PubMed Health⌕ Search

Biomedical subjects

G Norman

Publications and source records attributed to G Norman.

15 recordsLinked to original sources
PubMed1992

Markers for endothelial injury, clotting and platelet activation in preeclampsia.

The etiology of disseminated intravascular coagulation (DIC) in preeclampsia is not well understood. We measured plasma levels of fibronectin (FN), which may reflect endothelial cell injury, fibrinopeptide A (FPA), a specific marker of clotting, platelet counts (PLC) and mean platelet volumes (MPV), as well as beta-thromboglobulin (beta TG) and platelet factor 4 (Pf4), products of irreversible platelet activation in 24 preeclamptic patients and 24 controls matched for age, gestational age, labor status, and parity. In preeclampsia, FN and FPA were significantly elevated while PLC were significantly decreased (P less than 0.0001, less than 0.05 and less than 0.01, respectively). beta TG, Pf4, and MPV values did not show significant differences. These findings support the hypothesis that endothelial injury, clotting activation and platelet consumption are increased in preeclampsia. However, the much closer association of preeclampsia with FN levels as compared to FPA, beta TG, Pf4, suggests that endothelial injury is a more basic mechanism of preeclampsia than clotting or platelet activation.

Adolescent↗
PubMed1992

The teaching of behavioural sciences.

Medical science over the last few decades has undergone vast changes. Technologically it has advanced at a rapid pace. There has been a realization as well that the behaviour of individuals and communities also influences the occurrence of disease. Medical schools around the globe have realized the need for incorporating behavioural sciences as an integral part of the basic sciences taught to medical students. This paper presents the experience of Christian Medical College, Vellore in teaching behavioural sciences. Students are taught sociology, psychology and medical anthropology through a community-based, problem-oriented teaching programme. The students have first-hand experience of living in a community and learn by observation and interaction. Pre- and post-assessment has shown a significant improvement of their knowledge and attitude. Feedback from students also indicates that they find this programme relevant and interesting.

Behavioral Sciences↗
PubMed1991

Barium meal or endoscopy? A prospective randomized study of patient preference and physician decision making.

This study examines the preference of 64 out-patients for either a barium meal or an upper gastrointestinal endoscopy. The sequence of the examinations was randomized to avoid order bias. An initial preference for a barium meal of almost two-to-one, with 53% having no preference, was changed after the investigations to a preference for endoscopy of two-to-one with 5% having no preference. The use of mild sedation and the skill of the endoscopist had a major impact on the patients' opinion of the endoscopic procedure, and on their choice of examination for any repeat study. There was little agreement between clinical diagnosis and the result of investigation, but clinicians tended to accept the reported result of the investigation, especially if the result was abnormal. Despite a change in diagnosis in 34 of 49 patients there was little change in management as a result of the investigations, supporting the view that young patients with dyspepsia may be managed with symptomatic treatment initially, and without investigation. This study lends further support to the view that endoscopy should be the investigation of choice in patients with persistent dyspepsia, especially those whose age or infirmity may make barium examination suboptimal.

Barium Sulfate↗
PubMed1991

Observer variation in detecting the radiologic features associated with bronchiolitis.

Chest radiographs are commonly obtained to assess children for bronchiolitis, both to corroborate the diagnosis and to exclude other diagnostic possibilities. Their utility in this setting has not previously been examined. Using a blinded, randomized study design, we examined the interobserver and intraobserver variation in the detection of the radiologic features of bronchiolitis from the chest radiograph using "weighted kappa" statistics. This observer variation was compared with that found by other authors for other diagnoses. We also determined the reported presence of these radiologic features in radiographs from patients with bronchiolitis as compared with normal controls. Our study showed acceptable interobserver (kappa = 0.40-0.66) and intraobserver agreement (kappa = 0.50-0.78) on the radiologic features of bronchiolitis relative to other diagnoses. We demonstrated a higher reported presence of these accepted radiologic features in patients with bronchiolitis as compared to controls. Although kappa statistics are widely used in studies of observer variation, "weighted kappa" has received little attention in the radiologic literature. This statistical analysis allows observers to equivocate on the presence or absence of a feature and therefore allows the format of observer variation studies to simulate more closely the normal clinical setting.

Bronchiolitis, Viral↗
PubMed1991

An insular outbreak of dengue fever in a rural south Indian village.

In mid 1990, an epidemic of fever affected a single village in Kaniyambadi Block, South India. The illness was characterized by a fever of approximately five days duration, accompanied by headache, chills, sweating and muscle pain. The overall attack rate was 22.5 per cent. The attack rate was uniform across the various age groups and between the sexes. Testing of the acute and convalescent serum samples obtained from cases showed a serological response to dengue virus. The Aedes house index in the village was found to be 36 per cent with toilets serving as active breeding sites. Adjacent villages studied showed similarly high rates of Aedes prevalence, although no cases of the same fever were seen. Since previous exposure to dengue increases the risk for epidemics of dengue hemorrhagic fever and dengue shock syndrome, health education on methods of Aedes control is continuing.

Adolescent↗
PubMed1990

Altered platelet calcium metabolism as an early predictor of increased peripheral vascular resistance and preeclampsia in urban black women.

