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Biomedical subjects

R Charlton

Publications and source records attributed to R Charlton.

At least 73 records · Page 4Linked to original sources
PubMed1994

Effects of cadaver dissection on the attitudes of medical students.

A study was conducted to determine whether the attitudes of medical students to death and caring changed during the 3 months following exposure to cadaver dissection. All first-year students were invited to complete a questionnaire immediately before their initial cadaver dissection experience, after 6 weeks, and after a further 3 months. The questionnaire reflected attitudes to death, violent death, death of someone known to the respondent and caring when someone known to the respondent is seriously injured. Ethnicity and previous exposure to dying has no effect on responses, but overall men students' reactions were significantly less than for women (P < 0.001). The responses given on the final part of the questionnaire after 3 months were significantly lower than those to most questions in the first part of the questionnaire. The exceptions were those questions where the subject in the given scenario was known to the respondent, where reactions were rated significantly greater (P < 0.001) in the follow-up questionnaire and can be explained on the basis that they were a personal referent. Students rapidly develop a coping mechanism which enables them to view cadaver dissection as an occupation quite divorced from living human beings. During these early months of training solicitude decreases for those who die who are unknown to them, but concern for personal referents increases. Educators should be aware of the dramatic change of attitudes among students and the process of professionalization which might influence their caring of future patients.

Adaptation, Psychological↗
PubMed1994

P53 expression, ploidy and progression in pT1 transitional cell carcinoma of the bladder.

OBJECTIVE: To investigate a potential role for overexpression of the p53 protein in the identification of pT1 bladder tumours destined to progress. PATIENTS AND METHODS: The protein expression of the tumour suppressor gene p53, nuclear ploidy and tumour grade were studied in 25 patients with pT1 bladder tumours. Follow-up data was available for 21 tumours over a 10 year period. p53 expression was determined by immuno-histochemistry on paraffin embedded sections and flow cytometry was performed on cell suspensions derived from the same blocks. RESULTS: Ten of 21 (48%) tumours progressed to muscle invasive disease. Nuclear staining for the protein was seen in 16 (64%) tumours and of these nine (56%) progressed. All tumours with abnormal DNA content and all high grade tumours demonstrated overexpression of p53. Significantly more patients with high levels of p53 expression (> 10% nuclear staining) progressed compared with tumours with less than 10% of nuclei staining (P = 0.007). However, grade was the most specific predictor of progression (100%), with all grade 3 tumours progressing and grade was also the most significant prognostic indicator in terms of survival (P = 0.025). CONCLUSION: Tumour grade is likely to remain as the most useful aid to management decisions in pT1 bladder tumours.

Aged↗
PubMed1994

Autopsy and medical education: a review.

During the twentieth century there has been a decline in the rate of autopsies performed. A review of the literature reveals reasons for this decline which include: an improvement in the medical diagnostic technology available; inadequate training of doctors as to the importance of autopsy; and difficulties in obtaining consent from relatives and the present use of audit. Recommendations for changes in medical education are made which include: a greater appreciation of the procedure as a useful investigation tool; the development of attitudes towards death; and improving communication skills with the bereaved. Recommendations are also made regarding education of the public, awareness of differences in cultural attitudes, the role of leaflets, the post-autopsy conference and the place of audit.

Attitude of Health Personnel↗
PubMed1993

Education about death and dying at Otago University Medical School.

AIMS: To ascertain if medical training provides adequate preparation for students regarding; (a) coming to terms with death and dying, (b) communication pertaining to terminal illness and (c) symptom control of the dying. METHODS: A questionnaire was distributed to all undergraduates in years 3 to 6, of the Otago Medical School, including all three clinical schools. The students were asked to rate their perceived abilities in given clinical situations. RESULTS: There were 392 replies giving ratings on a scale from 0, for least confidence in ability, to 5, for most confidence in ability. A mean rating of 2.45 was given for preparation prior to cadaver dissection. A mean rating of 2.31 was given overall for communication skills pertaining to terminal illness with an average increase of only 0.49 between years 3 and 6, but 1.89 in the area of symptom control, with an average increase of 2.32 between years 3 and 6. Many students stated that extra teaching was required, primarily in areas relating to communication. CONCLUSION: A challenge exists for medical teachers to increase curriculum content in this area and suggestions are given.

Adaptation, Psychological↗
PubMed1993

p53 expression and clinical outcome in prostate cancer.

