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Biomedical subjects

J R Gilbert

Publications and source records attributed to J R Gilbert.

At least 91 records · Page 5Linked to original sources
PubMed1988

A survey of current prescribing practices of antiinflammatory and urate lowering drugs in gouty arthritis in the province of Ontario.

We recently conducted a cross-sectional survey of the prescribing practices of rheumatologists and a random sample of family physicians. While in general there was agreement as to the preferred management of gout, family physicians were (a) more likely to use phenylbutazone, (b) more liberal in their use of allopurinol, (c) less likely to cover the introduction of allopurinol with antiinflammatory agents or to titrate the dose against the serum uric acid, or to adjust the dose according to the serum creatinine. A small number of physicians continued to routinely use urate lowering drugs in the treatment of entirely asymptomatic hyperuricemia.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1987

A smoking cessation intervention program for family physicians.

Family physicians are able to approach many patients who smoke but are often hesitant to help them quit. Lack of knowledge about effective interventions is a major reason for this hesitancy. The important components that have been tested in physician-initiated smoking cessation interventions are advice to quit, information about the risks of smoking and techniques for quitting, nicotine gum, setting a date for quitting and offers of supportive follow-up visits. We describe a cessation program developed for family physicians that incorporates these factors into three types of visits over a 2-month period: the challenge visit, which occurs during a regular office visit and focuses on advice and setting a date to quit; the quit-date visit, which involves instructing patients on the proper use of nicotine gum, if applicable, and confirming their desire to quit; and four supportive follow-up visits, which provide continuing encouragement for 2 months and allow physicians to monitor withdrawal symptoms, relapses and other problems. Such a program can be effectively incorporated into a general practice.

Chewing Gum↗
PubMed1986

Hypertension control in two Canadian communities: evidence for better treatment and overlabelling.

We evaluated the prevalence and control of hypertension in two Canadian cities without university medical centre facilities. A stratified multistage probability sample was selected, and we interviewed 6258 adults between the ages of 30 and 69 inclusive. Blood pressure measurements were obtained during home interviews. Up to two further visits were made to people with untreated blood pressure elevation. By a diagnostic criterion of 90 mmHg, the hypertension prevalence was 114/1000. Six per cent of the hypertensives were undetected, 6% detected but untreated, 17% treated but uncontrolled and 70% were being treated and controlled. Control was better in females and older subjects. These findings show no disadvantages to hypertensives living away from university medical centres. We found a hypertension prevalence of 143/1000 among people who reported being diagnosed as hypertensive but who had normal blood pressure while not on medication. These results suggest a problem with over-labelling of hypertensives.

Adult↗
PubMed1986

The "intelligent workstation" for cell-surface phenotyping based on principles of pattern recognition and image analysis.

Technical advancements in computer hardware and the associated computerized architectures allow the design and fabrication of dedicated, modestly expensive computerized workstations to aid humans in complex decision-making tasks. We refer to these as "Intelligent Workstations" because they accommodate the hypothesis-driven reasoning ability of the user into the system. Concomitant with the rapid developments in computers, diagnostic and therapeutic technologies related to cell analysis have undergone growth. Combining these technologies requires careful formulation and analysis of the diagnostic model involving image cytometry. Here we present a model of the intelligent workstation for image cytometry and illustrate its advantages in cell-surface phenotyping. Combining cell morphology with cell-surface phenotyping has clear diagnostic utility that no other widely available methods can supply. Although the reported results are based on samples of peripheral blood, cell suspensions of disaggregated cells can also be analyzed.

Aged↗
PubMed1985

Clinical trial of common treatments for low back pain in family practice.

