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Biomedical subjects

J Grant

Publications and source records attributed to J Grant.

At least 19 recordsLinked to original sources
PubMed1992

Underutilization of Rh prophylaxis in the emergency department: a retrospective survey.

STUDY OBJECTIVE: To determine the practice of emergency physicians with regard to the issue of Rh isoimmunization. DESIGN: A retrospective chart review. SETTING: A university-affiliated tertiary care hospital emergency department. TYPE OF PARTICIPANTS: Pregnant women presenting with a risk factor for Rh sensitization. MEASUREMENTS AND MAIN RESULTS: One hundred thirty-eight patient encounters were analyzed descriptively as to whether they were candidates for Rh immune prophylaxis, and if so, whether it was given. Most (68%) were hospitalized. Of those, all were Rh typed, but two patients were not given Rh immune globulin (RhIG) when indicated. Of those discharged from the ED, most (86%) were not Rh typed, and none was administered RhIG. CONCLUSION: This study demonstrates a need for increased attention to the potential for Rh isoimmunization in patients presenting to the ED.

Abortion, Spontaneous↗
PubMed1992

Lethal olivopontoneocerebellar hypoplasia with dysmorphic features in sibs.

This report describes the clinical and neuropathological features in male and female sibs who died shortly after birth as a result of frequent convulsions and lack of spontaneous respiratory effect. Both sibs had a prominent occiput with mild contractures and the female also had overlapping fingers and rockerbottom feet. The genetic and neuropathological findings were consistent with a diagnosis of an autosomal recessive form of olivopontoneocerebellar hypoplasia/atrophy.

Abnormalities, Multiple↗
PubMed1992

Multiple primary cutaneous plasmacytomas.

BACKGROUND: Cutaneous plasmacytoma is an uncommon tumor and is mostly seen in the context of end-stage multiple myeloma. Only 20 cases of primary cutaneous plasmacytoma have been documented. A significant proportion of these patients went on to develop systemic disease with a poor prognosis. In a number of patients, however, the abnormal clone of plasma cells may arise in the skin and never progress to multiple myeloma involving the bone marrow. OBSERVATIONS: We describe a patient who developed multiple primary cutaneous plasmacytomas after a possible insect bite reaction. The monoclonality of the tumor cells is demonstrated using immunohistochemical techniques. He has been treated vigorously with chemotherapy and local radiotherapy and remains well 3 years after diagnosis. Bone marrow has been harvested for use as an autologous bone marrow transplant in the event of systemic relapse. CONCLUSIONS: Unlike previous reports of this rare entity, this case documents the monoclonality of tissue plasma cells with immunohistochemical techniques. As cutaneous plasmacytomas have been reported with an early significant mortality, unlike extramedullary plasmacytomas elsewhere, we have advocated combination chemotherapy and cryopreservation of uninvolved bone marrow for future autologous bone marrow transplantation should systemic myelomatosis develop in the patient.

Adult↗
PubMed1991

Effect of intermittent versus continuous enteral feeding on energy expenditure in premature infants.

The purpose of this study was to examine whether premature infants have higher rates of energy expenditure and diet-induced thermogenesis during intermittent feeding compared with continuous feeding. Using open-circuit respiratory calorimetry, we measured energy expenditure in 11 premature newborn infants on 2 successive days for 5 to 7 hours during and after either intermittent or continuous feeding. Infants were fed the same quantity of formula each day, either for 5 minutes or by continuous drip for 2 to 3 hours. The order of feeding type was randomized. No response of diet-induced thermogenesis to continuous feeding was found, whereas a peak increase of 15% over baseline was observed after intermittent feeding. Overall energy expenditure during the study period was significantly greater after intermittent compared with continuous feeding (2.18 +/- 0.07 kcal/kg per hour vs 2.09 +/- 0.05 kcal/kg per hour; p less than 0.05). Thus there was a mean 4% difference (range up to 17%) in energy expenditure between the two feeding modes. These results are similar to those obtained with adults and support the concept of the increased energy efficiency of continuous feeding. Further study will be necessary to document whether the increased energy efficiency provided by continuous feeding may be clinically significant.

Body Temperature↗
PubMed1991

Distance learning in a local setting: a structured learning course for the introduction of general practice to undergraduate students.

This paper describes the development and evaluation of a structured introductory course in general practice. Following some of the principles developed in distance education, the Department provides everything the student needs for the formal learning requirement as well as detailed assistance in how best to tackle the selected topics. The course was reported to be demanding, relevant and enjoyable. The major areas requiring attention were in reducing the amount of reading required, more help in learning to work in small student-run groups and more one-to-one supervision of physical examination skills. With further refinement the course should be applicable to other medical schools in developed countries.

Curriculum↗
PubMed1990

A methodology for validating nursing diagnoses.

A methodologic approach consisting of four phases is proposed for validating nursing diagnoses. The sequential phases include use of the Delphi technique, magnitude estimation scaling, patient observation, and testing nursing interventions through clinical trials. The proposed methodologic approach is a strategy for researching the diagnosis and treatment of human responses to actual or potential health problems--the foundation for nursing practice.

