PubMed Health⌕ Search

Biomedical subjects

M Godwin

Publications and source records attributed to M Godwin.

33 records · Page 2Linked to original sources
PubMed1999

Sex differences in renal transplantation in Canada.

To determine if a patient's sex influences access to renal transplantation in Canada, transplant recipient data for first cadaveric unrelated renal transplants were obtained from the Canadian Organ Replacement Register (CORR) for the period 1985-1992. There were 4683 first unrelated cadaveric transplant recipients during this time. Differences in the proportion of men and women registered with CORR who received a renal transplant were analyzed. In Canada between 1985 and 1992, 25% of males 40 years and older on dialysis received renal transplants compared with 18% of females (p < 0.0001, RR 1.54, 95% CI 1.40-1.67). There was no difference in the rates of transplants in males and females who were under 40 years of age. Adjusting for panel-reactive antibody data did not change the significance of the difference in transplant rates between the sexes. In Canada from 1985 to 1992, male patients with end-stage renal disease received proportionately more transplants than females.

Adult↗
PubMed1999

Investigating fatigue of less than 6 months' duration. Guidelines for family physicians.

OBJECTIVE: To develop an evidence-based systematic approach to assessment of adult patients who present to family physicians complaining of fatigue of less than 6 months' duration. The guidelines present investigative options, making explicit what should be considered in all cases and what should be considered only in specific situations. They aim to provide physicians with an approach that, to the extent possible, is based on evidence so that time and cost are minimized and detection and management of the cause of the fatigue are optimized. QUALITY OF EVIDENCE: MEDLINE was searched from 1966 to 1997 using the key words "family practice" and "fatigue." Articles about chronic fatigue syndrome were excluded. Articles with level 3 evidence were found, but no randomized trials, cohort studies, or case-control studies were found. Articles looking specifically at the epidemiology, demographics, investigations, and diagnoses of patients with fatigue were chosen. Articles based on studies at referral and specialty centres were given less weight than those based on studies in family physicians' offices. MAIN MESSAGE: Adherence to these guidelines will decrease the cost of investigating the symptom of fatigue and optimize diagnosis and management. This needs to be proved in practice, however, and with research that produces level 1 and 2 evidence. CONCLUSIONS: Adults presenting with fatigue of less than 6 months' duration should be assessed for psychosocial causes and should have a focused history and physical examination to determine whether further investigations should be done. The guidelines outline investigations to be considered. The elderly require special consideration. These guidelines have group validation, but they need to be tested by more physicians in various locations and types of practices.

Adult↗
PubMed1998

Practice choices of graduating family medicine residents.

OBJECTIVE: To examine the types of practices family medicine residents chose during the first 2 years after residency, and how these choices have changed over a 15-year period. DESIGN: Mailed survey. SETTING: Areas served by graduates of the Queen's University family medicine residency program. PARTICIPANTS: Two hundred thirty (76%) of the 303 graduates from 1977 to 1991 of the Queen's University family medicine residency program responded to the questionnaire. MAIN OUTCOME MEASURES: Type of practices residents entered immediately out of residency: whether they began full-time, part-time, locum tenens, or other type of practice; length of time spent in the first practice situation; and proportion of residents who had settled into a full-time practice within 2 years of completing residency. RESULTS: Residents who graduated before 1985 were significantly more likely to go into full-time practice immediately out of residency (P = .0001). The earlier residents had graduated from the program, the more likely they were to go immediately into full-time practice. This finding was not affected by residents' age, sex, size of community of origin, exposure to rural teaching sites, marital status, or how well prepared for practice they felt. Residents graduating before 1985 were also more likely to be in full-time practice within 2 years of completing their residency program (P = .003). CONCLUSIONS: Recent family medicine residents did not enter full-time practice immediately out of residency as often as those who had graduated earlier, nor did they commit to full-time practice within 2 years of graduating as often as residents graduating before 1985 did.