The results of a multicentered randomised clinical trial are reported of bed rest and of a physiotherapy and education programme for patients who presented in family practice with an acute episode of low back pain. No beneficial effect of either treatment was observed on several clinical outcome measures, including straight leg raising, lumbar flexion, activities of daily living, and pain. In fact the results favoured early mobilisation over bed rest and suggested that the physiotherapy and education programme was doing more harm than good. Moreover, additional analyses, which focused on clinically interesting patient subgroups, discovered no subset of patients who benefited from either of the treatments under study. Having failed to identify any clinically important benefits, or other explanations for these negative results, we can only conclude that family doctors have little reason to prescribe either bed rest or isometric exercises to patients who suffer from low back pain.

Back Pain↗
PubMed1984

How many well-baby visits are necessary in the first 2 years of life?

Since we could find no scientific basis for the 10 well-baby visits recommended in the first 2 years of life in Ontario, we carried out a randomized trial in 570 healthy, low-risk newborns to determine the efficacy and safety of decreasing the number of scheduled well-baby visits from 10 to 5. Among the 466 babies still in the trial at the end of the study period those in the 10-visit group had had a mean of 7.63 scheduled and 0.26 unscheduled well-baby visits and those in the 5-visit group a mean of 4.77 scheduled and 1.42 unscheduled well-baby visits. Reducing the recommended number of visits did not result in an increased incidence of illness or an increased prevalence of undetected abnormality, and the physical development of the babies in the two groups was almost identical. The mean scores of the two groups in assessments of mental development, maternal-child relations, maternal anxiety and parental satisfaction with health care were close. The results suggest that the recommended number of well-baby visits for healthy, low-risk newborns can be reduced to five for children of multiparas and six for children of primiparas. Any additional well-baby visits should be scheduled according to the needs and experience of the parents.

Child Development↗
PubMed1984

Educational package on hypertension for primary care physicians.

The usefulness of an educational package on hypertension that provides clinically important, up-to-date medical information and office "aids" to primary care physicians was tested in a randomized controlled trial. Fifty-six physicians completed a pretest multiple-choice questionnaire and were allocated at random either to a group that received the educational package (the "study group") or to a control group. There was a highly significant correlation between the pretest scores and the number of years since graduation (r = -0.55, p less than 0.0001), which indicated that younger physicians are more likely than older physicians to have an up-to-date knowledge of the management of hypertension. The increase in knowledge in the study group (17.5%) was significantly greater than that in the control group (2.7%). Furthermore, although the post-test scores in the control group were still significantly correlated with the number of years since graduation, those in the study group were not. It was concluded that although the older physicians knew less than their younger colleagues about hypertension, the use of the educational package significantly increased knowledge, and the increase was not limited by the physician's age.

Age Factors↗
PubMed1983

When is a patient's use of primary care services unwarranted? Some answers from physicians.

To explore physicians' perceptions of what constitutes unwarranted use of their services, examples of patient-initiated encounters considered unwarranted were contributed by physicians and categorized as requests for unnecessary services, inappropriately timed encounters or inconsiderate requests. A random sample of family and general practitioners in Ontario was surveyed with a questionnaire derived from these examples. Although there was no unanimity, examples of missed appointments, requests for further, unnecessary investigations, consultations or admissions to hospital, duplication of services, visits prompted by a desire to obtain free samples of over-the-counter drugs, some out-of-hours calls, and visits of healthy workers to obtain notes regarding fitness for work were seen as unwarranted by 70% or more of the respondents.

Canada↗
PubMed1983

Na+, K+, H+ and Cl- permeability properties of rabbit skeletal muscle sarcolemmal vesicles.

