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Biomedical subjects

S G Macpherson

Publications and source records attributed to S G Macpherson.

At least 19 recordsLinked to original sources
PubMed2005

The learning environment for junior doctor training--what hinders, what helps.

As part of a larger study on learning outcomes for the first year of postgraduate medical training (already reported), semi-structured interviews with middle grade trainees were used to explore their perceptions of trainee development during this first training year. Data generated focused not only on learning outcomes, but also on important process issues. Dissatisfaction was expressed with formal and informal teaching and learning opportunities. Factors that enhance the learning environment were identified. These included being supported, a feeling of being a valued member of the team, being stretched but not over stretched, having a broad range of experiences, knowing the system, having a clear remit and being well organized. Factors inhibiting the learning environment included fractured working patterns, insufficient time with patients and seniors, as well as the converse of many of the enhancing factors. The process issues gathered in this paper will be of interest to those involved in the delivery of training for junior doctors.

Attitude of Health Personnel↗
PubMed2004

Exit learning outcomes for the PRHO year: an evidence base for informed decisions.

OBJECTIVE: To evaluate potential learning outcomes for pre-registration house officer (PRHO) training and develop an evidence base for informed decision making. DESIGN AND SETTING: A 2-stage Delphi process was employed to establish the opinions of Scottish stakeholders with regard to learning outcomes for the PRHO year. PARTICIPANTS: Doctors involved in the provision of PRHO training, including deans, postgraduate tutors and general practitioners (GPs) with trainees, were invited to participate in the study. MAIN OUTCOME MEASURES: Respondents rated a range of outcomes according to which they believed should be included or excluded from the PRHO training year. RESULTS: Learning outcomes identified for PRHOs were grouped under the 12-domain framework of the 3-circle model: 'What the doctor can do', 'How they approach their practice' and 'Their professionalism'. Based on the consensus opinions gained in the Delphi study, the ratings were classified into priority groupings. Priority 1 contained 45 of the original 81 learning outcomes, representing each area of the 3-circle model, with emphasis on the domains of clinical skills, patient investigation/management, communication, appropriate attitudes and personal development. Health promotion and disease prevention was the only domain not represented at priority 1. Priority 2 contained 24 outcomes with emphasis on the understanding of clinical skills, patient management and personal development. Priority 3 contained 12 outcomes indicating a lack of emphasis for some outcomes, particularly the role of the doctor and health promotion. CONCLUSION: Consensus on the learning outcomes for PRHO training has been achieved, providing an evidence base for curriculum planning. The relative priority assigned to these outcomes can facilitate the use of the evidence. This evidence base should be referred to when reviewing any PRHO training programme.

Clinical Competence↗
PubMed2003

New doctors' perceptions of their educational development during their first year of postgraduate training.

The General Medical Council (GMC) in the UK describes a wide range of competences in which the new medical graduate should develop during the first postgraduate year. New graduates are known as pre-registration house officers (PRHOs). In this study, semi-structured open interviews with PRHOs approaching the end of their first postgraduate year were used to explore the trainees' perceptions of their development. After the interview their views on the importance given in their experience to the GMC's competences were explored though a questionnaire. Most noticeable from the interview data was the PRHOs'emphasis in the development of generic skills required of working in the 'real world'--skills such as communication, team working and the ability to cope with responsibility. In some outcomes, their noticeable progression, e.g. communication, or lack of progression, e.g. health promotion, reflected their views on the importance given. With other outcomes there was a paradox, e.g. practical skills were rated highly but were not noticeably developed; the role of the doctor was noticeably developed but was not highly rated. Overall the PRHOs developed most strongly in the 'professionalism' domain with not all the skills in the 'tasks' domain being similarly developed. This study helps to define the benefits and opportunities of the PRHO year, as currently perceived by the trainees, and should be of interest to those involved in the planning and delivery of postgraduate training.

Attitude of Health Personnel↗
PubMed1999

Early graft function and patient survival following cadaveric renal transplantation.

BACKGROUND: The influence of events that occur early following renal transplantation such as delayed graft function (DGF) and acute rejection on long-term graft survival has been widely reported, but its association with patient survival has received less attention. METHODS: We studied 589 patients who received their first cadaveric transplants between 1984 and 1993, all of whom received cyclosporine-based immunosuppression and who had a median follow-up of seven years. The following factors were identified, and both univariate and multivariate analyses were used to determine their association with long-term patient and graft survival: age, sex, duration of pretransplant dialysis, primary renal disease, immediate graft function (IGF), DGF, primary nonfunction (PNF), acute rejection, and serum creatinine at 3, 6, and 12 months. RESULTS: Patients with PNF had a poorer survival than those with DGF and IGF (P = 0.01), but there was no difference in survival between DGF and IGF (P = 0.54). Good graft function (serum creatinine of less than 200 mumol/liter) at three months was predictive of better long-term patient survival (P = 0.03). Other factors associated with poor patient outcome were older age, diabetes, adult polycystic kidney disease, male gender, and acute rejection. Cardiovascular disease was the most common cause of death (51.8%). Good graft function at three months (P < 0.001) and an absence of rejection episodes (P = 0.01) were associated with better graft survival. CONCLUSION: Patients with poor levels of early graft function (but not DGF) and those with either acute rejection episodes or early graft loss are at an increased risk of early death. These high-risk groups should be targeted for interventional studies in an attempt to improve patient survival.