Career Choice↗
PubMed1997

Men and women residents' experiences with women's health care in a family medicine center.

PURPOSE: To address the experience in women's health care available at the Queen's University Faculty of Medicine family residency program and to compare the amounts and types of experiences of men and women residents. METHOD: A retrospective analysis was made of 70,805 patient encounters with family medicine residents at the Queen's University Family Medicine Centre over a five-year period (June 1988-May 1993). Patient-encounter files contained patient, staff, and resident information, as well as service and diagnostic codes. Statistical analysis was done using a two-tailed Student's t-test to compare the mean numbers of encounters with the women patients for the men and women residents in ten service and diagnostic categories. RESULTS: Of the 70,805 patients, 65.1% were women. The mean numbers of patients seen by the 45 men residents (534) and the 90 women residents (519) did not differ significantly. The percentages of the women patients seen by the men and the women residents (58.6% and 68.4%, respectively), however, differed significantly. The mean ages of the women patients seen by the men and the women residents (44.5 years and 39.2 years, respectively) also differed significantly. The women had significantly more encounters with the women patients in five of the ten categories studied. CONCLUSION: The differences between the men and women residents' experiences was significant in several areas. A potentially confounding factor is that the women may have been preferentially placed in team areas with all women staff physicians and the men placed in team areas with all men staff physicians. As family medicine programs aim for levels of exposure that are sufficient and similar for men and women residents, it is important that they evaluate the clinical opportunities for residents in women's health and work to ensure that both men and women residents receive adequate exposure in this area. One step in this direction might be gender-balanced patient populations, which might be obtained by ensuring gender-balanced clinical teams.

Adult↗
PubMed1996

Interactions with the pharmaceutical industry: a survey of family medicine residents in Ontario.

OBJECTIVE: To determine the attitudes, knowledge and practices of family medicine residents relating to the pharmaceutical industry and to assess the effectiveness of existing guidelines on appropriate interactions with the pharmaceutical industry. DESIGN: Survey by mailed questionnaire. SETTING: Ontario. PARTICIPANTS: All 262 second-year family medicine residents in Ontario (seven centres); 226 (86.3%) responded. RESULTS: Fifty-two (23.0%) of the residents who responded stated that they had read the CMA policy statement on appropriate interactions between physicians and the pharmaceutical industry. A total of 124 (54.9%) stated that they would attend a private dinner paid for by a pharmaceutical representative; the proportion was not significantly reduced among those who had read the CMA guidelines, which prohibit the acceptance of personal gifts. In all, 186 (82.3%) reported that they would like the opportunity to interact with pharmaceutical representatives in an educational setting, even though several programs now discourage these interactions. Approximately three quarters (172/226 [76.1%]) of the residents indicated that they plan to see pharmaceutical representatives in their future practice. Residents at Centre 2 were significantly more critical of the pharmaceutical industry than those from the other centres. Overall, being aware of, and familiar with, departmental policy or CMA policy on interactions with the pharmaceutical industry did not affect the residents' attitudes or intended future practices. CONCLUSION: The presence of guidelines concerning physicians' interactions with the pharmaceutical industry does not appear to have a significant impact on family medicine residents in Ontario.

Adult↗
PubMed1996

Stimulatory effects of the putative metabotropic glutamate receptor antagonist L-AP3 on phosphoinositide turnover in neonatal rat cerebral cortex.

