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Biomedical subjects

P Richards

Publications and source records attributed to P Richards.

At least 73 records · Page 4Linked to original sources
PubMed1989

Prospective study of the disadvantage of people from ethnic minority groups applying to medical schools in the United Kingdom.

To assess whether the ethnic origin of applicants affects their likelihood of being accepted into medical school in the United Kingdom the outcome for the 2399 applicants who applied to read medicine at university in 1986 and included St Mary's Hospital Medical School as one of their five choices was studied prospectively. Altogether 2040 of the 2399 applicants were British (United Kingdom) nationals, constituting 24.7% (n = 8249) of all home applicants for medicine in 1986, and 1971 of them with postal addresses in the United Kingdom were sent questionnaires asking about their ethnic origin, whether English was their first language, and about their attitudes to ethnic monitoring. A total of 1817 (92.2%) applicants returned the questionnaire, 401 (22.6%) saying that they were from an ethnic minority group and 393 (21.6%) having non-European surnames. Multiple logistic regression identified 11 significant predictors of successful application, of which grades at O and A level, application after A levels, and date of application were the most important. After taking these four variables into account the predicted acceptance rates for home students on the basis of their application forms alone were 47.8% for white applicants and 35.6% for applicants from ethnic minority groups compared with actual acceptance rates of 49.6% and 27.3%, respectively. The difference in success of white and non-white applicants could partly but not entirely be explained by differences in the characteristics considered to be important in a professional context by selectors during shortlisting of candidates: academic ability, interests, and contribution to the community. No differences in the success rate of applicants from ethnic minority groups to individual medical schools could be identified. More research is needed to discover how perceptions of professional suitability are assessed from application forms and interviews.

Educational Measurement↗
PubMed1989

Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial.

OBJECTIVE: To determine the efficacy of oral nimodipine in reducing cerebral infarction and poor outcomes (death and severe disability) after subarachnoid haemorrhage. DESIGN: Double blind, placebo controlled, randomised trial with three months of follow up and intention to treat analysis. To have an 80% chance with a significance level of 0.05 of detecting a 50% reduction in an incidence of cerebral infarction of 15% a minimum of 540 patients was required. SETTING: Four regional neurosurgical units in the United Kingdom. PATIENTS: In all 554 patients were recruited between June 1985 and September 1987 out of a population of 1115 patients admitted with subarachnoid haemorrhage proved by the results of lumbar puncture or computed tomography, or both. The main exclusion criterion was admission to the neurosurgical units more than 96 hours after subarachnoid haemorrhage. There were four breaks of code and no exclusions after entry. One patient was withdrawn and in 130 treatment was discontinued early. All patients were followed up for three months and were included in the analysis, except the patient who had been withdrawn. INTERVENTIONS: Placebo or nimodipine 60 mg was given orally every four hours for 21 days to 276 and 278 patients, respectively. Treatment was started within 96 hours after subarachnoid haemorrhage. END POINTS: Incidence of cerebral infarction and ischaemic neurological deficits and outcome three months after entry. MEASUREMENTS: Demographic and clinical data, including age, sex, history of hypertension and subarachnoid haemorrhage, severity of haemorrhage according to an adaptation of the Glasgow coma scale, number and site of aneurysms on angiography, and initial findings on computed tomography were measured at entry. Deterioration, defined as development of a focal sign or fall of more than one point on the Glasgow coma scale for more than six hours, was investigated by using clinical criteria and by computed tomography, by lumbar puncture, or at necropsy when appropriate. All episodes of deterioration and all patients with a three month outcome other than a good recovery were assessed by a review committee. MAIN RESULTS: Demographic and clinical data at entry were similar in the two groups. In patients given nimodipine the incidence of cerebral infarction was 22% (61/278) compared with 33% (92/276) in those given placebo, a significant reduction of 34% (95% confidence interval 13 to 50%). Poor outcomes were also significantly reduced by 40% (95% confidence interval 20 to 55%) with nimodipine (20% (55/278) in patients given nimodipine v 33% (91/278) in those given placebo). CONCLUSIONS: Oral nimodipine 60 mg four hourly is well tolerated and reduces cerebral infarction snd improves outcome after subarachnoid haemorrhage.

