocessor controlled sampling. The results show that the technique has application to the study of the range of reflex responses within a movement cycle and also to the more complex restoration of a movement pattern over a number of cycles. It is applicable to investigation of normal and diseased states.
Reproducible preparations are given for salts of the following L-amino acid derivatives: Bpoc-Ala-OH, Bpoc-Arg(Mtr)-OH, Bpoc-Asn-OH, Bpoc-Asp(OtBu)-OH, Bpoc-Cys(Acm)-OH, Bpoc-Cys(S-tBu)-OH, Bpoc-Gln-OH, Bpoc-Glu(OtBu)-OH, Bpoc-Gly-OH, Bpoc-Ile-OH, Bpoc-Leu-OH, N-alpha-Bpoc-Lys(epsilon-Boc)-OH, Bpoc-Met-OH, Bpoc-Phe-OH, Bpoc-Pro-OH, Bpoc-Ser(OtBu)-OH, Bpoc-Thr(OtBu)-OH, Bpoc-Tyr-OH, Bpoc-Val-OH. A study of the deblocking of N-alpha-Bpoc peptides in dichloromethane containing 0.5% trifluoroacetic acid revealed that a rapid equilbrium is established between the first-formed monomeric alkene 2-p-biphenylylpropene and the hindered dimer 2,4-bis(p-biphenylyl)-4-methyl-1-pentene. Thioethers were found to be inefficient carbocation scavengers for the deblocking reaction. The most efficient scavengers were found to be thiophenol and benzyl mercaptan, and the following approximate reactivity order was established: benzyl mercaptan approximately thiophenol greater than indole much greater than 1,3-dimethoxybenzene approximately resorcinol greater than 1,3,5-trimethoxybenzene approximately dimethyl sulfide approximately thioanisole.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Conduction velocity, absolute refractory period, and subnormal conduction period measures of the right ulnar motor nerve were obtained during a simple reaction time task. 6 young, healthy, right-arm dominant male subjects were tested following 30 min. exposure in ambient (20 degrees C) and hot (36 degrees C) room air conditions. Motor and premotor components of fractionated reaction time were tested on the same arm. Oral, right forearm skin and a four-site mean skin temperature were monitored. During heat exposure, forearm skin temperature increased 4.7 degrees C and mean skin temperature 2.9 degrees C. Oral temperature did not alter. Conduction velocity increased 11.4%, absolute refractory period decreased 22.7%, and subnormal conduction period decreased 14.1% in the hot condition. Concomitantly, a 5.2% increase in premotor reaction time and 12.2% decrease in motor reaction time were observed. Total RT did not alter significantly. It was concluded that different component parts of reaction time were differentially influenced by exposure to heat.
Patient management problems (PMP) are being used in medical examinations with increasing frequency despite evidence which throws doubt on their validity as measures of clinical competence. This study investigated the construct validity of a PMP constructed in both written and interview formats. Each test was administered to groups of students of different seniorities and to two groups of doctors, interns and post-interns. The pattern of scores for the different groups was not that expected of a valid test of competence. The most competent groups (the post-interns) generally scored less well on the calculated indices than the senior students and interns. These findings were similar for both formats of the test so cueing was not thought to be the major factor. It appears that the scoring system is at fault. A comparison of performance on the written and interview (uncued) formats showed that many more options were chosen by all groups tested on the written PMP. It was concluded that written PMPs cannot yet be regarded as a valid simulation of clinical performance. Although content validity is high this does not appear to be so for construct validity or concurrent validity.
Explore the source record for details and available documents.
In a previous study we described a problem-based criterion-referenced test of the clinical competence of medical students which was felt to offer advantages over the traditional final-year examination. This paper reports the validity and reliability studies on which it is possible to judge the value of this new test when compared to the traditional approach. The results demonstrate a high level of content validity and provide evidence of the construct validity of the test. Efforts to obtain measures of concurrent and predictive validity were thwarted by a failure to attain reliable assessments of ward performance from resident and consultant staff. Satisfactory levels of internal consistency were established for the whole test. Marker reliability was satisfactory in all sections of the test except for those requiring examiners to rate practical clinical skills. This was so despite the use of simulated patients, behavioural check-lists and rater training. Possible solutions to this problem are discussed. It is concluded that this new approach overcomes many of the measurement problems inherent in the traditional final examination. It has been shown to be feasible to construct and administer in the medical school setting without the need for the allocation of additional resources.
A method of recording bone strain in the walking animal has been described (Cochran 1969). This communication describes a method of application of train gauges directly to bone which gave dependable and reproducible results. A telemetry system designed and built for the purpose of transmitting strain patterns from the walking animal is described. This has eliminated the need for long trailing wires from the animal, and has noise free recordings which can be made from six strain gauges simultaneously. The techniques and instrument described will be used to investigate in vivo the normal deformation of bone and the effect of various internal fixation devices on this deformation.
Ten males and six females exercised on an electrically braked cycle ergometer. Three conditions were tested: preferred pedal frequency with no cues; preferred frequency established by listening to a metronome and preferred frequency maintained by watching a digital display. Each condition was performed at a low workload and a high workload, and this set of tests was repeated once. During each test, computer sampling of pedal and breath information occurred, and the relationship of breath signal occurrences to pedal signals was plotted by a post stimulus histogram program. Fourier analysis of psh data (Time Series Spectrum Estimation) decomposed each histogram into it's frequency components. The magnitude of the frequency at the fundamental of the pedal period (F1), and it's first harmonic (F2), were assessed using F ratios. For retest results, preferred condition, 100% of subjects were entrained for both low and high workloads. With the metronome, 87% were entrained at the low workload and 94% at the high workload. For both workloads, 94% were entrained when watching a digital printout of pedal frequency. For preferred pedal rate, at the two workloads tested, the results of this study strongly support the existence of entrainment, and provide evidence for neurogenic input to ventilatory control during steady state work.
The inconsistency of the marking in clinical examinations is a well documented problem. This project identified some of the factors responsible for this inconsistency. A standardized rating situation was devised. Five students were videotaped as they performed part of a physical examination on simulated patients. Eighteen experienced medical and surgical examiners rated their performances using an objective checklist type of rating form. No differences were evident between physicians and surgeons. The group of examiners was divided into three subgroups, one receiving no training, one limited training and one more extensive training. Examiners re-rated the same students 2 months after the first rating. Inter-rater reliability was satisfactory for the first ratings and training produced no significant improvement. A substantial improvement was achieved by identifying the most inconsistent raters and removing them from the analysis. Training was shown to be unnecessary for consistent examiners and ineffective for examiners who were less consistent. On the basis of these results, only consistent examiners were selected to take part in the interactive component of the objective structured final year examinations. The ratings in these examinations achieved high levels of inter-rater reliability. It was concluded that the combination of an objective check-list rating form, a controlled test situation and the selection of inherently consistent examiners could solve the problem of inconsistent marking in clinical examinations.
The advances made by the use of a telemetric system in the study of bone strain in a free-moving horse are reported. A rosette strain gauge was bonded to the craniomedial aspect of the metacarpus of the horse. Attachment of a miniature FM transmitter to lead wires facilitated telemetric transmission of of resistance changes which corresponded to limb movement. During 3 different gaits, the trace pattern remained similar, although frequency and amplitude varied. The tracings were similar to those reported in other species in which nontelemetric transmission was used.
Explore the source record for details and available documents.
Explore the source record for details and available documents.