BACKGROUND: Although preeclampsia is an important and relatively common medical problem, its pathophysiology remains unresolved and the search for a biochemical marker that precedes the hemodynamic abnormalities of preeclampsia continues. We designed a study to investigate the hemodynamic changes that characterize preeclampsia and to evaluate the metabolism of platelet intracellular calcium as a possible predictor of the development of preeclampsia. METHODS: Hemodynamic measurements and spectrofluorometric determinations of the levels of intracellular calcium in platelets in the basal state and after stimulation with an agonist were performed in 48 nulliparous black women during each trimester of pregnancy. The data on the 14 women (29 percent) in whom preeclampsia developed were then compared with the data on the other 34, who served as normotensive controls. RESULTS: There was no significant difference between the two groups in the basal levels of intracellular calcium at any time. In contrast, the levels measured after arginine vasopressin was administered during the first trimester indicated an exaggerated response in the group with preeclampsia as compared with the control group (1494 +/- 388 [+/- SEM] percent vs. 545 +/- 55 percent of base line; P less than 0.0002), which was sustained through the second and third trimesters. All but three of the women with preeclampsia had responses higher than the highest response among the controls. Platelet intracellular calcium responses to arginine vasopressin during the first trimester were a sensitive predictor of the subsequent development of preeclampsia (P less than 0.00009). Although vascular resistance was similar in the two groups during the first trimester, it subsequently decreased in the control group (P less than 0.02) but not in the group with preeclampsia. CONCLUSIONS: Our findings indicate that preeclampsia is characterized by the absence of the normal pregnancy-related decrease in vascular resistance, which is preceded in most instances by an exaggerated response of platelet intracellular calcium to arginine vasopressin early in pregnancy. We therefore propose that an increase in the sensitivity of platelet calcium to arginine vasopressin can be used as an early predictor of subsequent preeclampsia.

Adolescent↗
PubMed1990

Evaluation of potential early markers of chorioamnionitis associated with preterm premature ruptured membranes.

Optimal expectant management of preterm premature rupture of membranes (PROM) requires the early detection of chorioamnionitis. To date, however, no universally sensitive and specific marker for chorioamnionitis has been identified. Recently, the serial determination of plasma fibronectin, antithrombin, and prekallikrein has been reported to facilitate the early detection of sepsis in critically ill neonates and adult surgical patients. A cross-sectional study was undertaken to determine if plasma levels of these markers change significantly in patients with overt chorioamnionitis following expectant management of preterm PROM. Plasma levels of fibronectin and prekallikrein were not significantly different between the study (30 patients with overt chorioamnionitis following preterm PROM) and control (30 undelivered patients without antenatal complication matched for gestational age) groups. Antithrombin levels were significantly lower in the study group (p less than 0.05), but the magnitude of the difference (102% versus 94%) is not likely to be of clinical significance. We conclude that determination of plasma levels of fibronectin, prekallikrein, and antithrombin is not likely to aid in the early detection of chorioamnionitis in the setting of preterm (PROM).

Antithrombins↗
PubMed1990

Reliability and learning from the objective structured clinical examination.

The difficulties in measurement of the clinical performance of students in the health professions are well known by educators. One innovative measure incorporated in several of the educational programmes, including the BSc in Nursing programme, in the Faculty of Health Sciences, at McMaster University, Hamilton, Ontario, Canada is the objective structured clinical examination (OSCE). The purpose of this study was to determine the reliability of this evaluation method, both within and between stations. One problem that has been noted by users of the OSCE method is that performance on individual OSCE stations is poorly correlated across stations, apparently regardless of the particular content of the station. A number of hypotheses have been advanced to attempt to explain this phenomenon: performance of any skill is sufficiently variable that the correlation is poor; different skills have little common basis, so that there is no generalizability from one to another, or reliability of assessment in any one station is low. To test these hypotheses, a study was designed for test-retest and interrater reliability. Students undergoing a 10-station OSCE also repeated their starting OSCE station at the end of the examination circuit. In addition, several stations were rated by more than one observer (interrater). This study of 71 first-year BScN students showed that the interrater reliability was high (ICC = 0.80 to 0.99), and test-retest reliability on the same station was good (ICC = 0.66 to 0.86); however, correlation across stations was low (alpha = 0.198). Thus it is apparent that there is high consistency of repeated performance of a skill but little consistency of performance on different skills.

Clinical Competence↗
PubMed1979

Perceived exertion of professional hockey players.

18 professional hockey players were tested on the treadmill with a modified Balke procedure and also for maximum isokinetic strength with the Cybex II instrument. Immediately after each test the subject completed the Borg Scale of Perceived Exertion. The treadmill effort was perceived as being "somewhat hard work" while the maximum strength effort was considered "very light." This conflicts with previous literature. It may be that professional hockey players adapt to physical stress and do not respond perceptually to such stimuli in a typical manner.

Adult↗
PubMedDate not supplied

Pain following colonoscopy: elimination with carbon dioxide.

Fifty-six patients have been examined in a prospective randomized study on the effects of air and carbon dioxide on post-procedural discomfort following colonoscopy. A significant reduction in post-procedural pain was observed at 6 hours (p = < 0.0005) and was still present the next day (p = 0.01). This was associated with a difference in the grading of flatus at 6 and 24 hours (p = < 0.0001 and < 0.05, respectively). An abdominal radiograph 1 hour after the procedure showed minimal gas in the CO2 patients, while the patients who had air showed distention of large and small bowel (p = < 0.0001 and < 0.01, respectively). Seventeen of 29 patients who had air suffered post-procedural pain, compared with 2 of 27 of the CO2 patients. Fifty-seven percent of the patients who were given air had colonic diameters over 6 cm on a 1-hour post-colonoscopy radiograph and 18% over 10-cm diameter. Provision by equipment manufacturers of simple and safe devices for routine delivery of CO2 for lower gastrointestinal endoscopy is long overdue.

Carbon Dioxide↗