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Biomedical subjects

J J Marty

Publications and source records attributed to J J Marty.

15 recordsLinked to original sources
PubMed2001

Learning to consult with computers.

OBJECTIVE: To develop and evaluate a strategy to teach skills and issues associated with computers in the consultation. INTERVENTION: An overview lecture plus a workshop before and a workshop after practice placements, during the 10-week general practice (GP) term in the 5th year of the University of Melbourne medical course. DESIGN: Pre- and post-intervention study using a mix of qualitative and quantitative methods within a strategic evaluation framework. OUTCOME MEASURES: Self-reported attitudes and skills with clinical applications before, during and after the intervention. RESULTS: Most students had significant general computer experience but little in the medical area. They found the workshops relevant, interesting and easy to follow. The role-play approach facilitated students' learning of relevant communication and consulting skills and an appreciation of issues associated with using the information technology tools in simulated clinical situations to augment and complement their consulting skills. The workshops and exposure to GP systems were associated with an increase in the use of clinical software, more realistic expectations of existing clinical and medical record software and an understanding of the barriers to the use of computers in the consultation. CONCLUSIONS: The educational intervention assisted students to develop and express an understanding of the importance of consulting and communication skills in teaching and learning about medical informatics tools, hardware and software design, workplace issues and the impact of clinical computer systems on the consultation and patient care.

Attitude to Computers↗
PubMed1996

The utility of routine frozen section examination for intraoperative diagnosis of thyroid cancer.

BACKGROUND: The value of routine frozen section examination for intraoperative diagnosis of thyroid cancer and determination of extent of thyroidectomy is controversial and needs to be evaluated on an institution to institution basis. METHODS: A prospective evaluation of 76 patients with nodular thyroid disease who had an adequate fine needle aspiration biopsy (FNAB) underwent thyroidectomy with routine thyroid frozen section examination. A direct comparison of FNAB and frozen section examination, along with a cost benefit analysis of frozen section examination, was completed. RESULTS: The thyroid pathology was carcinoma in 24, follicular adenoma in 24, multinodular goiter in 24, thyroiditis in 3, and a cyst in 1 patient. The sensitivity, specificity, and accuracy of frozen section examination were 93%, 100%, and 97%, respectively, compared with 88%, 89%, and 91% for FNAB (P > 0.05). Diagnosis was deferred in 38 patients (50%) in whom frozen section examination showed a follicular neoplasm. One to 6 frozen section examinations were obtained per patient with alteration in intraoperative management in only 2 patients (3%) at a charge of $246 to $606 per patient and a total charge of $26,040. CONCLUSION: In patients with an adequate FNAB, frozen section examination rarely affected intraoperative decision making in thyroid surgery and its routine use was not cost effective.

Biopsy, Needle↗
PubMed1995

The effect of cobalt-60 irradiation on bone marrow cellularity and alveolar osteoclasts.

The purpose of this study was to investigate the mechanisms of bone resorption in the rat dentoalveolar complex occurring as a result of orthodontic appliance therapy. Utilizing whole body radioactive cobalt 60 (Co60) irradiation in combination with orthodontic tooth movement, the activation, recruitment, and life span of osteoclasts was studied. Thirty-four adult Fischer 344 rats were irradiated with 10 and 20 Gray of Co60. Twelve days after irradiation, each rat was fitted with an orthodontic appliance; the rats were sacrificed 7, 14, or 21 days after appliance placement. To serve as controls, another group of 12 rats was subjected to orthodontic treatment only. Histologic sections were prepared from decalcified maxillary alveolar process, and osteoclasts were counted. In the control group, osteoclasts were presence in the periodontal membrane for four weeks after appliance placement, and the largest number of osteoclasts was observed in the second week. The smaller total irradiation dose (10 Gray, administered in 5 daily fractions) induced a transient reduction in the bone marrow cell count of more than 90%, followed by a complete rebound. The peak osteoclst number also was increased 110%. In contrast, the higher total dose (20 Gray, administered in 10 daily fractions) resulted in a reduction of 60% in bone marrow cellularity and a decrease in the peak osteoclast number by 40%. Fluctuations in bone marrow cellularity generally corresponded to similar variations in the osteoclast number, but there was an apparent lack of correspondence between bone marrow cell and white blood cell values. The total period of osteoclastic presence in the periodontal membrane following orthodontic activation, normally four weeks in duration, was reduced by one week in the irradiated animals. These findings lead us to speculate that the mechanisms of osteoclast activation and recruitment following orthodontic appliance therapy may involve three consecutive waves of osteoclast maturation. The total duration of osteoclastic bone resorption lasts 4 weeks, but the osteoclast lie span is calculated to be 9 to 10 days (9 days x 3 waves = 27 days). If the results of this study are proved to be reproducible, a scientific basis may have been provided to support the common practice in orthodontics wherein the duration between orthodontic appointments is 4-5 weeks.

Alveolar Process↗
PubMed1994

Detecting premalignant cervical lesions. Contribution of screening colposcopy to cytology.

The combination of parallel cytology and screening colposcopy was found to increase the detection of premalignant cervical lesions from 8.2% in a group of patients (based on cytology alone) to 15.3% in that group (based on the combination). The combination of the two methods used in parallel increased the sensitivity, negative predictive value and efficiency of cervical cancer screening over cytology alone while having only a small negative impact on the positive predictive value of a positive test. The addition of screening colposcopy to cytology produces a significant improvement over current uniphasic screening protocols.

