Biomedical subjects
G Graves
Publications and source records attributed to G Graves.
The utility of trained arthritis patient educators in the evaluation and improvement of musculoskeletal examination skills of physicians in training.
OBJECTIVE: To determine the level of examination skills of internal medicine residents and to assess whether an intervention by trained persons with arthritis could have a greater impact on their examination skills than participation in an ambulatory care training experience. METHODS: Twenty-seven residents attended a 6-week ambulatory care rotation that included didactic teaching as well as attendance at an outpatient arthritis clinic with supervision by rheumatologists. Sixteen residents were randomly assigned to have a training encounter with an arthritis educator along with the standard experience in the arthritis clinic, whereas 11 residents received training in the arthritis clinic only. Arthritis educators evaluated the musculoskeletal examination skills of each resident during the first week of the rotation. The 16 residents in the intervention group received instruction on joint examination techniques by the arthritis educator immediately following their evaluation. At the end of the 6-week rotation, the groups were re-evaluated by a different arthritis educator. A group of 21 rheumatologists was also asked to perform a comprehensive musculoskeletal examination on individual arthritis educators. The arthritis educators assessed the examination of the rheumatologists using the same evaluation instrument that was used to assess the residents. RESULTS: Initially, internal medicine residents carried out the musculoskeletal examination poorly (34.2 +/- 0.09% correct, n = 27). By contrast, the rheumatologists carried out a significantly greater amount of the examination correctly (54.5 +/- 0.05%). The musculoskeletal examination skills of the residents who received additional training from an arthritis educator were significantly greater at the end of the rotation than the group who did not receive this intervention (50.5 +/- 0.10% versus 41.9 +/- 0.14% correct, P = 2.15 x 10(-5). CONCLUSION: Internal medicine residents carried out the musculoskeletal examination poorly. However, an intervention by arthritis educators improved the musculoskeletal examination skills of internal medicine residents significantly and more effectively than the standard clinical teaching in a rheumatology outpatient clinic. The impact of the arthritis educator intervention persisted for at least 5 weeks.
Therapeutic plasma exchange for Guillian-Barré syndrome during pregnancy.
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Rates and outcome of pregnancies achieved in the first 4 years of an in-vitro fertilization program.
Between Feb. 1, 1984, and Dec. 31, 1987, 578 couples were treated in the in-vitro fertilization (IVF) program at University Hospital, London, Ont. The 160 confirmed pregnancies resulted in 86 deliveries and the birth of 108 babies. There were 20 spontaneous abortions, 12 ectopic pregnancies, 11 presumptive pregnancies, 4 neonatal deaths and 1 stillbirth. At the time of writing, 41 pregnancies of 20 weeks' gestation or more were in progress. Except for a high cesarean section rate the obstetric outcome of pregnancies achieved with IVF does not appear to be different from that expected for a group of infertile couples treated with conventional therapies. The pregnancy rates varied according to the denominator used.
Transvaginal, ultrasound-guided oocyte retrieval for in vitro fertilization.
As compared to laparoscopic oocyte retrieval, the trans-vaginal, ultrasound-guided technique can be performed away from a formal operating room, without general anesthesia and its attendant risks and with a significant reduction in operating time. Performed under paracervical block and minimal analgesia, transvaginal, ultrasound-guided oocyte retrieval results in a fairly easily tolerated level of pain during the procedure and very minimal residual pain postoperatively. The mean number of oocytes retrieved, fertilization and embryo transfer rates, and clinical pregnancy rates are not significantly different between the two procedures. If bleeding occurs from the vaginal puncture site, it is easily controlled with pressure. In this study, postoperative pelvic infection occurred in three patients. The above advantages and associated reduction in cost achieved with the trans-vaginal, ultrasound-guided procedure make it the current method of choice for oocyte retrieval.
Home intravenous antibiotic therapy in Arkansas.
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Intrapartum fetal heart rate monitoring as a predictor of fetal distress and immediate neonatal condition in low-birth weight (less than or equal to 1,800 grams) infants.
Among 1,318 live born infants delivered in our institution during a 120-day period, 1,025 (77.8%) were monitored electronically. Of the 1,025 monitored infants, 89 were of low birth weight (less than or equal to 1,800 gm) and were admitted to the neonatal intensive care unit. Twenty-seven (30%) of these had abnormal fetal heart rate tracings. The remaining 62 (70%) had normal fetal heart rate tracings. Of the 27 low-birth weight neonates with an abnormal fetal heart rate tracing, 24 (89%) were asphyxiated, whereas of those 62 low-birth weight infants with a normal fetal heart rate tracing, only nine (14%) had asphyxia (p less than 0.001). Of the 27 low-birth weight neonates with abnormal fetal heart rate tracings, 20 (74%) developed hyaline membrane disease, whereas of the 62 low-birth weight neonates with normal fetal heart rate tracings, 10 (16%) developed hyaline membrane disease (p less than 0.001). The results of this study suggest that electronic fetal monitoring provides a specific and sensitive method for identifying those low-birth weight infants who are at high risk for asphyxia and hyaline membrane disease.
Cell-mediated hyperacute rejection. IV. Lyt markers and adoptive transfer.
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Cell-mediated hyperacute rejection. III. Genetic determinants.
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Effect of chemotherapy on the healing of surgical wounds.
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Suicidal attempts in an outer region of metropolitan Melbourne and in a provincial region of Victoria.
A two year study of attempted suicide was undertaken in two Victorian regions. Incidence rates of 16.7 and 22.1 per 10,000 population were found in the metropolitan and provincial regions respectively. A number of factors were considered and found relevant to the difference in incidence. In addition, other parameters including multiple attempts, seasonal distribution, method used, association with alcohol and referral to psychiatric care were considered. Our findings are compared with those of earlier studies reported in Australia.
Contributions of lung recoil and airway resistance to forced expiratory flow limitation.
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Polymerase chain reaction amplification products separated on rehydratable polyacrylamide gels and stained with silver.
Separation of polymerase chain reaction (PCR) amplification of specific fragment length polymorphisms was carried out on rehydratable polyacrylamide gels on a horizontal flat slab system. A discontinuous sulfate-borate buffer system was employed on 5-8% T gels crosslinked with 3.5% C. Samples were diluted in leading sulfate ion buffer at 1/10 the ionic strength of the separating gel buffer and placed directly onto the surface of the rehydrated gels in 0.5-10 microliters volumes. The trailing ion and counterion were contained in a gel plug and placed directly onto the anodal and cathodal ends of the gel, and the electrodes placed directly onto the surface of the gel plugs. Filter paper wicks, soaked in diluted leading ion buffer, were placed along each side to lower the ionic strength of the edges, thereby increasing mobility at the edge and thus preventing smile effects. The gel-gel contact of the plug and separating gel prevent the production of a junction potential which occurs between dissimilar materials such as a paper wick and the gel. Ten- to 20-cm separations were carried out from 2-5 h, respectively, and resolution in the 20 cm system was 1.6-4 bp (base pairs) between 100 and 500 bp, 4-7 bp between 500 and 1000 bp, 12-20 bp between 1000 and 2000 bp and about 50 bp between 2000 and 3000 bp. Between 3000 and 4000 bp, resolution fell off to +/- 100 bp. Sensitivity, using a silver stain, indicated that one could readily distinguish less than 10 pg of DNA per mm width on the gels.(ABSTRACT TRUNCATED AT 250 WORDS)