Biomedical subjects

Pamela Williams

Publications and source records attributed to Pamela Williams.

6 recordsLinked to original sources

PubMed2006

Cultural competency training for third-year clerkship students: effects of an interactive workshop on student attitudes.

UNLABELLED: With an increasing awareness of health disparities, medical schools are challenged to develop training in cultural competency for their students. We developed and evaluated the effectiveness of an interactive workshop designed to improve third-year students' attitudes, beliefs and cross-cultural communication skills. METHODS: At the start of a six-week required family medicine clerkship, 196 medical students participated in small group (20-24 students) workshops. Didactics included facts about health disparities and a model of cultural competency. During a skill-building component, students were exposed to live vignettes portraying ineffective and effective cross-cultural doctor-patient interactions. Impact on students' attitudes, perceived bias and knowledge of techniques was assessed by comparing pre- and postworkshop scores. RESULTS: Participants increased their cultural awareness on most items of a cultural awareness scale. Fifty-five-, 71- and 66% of the sample agreed or strongly agreed the program was valuable, appropriate and effective, respectively. Conversely, only 17-, 6- and 9% of the sample disagreed or strongly disagreed, respectively. CONCLUSIONS: A workshop for third-year students led to an increase in cultural awareness and was considered appropriate and valuable. Further study, including longitudinal training and evaluation, is needed regarding effective methods to increase cultural competence in clinical practice.

Adult↗

PubMed2004

Caring for patients and families at the end of life: withdrawal of intensive care in the patient's home.

AIM: To describe our experience of transporting 17 intensive care patients home to die. DESIGN: A brief report. SETTING: Mixed medical/surgical intensive care unit (ICU). RESULTS: After discussions with their families, 17 adult patients in whom ongoing care was deemed either inappropriate or futile were transported home. Once there, intensive care modalities of ventilation and vasopressor therapy were withdrawn. The patients were sedated initially with intravenous morphine and if death was not immediately imminent, subcutaneous morphine was administered. In these cases where death took longer than 2 hours, the patients were managed with the assistance of district nurses, the family general practitioner, or staff from the South Auckland Hospice. CONCLUSIONS: All the patients in this report were Maori or Polynesian and all families reported this as a positive experience. Since completion of this report, we have taken our first European patient home to die.

Adult↗

PubMed2004

Picoprep-3 is a superior colonoscopy preparation to Fleet: a randomized, controlled trial comparing the two bowel preparations.

PURPOSE: Bowel preparations for colonoscopy have to balance the demand for adequate cleansing action of the bowel and patient acceptability. There has been no study comparing Picoprep-3 (sodium picosulfate), a relatively new product, to Fleet (sodium phosphate), a well-studied and widely used preparation. This study was designed to compare the efficacy and patient tolerance of these two bowel preparations for colonoscopy. METHODS: A randomized, single-blinded, prospective trial was conducted. A total of 400 consecutive patients presenting for elective colonoscopy at St George Private Hospital during a 20-week period were randomly assigned to receive Picoprep-3 or Fleet. Patients were asked to record the effects of the preparation, noting tolerability, taste, and side effects. Two hundred patients were assigned to the Picoprep-3 group and 200 to the Fleet group. Surgeons were blinded to the preparation used and rated the quality of the bowel preparation on a scale of 1 to 5 (1 being the optimal score). RESULTS: Picoprep-3 was found to be better tolerated (P < 0.0001) and better tasting (P < 0.0001) than Fleet. Patients in the Picoprep-3 group reported significantly less nausea (P < 0.001), vomiting (P < 0.004), dizziness (P < 0.01), abdominal pains (P = 0.0005), and thirst (P < 0.0001) associated with the preparation. There was no significant difference in visualization of the colon between the two groups as judged by the two colonoscopists (P = 0.06). CONCLUSIONS: Colonoscopy preparation with Picoprep-3 has similar efficacy but superior taste and tolerability compared with Fleet. Picoprep-3 caused less adverse side effects in the study population.

Cathartics↗

PubMed2002

Mapping CD55 function. The structure of two pathogen-binding domains at 1.7 A.

Decay-accelerating factor (CD55), a regulator of the alternative and classical pathways of complement activation, is expressed on all serum-exposed cells. It is used by pathogens, including many enteroviruses and uropathogenic Escherichia coli, as a receptor prior to infection. We describe the x-ray structure of a pathogen-binding fragment of human CD55 at 1.7 A resolution containing two of the three domains required for regulation of human complement. We have used mutagenesis to map biological functions onto the molecule; decay-accelerating activity maps to a single face of the molecule, whereas bacterial and viral pathogens recognize a variety of different sites on CD55.

Animals↗

PubMed2002

Comparative risk analysis of six volatile organic compounds in California drinking water.

The widespread use and storage of volatile organic compounds (VOCs) in the United States has led to releases of these chemicals into the environment, including groundwater sources of drinking water. Many of these VOCs are commonly found in public drinking water supplies across the nation and are considered by state or federal agencies to be potentially carcinogenic to humans. In this paper, we evaluate the detection frequencies, detected concentrations, and relative cancer risks of six VOCs in drinking water sources in California from 1995 to 2001. We find that during this 7-year period, the most frequently detected VOCs in sampled drinking water sources were chloroform (12-14%), PCE (11-13%), and TCE (10-12%). Detection frequencies in water were lower for 1,1-DCE (3-6%), MTBE (1-3%), and benzene (<1%). Mean detected concentrations were also consistently above California's primary maximum contaminant level for some VOCs, including benzene, PCE, and TCE. Although none of the six VOCs necessarily poses a significant public health threat from drinking water exposures, 1,1-DCE and benzene werefound to pose the greatest cancer risk relative to the other VOCs. However, after adjusting for the occurrence of each VOC in drinking water, chloroform and PCE were found to pose the greatest relative cancer risk. Despite media reports about significant MTBE contamination of drinking watersupplies in California, MTBE detections were infrequent and this chemical was found to pose the least cancer risk relative to the other VOCs.

California↗

PubMed2002

Gene expression in response to muscle stretch.

In studying the way the musculoskeletal system adapts, it is important to consider how the different tissues interact with each other. During growth, and in response to changes in posture, the functional length of muscle is adjusted by altering the number of sarcomeres in series to the optimum for force generation and power output. In some cases, insufficient adaptation gives rise to problems such as muscle contracture. Stretch has marked effects on muscle mass with eccentric contraction being the most effective form of exercise for building muscles. As far as the mechanism is concerned, the current authors have cloned the deoxyribonucleic acid (cDNA) of a splice variant of the insulinlike growth factor gene that is produced by active muscle that seems to be the factor that controls local tissue repair, maintenance, and remodeling. This new growth factor has been called mechanogrowth factor to distinguish it from the liver insulin growth factors, which have a systemic mode of action. The discovery of the locally produced insulinlike growth factor seems to provide the link between the mechanical stimulus and the activation of gene expression.

Adaptation, Physiological↗