Abnormally high levels of expression of p53 protein are found in many human cancers. In most cases increased expression is associated with point mutations in one allele of the p53 gene and loss of the other allele. Accumulation of the protein product can be detected by immunohistochemistry. p53 protein expression in 68 men with prostate cancer, followed up for at least 8 years or until death, was assessed by immunohistochemistry. The aim of the study was to determine the association between p53 protein expression, cell cycling and clinical outcome. Nine (13%) of 68 tumours stained positively for p53; all 9 tumours were category T3 or T4. p53 positive tumours had a significantly greater Gleason score than p53 negative tumours. Eight of the 9 p53 positive tumours had > 10% cells in G2 + mitosis, compared with 61% of p53 negative tumours. All 17 patients with p53 positive tumours available for follow-up progressed clinically, compared with 28 of 38 patients (74%) with p53 negative tumours. The median time to progression was 12 months in p53 positive tumours and 24 months in p53 negative tumours. Median survival in p53 positive tumours was 40 months, compared with 76 months in p53 negative tumours. This study demonstrates that overexpression of p53 in a small population of prostate cancers is associated with a poor prognosis in terms of progression and survival.

Aged↗
PubMed1993

General practice in New Zealand.

General practice in New Zealand has evolved into a 'user pays' system and although operating within a national health service, it has many interesting differences from general practice in the United Kingdom. Emphasis is placed on biculturalism in health care. Income is derived through a fee for service, which includes a proportion from patients dependent on their means tested reimbursement from the government for provision of general medical services. Consultations are fewer in number and longer in duration. New Zealand society has considerable awareness in the area of medical ethics and there is a medical insurance scheme which covers ill health as a result of accidents. Great advances have been made in provision for out of hours work. New Zealand has its own royal college of general practitioners, membership examination and scheme for vocational training. This paper, based on the authors' personal experience of 12 months' study leave in New Zealand in 1991-92, examines these important areas of difference and reflects on the health reforms that are currently taking place in New Zealand.

Delivery of Health Care↗
PubMed1992

Palliative care in non-cancer patients and the neglected caregiver.

Diseases other than cancer can be progressive and have a terminal phase and many of the philosophies of palliative care are applicable. The case studies emphasize two types of palliation. First, for the patient and that is well recognized and second, palliation for the caregiver which should include provision of respite care.

Aged↗
PubMed1992

The philosophy of palliative medicine: a challenge for medical education.

The hospice movement has admirably improved management of the dying under its care. However, the majority of medical care of the terminally and chronically ill remains in the hands of practitioners outside hospices and is often open to criticism. This paper reviews the philosophy and practice of palliative medicine from the perspective of general practice and the shortcomings of present medical education in this area. Proposals are made for a radical shift in medical undergraduate teaching through an organized interdepartmental contribution by enthusiastic teachers to all years in training.

Communication↗
PubMed1989

Immune function in patients treated with phenytoin.

Multiple immunologic side effects have been ascribed to phenytoin. Numerous reports in the literature discuss the possible cellular and humoral abnormalities that appear to be present in patients given phenytoin. The most consistent finding is a reduction in serum IgA found in up to 20% of patients. To resolve some of the conflicting studies on cellular immune status, 191 patients taking phenytoin were evaluated initially with an serum IgA determination, and then further immune studies were done on the 11% with IgA values lower than two standard deviations below the mean. Data collected included total lymphocyte counts, lymphocyte population studies, and responses to in vitro mitogen stimulation. Only 2 of 191 patients had serum IgA values less than 5 mg/dL, which is an incidence not significantly different than that in the population at large. The patients with decreased serum IgA values did not have an increased incidence of autoimmune phenomena, allergic disorders, gastrointestinal manifestations, or recurrent upper respiratory tract infections. Their cellular immune status showed no significant variations from control values. Thus it appears that routine monitoring of patients on phenytoin with serum IgA determinations is of limited value, and the immunologic side effects of phenytoin are not expressed as a cellular abnormality.

Adolescent↗
PubMed1976

Patterns of iron storage in dietary iron overload and idiopathic hemochromatosis.

Bone marrow iron stores rise in proportion to the total body iron store in dietary iron overload. The situation in the genetic disorder of idiopathic hemochromatosis is not as clear. A method for measuring the storage iron concentration chemically on samples of bone marrow obtained by trephine needle biopsy was therefore developed. Its value as a measure of tissue iron stores was established in a preliminary investigation in which specimens of liver, spleen, and bone marrow were obtained at necropsies on 66 South African Negroes among whom dietary iron overload is common. A wide range of nonheme iron concentrations was found, but in each individual there was a highly significant correlation between the concentrations in the three tissues. Nonheme iron concentrations were then determined on trephine bone marrow biopsy specimens from eight Caucasian patients with untreated idiopathic hemochromatosis, and on percutaneous liver biopsy specimens from four of them. The concentrations in the livers were in the anticipated range of 5,000 mug per gram wet weight (2 per cent dry weight). In contrast the geometric mean value for bone marrow iron concentration was 186 mug per gram wet weight, a figure that fell below the fiftieth percentile for marrow iron concentrations in the South African Negroes, whereas the geometric mean liver iron concentration was above the ninetieth percentile. These findings indicate that subjects with idiopathic hemochromatosis whose liver iron stores are grossly increased do not show a comparable rise in bone marrow iron stores.

Adult↗