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Biomedical subjects

L Snell

Publications and source records attributed to L Snell.

At least 37 records · Page 2Linked to original sources
PubMed1997

Does knowledge of drug prescribing predict drug management of standardized patients in office practice?

Drug prescribing for the elderly is an important area of medical knowledge since inappropriate prescribing may lead to significant adverse drug events. The objective of this study was to evaluate the association between knowledge of drug use and quality of drug management by general practitioners in practice. A cross-sectional study design was used to evaluate a sample of 37 GPs in practice. A set of common musculoskeletal problems was chosen to evaluate doctors' knowledge of non-steroidal anti-inflammatory drug use, while performance in practice was assessed using elderly standardized patients. The reliability of knowledge test scores was evaluated using measures of internal consistency. The relationship between knowledge of drug use and quality of therapeutic management in practice was evaluated by rank order and linear correlation analysis. Demographic characteristics of participating and non-participating doctors were similar. The reliability of the knowledge test was 0.55. The reliability of performance scores was 0.66. The correlation between overall performance on the standardized patient cases and total knowledge test score was 0.22 (95% confidence interval = 0-0.63). Knowledge test scores were poorly correlated with quality of therapeutic management in office practice. This indicates that knowledge tests alone cannot predict quality of performance with regard to drug prescribing for the elderly in primary care office practice.

Clinical Competence↗
PubMed1997

Expression of estrogen receptor variant messenger RNAs and determination of estrogen receptor status in human breast cancer.

Estrogen receptor (ER) status of breast cancer can be assessed by immunohistochemical assay (IHA), although we have previously observed that ER-IHA levels can be inconsistent between amino-terminal and carboxyl-terminal-targeted antibodies. To address the hypothesis that this discrepancy is attributable to expression of ER variant mRNAs encoding truncated ER-like proteins, we have studied 39 IHA-consistent and 24 IHA-inconsistent breast tumors by reverse transcription polymerase chain reaction to examine the expression of multiple exon-deleted (D-ER) variant mRNAs and the truncated ER clone 4 variant mRNA. ER variants D7-ER, D-3-4-ER, and D4-7-ER were detected at similar frequencies in both groups. However, ER variants D2-3/7-ER, D2-3-4-ER (P < 0.05), and D-3-7-ER (P < 0.01), which encode putative short ER-like proteins that might be recognized only by an amino-terminal-targeted antibody, were preferentially detected in inconsistent cases. ER clone 4 mRNA expression was also higher in inconsistent tumors (P < 0.001). Further analysis showed that, whereas overall prevalence of ER variant mRNAs was similar in both tumor groups, occurrence of the subset of variant mRNAs encoding putative truncated proteins was also higher in IHA-inconsistent tumors (P < 0.05). These data suggest that ER variant mRNAs encoding truncated ER proteins may contribute to discrepancies in ER-IHA levels determined using amino- or carboxyl-terminal-targeted antibodies.

Breast Neoplasms↗
PubMed1996

Differential expression of psoriasin messenger RNA between in situ and invasive human breast carcinoma.

The mRNA encoding the calcium-binding protein psoriasin was identified as being more highly expressed in the in situ versus the invasive component of the same breast tumor. Reverse transcription-PCR analysis of total RNA extracted from three independent cases of ductal carcinoma in situ of the comedo type and three cases of high-grade invasive ductal carcinoma revealed a detectable level of psoriasin mRNA expression in the in situ lesions only. Similar analysis performed on total RNA extracted from frozen sections of 32 independent breast samples, representing a continuum from normal to invasive tumor, confirmed high psoriasin expression in ductal carcinoma in situ of the comedo type only. The possible functional role of the psoriasin protein in breast tumor cells remains to be determined.

Breast Neoplasms↗
PubMed1996

The NCIC-Manitoba Breast Tumor Bank: a resource for applied cancer research.

