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Biomedical subjects

J W Agar

Publications and source records attributed to J W Agar.

14 recordsLinked to original sources
PubMed2004

How doctors discuss major interventions with high risk patients: an observational study.

OBJECTIVE: To investigate the difficulties doctors face in discussing treatment options with patients with acute, life threatening illness and major comorbidities. DESIGN: Observational study of doctor-patient interviews based on a standardised clinical scenario involving high risk surgery in a hypothetical patient (played by an actor) with serious comorbidities. PARTICIPANTS: 30 trainee doctors 3-5 years after graduation. MAIN OUTCOME MEASURES: Adequacy of coverage of various aspects was scored from 3 (good) to 0 (not discussed). RESULTS: The medical situation was considered to be well described (median score 2.7 (interquartile range 2.1-3.0)), whereas the patient's functional status, values, and fears were poorly or minimally addressed (scores 0.5 (0.0-1.0), 0.5 (0.0-1.0), and 0.0 (0.0-1.5), respectively; all P < 0.001 v score for describing the medical situation). Twenty nine of the doctors indicated that they wished to include the patient's family in the discussion, but none identified a preferred surrogate decision maker. Six doctors suggested that the patient alone should speak with his family to reach a decision without the doctor being present. The doctors were reluctant to give advice, despite it being directly requested: two doctors stated that a doctor could not give advice, while 17 simply restated the medical risks, without advocating any particular course. Of the 11 who did offer advice, eight advocated intervention. CONCLUSIONS: Doctors focused on technical medical issues and placed much less emphasis on patient issues such as functional status, values, wishes, and fears. This limits doctors' ability to offer suitable advice about treatment options. Doctors need to improve their communication skills in this difficult but common clinical situation.

Clinical Competence↗
PubMed1994

Renal biopsy in angiotropic large cell lymphoma.

Angiotropic large cell lymphoma is a rare microvascular malignancy presenting most commonly with neurologic symptoms but, from a review of the scarce literature, also invariably with evidence of renal involvement. We believe this to be the first case in which the diagnosis was made by initial renal biopsy and in which follow-up of the effectiveness of chemotherapy was assessed by a second biopsy. Proteinuria is prominent in this condition and may result either from the epithelial cell abnormalities associated with the minimal-change lesion or from a direct interaction between the B cell-derived malignant cells and the glomerular endothelium. We believe the kidney may be the most appropriate organ with which to histologically confirm the diagnosis of suspected angiotropic large cell lymphoma and examination of the kidney may prove to be the best way to allow histologic follow-up of the disease or the efficacy of its therapy.

Biopsy, Needle↗
PubMed1992

Application of machine learning to a renal biopsy database.

This pilot study has applied machine learning (artificial intelligence derived qualitative analysis procedures) to yield non-invasive techniques for the assessment and interpretation of clinical and laboratory data in glomerular disease. To evaluate the appropriateness of these techniques, they were applied to subsets of a small database of 284 case histories and the resulting procedures evaluated against the remaining cases. Over such evaluations, the following average diagnostic accuracies were obtained: microscopic polyarteritis, 95.37%; minimal lesion nephrotic syndrome, 96.50%; immunoglobulin A nephropathy, 81.26%; minor changes, 93.66%; lupus nephritis, 96.27%; focal glomerulosclerosis, 92.06%; mesangial proliferative glomerulonephritis, 92.56%; and membranous nephropathy, 92.56%. Although in general the new diagnostic system is not yet as accurate as the histological evaluation of renal biopsy specimens, it shows promise of adding a further dimension to the diagnostic process. When the machine learning techniques are applied to a larger database, greater diagnostic accuracy should be obtained. It may allow accurate non-invasive diagnosis of some cases of glomerular disease without the need for renal biopsy. This may reduce both the cost and the morbidity of the investigation of glomerular disease and may be of particular value in situations where renal biopsy is considered hazardous or contraindicated.

Artificial Intelligence↗
PubMed1989

Caught in the act!

Explore the source record for details and available documents.

Erythrocytes↗
PubMed1981

Renal vein renin activity and prostaglandins A and E in hypertension.

The relation between renal vein renin activity (RVRA) and renal vein-prostaglandin A (PGA) and prostaglandin E (PGE) concentrations was examined in 50 patients with hypertension who underwent renal vein catheterizations for suspected renovascular hypertension. In 14 patients wih unilateral renal artery stenosis, mean renal vein PGE concentrations were higher in the renal vein draining the nonischemic kidney, while RVRA was increased in the renal vein draining the ischemic kidney. PGE ratios from the two sides were inversely related to RVRA ratios in this group. In the other 36 patients with either bilateral renal artery stenosis, essential hypertension or nonrenovascular unilateral renal disease, RVRA and PGE concentrations were similar in both kidneys. No relation between RVRA and PGA could be established for any group.

Adolescent↗
PubMed1979

Elevation of serum lactate dehydrogenase levels in renal infarction.

The diagnostic value of a strikingly elevated serum lactate dehydrogenase (LDH) level in association with only small or no increases in SGOT and alkaline phosphatase levels was noted in five patients with proved renal infarction. Four had renal artery embolism and infarction in association with atrial arrhythmias; one had an acute extension of an abdominal aortic aneurysm occluding the renal artery. Other causes of a considerable isolated increase in the serum LDH level such as hemolysis and myocardial infarction can usually be easily excluded.

Aged↗