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Biomedical subjects

M Kingston

Publications and source records attributed to M Kingston.

17 recordsLinked to original sources
PubMed2005

Determining the professional attributes of a hospitalist: experience in one Australian metropolitan hospital.

Data were prospectively recorded on 1294 consecutive patients admitted to a General Medical Unit at the Gold Coast Hospital to review the caseload and pre-requisite professional skills of a general physician working as a full-time hospitalist. Based on this review, the general physician hospitalist must possess expertise in the management of common medical conditions and comorbidities, uncommon medical conditions, elderly patients, the seriously ill, the terminally ill, psychiatric patients, surgical patients and patients with dermatologic, ophthalmic and gynaecological problems. The hospitalist must also be proficient in medical education and organization governance. The demonstration of such skills ensures the 'hospitalist' model is efficient and effective for hospital-based care.

Aged↗
PubMed2004

Antibiotic prescribing policy and Clostridium difficile diarrhoea.

BACKGROUND: Broad-spectrum antibiotics, particularly intravenous cephalosporins, are associated with Clostridium difficile diarrhoea. Diarrhoea due to C. difficile is a growing problem in hospitals, especially among elderly patients. AIM: To establish whether changing an antibiotic policy with the aim of reducing the use of injectable cephalosporins leads to a reduction in the incidence of C. difficile diarrhoea in elderly patients. DESIGN: Retrospective analysis. METHODS: A group of patients who were subject to the new antibiotic policy from the period following July 2000, were compared with patients who were admitted prior to July 2000 and were not subject to the new policy. Infections, antibiotic prescriptions and mortality rates were determined from case notes, and C. difficle diarrhoea rates from microbiological data. RESULTS: Intravenous cephalosporin use fell from 210 to 28 defined daily doses (p < 0.001) following the change in antibiotic policy, with a corresponding increase in piperacillin-tazobactam (p < 0.001) and moxifloxacin (p < 0.001) use. The new policy led to a significant reduction in C. difficile diarrhoea cases. The relative risk of developing C. difficile infection with the old policy compared to the new policy was 3.24 (95%CI 1.07-9.84, p = 0.03). DISCUSSION: The antibiotic policy was successfully introduced into an elderly care service. It reduced both intravenous cephalosporin use and C. difficile diarrhoea.

Aged↗
PubMed2003

Temporal sensitivity of bovine embryos to culture environment after fertilization and the implications for blastocyst quality.

The aim of this study was to examine the temporal sensitivity of bovine embryos to culture environment after fertilization to determine which period, if any, is most critical in determining blastocyst quality. Bovine zygotes produced in vitro were divided into six groups and cultured either in vitro (in synthetic oviductal fluid, SOF), in vivo (in the ewe oviduct) or in a combination of both systems. Development to the blastocyst stage, the ability of the blastocysts to withstand cryopreservation and the relative abundance of several gene transcripts were examined. Culture in SOF for either 2 or 4 days, followed by subsequent culture in the ewe oviduct, resulted in a significantly lower yield of blastocysts than did all other methods, the effect being most marked in embryos that were cultured in SOF for 4 days. In contrast, culture in vivo for the first 2 or 4 days after fertilization followed by culture in vitro did not have such a marked effect on blastocyst development. Blastocysts produced after culture in the oviduct for 6 days had the highest rates of survival over 72 h after warming (100% survival at 24 h; >95% survival at 72 h). The embryos that spent the last 4 days of culture in vivo also had relatively high rates of survival (100% at 24 h, 73.7% at 72 h). Blastocysts produced entirely in SOF had very low rates of survival after vitrification, with <40% viable at 24 h and <20% survival at 72 h. Blastocysts derived from embryos that spent the first 2 days in vivo and the last 4 days in vitro had the lowest rates of survival (6.7%), whereas those that spent the last 2 days only in SOF had intermediate rates of survival (40.6%). These differences were reflected in the relative abundance of transcripts for the Bax gene.

Animals↗
PubMed2001

Tropical warts.

Explore the source record for details and available documents.

Adult↗
PubMed1998

The use of clinical measures in the Lidcombe Programme for children who stutter.

This paper aims to demonstrate how the speech measures which are collected to inform the therapy process also have the potential to evaluate clinical change and effectiveness. Certain methodological issues pertinent to evaluating therapy for early stuttering are raised and the clinical measures that are a part of the Lidcombe Programme (Onslow 1993) are discussed in relation to these. Reference to a single case study is made to demonstrate how the measures contribute to clinical decision-making. Some initial results of the authors' use of the Lidocombe Programme in the UK is outlined.

Child↗
PubMed1986

The antidiabetic activity of aloes: preliminary clinical and experimental observations.

