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Biomedical subjects

M Crouch

Publications and source records attributed to M Crouch.

At least 19 recordsLinked to original sources
PubMed2005

Enhancing patient-based learning: introducing STRAC and the reflective history template.

The University of New South Wales School of Rural Health, Australia, like many other rural clinical schools, relies heavily on patient-based learning which is largely serendipitous. The learning is not driven by courses of lectures but by the patients who become available in a variety of settings. Students, who, in their first 3 years have been exposed to a very structured didactic learning experience, start their rural experience in Year IV with a curriculum mainly concerned with general medicine and surgery. They have to learn to adapt to a largely self-directed model. While their rural clinical experience is very much broader than that of their city-based peers, an excellent feature, it engenders feelings of insecurity and a perceived need for students and faculty to have a method of tracking patient encounters so they can ensure the syllabus is covered. Early attempts with a paper-based system and later a Reflective Learning Diary proved unsuccessful. This article presents Syllabus Tracking (STRAC) together with a Reflective Case History Template which encourages reflective learning from patients encountered. STRAC is a web-based solution that includes a reporting function, and is easily modified to suit the needs of the curriculum. It is believed it may also prove useful for future applications. Most rural clinical schools in Australia are young, as are these tools. They are not formally evaluated but are offered to other schools as a suggestion.

Curriculum↗
PubMed2004

A randomized, controlled trial of tea tree topical preparations versus a standard topical regimen for the clearance of MRSA colonization.

Two topical MRSA eradication regimes were compared in hospital patients: a standard treatment included mupirocin 2% nasal ointment, chlorhexidine gluconate 4% soap, silver sulfadiazine 1% cream versus a tea tree oil regimen, which included tea tree 10% cream, tea tree 5% body wash, both given for five days. One hundred and fourteen patients received standard treatment and 56 (49%) were cleared of MRSA carriage. One hundred and ten received tea tree oil regimen and 46 (41%) were cleared. There was no significant difference between treatment regimens (Fisher's exact test; P = 0.0286). Mupirocin was significantly more effective at clearing nasal carriage (78%) than tea tree cream (47%; P = 0.0001) but tea tree treatment was more effective than chlorhexidine or silver sulfadiazine at clearing superficial skin sites and skin lesions. The tea tree preparations were effective, safe and well tolerated and could be considered in regimens for eradication of MRSA carriage.

Administration, Topical↗
PubMed2001

Differentiation of bipolar CG-4 line oligodendrocytes is associated with regulation of CREB, MAP kinase and PKC signalling pathways.

Undifferentiated bipolar CG-4 cell line oligodendrocytes provide a model system for the O-2A progenitor cell from which oligodendrocytes are derived both in vivo and in vitro. The exchange of neuroblastoma conditioned basal media for basal media causes differentiation of undifferentiated bipolar CG-4 cells into multipolar oligodendrocyte-like cells whilst replacement with basal media containing 20% foetal bovine serum favours the formation of type-2 astrocyte-like cells. Here, we demonstrate that activation of these differentiation pathways correlates with distinct changes both in cell metabolism and in signal transduction. Exchange of neuroblastoma conditioned media for basal media correlates with stimulation of basal metabolic activity, reduced phosphorylation of p44/42 MAP kinase and reduced phosphorylation of the transcription factor CREB. In contrast, differentiation with basal medium containing 20% foetal bovine serum (FBS), into type 2 astrocyte-like cells, correlates with reduction in basal metabolic activity, increased phosphorylation of p44/42 MAP kinase and increased phosphorylation of the transcription factor CREB. Inhibition of protein kinase C blocked both the metabolic and morphological changes associated with differentiation towards mature multipolar oligodendrocyte-like cells. Inhibition of PKA and MEK did not effect metabolic activity. The rapid return of neuroblastoma conditioned basal media to cells treated with basal media, increased phosphorylation of CREB and MAP kinase. These results demonstrate that protein kinase C and p44/42 MAP kinase signalling pathways are modulated during bipolar CG-4 cell differentiation and demonstrate that the transcription factor CREB may play a pivotal role in differentiation along oligodendrocyte-or astrocyte-lineages.

Alkaloids↗
PubMed1998

Frankenstein's nurse! What are schools of nursing creating?

The research presented in this paper examines the socialisation of nursing students under the current educational arrangements and the way in which it creates nurses who assign high status to technological expertise and its manipulation, while regarding many of the traditional, more 'basic', nursing skills as being of low status. Such a professional outlook has serious implications for areas of nursing practice where technology is largely inappropriate and where care of the body dominates practice (such as in aged care). In a longitudinal study which followed student nurses from neophyte to graduand status, results showed that intentions to work in aged care decrease as students progress through their pre-service programs. At the same time, however, these students come to regard areas that require a manipulation of technology, such as is perceived in surgical wards and intensive care, as the 'real' role of nursing. Structures which guide students through the socialisation process, (i.e. the curriculum and teaching staff) were examined regarding their contribution to the establishment and maintenance of this culture. The findings of this study have important implications for the future of quality nursing in areas like aged care--as well as for the future success of nursing in its quest to be regarded as a 'true', autonomous profession.

