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Biomedical subjects

K V Mann

Publications and source records attributed to K V Mann.

34 records · Page 2Linked to original sources
PubMed1990

Priority issues in continuing medical education show sensitivity to change in Canadian health care.

The degree and scope of significant change in health care expectations, roles and delivery patterns in Canada have been widely documented. In 1988 the Sub-Committee on Research of the Standing Committee on CME [continuing medical education], Association of Canadian Medical Colleges, conducted a survey to determine whether those responsible for the CME portion of the medical school curriculum are changing their perceptions to keep pace with the changes in health care. The results were compared with those of a similar survey done in 1983. In both surveys people directly responsible for delivery of formal CME were asked to identify and rank research needs in CME. The response rates were very high. The CME issues identified in the two surveys had changed considerably, with entirely new issues being identified in 1988 and the emphasis placed on issues having changed. The identification of factors that promote or inhibit application of new knowledge by practising physicians was of lowest importance in 1983 and of primary importance in 1988, and comparison of the cost-effectiveness of CME methods was an important issue in 1983 and among the least important in 1988. The noted changes mirror developments in Canada's health care milieu.

Attitude of Health Personnel↗
PubMed1990

Defining fitness and aptitude to practice medicine.

This article describes the use of the critical incident technique to define noncognitive behaviours, referred to as 'fitness and aptitude', that physicians should demonstrate in their practice. A total of 484 behaviours were categorized under four categories: attitude and personal attributes; communication; practice organization; and professional competence. Each category was further subdivided into subcategories. The communication category was by far the largest, representing 46% of all behaviours. The behaviours were written as objectives so that they could be included in a medical school curriculum and evaluated with much less subjectivity.

Aptitude↗
PubMed1990

The effect of an educational program on knowledge & attitudes about blood pressure by junior high school students: a pilot project.

This study tested the effectiveness of a 10 minute videotape and complementary print program guide on the knowledge and attitudes of junior high school students about blood pressure (BP). A randomized two group pre-test, post-test and delayed post-test design was used. The experimental group received an educational session on BP, designed for this study, which consisted of a 40-minute session, comprised of a 10-minute video presentation and discussion by the teacher on BP (guided by the program guide). The educational session was effective in improving students knowledge of BP at one week post-test; however, this positive effect did not persist at the three month post-test. Student interest in, or knowledge of, their own BP was not obviously affected by the session. The findings were interpreted in light of Social Learning Theory (SLT) and the PRECEDE Model of Health Education (PMHE). In testing the effect of one component of an educational program, i.e., the videotape and teacher lesson the environmental determinants of behaviour change could not be addressed in this study. The educational session was able, however, to achieve the desired knowledge change. The 10-minute videotape and complementary print program guide was shown to be a viable educational tool and can therefore be utilized as a resource in a broader multi-faceted program of cardiovascular (CV) health promotion.

Adolescent↗
PubMed1989

The public's health is too important to be left to public health workers. A commentary on Guide to Clinical Preventive Services.

Practicing physicians are the key to effective health promotion and disease prevention in their communities, according to the Guide to Clinical Preventive Services released in May by the United States Preventive Services Task Force. The Guide focuses on the clinical practitioner and strongly advocates integrating preventive activities into clinical practice. It also shows how required interventions can be done by the physician normally responsible for ongoing care. Case-finding is emphasized as a viable and desirable strategy in early detection of disease. The report also acknowledges behavioral and lifestyle components of risk factors for disease and the physician's opportunities to promote change in patients' risky behavior. We discuss the implications of including patient education and counseling in the physician's clinical armamentarium, highlighting changes in educational and health care delivery systems that can make such interventions work in preventive programs. The soundness of a best-evidence synthesis method to formulate recommendations and the use of a priori scientific rules to determine the effectiveness of many current and proposed preventive activities are hallmarks of the task force's approach to integrating science and clinical practice.

Canada↗
PubMed1989

Physicians' perceptions of their role in cardiovascular risk reduction.

Fifty randomly selected family physicians were interviewed to evaluate the role of primary care physicians in the reduction and control of cardiovascular risk in their patients. The interview schedule, developed from the PRECEDE framework, incorporated three categories of factors modifying behavior: predisposing, reinforcing, and enabling. In relation to high blood pressure, elevated serum cholesterol, and smoking, physicians were questioned regarding (a) knowledge and beliefs of desirable practice, (b) perceptions of personal ability, (c) factors that affect their preventive performance, and (d) perceptions of their own role and those of other resources. Physicians believed all three risk factors to be modifiable, and that reduced cardiovascular risk could prolong life and improve quality of life. Participants perceived themselves most effective in reducing high blood pressure, followed by serum cholesterol reduction and smoking cessation. Relationships with patients, patient compliance, personal committment, and belief in the efficacy of risk reduction were most frequently perceived to contribute to effectiveness. Physicians perceived themselves least skilled in enhancing patient compliance and achieving behavior change. Most physicians were committed to cardiovascular disease prevention and saw their own role as central. Contributions of other resources were not well understood. The effect of these complex and interacting perceptions has implications for attempts to enhance physicians' preventive activities.