The NCIC-Manitoba Breast Tumor Bank is one of several tumour banks that have been established through the Molecular Epidemiology Program of the National Cancer Institute of Canada (NCIC). The NCIC-Manitoba Breast Tumor Bank is an example of one model developed to facilitate research designed to translate the findings of basic science into information useful in the clinical arena. The tumour bank's mandate is to provide a national resource that consists of a preassembled dataset of matched samples of paraffin-embedded and frozen tumour tissue with corresponding pathological and clinical data. In the first 3 years the tumour bank has accrued data and samples from over 1800 cases of breast cancer and has provided support for 20 research projects across Canada and the United States.

Academies and Institutes↗
PubMed1996

Effects of short-term exercise on appetite responses in unrestrained females.

OBJECTIVE: To examine the short-term effects of exercise and diet composition on appetite in unrestrained females. DESIGN: A 2 x 2 repeated measures design study was conducted, with exercise and lunch type as the repeated factors. SETTING: The Human Appetite Research Unit at Leeds University Psychology department. SUBJECTS: 13 unrestrained, normal weight females were recruited from the student and staff population of Leeds University. INTERVENTIONS: Subjects were assigned to four experimental treatments in a counterbalanced order. These were a control (no-exercise) session and an intense (70% VO2 max) exercise session followed by a free-selection test lunch consisting of high-fat/low-carbohydrate or low-fat/high-carbohydrate foods. The effects of exercise and lunch type were measured by monitoring energy intake and macronutrient intake during the test lunches only. Visual analogue scales were used to monitor profiles of motivation to eat during the treatments. RESULTS: Subjects did not experience the marked suppression of hunger induced by exercise, which is a striking and robust finding in men. Moreover, unlike men, females rated a range of foods to be more palatable after exercise (F(1,12) = 8.0, P < 0.05). Similar to male subjects, exercise in females had no significant short-term effect on energy or macronutrient intake. Energy intake was significantly influenced by the fat:carbohydrate composition of the foods available (F(1,12) = 64.7, P < 0.001), and the short-term energy deficit induced by exercise when followed by low-fat lunch was completely wiped out when exercise was followed by a high-fat lunch (F(1,12) = 66.2, P < 0.001). CONCLUSIONS: These results show that there are similarities and differences between males and females in the appetite response to foods varying in macronutrient composition following vigorous exercise. The differences may help to explain why exercise so often produces a disappointing effect on weight control in females.

Adult↗
PubMed1994

Faculty ratings of resident humanism predict patient satisfaction ratings in ambulatory medical clinics.

OBJECTIVE: To determine whether patient satisfaction ratings can be predicted by faculty ratings or self-ratings of resident humanism. DESIGN: A prospective three-month collection of patient satisfaction ratings in two ambulatory care clinics and simultaneous acquisition of faculty ratings and self-ratings of resident humanism using ABIM questionnaires. SETTING: Two teaching hospital ambulatory care internal medicine clinics. PARTICIPANTS: Forty-seven internal medicine residents and 17 faculty internists were sent questionnaires for evaluation of humanism of individual residents. One thousand one hundred ninety-four consecutive outpatients cared for by the residents were eligible for patient satisfaction questionnaires. MEASUREMENTS AND MAIN RESULTS: Thirty-three residents and 13 faculty completed evaluations of resident humanism while 792 patients completed satisfaction questionnaires, which were used for analysis. The faculty ratings of resident humanism correlated strongly with patient satisfaction ratings, while the resident self-ratings did not. CONCLUSIONS: Faculty ratings of resident humanism were highly predictive of patient satisfaction with the care rendered by internal medicine residents in two ambulatory care clinics. This suggests that ambulatory care settings are useful for evaluation of noncognitive behavioral features of resident performance.

Ambulatory Care↗
PubMed1994

The feasibility and value of using patient satisfaction ratings to evaluate internal medicine residents.