Clinical Nursing Research↗
PubMed1990

Quantitative assessment of diagnostic ability.

This paper describes variables critical to diagnostic thinking that are based on research by Bordage and Grant & Marsden on the diagnostic thinking of medical students and experienced doctors. The purpose of the study is to use their findings to develop an inventory of diagnostic thinking. A 56-item diagnostic thinking inventory was initially developed; each item contains a stem followed by a 6-point, semantic differential scale. The inventory is designed to measure two aspects of diagnostic thinking: the degree of flexibility in thinking and the degree of knowledge structure in memory. The specific goal of the study is to determine which items discriminate best between weaker and stronger diagnosticians and to reduce the inventory to only those items which significantly contribute to the overall score. Thirty subjects from nine groups, each representing a distinct phase of medical education and clinical practice, participated, namely first- and third-year clinical medical students, house officers, senior house officers, registrars, senior registrars, consultants, trainees in general practice, and general practitioners, all from the UK (n = 270). Discrimination indices were calculated for each item. The revised version of the inventory contains 41 items. All the subjects found the exercise meaningful and the resulting scores showed variance and discrimination. The inventory will eventually be used to assess individual student's and clinician's diagnostic thinking and to plan ways of improving their diagnostic thinking.

Clinical Competence↗
PubMed1990

The learning needs in diabetes of general practitioners.

The aim of the study was to determine the learning needs of General Practitioners (GPs) in diabetes. A postal questionnaire was sent to all GPs in South East Thames Region (England). The level of interest in continuing professional education in diabetes is sufficient to merit production of tailored learning materials and opportunities. Eighty-three percent of GPs would definitely or probably avail themselves of the opportunity even if they did have to pay. This percentage represents a figure of over 780 GPs. They are most keen to learn the clinical and other skills associated with diabetes and its management. A large number, 71%, requested education on retinal examination and adjustment of insulin, 56% on adjustment of tablet therapy, and 51% on the management of children with diabetes. Individual study materials, backed up by small group meetings and video material would be the most appreciated format. A course of study divided into half-hourly periods adding up to a total of about 5 h might be the most widely acceptable format. GPs would most like to study with other GPs from local practices and with hospital staff. Group work might best be designed to incorporate both an experienced GP, if one were available, and a consultant. The materials themselves might also best be designed and written by such a partnership.

Diabetes Mellitus↗
PubMed1990

The management of suspected myocardial infarction by Scottish general practitioners with access to community hospital beds.

General practitioners working in 20 community hospitals in Scotland participated in a survey of the management of myocardial infarction. During one year they suspected acute myocardial infarction in 451 patients. Of these patients, 278 (62%) were admitted to a community hospital, 125 (28%) to a district general hospital and 48 (11%) were kept at home. The main reasons given for admission to a community hospital were for monitoring and investigation, while the main reasons for admission to a district hospital rather than a community hospital were the relative youth of the patient and the severity of the illness. Acute myocardial infarction was confirmed in 323 (72%) cases, but in 26 (6%) cases the final diagnosis was other than ischaemic heart disease. Patients with acute myocardial infarction who entered a community hospital did so a median of two hours 25 minutes after the onset of symptoms. Among 18 patients admitted to a community hospital in whom resuscitation was attempted after cardiac arrest four (22%) were subsequently discharged from hospital. The mortality rate from acute myocardial infarction in the community studied was 171/418 (41%), of whom 95 died suddenly before coming under medical care. It is concluded that in rural areas of Scotland an acceptable standard of care for patients with acute myocardial infarction, including the administration of thrombolytic therapy, could be provided rapidly by general practitioners working in community hospitals.

Adult↗
PubMed1989

Senior house officers and their training. I. Personal characteristics and professional circumstances.

To assess the experience and perceptions of training of senior house officers in medicine a population survey of senior house officer training was conducted on senior house officers, registrars, senior registrars, and consultants in six medical specialties in South East Thames region by interview and postal questionnaire. The overall response rate was 72%, varying from 62% to 83% according to status and from 61% to 80% according to specialty. Although most of the 226 senior house officer respondents were aged 28 or under (168/225), had been qualified for four years or less (168/225) and were British (176/223), a quarter were older and had been qualified for five years or more; in all, 17 other nationalities were represented. Twenty two were aged over 33, and 17 had been qualified for more than 10 years. Thirty five senior house officers worked more than the mode of the distribution of duty rotas (one in three). Among postgraduate qualifications achieved or pursued, those related to general practice were highly represented (164 examinations); 111 senior house officers intended becoming general practitioners, 63 non-teaching hospital consultants, and 34 university or NHS teaching staff. Analysis of career progression showed that an appreciable number (31/221) had had more than three senior house officer posts. The findings indicate that the main implications for training and education are time for study, careers advice, and revision of educational programmes.

Adult↗