Biopsy↗
PubMed1993

Sputum cytology.

Examination of sputum is the least invasive method of obtaining a cytologic diagnosis in a patient suspected of harboring lung cancer. Cytologic diagnosis has advanced to a point where it is of comparable value to histology. The authors discuss the sensitivity, specificity, reliability, and pitfalls of sputum cytology as well as the role it plays in screening of early lung cancer. The advantages and shortcomings of sampling and cytopreparatory techniques are also reviewed. Concluding remarks outline future developments in sputum cytology.

Forecasting↗
PubMed1993

Atypical thyroglossal duct cyst: a rare cause for a solitary cold thyroid nodule in childhood.

A case of an atypical thyroglossal duct cyst is described in a 9-year-old boy who presented with a lateral neck mass that was hypofunctioning on thyroid scan and clinically indistinguishable from a thyroid nodule. Preoperative fine needle aspiration biopsy results demonstrating abundant, normal appearing squamous epithelial cells and keratinaceous material was suggestive of the diagnosis. Definitive diagnosis was made only after complete mobilization of the left lobe of the thyroid gland and cyst resection. A standard Sistrunk procedure was performed, and cyst excision was accomplished without resection of the left lobe of the thyroid gland. Microscopic examination disclosed a keratinizing pseudostratified squamous epithelium that has not been previously reported with thyroglossal duct cysts.

Biopsy, Needle↗
PubMed1982

Intra-dose variation in plasma protein binding of sodium valproate in epileptic patients.

1 The fluctuations in protein binding of sodium valproate during one dosing interval were studied in five patients stabilized on valproate and taking concurrent anticonvulsant therapy. 2 The patients took their usual morning dose of valproate (400-800 mg) and serial blood samples were collected by venepuncture at 0, 1, 2, 3, 4, and 6 h post-dose. 3 Free valproate was separated from protein bound drug by plasma ultrafiltration and the ultrafiltrate and total plasma valproate concentrations were measured by a gas chromatographic method. 4 The maximum and minimum concentrations in the ultrafiltrates occurred at the same times as in the plasma. However, the percentage fluctuation was always greater in the ultrafiltrates (range 192-412%) compared with the plasma (range 153-374%) due to the concentration-dependent nature of valproate protein binding. 5 If free valproate levels are to be monitored, knowledge of sampling time and dosage history is important for interpretation of the results.

Adolescent↗
PubMed1980

An assessment of the clinical use of glyceryl trinitrate in a hospital outpatient population.

Despite the availability of information on the use of glyceryl trinitrate (GTN) in standard texts, in practice many patients fail to obtain maximum benefit from GTN. This study of an Outpatient population, documents the patients' knowledge of the use and precautions which should apply to GTN and records the ways in which these patients took the drug. Fifty patients who regularly took GTN (greater than 5 tablets per week) were asked a series of questions by the same interviewer. Forty-nine of the 50 patients took GTN for the relief of chest pain, but only 34 patients knew that the drug could be used to prevent chest pain. Although 48 patients kept their bulk supply of GTN in the original container, over 40% transferred some or all of the tablets to other containers and locations. Seventy per cent of patients knew that GTN tablets deteriorate with time. However, knowledge of the factors which influence the rate of deterioration was lacking. Less than half the patients knew that the prompt relief of pain or the local effects on the buccal mucosa could be used as simple tests of the activity of tablets. It is recommended that all physicians should take more time to explain to their patients how to use glyceryl trinitrate correctly.

Aged↗
PubMed1980

Plasma cyclic AMP levels in response to exercise and terbutaline sulphate aerosol in normal and asthmatic subjects.

A study was performed to investigate changes in plasma cyclic adenosine monophosphate (cyclic AMP), peak expiratory flow and arterial blood gas tensions in response to running exercise and terbutaline sulphate aerosol in asthmatic patients regularly receiving sympathomimetic bronchodilator aerosols. Seven normal subjects were controls. Placebo aerosol was administered 20 min before the first exercise study and 1.0-1.25 mg terbutaline sulphate substituted 20 min after the first test and again 20 min before the second test. Blood gas tensions, expiratory flow and cyclic AMP were measured at rest, during and after exercise. Exercise induced a significant increase in cyclic AMP in both asthmatic and normal subjects. The change in plasma levels was not significantly different between groups. Cyclic AMP values were higher at rest and during exercise with terbutaline sulphate compared with placebo for both groups. Terbutaline sulphate blocked the marked fall in peak expiratory flow and arterial oxygen tension observed in the asthmatic subjects following the first test. Values for cyclic AMP following exercise were not significantly different between asthmatic and normal subjects. In contrast to other reports our asthmatics have a marked increase in cyclic AMP in response to exercise and to a beta-sympathomimetic aerosol.

Adult↗
PubMedDate not supplied

Pathology and laboratory medicine as a service.

Quality is multidimensional. The relative importance of these dimensions to those using the service of the laboratory and a pathologist has not been previously defined as a conceptual model for measuring and investigating service quality. Ten major determinants of service quality are described: access, communication, competence, courtesy, credibility, reliability, responsiveness, security, technology, and understanding. These components must be integrated into any formula for a successful health-care outcome.

Clinical Competence↗