Counselling in general practice.
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Counseling↗
Biomedical subjects
P S McDonald
Publications and source records attributed to P S McDonald.
The heartsink patient: a preliminary study.
Eight GPs identified 78 heartsink patients; in an open-ended interview they were asked to explain why they regarded them in this way. A GP's definition of a heartsink patient was influenced by GP sex, practice location, and time of surgery, although the number of participating GPs was too low to make any definite assertions. Practitioners' anticipations of heartsink consultations were generally over-exaggerated, with most of the encounters going better than expected. GPs expressed the view that these patients raised serious professional issues for them, whilst there was also a dislike for these patients' personalities and behaviour. Two levels of the heartsink state are hypothesized: one, a state of inertia, is when the heartsink patient has been a chronic high user of the primary health care system, and a GP has exhausted all avenues. The other is an acute situation with those heartsink patients who have been low users of the system in the past. Recent, new events in these patients' lives have raised an issue that is just as much to do with patient and doctor reaction to these events, as it is about finding a diagnosis or solution to the problem. We present the results and hypotheses to provoke further discussion and research.
Adult↗
Retinol and retinol-binding protein in lung cancer screening.
Human epidemiology studies demonstrate an inverse correlation between serum levels of vitamin A and the incidence of lung cancer. While such studies suggest that vitamin A may have a role in cancer prevention, the intent of this study was to investigate the use of vitamin A status parameters as markers for detection of occult lung cancer. In the first of two phases of this study, we established criteria for a prospective screening study. Serum levels of retinol-binding protein (RBP), zinc, retinol, and beta-carotene in lung cancer patients were compared to levels in controls. For the second phase, a prospective screening study, 100 ambulatory male cigarette smokers over the age of 45 were enrolled. Subjects were excluded if they had a known diagnosis of cancer, recent weight loss, or serum albumin less than 3.5 g/dl. Subjects with RBP less than 4.2 mg/dl and retinol less than 42 micrograms/dl were classified as high-risk; those remaining were classified as controls. A chest X-ray (CXR) was obtained on all 17 high-risk subjects and on 26 of the 83 controls. CXR was read and follow-up was performed by physicians without knowledge of this study. Lung cancer was detected in 24% (4/17) of the high-risk subset, and 4% (1/26) of the controls. These data suggest that retinol and RBP may be useful in lung cancer screening for selecting a high-risk population that warrants further examination.
Biomarkers, Tumor↗
Colonic impaction in guinea pigs fed a chemically defined diet: a case report.
Pathogen-free female Hartley guinea pigs were divided into four diet groups to determine optimal nitrogen requirements for growth, pregnancy and lactation. Three chemically defined test diets varying in total nitrogen were compared with commercial guinea pig feed. Within 13 days, 24 of 78 animals from the three test diet groups died or required euthanasia. Affected guinea pigs were depressed, lost weight and had distended abdomens. Distension, impaction and, in most cases, rupture of the spiral of the ascending colon and subsequent peritonitis were observed at necropsy. Husbandry changes which resulted in a decreased incidence of impactions included increased acclimatization time on commercial feed post-shipping, decreased animal density per cage and cessation of water medication with oxytetracycline.
Animal Feed↗
Saying "no" assertively.
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Assertiveness↗
Monoclonal gammopathy of the immunoglobulin A class in a two-year-old girl with ataxia telangiectasia.
Ataxia telangiectasia is an autosomal recessive neurologic disorder which is frequently associated with a deficiency of IgA immunoglobulin. We report an unusual case of monoclonal gammopathy of the IgA kappa type in a 2-year-old female patient newly diagnosed with ataxia telangiectasia. Quantitative analysis of the patient's immunoglobulins revealed a marked elevation in the IgA fraction with a value of 672 mg/dL (normal 14-123 mg/dL). The IgG and IgM fractions were normal. Serum protein electrophoresis showed a band of restricted mobility present in the gamma region, which was identified as a monoclonal IgA kappa immunoglobulin on immunofixation electrophoresis. This is the first case report of a patient with ataxia telangiectasia associated with an IgA monoclonal gammopathy.
Ataxia Telangiectasia↗