Administration, Oral↗
PubMed1989

Synthesis and biological properties of the lipophilic technetium-99m complex 99mTc(acac)3.

In the development of technetium-99m radiopharmaceuticals for the evaluation of regional cerebral perfusion, one series of complexes that has remained unexplored is the neutral lipophilic tris complexes formed with beta-diketonato ligands. The prototype complex of this series, tris(2,4-pentanedionato) technetium(III), has been prepared via a new synthetic route and chemically characterized using 99Tc and the biodistribution of the no-carrier-added 99mTc complex has been determined. The 99mTc complex was found to be distributed throughout the body with persistent high blood levels indicative of a high degree of protein binding. The primary route of excretion was the hepatobiliary system as indicated by the appearance of 99mTc in the gut and feces at longer sample times post-injection. Although this complex was not retained by the brain, it does provide a starting point from which a more effective agent might be developed.

Animals↗
PubMed1989

Short-listing of applicants from UCCA forms: the structure of pre-selection judgements.

Applicants for admission to St Mary's Hospital Medical School in 1986 were short-listed for interview by one of four assessors, who each made their assessments on a nine-item pro forma. One short-lister had also been studied in detail during 1981. Short-listers used the full range of possible judgements, in approximately the proportions requested. Only minor differences were found between them in the mean and range of their judgements, suggesting that similarity of standards can be maintained while using a number of separate short-listers. A confirmatory factor analysis of individual short-listers' judgements showed that all were extracting three separate factors, named 'Academic ability', 'Interests' and 'Contribution to community', although the less experienced short-listers differentiated these items less well than the more experienced. The short-lister assessed in 1981 and 1986 had retained an almost identical factor structure over the 5-year period.

Educational Measurement↗
PubMed1989

Reliability of short-listing in medical student selection.

One in eight Universities Central Council on Admissions (UCCA) applications for admission to St Mary's Hospital Medical School in 1986 were in due course recirculated to the four short-listers, being seen again either by the same short-lister or by another short-lister. Intrarater reliabilities were high, not only for measures of educational achievement, but also for the more subjective assessments. Interrater reliabilities were more variable, being very high for educational achievement, but rather lower for the more subjective items, and being lowest for the assessment of 'Interests', suggesting divergence between short-listers' perceptions of the terms. Nevertheless, all reliabilities were sufficiently high to justify the continued use of these criteria during selection.

Educational Measurement↗
PubMed1988

Reliability of interviewing in medical student selection.

Six interviewing panels which had assessed candidates for places at a medical school in 1984 were reconvened in 1987 to assess videotapes of the interviews conducted by themselves and by other panels. Overall recommendations made by panels showed excellent reliability within panels and high reliability between panels.

Educational Measurement↗
PubMed1988

The clinical significance of elevated CSF and plasma histamine in cerebral aneurysm surgery utilizing cardiopulmonary bypass with total circulatory arrest.

Recently there has been a renewed interest in the neurosurgical treatment of large cerebral aneurysms and AV malformations utilising cardiopulmonary bypass (CPB) and total circulatory arrest (TCA). However, the differing tolerance limits of coagulation and bleeding, pH control and fluid constraint are difficult to reconcile. Although clinical assessment, electro encephalogram (EEG) and intracranial pressure-monitoring assist in identification of cerebral damage, CPB and TCA inflict their own penalties with resultant uncertainty in post-operative neurological evaluation, and producing difficulties in interpretation and management. Additionally, an unanswered question is, to what extent the known cardiac and cerebral effects of circulating histamine might influence the post-circulatory arrest recovery in these patients, and whether this would further compromise the neurological result. We report our experience of 9 such cases who underwent this procedure, and were able to achieve a satisfactory neurological result in 7 patients with differing lesions. During the operation both CSF (from the open cranium) and blood (from the right internal jugular vein) were sampled at intervals for subsequent plasma histamine estimation. Despite markedly elevated histamine levels during CPB and TCA, this was not associated with an unfavourable neurological outcome. These early findings have given us encouragement to the useful role of CPB and TCA in these complex neurosurgical presentations, and raise interesting questions about the clinical importance of histamine-evoked cerebral ischaemia that has been demonstrated in experimental models.