1. The effects of the metabotropic glutamate receptor (mGluR) antagonist, L-2-amino-3-phosphonopropionate (L-AP3) on phosphoinositide turnover in neonatal rat cerebral cortex slices has been investigated. 2. At concentrations of < or = 300 microM, L-AP3 inhibited total [3H]-inositol phosphate ([3H]-InsPx) and Ins(1,4,5)P3 mass responses stimulated by the selective mGluR agonist, 1-amino-cyclopentane-1S, 3R-dicarboxylic acid (1S, 3R-ACPD). Comparison with the competitive mGluR antagonist (+/-)-alpha-methyl-4-carboxyphenylglycine ((+/-)-MCPG) clearly demonstrated that L-AP3 caused inhibition by a mechanism that was not competitive, as L-AP3 decreased the maximal response to 1S, 3R-ACPD (by approximately 40% at 300 microM L-AP3) without significantly affecting the concentration of 1S, 3R-ACPD required to cause half-maximal stimulation of the [3H]-InsPx response. 3. In contrast, at a higher concentration L-AP3 (1 mM) caused a large increase in [3H]-InsPx accumulation which was similar in magnitude in both the absence and presence of 1S, 3R-ACPD (300 microM). D-AP3 (1 mM) had no stimulatory effect alone and did not affect the response evoked by 1S, 3R-ACPD. L-AP3 (1 mM) also caused a large increase in Ins(1,4,5)P3 accumulation. The magnitude of the response (4-5 fold increase over basal) approached that evoked by a maximally effective concentration of 1S, 3R-ACPD, but differed substantially in the time-course of the response. The stimulatory effects of 1S, 3R-ACPD and L-AP3 on Ins(1,4,5)P3 accumulation were also similarly affected by decreases in extracellular calcium concentration. 4. Detailed analysis of the inositol phospholipid labelling pattern and the inositol (poly)phosphate isomeric species generated following addition of L-AP3 was also performed. In the continued presence of myo-[3H]-inositol, L-AP3 (1 mM) stimulated a significant increase in phosphatidylinositol labelling, but not that of the polyphosphoinositides, and the inositol (poly)phosphate profile suggested that substantial Ins(1,4,5)P3 metabolism occurs via both 5-phosphatase and 3-kinase routes. 5. A significant stimulatory effect of L-AP3 (1 mM) on [3H]-InsPx accumulation was also observed in neonatal rat hippocampus, and cerebral cortex and hippocampus slices prepared from adult rat brain. 6. These data demonstrate that whilst L-AP3 antagonizes mGluR-mediated phosphoinositide responses at concentrations of < or = 300 microM, higher concentrations substantially stimulate this response. The ability of (+/-)-MCPG (1 mM) to attenuate significantly L-AP3-stimulated [3H]-InsPx accumulation, suggests that both the inhibitory and stimulatory effects of L-AP3 may be mediated by mGluRs.

Alanine↗
PubMed1996

Delisting of drugs in Ontario. How attitudes and prescribing strategies of family physicians in the Kingston area changed.

OBJECTIVE: To assess how attitudes and prescribing strategies of family physicians changed when drugs were delisted from the Ontario Drug Benefit formulary. DESIGN: Mailed, self-administered survey. SETTING: Family physicians' offices in Ontario. PARTICIPANTS: All family physicians practising in the Kingston, Frontenac, Lennox, and Addington Health District. MAIN OUTCOME MEASURES: Physicians were presented with six vignettes involving patients receiving a delisted drug. The choices were to recommend the patient pay for the medication, to substitute a drug still listed on the formulary, to make a special request that the medication be covered for this patient, or to offer another option. As well, the physicians were asked to indicate, on a 5-point Likert scale, their opinions regarding the effect of delisting on themselves and their patients. RESULTS: Physicians were most likely to change to a medication that was still on the formulary. Patient sex and ability to pay were factors in physicians' decisions. Physicians believe that the delistings are not likely to have adversely affected patients' health, that noncompliance is a problem because many once-daily formulations have been removed, that suitable alternatives are not always available, and that physicians should have been consulted more before the changes were made. CONCLUSIONS: Physicians usually substitute listed medications for medications that have been delisted. This is especially true for female patients and patients who are unable to pay.

Adult↗
PubMed1995

Availability of thrombolytic therapy in rural Newfoundland and Labrador.