The ion permeability properties of rabbit skeletal muscle sarcolemmal vesicles were investigated by means of radioisotope flux, membrane potential, and light-scattering measurements. An enriched sarcolemmal fraction was obtained from the 22-27% region of sucrose gradients after isopycnic centrifugation. The presence of contaminating sarcoplasmic reticulum was assessed with the use of a purified sarcoplasmic reticulum vesicle fraction. 22Na+, 86Rb+, 36Cl-, and [3H]sucrose flux measurements indicated that the sarcolemmal fraction possessed isotope spaces ranging between 1.5 and 4 microliters/mg protein. Membrane potential measurements using the voltage-sensitive fluorescent probe 3,3'-dipentyl-2,2'-oxadicarbocyanine iodide (diO-C5-(3)) indicated that sarcolemmal vesicles were impermeable to H+ and Na+ but that 10-15% of the vesicles were permeable to K+. Light-scattering measurements indicated a small fraction of sarcolemmal vesicles were permeable to both K+ and Cl-. Whether the low permeability of sarcolemmal vesicles to Na+, K+, and Cl- is the result of a low concentration of ion channels or the inactivation of these channels during isolation is at present uncertain.

Animals↗
PubMed1982

Sodium-calcium ion exchange in skeletal muscle sarcolemmal vesicles.

The Ca2+ permeability of rabbit skeletal muscle sarcolemmal vesicles was investigated by means of radioisotope flux measurements. A membrane vesicle fraction highly enriched in sarcolemma, as revealed by enzymatic markers, was obtained from the 22-27% region of sucrose gradients after isopycnic centrifugation. The ability of sarcolemmal vesicles to exchange Na+ for Ca2+ was investigated by measuring Ca2+ influx into and efflux from sarcolemmal vesicles in the presence and absence of a Na+ gradient. It was found that Ca2+ movements were enhanced in the direction of the higher Na+ concentration. When intra-and extravesicular Na+ concentrations were high, Na+-Na+ exchanged predominated and Na+-Ca2+ exchange was low or absent. The presence of the Ca2+ ionophore A23187 in the dilution medium resulted in the rapid release of Ca2+ and the elimination of the Na+-enhanced efflux of Ca2+, suggesting that internal rather than bound external Ca2+ was exchanged with Na+ . La3+ abolished Na+-Ca4+ exchanged was not due to sarcoplasmic reticulum or mitochondrial contaminants. This investigation suggests that skeletal muscle, like cardiac muscle and neurons, is capable of a transmembranous Na/-Ca2+ exchange.

Animals↗
PubMed1981

Choice of ecbolic and the morbidity of day-case terminations of pregnancy.

In 103 women admitted for out-patient vaginal terminations of pregnancy, the relation was investigated between the use of ecbolics and blood loss, vomiting and other side effects. Patient self-rating was incorporated in the study for comparative purposes. Use of a combined preparation of oxytocin and ergometrine resulted in the lowest blood losses. Ergometrine administered alone was associated with immediate nausea and vomiting but no delayed effects. Seven days after abortion, 35% of the women were still complaining of vaginal bleeding, although in most the volume was low.

Abortion, Induced↗
PubMed1980

Predicting compliance with a regimen of digoxin therapy in family practice.

The ability of family physicians to predict patients' compliance with a regimen of digoxin therapy was studied by an analytic survey. Compliance was assessed by a pill count at a home visit and measurement of the serum digoxin level in a blood sample obtained at that visit. Of 74 patients 70% were found to be taking more than 80% of their pills and 86% had a therapeutic serum digoxin level. The 10 physicians were unable to predict compliance better than chance, even for the 58 patients they had known for 5 or more years. Physicians should be cautious in predicting compliance, and when they prescribe oral digoxin therapy they should monitor the patient's compliance by means of the serum digoxin levels.

Adult↗
PubMed1979

Morbidity of day-case gynaecological surgery. A comparison of thiopentone and Althesin.

To compare two anaesthetic techniques, morbidity following day-case gynaecological surgery in 170 patients was assessed by means of a questionnaire at the time of leaving hospital. A further questionnaire sought information for the evening of the operation, and the 1st and 2nd days after operation. Ninety-four per cent of patients returned the latter questionnaire. There was a high frequency of morbidity extending into the 2nd day after operation. An anaesthetic technique using Althesin and nitrous oxide in oxygen offered no advantage over a technique with thiopentone and nitrous oxide in oxygen and halothane.

Adolescent↗