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Biomedical subjects

M L Snaith

Publications and source records attributed to M L Snaith.

At least 19 recordsLinked to original sources
PubMed2004

Comparing and contrasting undergraduate competence in musculoskeletal medicine with cardiovascular medicine and neurology.

OBJECTIVES: With an increasing prevalence of musculoskeletal conditions within the UK, specialty bodies are concerned that graduating medical students may lack appropriate knowledge in this system. We investigated the knowledge base of final year Sheffield medical students in the musculoskeletal system, compared with other major body systems. METHODS: A computer-based assessment was designed covering core topics that a pre-registration house officer should know about in musculoskeletal medicine, cardiology and neurology, using a predesigned testing format. The test was blueprinted against internal and external guidelines. It comprised 24 extended matching questions, each with three stems. A sample of 74 volunteer students from the final year (year 5) of the medical course at the University of Sheffield took part in the assessment. RESULTS: Overall scores of students on the test ranged from a baseline of 45% to a maximum of 85%. Test reliability was 0.75 (Cronbach's alpha). On stratifying the overall percentages into marks for individual systems, it was found that there were no significant differences between scores in musculoskeletal medicine, cardiovascular medicine or neurology. CONCLUSIONS: Despite the disparity of teaching between musculoskeletal medicine and other major organ systems within Sheffield's integrated medical curriculum, the knowledge base of medical students in the basic and clinical musculoskeletal sciences appears to be similar to that for cardiovascular medicine and neurology by the time of graduation. Nevertheless, several important issues must be addressed before these findings can be generalized.

Adult↗
PubMed2004

Rheumatology training in the United Kingdom: the trainees' perspective.

BACKGROUND: Rheumatology training has undergone significant changes in the last decade with Calmanization, implementation of the New Deal for junior doctors and newer educational strategies for improving musculoskeletal training, like a core curriculum. However, concerns have been expressed about the quality of postgraduate training programmes in the UK. OBJECTIVES: First, to assess current trainees' perceptions of the quality of core and subspecialty training, the impact of workload on training, and to explore demographic variations in training experience. Secondly, to identify educational strategies that trainees felt would enhance their training. METHODS: The questionnaire was initially distributed to all specialist registrars attending the BSR Annual Meeting in Brighton in April 2002. Subsequently, the questionnaire was posted to all registrars on the Joint Committee for Higher Medical Training list with a reminder after 4 weeks. RESULTS: Trainees rated positively training in routine patient care, musculoskeletal examination and injection skills while training in primary care rheumatology, epidemiology, paediatric rheumatology and sports medicine was rated negatively. There is agreement that the reduction in junior doctors' hours has adversely affected training, and issues relating to workload have overtaken training issues. Trainees undertaking dual accreditation are more likely to feel this. Educational strategies deemed to enhance training included training workshops focused on specific topics, such as musculoskeletal radiology (89.2%), and an adequate debriefing session after an out-patient clinic (81.6%). An independently administered, reliable and valid scale for quality of training could be used to assess regional variations in training and monitoring quality. CONCLUSIONS: The changes to junior doctors' hours, the working patterns of doctors and service commitments have all affected the quality and time available for certain aspects of rheumatological training. A major effort to enhance quality is necessary to ensure that the objectives of training are met within the intended training budget.

Attitude of Health Personnel↗
PubMed2003

The value of masters educational programmes for specialist registrars in rheumatology.

The training of junior doctors has undergone major changes in recent years. There is now more structure, with defined assessment time points leading to a Certificate of Specialist Training. This certificate provides documentation indicating that the trainee has undergone a satisfactory period of training and that they are sufficiently competent to practise as a specialist, unsupervised. The changes have led to re-examination of the role of, and educational provision for, research training as well as clinical training. In this article we review these issues and argue that the development of masters educational programmes may help to address several concerns.

Education, Medical, Graduate↗
PubMed1999

Generic and condition-specific outcome measures for people with osteoarthritis of the knee.

OBJECTIVES: The aims of this study were to evaluate two condition-specific and two generic health status questionnaires for measuring health-related quality of life in patients with osteoarthritis (OA) of the knee, and to offer guidance to clinicians and researchers in choosing between them. METHODS: Patients were recruited from two settings: 118 from knee surgery waiting lists and 112 from rheumatology clinics. Four self-completion questionnaires [Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Health Assessment Questionnaire (HAQ), Short Form-36 (SF-36) and Euroqol] were sent to subjects on two occasions 6 months apart. Construct validity, convergent validity, internal consistency and responsiveness were examined using primarily non-parametric methods. RESULTS: All instruments proved satisfactory in terms of ease of use, acceptability to patients, internal consistency and reliability. In the surgical group, the OA-specific WOMAC performed better than the HAQ and the generic measures in terms of validity and responsiveness to change, whereas in the rheumatology group the SF-36 was more responsive. CONCLUSION: WOMAC is the instrument of choice for evaluating the outcome of knee replacement surgery in OA. The SF-36 provides a more general insight into patients' health and may be more responsive to change than the WOMAC in a heterogeneous rheumatology clinic population. Researchers wishing to undertake an economic evaluation might consider the EQ-5D for a surgical, but not a rheumatology clinic group.

Aged↗
PubMed1999

Assessment, investigation, and management of acute monoarthritis.