OBJECTIVE: To determine the feasibility and value of using patient satisfaction ratings to evaluate the physician-patient relationship skills of medical residents. DESIGN: A cross-sectional survey was used to collect patient satisfaction information for medical residents from all patients attending the out-patient teaching clinics over a three-month period. The feasibility of patient rating was assessed by evaluating the reliability of resident satisfaction scores and potential sources of bias in rating. The value of using this method was assessed by evaluating the proportion of variance in ratings attributable to residents, the prevalence of residents with ratings substantially below average, and the effect of training on patient satisfaction. SETTING: The medical clinics of two teaching hospitals at McGill University. PARTICIPANTS: 91 medical residents and clinical clerks, 1,003 patients, and 1,219 visit ratings. RESULTS: An average of 12.2 satisfaction ratings were collected per resident, providing a reliability of 0.56 (intraclass correlation) for resident satisfaction score. Adjustment for differences in patient populations would be necessary to obtain comparable scores among residents. Fifteen percent of the residents had a substantially greater proportion of poor and fair satisfaction ratings than the study average. Residents were responsible for a substantial proportion of the variance in clinic waiting time and patient satisfaction rating. Training appeared to have no effect on improving satisfaction scores, except among women residents. CONCLUSIONS: Patient satisfaction ratings provide valuable information about a resident's ability to establish an effective physician-patient relationship. However, the number of ratings required to obtain a reliable estimate of resident skill may limit the feasibility of using patient ratings as part of residency evaluation.

Adolescent↗
PubMed1989

Reading habits of house-staff: what, where and why.

As in-training evaluations often comment that house-staff do not read enough about cases, this study looked at the reading habits of internal medicine students and house-staff to assess whether they were reading about cases. All 38 trainees at a major teaching hospital were surveyed with a questionnaire. Overall, the house-staff read 8.7 hours/week, of which half is spent reading about cases. They read around approximately half of the cases they see. The more senior house-staff use journals and one major textbook; the medical students use only textbooks. The reading is done mainly at home, except by the senior residents who spent a quarter of their reading time in the library. The major reasons why the house-staff read are to prepare for presentations or for rounds with the attending physicians. These results suggest that contrary to what we anticipated, house-staff do indeed read about the cases they see on the wards.

Education, Medical, Continuing↗
PubMed1987

Altered Purkinje cell maturation in rats exposed prenatally to ethanol. I. Cytology.

Sprague-Dawley pregnant rats received a liquid ethanol diet that was nutritionally balanced and provided 35% of calories in ethanol, beginning on day 6 of gestation. Control animals were pair-fed the same diet except that maltose-dextrins were substituted for ethanol. At birth pups of both ethanol-exposed and pair-fed groups were fostered by surrogate mothers which received normal rat chow ad libitum. An average of eight alcohol-exposed and eight pair-fed pups were killed at 0-1, 5, 7, 10, 14, 21, 28, and 42 days. Their fixed cerebella were bisected in the midvermal plane and one-half embedded in Araldite. Thin sections were cut from lobules II/III and stained with uranyl acetate and lead citrate and visualized with the electron microscope to evaluate the effect of ethanol on Purkinje cell growth and maturation. Although the basic layering of the cerebellar cortex was not altered, alignment of Purkinje neurons to form a monocellular layer was delayed associated with disorientation of some neurons in the ethanol-exposed pups. Delayed differentiation of Purkinje neurons in the experimental animals was also noted as evidenced by the ribosomal accumulation at the basal aspect of the cell at 14 days postnatally, resembling a 7-day control pup. Purkinje neurons of control pups were well differentiated at 14/21 days, with a centralized nucleus surrounded by a cytoplasm containing Nissl bodies, numerous Golgi complexes, and mitochondria. The ethanol-exposed pups at 14/21 days showed delayed maturation indicated by a basal ribosomal mass, with few segments of rough endoplasmic reticulum. At 28/42 days the Purkinje neurons of the controls showed a greater degree of differentiation and maturation in contrast to the reduced protein-synthesizing machinery, i.e., poorly developed endoplasmic reticulum and Nissl bodies, in the experimental pups. These studies showed delayed differentiation and maturation of Purkinje neurons as a consequence of ethanol exposure.