Adolescent↗
PubMed1994

Long-term outcome of the use of OKT3 to treat steroid-resistant acute renal allograft rejection.

OKT3 was used to treat steroid-resistant acute renal allograft rejection in 30 of 496 adult patients transplanted over a 6-year period. Rejection was reversed (defined as a fall in serum creatinine by 50% or more within 30 days of treatment with OKT3) in 40% of cases. Successful reversal was significantly more likely when rejection occurred shortly after transplantation (t ratio -2.53; P = 0.019). The long-term outcome was disappointing; the actuarial graft survival at 1 year from the start of treatment with OKT3 was 42%, and no grafts have thus far survived longer than 3 years. Graft survival was shorter in older patients (coefficient/standard error 2.226; P < 0.05), and no other predictor of long-term outcome was identified. Patient survival at 3 years was 88%. Serious infection occurred in 33% of patients, with two deaths. Our experience suggests that treatment with OKT3 is unlikely to reverse acute renal allograft rejection in more than half of patients where rejection is resistant to steroids. Although long-term graft survival occurred in a few cases, the overall long-term outcome was disappointing, particularly in older patients. Finally, our analysis indicates the difficulty of predicting which patients will derive long-term benefit when OKT3 is used to treat steroid-resistant rejection.

Acute Disease↗
PubMed1988

Acute torsion of the gallbladder.

Acute torsion of the gallbladder is an acute surgical emergency which may be encountered more frequently in the presence of an ageing population. We report a 98-year-old patient in whom the diagnosis was made at exploratory laparotomy performed for unexplained peritonism. Emergency cholecystectomy was followed by an uncomplicated post-operative recovery.

Aged↗
PubMed1985

Malignant phaeochromocytoma.

Malignant phaeochromocytoma is a rare tumour and experience in its management is therefore limited. Five patients are discussed in whom the development of metastases was associated with rapidly progressive disease.

Adrenal Gland Neoplasms↗
PubMed1983

Early detection of obstructed ureter by ultrasound following renal transplantation.

Serial ultrasound examinations were carried out following 144 renal transplants. Eleven patients (8%) required surgery for ureteric obstruction and in all cases the ultrasound correctly identified the obstruction at an early stage. One false positive result was obtained with the ultrasound and this compared favourably with both the intravenous urogram (IVU) and isotope renogram. There were false positive and false negative results with both the IVU and renogram in addition to which neither of these techniques, particularly the IVU, is as simple or atraumatic for the patient as the ultrasound. Serial ultrasound examinations have a useful role in the detection of ureteric obstruction as well as being of value in the detection of perinephric fluid collections and acute rejection.

Diagnostic Errors↗
PubMed1981

Cell-mediated immunity during RDT and the outcome of transplantation.

Previous studies have demonstrated depression of cell-mediated immunity (CMI) in uraemia. We have measured CMI in a group of 248 patients on regular dialysis using a quantitative dinitrochlorobenzene (DNCB) skin test which gives a score of 0 to 15. Ninety-eight of these patients subsequently had first cadaver transplants and the relationship between the DNCB score and graft survival has been examined. Graft survival was found to decline progressively with higher DNCB scores. Blood transfusion also had a major influence on graft survival and the relation between the DNCB score and outcome was observed in all the blood transfusion groups.

Adolescent↗
PubMed1980

Adjuvant chemotherapy and immunotherapy for colorectal cancer: preliminary communication.

Following surgical resection of Dukes' B or C colorectal cancers 72 patients have been randomly allocated to receive: 5-fluorouracil; or 5-fluorouracil and levamisole; or no treatment. Adjuvant treatment was continued for one year. 66 patients remain evaluable for up to 24 months. Preliminary results show no significant differences in survival or recurrence rates. Two patients receiving 5-fluorouracil and levamisole developed severe, but reversible, neutropenia. Other side effects were uncommon.

Clinical Trials as Topic↗
PubMed1978

Morbidity and mortality in renal transplant patients after incidental surgery.

Sixty-five further surgical procedures were carried out in 39 renal transplant patients without mortality and with low morbidity. There was a 9 per cent incidence of clean wound infection, and minor chest infection occurred in another 9 per cent. Stay in hospital for these procedures was not prolonged. The function of the transplanted kidney showed no deterioration after these further surgical procedures. The successfully transplanted patients is thus a good candidate for further surgery despite the previous renal failure and the continuing immunosuppressive therapy.

Creatinine↗