Cardiovascular Diseases↗
PubMed1989

Nonsedating histamine H1-receptor antagonists.

The chemistry, pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosages of the nonsedating histamine H1-receptor antagonists terfenadine, astemizole, loratadine, and acrivastine are reviewed. Terfenadine and astemizole are chemically unrelated to histamine H1-receptor antagonists such as diphenhydramine and chlorpheniramine. Loratadine is structurally related to the antihistamine azatadine, and acrivastine is a side-chain-reduced metabolite of the antihistamine triprolidine. Like other histamine H1-receptor antagonists, they competitively block histamine receptor sites rather than inhibiting histamine release. All four drugs have relatively long half-lives and are rapidly absorbed after oral administration. Terfenadine, astemizole, and loratadine are metabolized extensively in the liver; terfenadine and astemizole are both 97% protein bound. Terfenadine 60 mg twice daily has been shown to be as effective as conventional antihistamines for the treatment of seasonal allergic rhinitis. In clinical trials, astemizole 10 mg daily was comparable to or better than chlorpheniramine for treatment of chronic rhinitis. Both terfenadine and astemizole were effective for treatment of chronic urticaria. For treatment of seasonal allergic rhinitis, loratadine combined with pseudoephedrine may be preferable to triprolidine-pseudoephedrine and acrivastine-pseudoephedrine combinations that require more frequent dosing. Acrivastine must be administered more frequently than the other nonsedating antihistamines. None of these four agents impairs psychomotor activity. Infrequently reported adverse effects include dry mouth, skin reactions, and weight gain. The absence of substantial sedative effects and the less-frequent dosing schedules make these agents good alternatives to the classic antihistamines for treatment of seasonal and chronic rhinitis and chronic urticaria.

Histamine H1 Antagonists↗
PubMed1989

Management of acute iron overdose.

Treatment of severe iron overdose in two children is described, and the pathophysiology of iron toxicity and management of acute iron poisonings are reviewed. An 11-month-old boy was comatose and in shock several hours after ingesting approximately 50 ferrous sulfate tablets (elemental iron 390 mg/kg). He had hyperglycemia and leukocytosis. Lavage was performed with a solution containing deferoxamine and sodium bicarbonate, and deferoxamine was given by continuous i.v. infusion for 48 hours. The initial serum iron (SI) concentration of 14,250 micrograms/dL decreased to 657 micrograms/dL nine hours after i.v. deferoxamine therapy was initiated. A roentgenogram showed tablets in the stomach and small bowel. Packed red blood cells were administered to treat apparent necrotizing gastroenteritis. SI concentration returned to normal by day three [corrected], and the child recovered. A 2.5-year-old boy was examined 1.25 hr after ingesting an estimated 55 tablets of ferrous gluconate 325 mg (elemental iron 130 mg/kg). Initial SI concentration was 134 micrograms/dL, and total iron-binding capacity (TIBC) was 219 micrograms/dL. A roentgenogram indicated iron concretion in the stomach and iron tablets in the small bowel. He underwent lavage with solution containing sodium bicarbonate. An i.m. dose of deferoxamine was administered, followed by i.v. deferoxamine therapy. SI concentration eight hours after the ingestion was 290 micrograms/dL, and whole-bowel irrigation was begun with polyethylene glycol-electrolyte solution. The irrigation and deferoxamine therapy were discontinued 20 hours after the ingestion, when SI concentration was 73 micrograms/dL, and the child recovered. Acute iron ingestions of more than 60 mg/kg are potentially serious. Patient 1 had severe iron intoxication, while aggressive treatment prevented severe toxicity in patient 2. Acute iron toxicity includes effects on the GI tract and the cardiovascular, metabolic, hepatic, and central nervous systems. Guidelines for assessing the severity of an overdose and selecting the most appropriate therapy are provided. The indications for chelation therapy with deferoxamine, gastric decontamination procedures including use of lavage solutions and whole-bowel irrigation, and adjunctive measures are described. Management of acute iron overdose includes supportive care, GI decontamination, and chelation therapy.

Chelating Agents↗
PubMed1988

Use of ipratropium bromide in obstructive lung disease.

