The teaching clinic: a supervisory alternative.
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Biomedical subjects
Publications and source records attributed to S Dowling.
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Factor VIII procoagulant activity (VIIIc), antigen (vWa), mobility of the antigen on two dimensional immunoelectrophoresis and platelet function were studied in 9 families with reduced ristocetin induced platelet aggregation rate (RIPA) and/or deficiency of plasma factor(s) required for ristocetin aggregation of washed normal platelets (vWf). the families could be subdivided into 4 groups. Group I showed dominant inheritance and reduced levels of VIIIc and vWa characteristic of typical von Willebrand's disease. All patients had reduced vWf and in 7 of 10 RIPA was reduced. Group II showed normal levels of VIIIc but reduced vWa. All showed reduced vWf but RIPA was reduced in one patient only. There was a good correlation between vWf and vWa and VIIIc in both groups. The bleeding time correlated with vWf in group I but not group II. Group III showed normal or nearly normal VIIIc and vWa but there was an increased mobility of vWa compared to normals and to groups I and II. RIPA was markedly reduced as was the vWf in one patient. Group IV is represented by one child with a strong family history of bleeding, who had reduced RIPA and defective platelet release reaction. The vWf in this child was normal and the ratio between VIIIc and vWa was similar to that seen in carriers of haemophilia. This spectrum of abnormalities of ristocetin aggregation justifies the use of the term 'von Willebrand's syndrome'.
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Between October 1991 and October 1993, 17 AIDS patients (14 intravenous drug users, 3 sexually acquired) were commenced on percutaneous endoscopic gastrostomy (PEG) feeding in St James's Hospital. Indications were progressive weight loss related to severe anorexia, persistent oesophageal candidiasis (5) and absence of gag reflex (1). Two patients requested PEG tube removal after one week because of crampy abdominal pain without peritonitis. Five patients died from AIDS related infections within 6 weeks of PEG insertion. Ten patients were followed up for > 2 months (mean 5.2 months, range 2.5-15.5 months). In these 10 patients, 1 patient developed a PEG site infection which responded to topical antibiotics. There were no other complications. There was a significant (P < 0.001) increase in energy and protein intake at 2 months. Variant degrees of weight gain occurred in all patients (mean 2.6 kg) (P < 0.01). Small but significant increases in other anthropometric variables occurred. Patients who died within 6 weeks of PEG insertion were older, and had a lower serum albumin than the group who survived > 2 months (P < 0.01). A self-administered questionnaire demonstrated that the majority of patients found PEG feeding acceptable and preferable to nasogastric (NG) feeding.
Palliative Care is an important and emerging medical speciality, formally recognised by the Irish Medical Council in June 1995. Three years previously, in 1992, the Association of Palliative Medicine for Great Britain and Ireland published an official curriculum for undergraduate medical education in palliative care. The European Association of Palliative Care held a workshop the following year and reported that, with the exception of the UK, education for medical students is incomplete. This review examines the evidence that European undergraduate medical education in palliative care is underdeveloped. Key elements of effective undergraduate teaching programmes in this discipline are identified. Finally, it is noted that little has been written about undergraduate palliative care education in Irish medical schools; the situation in this country is thus unknown. A study to determine current education in palliative care in Irish medical schools is required.
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