The dried sap of the aloe plant (aloes) is one of several traditional remedies used for diabetes in the Arabian peninsula. Its ability to lower the blood glucose was studied in 5 patients with non-insulin-dependent diabetes and in Swiss albino mice made diabetic using alloxan. During the ingestion of aloes, half a teaspoonful daily for 4-14 weeks, the fasting serum glucose level fell in every patient from a mean of 273 +/- 25 (SE) to 151 +/- 23 mg/dl (p less than 0.05) with no change in body weight. In normal mice, both glibenclamide (10 mg/kg twice daily) and aloes (500 mg/kg twice daily) induced hypoglycaemia after 5 days, 71 +/- 6.2 and 91 +/- 7.6 mg/dl, respectively, versus 130 +/- 7 mg/dl in control animals (p less than 0.01); only glibenclamide was effective after 3 days. In the diabetic mice, fasting plasma glucose was significantly reduced by glibenclamide and aloes after 3 days. Thereafter only aloes was effective and by day 7 the plasma glucose was 394 +/- 22.0 versus 646 +/- 35.9 mg/dl, in the controls and 726 +/- 30.9 mg/dl in the glibenclamide treated group (p less than 0.01). We conclude that aloes contains a hypoglycaemic agent which lowers the blood glucose by as yet unknown mechanisms.

Aloe↗
PubMed1985

Hepatic tumors in Saudi Arabia. A practical approach to diagnosis.

All cases of liver tumor referred to the King Faisal Specialist Hospital and Research Centre in Saudi Arabia during 2.5 years were reviewed. Hepatocellular carcinoma, 104 cases, was considerably more common than metastatic carcinoma with unknown primary, 15 cases. Lymphoma presenting as liver tumor occurred in three cases and there were no cases of cholangiocarcinoma. There were only two cases of benign tumor, both hemangioma. Hepatocellular carcinoma was characterized by a male predominance of 6:1, positive hepatitis B surface antigen in 60%, presentation with an enlarged, hard liver in over 90%, a systolic-diastolic bruit over the mass in 45%, a single highly echogenic lesion in the right lobe on ultrasound in 80%, and rapid progression. The serum AST (aspartate aminotransferase, serumglutamic oxalacetic transaminase [SGOT]) was abnormal in 97% and was higher than the alanine aminotransferase (ALT) in 93% of cases compared with 17% in 100 consecutive cases of chronic active hepatitis. Sixty-six percent of patients with hepatocellular carcinoma had serum AFP greater than 200 ng/ml. Excluding five cases of germ cell tumor (none involving the liver), and pregnant patients, serum AFP was less than 200 ng/ml in all other patients in whom it was measured between 1979 and 1981. A practical approach to the diagnosis of hepatocellular carcinoma is outlined. Biopsy does not appear to be indicated in many cases of advanced hepatocellular carcinoma.

Alanine Transaminase↗
PubMed1985

Treatment of severe hypophosphatemia.

A 4-h infusion of 310 to 465 mg (10 to 15 mMol) phosphorus given to 28 of 31 consecutive seriously ill hypophosphatemic patients increased the serum phosphorus level above 1.2 mg/dl in all but one patient. There was no significant change in the mean serum calcium, potassium or blood pressure, no patient deteriorated, and six patients were stronger and more alert after the infusion. In seriously ill patients we recommend a 4-h infusion of 15 mg/kg (0.5 mMol/kg) phosphorus if the serum phosphorus is less than 0.5 mg/dl, or a 7.7-mg/kg (0.25 mMol/kg) infusion if the serum phosphorus is between 0.5 and 1.0 mg/dl.

Adult↗
PubMedDate not supplied

The pattern of plasma sodium abnormalities in an acute elderly care ward: a cross-sectional study.

INTRODUCTION: The combination of ageing, illness, and medications can lead to hyponatraemia or hypernatraemia. AIMS: To describe the distribution of plasma sodium levels in older patients admitted to hospital. METHODS: We carried out a hospital based cross-sectional study examining 1,511 serum sodium concentrations ([Na+]) among 336 elderly patients and attempted to elucidate the cause(s) of the abnormal serum [Na+]. RESULTS: The study population had a mean age of 81.4. Ninety-two (27.4%) patients had hyponatraemia and seven patients (2.1%) had hypernatraemia during their hospitalisation. The distribution of [Na+] results was towards the lower end of the normal range. The mortality rate of patients with hyponatraemia was 14.1% and that of patients with normal serum [Na+] was 8.9%. Six patients with hypernatraemia died in hospital. Lower respiratory tract infection and medication accounted for the majority of cases. CONCLUSIONS: Deranged [Na+] is common among elderly patients admitted to hospital.

Acute Disease↗