Adult↗
PubMed1987

Choice and ordering of medical school applications: cause for concern.

The probability of admission to medical school in the UK can be predicted from the choices of schools and their order on the UCCA form, even after academic factors have been taken into account. The effect may of itself influence a candidate's chance of admission by a factor of about four times. This situation justifies the recurrent complaints of applicants about the problems of medical school choice and ordering. The disadvantage imposed on many applicants would be reduced if rank ordering of choices was replaced by alphabetical ordering.

Educational Measurement↗
PubMed1987

Hemispherectomy for childhood epilepsy: a 36-year study.

Between 1950 and the present day 17 patients who had been treated for hemiplegic epilepsy by hemispherectomy were followed up. The outcomes of surgery in terms of survival, arrest of dementia, relief from gross disorders of behaviour and from habitual epilepsy were uniformly good. It is concluded that hemispherectomy has an enduring rôle in the treatment of hemiplegic epilepsy for patients who are carefully selected, prepared and postoperatively rehabilitated.

Brain↗
PubMed1987

AIDS and the neurosurgeon.

AIDS is a fatal viral infection transmitted by body fluids, primarily blood, which is becoming more common in the U.K., and if the gloomiest predictions are true will affect millions in the next decade. Most, if not all, of these patients will at stage develop neurological manifestations: therefore the neurosurgeon will find it difficult to avoid close contact with the syndrome. As the presentation may mimic a number of neurological conditions, or patients with AIDS may suffer head injury, subarachnoid haemorrhage, or other common conditions, it is probably wise to assume all patients have AIDS and to modify operating technique and other procedures where blood may be spilt to minimise the risks of acquiring the infection.

AIDS Dementia Complex↗
PubMed1986

Prospective survey of performance of medical students during preclinical years.

The performance during the preclinical course of 517 students who had applied to this medical school for admission in 1981 and who had been accepted by the school or by another British medical school was analysed in relation to variables measured at the time of application to find factors that predicted success in the preclinical course, whether students chose to take an intercalated degree, and the class achieved in the intercalated degree. Thirty one of the 507 students who entered medical school withdrew from the course or failed their examinations; these students were particularly likely not to have an A level in a biological science. O level grades were of minimal predictive value for performance during the preclinical course. A level grades discriminated between successful and unsuccessful students but had too low a specificity or sensitivity to be of use in individual prediction. Mature entrants performed better overall than school leavers. Background variables accounted for only 14.2% of the variance in performance, implying that motivation and personality may be more important in determining performance. The 80 students who chose to take an intercalated degree were more likely to be men and not to be mature entrants; for a further 50 students intercalated degrees were obligatory. Performance in the intercalated degree related to performance during the preclinical course and to assessments made at the selection interview but not to achievement at O or A level.

Achievement↗
PubMed1986

Return migration from Australia: a case study.

"The study investigates the departure from Australia of former settlers who arrived during the 1980 calendar year. The 1980 settler arrival cohort [consists] of 75,167 visaed migrants.... The study has three main aims: (i) to analyse departures from Australia of the 1980 settler arrival cohort with a view to gauging the success of Australia's immigration program in retaining settlers; (ii) to examine the retention rates of settlers with respect to characteristics...including age, sex, marital status, country of last residence, and settler eligibility category; and (iii) to consider implications of the findings." Australia's present immigration policy is discussed, previous research on return migration from Australia is summarized, and a detailed analysis of the departure data is presented. "This study found that by August 1984, 12.4 per cent of non-refugee settlers who arrived in Australia during 1980 had departed permanently but that only 0.6 per cent of the 1980 refugee cohort had done so." These figures represent a decline in immigrant departure rates since the 1960s and early 1970s. Small differences in departure rates by place of birth, age, and marital status, which may have demographic consequences if sustained over time, are noted. (SUMMARY IN FRE AND SPA)

Age Factors↗