OBJECTIVE: To determine the availability of thrombolytic therapy in rural Newfoundland and Labrador. DESIGN: Self-administered questionnaire mailed to staff at health care facilities. Respondents were sent two reminders by mail, and questionnaires not returned were completed through telephone interviews. SETTING: Rural health care facilities, including hospitals, 24-hour clinics and satellite clinics. PARTICIPANTS: All chief medical officers, nursing supervisors and administrators in the 34 government-funded rural health care facilities in Newfoundland and Labrador. OUTCOME MEASURES: Number of facilities offering thrombolytic therapy to patients with acute myocardial infarction (AMI) in 1992. For each facility: number of patients presenting with AMI during that year, number of these patients who received thrombolytic therapy, number of staff trained in advanced cardiac life support, travel time to the nearest referral centre, population served and number of beds. RESULTS: Of the 34 rural health care facilities in Newfoundland and Labrador, 91% (31/34) responded to the survey. Thrombolytic therapy was offered in 93% (13/14) of the rural hospitals, 22% (2/9) of the 24-hour clinics and none of the single-physician satellite clinics. In 1992, 390 patients with AMI presented to these health care facilities; 39% of these patients presented to facilities that did not offer thrombolytic therapy. CONCLUSIONS: Thrombolytic therapy has been successfully introduced in many of the rural and isolated health care facilities in Newfoundland and Labrador. An important factor in this success is continuing medical and nursing education on the effectiveness of thrombolytic therapy and the skills needed to provide it. Cost-effectiveness data are needed to determine whether it is reasonable to offer this therapy in isolated, low-volume clinics. More research on the outcomes in patients receiving thrombolytic therapy in rural facilities is also needed.

Humans↗
PubMed1994

Differences in the treatment of male and female patients with end-stage renal disease.

OBJECTIVE: To determine whether there is a difference in the allocation of types of dialysis to male and female patients with end-stage renal disease (ESRD). DESIGN: Descriptive study. SETTING: Canada. PATIENTS: All patients registered with the Canadian Organ Replacement Register (CORR) whose treatment began between 1981 and 1991. Data were obtained for 19,732 patients, of whom 18,010 had sufficiently complete data and were being treated with either peritoneal dialysis or hemodialysis 3 months after the diagnosis of ESRD. OUTCOME MEASURES: Proportions of patients receiving peritoneal dialysis and hemodialysis according to sex. RESULTS: Significantly more male (58.1%) than female (50.8%) patients were receiving hemodialysis 3 months after diagnosis (p < 0.00001). Multivariate analysis to control for the possible confounding effects of age, province of treatment, diagnosis, concurrent illness and year of diagnosis did not explain the difference. CONCLUSIONS: In Canada from 1981 to 1991 male patients were more likely than female patients to receive hemodialysis for the treatment of ESRD. Additional research is needed to explain this finding.

Adolescent↗
PubMed1993

Prevalence of cervical pathogens in women with and without inflammatory changes on smear testing.

OBJECTIVE: To assess correlation between nonspecific cervicitis, inflammation, or exudate on cervical smears tests and confirmed presence of known cervical pathogens. DESIGN: Investigation of women attending a family practice clinic for smear test by microbiological screening for Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Trichomonas vaginalis, Candida species, group B streptococcus, Gardnerella vaginalis, and Neisseria gonorrhoeae. SETTING: Family practice teaching clinic in a university hospital. PATIENTS: 411 women presenting for a smear test. MAIN OUTCOME MEASURES: Prevalence of genital infections associated with presence or absence of inflammatory changes on cervical smear. RESULTS: Of the 132 women with inflammatory changes on cervical smear, 64 (48%) had positive cultures. Of the 248 without inflammatory changes, 117 (47%) had positive cultures. Subgroup analysis on individual organisms also showed no significant difference between the two groups. CONCLUSION: Reports of inflammatory changes on cervical smear testing are a poor indicator of infection.

Adult↗