Trauma is the commonest cause of acute monoarticular joint pain and swelling in patients attending an accident and emergency (A&E) department. However, in a significant minority of patients there will be no history of trauma and consequently a different approach to assessment and investigation is required. Our aim is to offer an outline of how to assess, investigate, and manage a patient with monoarthritis. Despite advances in antibiotic treatment diagnostic delay partly explains why septic arthritis is still associated with considerable morbidity and mortality. It is therefore imperative that joint infection is considered above all other diagnoses. Arthrocentesis is a relatively safe procedure and doctors in A&E medicine are encouraged to develop the skills required to aspirate large joints. In the same way that the A&E department is often portrayed as the shop window of a hospital, the joint can reflect a wide variety of internal diseases. Connective tissue disease, inflammatory bowel disease, sarcoidosis, and vasculitis can all present with a monoarthritis. A non-specific reactive monoarthritis may be a feature of a wide variety of common and uncommon infections including, brucellosis, Lyme disease, and leptospirosis. Drugs are also associated with acute arthritis either through their metabolic consequences or as idiosyncratic drug reactions. The ability for the joint to reflect multisystem disease necessitates close liaison with specialists from other fields. A multidisciplinary approach to the management of these patients is strongly encouraged as some will have unusual diseases that require specialist advice. It is not difficult to appreciate how the patient with monoarthritis can present the clinician with a fascinating diagnostic and therapeutic challenge, which we hope this article will help to unravel.

Acute Disease↗
PubMed1993

The association of malignancy with SLE: an analysis of 150 patients under long-term review.

We describe seven patients who developed malignancy before, after or at the onset of systemic lupus erythematosus (SLE). They comprise three cases of breast adenocarcinoma, two cases of Hodgkin's lymphoma, and one each of cholangiocarcinoma and thymoma. Only one of this group had been treated with cytotoxic agents, and five have subsequently died. They belonged to a group of 150 SLE patients, many of whom had been treated with steroids and cytotoxic agents, under long-term follow-up at a specialized lupus clinic. We discuss the reported association of malignancy in patients with SLE.

Adenocarcinoma↗
PubMed1993

The BILAG index: a reliable and valid instrument for measuring clinical disease activity in systemic lupus erythematosus.

The British Isles Lupus Assessment Group (BILAG) index is a computerized index for measuring clinical disease activity in systemic lupus erythematosus (SLE), which was developed according to the principle of the physician's 'intention to treat'. The index allocates separate alphabetic scores to each of eight organ-based systems; a total score is not calculated. This study demonstrated good between-rater reliability for the BILAG index for each organ-based system. There was no evidence of bias between observers. The BILAG index had good overall sensitivity (87%) and specificity (99%) when compared with the 'gold standard' criterion (starting or increasing disease-modifying therapy). There were high positive predictive values overall (80%), and for each organ-based system, with the exception of the neurological system.

Adolescent↗
PubMed1992

Treponemal infection coexisting with systemic lupus erythematosus.

A patient with systemic lupus erythematosus (SLE)/erosive arthritis overlap is described who was also shown to have late latent treponemal infection. The possibility of serological reactivation is discussed. Since antiphospholipid antibodies are the basis of the reagin tests for syphilis as well as being present in patients with SLE, difficulties with diagnosis may ensue.

Female↗
PubMed1992

Idiopathic myositis: a rheumatological view.

Twenty five patients with idiopathic myositis attended this department for long term follow up from 1980 to 1989. Twelve patients had primary polymyositis (four men, eight women) and six had primary dermatomyositis (three men, three women); five women had an overlap syndrome. Two patients had a malignant condition associated with the myositis. The mean age at diagnosis was 40 years. All of the patients had proximal muscle weakness, 18/25 had a raised creatine kinase value (mean 2325 IU/l), 19/20 had an abnormal electromyogram, and 19/24 had positive muscle biopsy samples. Of the disease specific antibodies, anti-Jo-1 was detected in only 1/21 patients tested (three patients with fibrosing alveolitis were negative for this antibody), but the 56 kDa antibody was detected in 12/17 patients. The HLA data analysed in the white patients (17/25) showed that 6/8 of those tested were HLA-DR3 positive. All patients were treated with prednisolone and azathioprine was used for 14/25 patients. Only three deaths occurred during the eight year follow up, but there was a substantial morbidity, which may reflect the referral pattern. Muscle strength tests and creatine kinase levels were useful in recording the response to treatment in some patients. These data emphasise that careful long term follow up of patients with myositis is mandatory and that although the present treatment strategy has substantially reduced the death rate, morbidity associated with the disease remains a major problem.

Adolescent↗
PubMed1991

Dietary fish oil and the severity of symptoms in patients with systemic lupus erythematosus.

A prospective, double blind, cross over study assessing the effects of a low fat, high marine oil diet in 27 patients with active systemic lupus erythematosus has been performed. The patients were given 20 g daily of MaxEPA (eicosapentaenoic acid) or 20 g of olive oil (placebo) in matching capsules added to a standardised isoenergetic low fat diet. When individual outcome measures of the 17 patients who completed the full 34 week study were considered 14 who were receiving MaxEPA achieved useful or ideal status, whereas 13 receiving placebo were rated as worse or no change. The difference between the two types of capsule was statistically significant. No major side effects were noted, and it is suggested that dietary modification with additional marine oil may be a useful way of modifying disease activity in systemic lupus erythematosus.

Adult↗