The chemistry, pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage of ipratropium bromide are reviewed. Ipratropium bromide, a synthetic quaternary isopropyl derivative of atropine, interrupts vagally mediated bronchoconstriction by inhibiting the cyclic guanosine 3',5'-monophosphate system at parasympathetic nerve endings. Ipratropium bromide is poorly absorbed after oral and inhaled administration but diffuses rapidly into tissue after i.v. or i.m. administration. The elimination half-life is 3.2-3.8 hours. After inhalation, the drug is eliminated in the urine and feces. The bronchodilatory effect of ipratropium bromide in stable chronic obstructive pulmonary disease appears to be comparable, and may be superior, to that of the beta-sympathomimetic agents. In acute exacerbations, ipratropium bromide is useful but may not be the preferred agent because of a delayed onset of action (within 15 minutes; mean dose-dependent duration of effect, three to five hours). Combination therapy with other bronchodilating drugs has proved useful. Ipratropium bromide may be a useful adjunctive agent in the treatment of asthma. Since the onset of action is delayed, ipratropium bromide should not be used as single-drug therapy in an acute asthmatic exacerbation. Reported adverse effects, including cough, nausea, palpitations, dry mouth, nervousness, gastrointestinal distress, and dizziness, have been mild. The usual dosage is two inhalations (36 micrograms) four times daily, and the maximum number of doses per day should not exceed 12. Although ipratropium bromide is currently indicated only for maintenance therapy in stable chronic bronchitis and emphysema, it may be useful as adjunctive therapy in asthma and in the management of acute exacerbations of chronic bronchitis and asthma. Additional experience in a variety of chronic obstructive pulmonary disorders will help to clarify the role of ipratropium bromide in the treatment of obstructive pulmonary disease.

Asthma↗
PubMed1988

Defining fitness and aptitude to practice medicine.

The results of a study to determine the qualities and characteristics necessary for physicians to demonstrate in their practice reinforce the need for a medical school to emphasize the non-cognitive domain in its curriculum. The behaviors described in this study were written as educational objectives so that they could be evaluated with less subjectivity.

Aptitude↗
PubMedDate not supplied

Five-year multicenter retrospective review of cyclobenzaprine toxicity.

Cyclobenzaprine (CBP) has a cyclic structure similar to amitriptyline. In overdose, CBP has been suggested to produce the cardiovascular and neurologic toxicity found with the cyclic antidepressants. To examine this possibility, a retrospective chart review of all cases of CBP exposure reported to five regional poison centers was performed for the years 1989-93. There were a total of 750 charts identified for CBP exposure, of which 523 had data sufficient for evaluation. There were 121 polydrug ingestions leaving 402 pure CBP ingestions. Ages ranged from 7 mo to 77 yrs, with a mean of 20 yrs; 26% were 6 yrs or less. Females comprised 63% of the patient group. No deaths occurred. Dysrhythmias beyond sinus tachycardia were infrequent, and none were life-threatening. No seizures occurred. Common effects were lethargy, sinus tachycardia, and agitation, and both hypertension and hypotension were seen. All symptomatic cases with a known time of ingestion were symptomatic within 4 h of ingestion. Doses ingested ranged from 5-1000 mg, with a mean of 133 mg. Asymptomatic and symptomatic patients had a mean dose ingested of 45 mg and 183 mg, respectively. Treatment was primarily gastrointestinal (GI) decontamination and supportive care. Other therapies required were mechanical ventilation, dopamine, fluid bolus, sedation, and foley catheter. Symptoms requiring treatment beyond GI decontamination did not occur with ingestions less than 100 mg. In conclusion, cyclobenzaprine does not appear to produce the life-threatening cardiovascular or neurologic effects of the cyclic antidepressants in doses less than 1 g. Lethargy and anticholinergic effects are prominent, though serious toxicity is infrequent.

Adolescent↗
PubMedDate not supplied

Primary care physicians' perceptions of adolescent pregnancy and STD prevention practices in a Nova Scotia county.

INTRODUCTION: This study was carried out to determine the predisposing, enabling, and reinforcing factors related to practice behaviors in the prevention of adolescent pregnancy and sexually transmitted diseases (STDs), and to assess physicians' "ideal" history taking and service provision versus their actual practice in this clinical area. METHODS: Twenty-six of 37 physicians in a single county in Nova Scotia took part in a face-to-face interview. RESULTS: Analysis of predisposing factors found that, for seven of 10 areas related to knowledge of the epidemiology of adolescent pregnancy and STDs, fewer than 50% of male physicians were able to give correct responses. All physicians believed this to be an important area for prevention, and 89% that prevention is possible, but only 62% believed that their own prevention efforts are effective. Respondents were about equally likely to view schools and physicians as having responsibility for prevention of adolescent pregnancy and STDs. Significant enabling factors included high levels of perceived personal comfort and skill, but time factors and opportunities to interact with adolescents sufficiently frequently to carry out prevention were seen as barriers. Most physicians (68%) agreed that the physician fee schedule was a negative reinforcing factor. Male physicians and those in rural practice were significantly more likely to have larger gaps between those preventive practices they saw as desirable and those they actually performed.

Adolescent↗