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Biomedical subjects

M Grant

Publications and source records attributed to M Grant.

At least 145 records · Page 8Linked to original sources
PubMed1991

Iliad training enhances medical students' diagnostic skills.

Iliad is a computerized, expert system for internal medical diagnosis. The system is designed to teach diagnostic skills by means of simulated patient case presentations. We report the results of a controlled trial in which junior students were randomly assigned to received Iliad training on one of two different simulated case mixes. Each group was subsequently tested in both their "trained" and "untrained" case domain. The testing consisted of computerized, simulated patient cases for which no training feedback was provided. Outcome variables were designed to measure the students' performance on these test cases. The results indicate that students made fewer diagnostic errors and more conclusively confirmed their diagnostic hypotheses when they were tested in their trained domain. We conclude that expert systems such as Iliad can effectively teach diagnostic skills by supplementing trainees' actual case experience with computerized simulations.

Clinical Clerkship↗
PubMed1991

The experience of pain and perceptions of quality of life: validation of a conceptual model.

Pain is a common symptom of terminally ill cancer patients and a major challenge for hospice care. This paper presents a conceptual model of the relationship between pain and quality of life that was derived from the authors' previous research. The model should prove useful to hospice clinicians and researchers in evaluating the impact of palliative care on the quality of life.

Evaluation Studies as Topic↗
PubMed1991

A six country survey of the content and structure of heroin treatment programmes using methadone.

The use of methadone in the treatment of drug dependence has provoked a good deal of controversy. However, it is clear that there is considerable variation between methadone treatment programmes and relatively little detail is available about the organization and operation of these programmes. This World Health Organization survey examines the content and structure of methadone treatment programmes, and particularly methadone maintenance programmes, in six countries. The six countries were Australia, Canada, France, the Netherlands, Thailand and the UK. The report presents information about the extent of national problems and about such issues as type of dispensing practices, dose- and time-limits for prescribing methadone, programme entry criteria, staffing, integration with other services, and urine testing. Developments and trends during the decade 1980-1990 are discussed and implications for further research and programme development are presented.

Cross-Cultural Comparison↗
PubMed1991

Brief exercise induces an immediate and a delayed leucocytosis.

Haematological profiles were measured: (1) before and for 5 h 30 min after 30 min sports (squash, swimming, jogging); and (2) before, during and for 2 h 30 min after 30 min cycle ergometry at workloads which required rates of oxygen consumption that were between 48% and 84% of maximal. In both instances exercise induced an immediate leucocytosis (owing to rises in both neutrophils and lymphocytes) which subsided rapidly at the finish of exercise and was followed by a delayed neutrophilia of greater magnitude which peaked at approximately 3 h after the start of exercise. Changes in plasma catecholamines and cortisol recorded during and after exercise (cycle ergometry only) support the hypothesis that the immediate leucocytosis during brief exercise is attributable to elevated catecholamine levels, whereas the delayed neutrophilia is due to raised cortisol levels.

Adult↗
PubMed1991

Family factors influencing cancer pain management.

The purpose of this study was to describe family factors which influence cancer pain. Previous research has focused on the patients' and professional caregivers' perspective of pain. Cancer pain is an intense burden on the entire family as well as on the patient. Findings of the study demonstrate family perceptions of pain, caregiver burden associated with pain, caregiver moods and differences in caregiver experiences of pain between three sites of care including a hospice, a community hospital and a cancer centre. Understanding the perspective of the family caregivers and their role in pain management can assist health care providers in management of the patient's pain.

Adult↗
PubMed1991

Clinical decision making and pain.

Pain management is intimately linked to decision making. Nurses play a key role in making decisions regarding pain and its management. This paper presents data from a preliminary study (N = 53) extending the investigators' pain research into the areas of clinical decision making and ethical dilemmas related to pain management. Nurses completed surveys focused on actual experiences of caring for patients in pain. The results identify common clinical decisions related to pain, barriers to providing optimum pain relief, and ethical/professional conflicts in pain management. Decisions related to the amount of pain intensity, when to give medications, and choice of analgesics. Nurses identified verbal and nonverbal cues central to their decisions regarding pain assessment. Barriers to effective pain management included physician knowledge and cooperation, patient/family knowledge and cooperation, as well as nursing knowledge and time. Respondents identified ethical dilemmas about overmedication or undermedication, conflicts with physicians or patients, and concern over opioid side effects. A tentative model of decision making related to pain is presented.

Adult↗
PubMed1991

A cross-cultural pilot study on alcohol education and young people.

Alcohol use has become normative for adolescents in most developed and developing countries, with serious health implications. In response to this problem, the World Health Organization convened a group of investigators in 1985 from centres in four countries--Australia, Chile, Norway and Swaziland--to participate in a pilot study on the efficacy of the social influences approach in school-based alcohol education. The goal of the educational programme was to delay onset and minimize involvement of alcohol use among 13-14 year-old adolescents. 25 schools in the 4 countries, representing middle- and lower-class populations, were randomly assigned to peer-led education, teacher-led education or a control condition. The programme focused on the social and environmental influences to drink alcohol, and skills to resist those influences. It consisted of 5 lessons over 2 months. Baseline and post-test data measured alcohol-use knowledge, attitudes, skills and friends' drinking patterns. Data were collected immediately prior to and 2 months following the educational programme. The data converge on the finding that peer-led education appears to be efficacious in reducing alcohol use across a variety of settings and cultures.