Cohort Studies↗
PubMed1995

Who cares about care in nursing education?

Many sources indicate that nurses have a negative view of work with ageing patients. Wide-spread stereotypes concerning old age no doubt exercise influences in the formation of nurses' attitudes. The research reported here suggests that nurses' negative attitudes towards the elderly are consolidated rather than dissolved in the course of their training. The reasons for this may not, in fact, lie in the nature of the gerontology components (small as they usually are) of the curriculum. Rather, the course (or the "professional socialisation" process) as a whole appears to carry messages that devalue personal care duties--contra the prestige of activities attached to all levels of medical technology. The ageing patient, often requiring much hands-on (the body) care is thus located well outside areas of work which are perceived by nurses to include clearly focused professional pathways.

Adult↗
PubMed1995

The social life of bonding theory.

'Bonding' as a crucial factor of the early post-partum entered obstetric and paediatric practice after the publication of Maternal and Infant Bonding in 1976 by Klaus and Kennell. The concept has held its place since, as witnessed by medical textbook accounts of it, and the perception of 'instantaneous bonding' as a vital component of the ideal birth experience has dominated media representations of childbirth and, until very recently, feminist writing. Only during the last few years has this literature taken into account research findings concerning the guilt and anxiety experienced by women whose expectations regarding 'bonding' are not realised. While it is now generally acknowledged that maternal attachment develops over an extended period of time, 'bonding' as used extensively in both popular and scientific literature conflates a wide range of meanings and blurs the boundaries between process and outcome. This facilitates the entry of ideological elements into a field which is, by its very nature, deeply significant for human experience. We therefore argue for a continuing critical appraisal of the role of 'bonding' in both general and scientific research.

Anxiety↗
PubMed1994

Cancer of the esophagus in Acadiana.

Cancer of the esophagus is a frequently fatal cancer whose incidence appears to be increasing. In Acadiana, esophageal cancer occurs predominantly in males, with a higher incidence in black males. Results of surgical treatment, with or without other therapy, are dismal. Combined treatment with chemotherapy and radiotherapy improved survival when compared to surgery. Survival benefits with chemotherapy and radiotherapy are, unfortunately, modest at present.

Adenocarcinoma↗
PubMed1986

Personal and mediated health counseling for sustained dietary reduction of hypercholesterolemia.

Methods of effective cardiovascular risk reduction that are suitable for use in clinical settings are needed. Several behavioral interventions were designed to be compatible with office-based medical practice, to be delivered by paraprofessional counselors, and to be of low intensity and low cost. Eighty-three hypercholesterolemic volunteers were assigned to one of three experimental conditions (face-to-face counseling, mail and telephone counseling, initial session only). Twenty-six nonrandomized subjects served as a no-contact group and were followed for 1 year. Participants in the first three groups received risk factor education, behavioral recommendations, and a packet of materials, while those in the face-to-face and mail/telephone counseling groups were contacted for five brief follow-up sessions over a 4-month period. At the 1-year follow-up evaluation, subjects in the face-to-face and mail/telephone counseling conditions showed decreases in plasma cholesterol of 6.2 and 4.6%, respectively (P less than 0.01), while the other two groups evidenced small increases. There were no differences by condition for plasma triglycerides, systolic or diastolic blood pressure, or weight. Low-intensity, low-cost behavioral interventions delivered by paraprofessionals can produce long-term decreases in a major cardiovascular risk factor. Physicians are encouraged to incorporate similar interventions into their practices.

Adult↗
PubMed1981

Deep venous thrombosis and a circulating anticoagulant in systemic lupus erythematosus.

We describe deep venous thrombosis and a circulating anticoagulant in a male adolescent with systemic lupus erythematosus (SLE). The association of deep vein thrombosis with SLE in a pediatric patient has not, to our knowledge, been previously reported. The circulating anticoagulant was characterized as a lupus-type inhibitor. This was demonstrated by an abnormal partial thromboplastin time (PTT), the failure of the PTT to correct with the addition of an equal amount of normal plasma, and a positive tissue thromboplastin inhibitor test. Physicians should be aware that a circulating anticoagulant can be associated with SLE and that there may be a paradoxically increased incidence of thromboembolic phenomena in patients with this abnormality.

Adolescent↗