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Biomedical subjects

K C Calman

Publications and source records attributed to K C Calman.

At least 19 recordsLinked to original sources
PubMed1991

The pre-registration house officer year: a critical incident study.

To define the major problems faced by pre-registration house officers, 328 critical incidents from 200 house officers and related staff were collected. Each incident was analysed and key words representing the main features were abstracted. These were then aggregated into eight broad categories; personal aspects, clinical skills, communication and relationships, problem-related, organization skills, education, dying patients, and administration. Further analysis of the incidents suggested a series of conclusions which include the need for effective supervision of the house officer with feedback on performance. An induction/orientation period is necessary; there is evidence that a proportion of house officers need additional experience of practical procedures; house officers often have difficulty in setting priorities and they have little experience, prior to qualification, of organizational skills; during the year they are very busy with little time off. Facilities and accommodation may be less than adequate. They perceive a lack of support from senior staff to help with personal problems and career guidance; they are conscious that communication skills are of great importance and would like additional help with this; there is little time for formal education during the year. The range of clinical material presented is enormous, however, and the challenge for medical education is to ensure that the opportunities for learning are not missed.

Clinical Competence↗
PubMed1991

The Peter Lowe Lecture--medicine in the 1990s.

This paper set out to examine the role of medicine and medical practice. It has done so by posing a series of questions related to the role of the doctor, health and health care, and the patient-doctor relationship. One of the objectives was to re-examine some of the principles of medical practice, another to consider a vision of medicine for the future. The result of this examination has not turned up anything particularly new or original. What it has done, I believe has been to endorse the principles of medicine which have been established for thousands of years. Yet perhaps in some ways they need to be re-asserted and discussed afresh. Because of the enormous changes in society, in health care and the external and internal pressures on doctors, such values can be forgotten or lost. Change is inevitable and doctors must adapt to meet the changes. They must do so in a positive way and wherever possible take the lead in shaping the health and health care of the future. The values of the future are those of the past, though the setting and context may be quite different. These values include, the importance of caring, the central role of communication, the need to be involved in health as well as illness, the implications of making a diagnosis and the fundamental nature of education and training. There is a need to retain common sense and perspective in making decisions. My vision of the future of medicine is therefore clear.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Medicine↗
PubMed1979

Enhancement of methotrexate absorption by subdivision of dose.

A comparison was made in fasting patients between a single 100 mg oral dose of methotrexate formulated as its sodium salt in a palatable syrup and the same total quantity of drug administered in four divided doses of 25 mg taken at 2-h intervals. Allocation to the order of these treatment schedules was on a random basis. The area under the serum methotrexate concentration-time curve until 50 h was found to be considerably greater after the divided dose regimen, the mean ratio AUC 25 mg x 4/AUC 100 mg being 1.86 (+/- 0.90). There was no significant difference in peak serum methotrexate concentrations or methotrexate half-life estimates between the two regimens, however. The results of this study are consistent with saturation of an intestinal transport process when methotrexate is administered orally in a single large dose.

Half-Life↗
PubMed1979

Bioavailability of methotrexate: implications for clinical use.

The absorption of oral methotrexate in syrup form has been compared in six patients with that of an identical IV dose (50 mg/m2). There was variable absorption amongst the group with respect to maximum levels achieved and the time taken to reach those levels. The area under the time-concentration curve was always smaller when the drug was given orally than after IV administration. A total of 33 patients receiving methotrexate for a variety of tumour types were followed for response to treatment and toxicity. A significantly longer methotrexate half-life (t1/2) was found in nine partial responders (9.2 +/- 1.6 h) than in the nonresponders (3.8 +/- 0.7 h). Severe methotrexate toxicity was not seen though occasional mucositis, conjunctivitis, and diarrhoea occurred in seven patients. The side effects could not be predicted from the dose, the bioavailability data, or the serum creatinine. Measurements of serum and urine methotrexate levels are useful in the assessment of absorption and bioavailability of the drug the prediction of tumour response.

Administration, Oral↗
PubMed1979

Serum, tear and salivary concentrations of methotrexate in man.

1. Methotrexate handling has been studied in four patients with psoriasis and eleven patients with neoplastic disease. 2. Methotrexate levels in serum, tears and saliva were measured by radioimmunoassay while protein binding studies were performed by continuous ultrafiltration. 3. There was a close correlation between methotrexate concentrations in tears and serum (P less than 0.001, r = 0.714). Parotid salivary and serum methotrexate levels were similarly correlated (P less than 0.001, r = 0.557) but not mixed salivary and serum levels (P greater than 0.1, r = 0.232). 4. The mean protein binding was 95.11% +/- 2.26 (s.d.) while the ratio of methotrexate levels in tears to the free serum methotrexate level was 1:1.04. The corresponding parotid salivary level: free serum level ratio was 1:18.11. 5. No relationship could be determined between the methotrexate levels in tears and conjunctivitis observed in some of the patients under study.

Humans↗
PubMed1979

Nutritional support in patients with malignant disease.

Clinicians have long been aware of the major nutritional and metabolic abnormalities that occur in patients with cancer. Such abnormalities are varied and hence both the indications and techniques for their correction are also diverse. The aim of the present paper is to consider certain specific aspects of nutritional support in cancer and the authors end with a brief review of areas of study which may prove useful in future.

Diet↗
PubMed1977

Nuclear oestrogen receptors and treatment of breast cancer.

In an attempt to improve the predictive value of oestrogen-receptor measurements in breast-tumour biopsy specimens, oestrogen receptor was measured at both cytoplasmic and nuclear levels. Although 33% of patients had receptors at both levels, another 17% had cytoplasmic but no nuclear receptors. Theoretically, this latter group would not be expected to respond to hormone therapy. 7% had nuclear but not cytoplasmic receptors. The six-month follow-up data for the group of patients with receptors at both cytoplasmic and nuclear levels suggests qualitatively that this group has a good chance of responding favourably to hormone therapy. Much larger numbers must be accumulated before quantitative conclusions can be reached.

Breast Neoplasms↗
PubMed1976

Bilateral nephrectomy prior to renal transplantation.

Bilateral nephrectomy was performed in 53 patients on regular haemodialysis. The indications were pyelonephritis in 30, polycystic kidneys in 6, glomerulnephritis in 7, uncontrollable hypertension in 9 and horseshoe kidney in 1. In 87 per cent of cases the operation was carried out as a separate procedure prior to transplantation. The mortality was 9 per cent and the postoperative complications included hypotension, clotting of arteriovenous shunts, pneumonia and subphrenic abscess. As a result of our experience we have revised our indications for bilateral nephrectomy which now are pyelonephritis only when associated with persistent bacteriuria or ureteric reflux, polycystic kidneys and uncontrollable hypertension.

Adolescent↗
PubMed1975

Ultrasound in the diagnosis of fluid collections following renal transplantation.

Ultrasound examinations of the pelvis and kidney have been carried out following 68 renal transplants. In 16 patients moderate sized or large perirenal or pelvic fluid collections were demonstrated. The composition of the fluid was lymph in seven cases, pus in four, blood in three and urine in two. Ten of these 16 patients had clinical features compatible with a pelvic fulid collection while six had no such localising features. We have found ultrasound to be extremely valuable in the diagnosis and precise localisation of pelvic fulid collections following transplantation, often at a stage before pressure effects and symptoms have appeared. It also provides a rapid and reliable means of excluding a pelvic or perirenal abscess in the pyrexial patient.

Abscess↗