Adolescent↗
PubMed1990

Assessment of quality of life with a single instrument.

A number of single measures of quality of life have been developed over the last few years. Some of these instruments have been used more frequently than others. Psychometric properties are reported in many of these instruments, and continued psychometric development is needed. Instruments differ in the content tested, and users are encouraged to have specific objectives in mind when selecting an instrument. The continued research interest and activity in the field of single measures has provided beginning tools for both research and clinical evaluations. Quality of life measures add to the depth of evaluation of the impact on cancer and cancer treatment, and provide a measurement dimension that augments that of the historic evaluation via morbidity and mortality statistics. Continued work on single measures for quality of life will provide both researchers and clinicians with valuable tools.

Humans↗
PubMed1990

Use of a HpaII-polymerase chain reaction assay to study DNA methylation in the Pgk-1 CpG island of mouse embryos at the time of X-chromosome inactivation.

A HpaII-PCR assay was used to study DNA methylation in individual mouse embryos. It was found that HpaII site H-7 in the CpG island of the X-chromosome-linked Pgk-1 gene is less than or equal to 10% methylated in oocytes and male embryos but becomes 40% methylated in female embryos at 6.5 days; about the time of X-chromosome inactivation of the inner cell mass.

Animals↗
PubMed1990

Prostacyclin analogue iloprost decreases thrombolytic potential of tissue-type plasminogen activator in canine coronary thrombosis.

Platelets play an important role in the formation of a coronary thrombus and reocclusion after thrombolysis. Therefore, we examined the thrombolytic potential of concomitant intravenous administration of potent platelet inhibitor iloprost, a prostacyclin analogue, with tissue-type plasminogen activator (t-PA; n = 8) and t-PA alone (n = 9) in dogs with an electrically induced occlusive coronary artery thrombus. t-PA (0.75 mg/kg) was given over 20 minutes, and iloprost (4 micrograms/kg) was given over 40 minutes. Reperfusion rate was 63% (five of eight dogs) in the t-PA plus iloprost group and 67% (six of nine dogs) in the t-PA alone group (p = NS). The time to thrombolysis (or reperfusion) in the t-PA plus iloprost group was almost twice as great as in the t-PA alone group (33.0 +/- 13.3 vs. 18.5 +/- 6.7 minutes, mean +/- SD, p less than 0.02), and the duration of reperfusion was much shorter (3.4 +/- 1.8 vs. 39.3 +/- 17.4 minutes, p less than 0.005). Peak coronary artery blood flow after reperfusion in the t-PA plus iloprost group was also less (20 +/- 17 ml/min) than in the t-PA alone group (58 +/- 21 ml/min, p less than 0.005). Reocclusion occurred in all dogs given t-PA with iloprost despite potent synergistic platelet inhibitory effects of t-PA and iloprost, whereas four of six dogs given t-PA alone reoccluded. Neither regimen exerted a significant beneficial effect on regional myocardial shortening during coronary reperfusion. Plasma levels of t-PA were lower when iloprost was given with t-PA (1,022 +/- 360 vs. 1,459 +/- 270 ng/ml in t-PA alone group, p less than 0.05). The detrimental effects of iloprost identified in this study may relate to the reduction in plasma t-PA concentrations by its degradation in the liver caused by the prostacyclin analogue iloprost.

Animals↗
PubMed1990

Preferential X-chromosome inactivation, DNA methylation and imprinting.

Non-random X-chromosome inactivation in mammals was one of the first observed examples of differential expression dependent on the gamete of origin of the genetic material. The paternally-inherited X chromosome is preferentially inactive in all cells of female marsupials and in the extra-embryonic tissues of developing female rodents. Some form of parental imprinting during male and female gametogenesis must provide a recognition signal that determines the nonrandomness of X-inactivation but its nature is thus far unknown. In the mouse, the imprint distinguishing the X chromosomes in the extra-embryonic tissues must be erased early in development since X-inactivation is random in the embryonic cells. Random X-chromosome inactivation leads to cellular mosaicism in expression and differential methylation of active and inactive X-linked genes. Transgene imprinting shares many features with X-inactivation, including differential DNA methylation. In this paper we consider when methylation differences in early development affecting X-chromosome activity and imprinting are established. There are processes of methylation and demethylation occurring in early development, as well as changes in the activity of the DNA methylase itself. Methylation of a specific CpG site associated with activity of the X-linked PGK-1 gene has been studied. This site is already methylated on the inactive X chromosome by 6.5 days' gestation, close to the time of X-inactivation. However, differential methylation of this site is not the primary imprint marking the paternal X chromosome for preferential inactivation in the extra-embryonic membranes.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