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Biomedical subjects

R Charlton

Publications and source records attributed to R Charlton.

At least 19 recordsLinked to original sources
PubMed1998

The diagnosis and initial treatment of asthma in young children in New Zealand and the United Kingdom.

AIMS: To conduct a pilot study to test methodology in ascertaining if there are differences between New Zealand and the UK in the symptom and circumstance set that influences a general practitioner in the initial diagnosis of asthma, and to ascertain the treatment prescribed at the time that the diagnosis is made. METHODS: Questionnaires were mailed to 110 general practitioners in each country. General practitioners from the Otago region in New Zealand and from the Nottingham region in Britain were contacted. A follow-up reminder was sent to all non-responders three weeks after the initial mail out. Questions were asked about the symptoms and signs that were considered important, as well as other influences (e.g., passive smoking) when making a diagnosis of asthma in a child under the age of five years. The doctors were also asked what treatment they prescribed at the time of the actual diagnosis of asthma. RESULTS: British doctors considered night cough (p = 0.05) and cough associated with emotion (p = 0.004) more diagnostic of asthma. New Zealand doctors rated cough associated with temperature change (p = 0.05) as being important and they had a lower threshold in diagnosing asthma with respect to history of similar attacks (p = 0.008) compared to their British counterparts. More New Zealand doctors reported using prophylactic/anti-inflammatory agents as first line therapy (59% vs 28%; p = 0.002). CONCLUSIONS: We conclude that there are only minor differences in general practitioners' diagnostic criteria for asthma in the two countries with reference to this small sample. We believe, however, that differing diagnostic criteria could account for different reported incidences of childhood asthma in some countries. There is need for internationally accepted diagnostic criteria.

Asthma↗
PubMed1998

Meningococcal disease. Is early diagnosis possible?

Meningococcal disease is a public health problem because of its high mortality and is one disease that many GPs have not seen. Case reports illustrate that presentation is rarely classic 'meningitis' and further research is required to enable earlier detection.

Child↗
PubMed1997

Nine novel L1 CAM mutations in families with X-linked hydrocephalus.

Mutations in the gene for neural cell adhesion molecule L1 are responsible for the highly variable phenotype found in families with X-linked hydrocephalus, MASA syndrome, and spastic paraplegia type I. To date, 32 different mutations have been observed, the majority being unique to individual families. Here, we report nine novel mutations in L1 in 10 X-linked hydrocephalus families. Four mutations truncate the L1 protein and eliminate cell surface expression, and two would produce abnormal L1 through alteration of RNA processing. A further two of these mutations are small in-frame deletions that have occurred through a mechanism involving tandem repeated sequences. Together with a single missense mutation, these latter examples contribute to the growing number of existing mutations that affect short regions of the L1 protein that may have particular functional significance.

Amino Acid Sequence↗
PubMed1997

Altered monocyte calcium dynamics in sepsis.

PURPOSE: This study was designed to evaluate monocyte calcium concentration and mobilization in normal and septic surgical patients. METHODS: Monocytes were isolated from 15 "septic" surgical patients, washed, and loaded with the fluorescent calcium chelator, FURA-2. Monocytes from 20 normal volunteers served as controls. Intracellular calcium concentration ([Ca2+]i) was measured by means of fluorescent spectrophotometry before, during, and after stimulation with concanavalin A. Differences were evaluated for statistical significance by analysis of variance. The study was repeated using normal monocytes preincubated in "septic" serum and "septic" monocytes preincubated in normal serum. Additional paired whole blood specimens were obtained from the control group and were incubated with Escherichia coli endotoxin. Monocytes were then isolated and evaluated as described. RESULTS: Sepsis was associated with significantly low resting monocyte calcium concentrations. Although concanavalin A stimulation resulted in marked calcium mobilization in both normal and septic cells, final cellular calcium concentration was significantly lower in the stimulated "septic" monocytes. Similar alterations were seen in normal cells incubated with septic serum, but could not be reproduced by incubation with endotoxin. This deficiency could not be corrected in septic cells incubated in normal serum. CONCLUSION: Sepsis is associated with a significant alteration of monocyte calcium dynamics in both resting and stimulated cells. These changes appear to be modulated by a serum factor other than endotoxin.

Adult↗
PubMed1996

Medical education--addressing the needs of the dying child.

This paper reviews the formulation of attitudes, the acquisition of knowledge and the development of skills which together enable medical practitioners to provide comprehensive palliative care for terminally ill children. Ideally, these should be developed to such an extent that a 'good death' can be achieved. Current medical education does not address these areas and the associated issues, including the breaking of bad news, understanding the grief reaction to serious illness and children's perceptions of death. Neither does training include how to take management decisions concerning informed consent, the transition from active treatment to palliative care, symptom control and choosing the place for care. These, and the unintentional attitude that regards the dying child as a 'medical failure', are discussed, together with the need to meet the needs of the parents and siblings, and the effects of bereavement. Finally, recommendations are made for undergraduate curricula and the need to emphasize the relationship of caring for the family unit, and not just the patient.

Attitude to Death↗