Abnormalities, Drug-Induced↗
PubMed1987

Altered Purkinje cell maturation in rats exposed prenatally to ethanol. II. Synaptology.

Pregnant rats of Sprague-Dawley strain were offered a protein- and vitamin-enriched nutritionally balanced liquid ethanol diet, providing 35% of calories as ethanol. Control animals were pair-fed identical liquid diet except that maltose-dextrins were substituted for ethanol. Pups of both ethanol-exposed and pair-fed groups were surrogate-fostered by mothers which received normal rat chow ad libitum. An average of eight pups of each experimental and control group was killed at 0-1, 5, 7, 10, 14, 21, 28, and 42 days. After fixation, their cerebella were bisected in the midvermal plane and one-half embedded in Araldite. Thin sections cut from lobules II/III were stained with uranyl acetate and lead citrate and the synaptology of the Purkinje neurons was studied with the electron microscope in both the experimental and control groups. Impaired climbing fiber maturation was seen in ethanol-exposed pups as evident from the presence of somatic spines--climbing fiber synapses at 14 days postnatally. In the 14-day-old control pups the climbing fiber maturation was complete or nearly complete as evident by their synapses on spines situated on the smooth dendritic branches and by the absence or paucity of climbing fiber--somatic spine synapse. In addition, a reduction in the number of parallel fibers was evident from the increase in Purkinje cell spines per varicosity in the ethanol-exposed pups. We conclude, therefore, a direct or indirect effect of ethanol occurs on climbing fiber maturation and Purkinje cell parallel fiber relationship.

Abnormalities, Drug-Induced↗
PubMed1971

Social trauma as related to cancer of the breast.

A number of writers, primarily in the field of psychophysiology, have suggested that breast cancer may be related to a variety of untoward psychological states and that these may be related in turn to having experienced misfortune in the social milieu. Other research has indicated that endocrine function may figure in the etiology of this disease. For these reasons, we wished to examine the relationship between the experiencing of social trauma which could induce endocrine effect and the development of cancer of the breast. We hypothesized that breast cancer cases, more often than controls, would have encountered traumatic incidents in their social milieu in the 5-year period prior to the diagnosis of their disease.Three hundred and fifty-two breast cancer cases and 670 controls with other types of cancer and non-neoplastic diseases of organs other than the breast and genitalia from Roswell Park Memorial Institute were interviewed. Comparisons were made concerning the extent to which the subjects and their immediate and extended families incurred such life events as death, divorce, illness, economic want, residential mobility, and feelings of being upset. No difference was found between the breast cancer cases and the controls either in the experiencing of single events or cumulative numbers of events by themselves or by members of their families. There may be events of a different type, not studied here, which are related to the development of cancer of the breast.

Adult↗
PubMedDate not supplied

Casemix in an internal medicine clerkship: educational value of the clinical problems seen.

OBJECTIVE: To evaluate the casemix seen during an internal medicine clerkship and to assess the educational value of the problems seen. DESIGN: A modified Delphi-group opinion technique was used to develop a clerk log that included priority problems for internal medicine. Over a 12-month period, clerks recorded their exposure to the problems seen during their eight-week rotations. General internists rated the importance of each of the problems on a three-point scale. SETTING: The inpatient internal medicine services in six university teaching hospitals. SUBJECTS: All clinical clerks in a single undergraduate year recorded their experiences. All university-based general internists participated in rating problem importance. MEASUREMENTS AND MAIN RESULTS: The final approved log contained 72 problems, 64 of which received importance ratings greater than or equal to 2 on the three-point scale. The frequency of clerk exposure per problem was high and the correlation between frequency of exposure and importance was good. Ten important problems had relatively low exposure and four problems of lower importance had high exposure. CONCLUSIONS: The clinical clerks were exposed to a broad spectrum of diseases, but some key problems were not well represented on the wards. Alternative strategies, including increased ambulatory care exposure, will be required to complete the exposure and to assure that the quality of patient exposure matches the quantity.

Clinical Clerkship↗