Images of physicians in literature: medical Bildungsromans.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to A H Jones.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
During the past fifteen years, the relationship between literature and medical ethics has evolved from the occasional use of stories as a substitute for the traditional case study in medical ethics to the emergence of a narrative approach to ethical analysis and decision making. Thus far, literary theory has been more important to narrative medical ethics than have works of literature themselves. Perri Klass's novel Other Women's Children deserves special scrutiny, however, because an analysis of it demonstrates ways that a narrative approach could enhance traditional philosophical and legal approaches to resolving ethical dilemmas in medicine.
Introduced to U.S. medical schools in 1972, the field of literature and medicine contributes methods and texts that help physicians develop skills in the human dimensions of medical practice. Five broad goals are met by including the study of literature in medical education: 1) Literary accounts of illness can teach physicians concrete and powerful lessons about the lives of sick people; 2) great works of fiction about medicine enable physicians to recognize the power and implications of what they do; 3) through the study of narrative, the physician can better understand patients' stories of sickness and his or her own personal stake in medical practice; 4) literary study contributes to physicians' expertise in narrative ethics; and 5) literary theory offers new perspectives on the work and the genres of medicine. Particular texts and methods have been found to be well suited to the fulfillment of each of these goals. Chosen from the traditional literary canon and from among the works of contemporary and culturally diverse writers, novels, short stories, poetry, and drama can convey both the concrete particularity and the metaphorical richness of the predicaments of sick people and the challenges and rewards offered to their physicians. In more than 20 years of teaching literature to medical students and physicians, practitioners of literature and medicine have clarified its conceptual frameworks and have identified the means by which its studies strengthen the human competencies of doctoring, which are a central feature of the art of medicine.
In a double-blind, randomized, parallel-group clinical trial, 340 asthmatic patients aged 12-70 years received budesonide 400 micrograms once daily in the morning, budesonide 400 micrograms once daily in the evening, budesonide 200 micrograms twice daily or placebo, for 12 weeks in addition to inhaled short-acting beta 2-agonists used as required (p.r.n.). Budesonide was given as Pulmicort Turbohaler. Peak expiratory flow rate (PEFR) increased by 20 to 30 1 min-1 in each of the active treatment groups, significantly more than in the placebo group (P < 0.01). There were no significant differences between the active treatment groups. Symptom improvement and decreased beta 2-agonist use reflected the PEFR data. Incidences of adverse events in the active treatment groups were similar to those observed in the placebo group. Budesonide 400 micrograms given once daily morning or evening is equieffective with the same total daily dose given twice daily in the treatment of mild to moderate stable asthmatics.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Epithelial structural proteins, the keratins and keratin-associated proteins, are useful as markers of differentiation because their expression is both region-specific and differentiation-specific. In general, basal cells in all stratified oral epithelia express similar keratins, while the suprabasal cells express a specific set of markers indicating commitment to a distinct program of differentiation. Critical factors in the regulation of epithelial protein expression are now under investigation. The promoter regions of keratin genes are being characterized to determine what sequences within the genes are responsible for differential expression. One important extracellular factor that influences epithelial protein expression is retinol (vitamin A), which exerts its effects via a group of nuclear receptor proteins that may also be expressed in a region-specific manner. These molecular biological approaches enhance our understanding of the mechanisms regulating differentiation of oral epithelia and its regional complexity.
One hundred and fourteen adults with hearing loss, but without otorrhoea, were studied with the aim of establishing whether tympanometry could be used as a screening test to identify potentially treatable aural pathology. Tympanometry was compared with independent otoscopy. No middle ear pathology likely to be of significance in an elderly person was found in ears with a normal tympanogram. All ears with significant pathology gave an abnormal tympanogram, and in addition there was a false positive rate of 6.8%. We suggest that elderly patients with dry ears and a normal tympanogram could be fitted with a hearing aid without specialist otological examination.
Explore the source record for details and available documents.
This study reports the presence of sialic acid in Actinomyces viscosus strains T14V and T14AV. Mild acid hydrolysis of whole organisms released a compound which reacted positively in the periodate-thiobarbituric acid, direct Ehrlich's and resorcinol assays, and which co-chromatographed on paper with authentic N-acetylneuraminic acid. Strain T14V contained 10-fold greater concentrations of sialic acid than did strain T14AV. Sialic acid content was dependent upon the stage of growth of the culture, reaching a maximum in early stationary phase. Epifluorescence microscopy of fluorescein isothiocyanate (FITC)-conjugated Limulus polyphemus agglutinin (LPA), a lectin specific for sialic acid, revealed a uniform distribution of bound lectin on the surfaces of strains T14V and T14AV. Additional evidence for surface localization was obtained by demonstration of whole-cell agglutination of both strains with LPA. All LPA interactions with A. viscosus were inhibited by the presence of 0.1 M-N-acetylneuraminic acid. Neuraminidases from Clostridium perfringens, Arthrobacter ureafaciens and Vibrio cholerae did not release detectable amounts of sialic acid, but the extracellular enzyme from A. viscosus cleaved amounts equivalent to those obtained by acid hydrolysis. Other laboratory strains (W1053, M100, W859, 5-5S, RC45, ATCC 19246, and 'binder') as well as recent clinical isolates of A. viscosus were agglutinated by LPA and released sialic acid upon mild acid hydrolysis. Surface-available sialic acid has been implicated in the inhibition of alternative complement pathway activation and subsequent opsonophagocytosis. Thus the occurrence of surface sialic acid in A. viscosus may represent a mechanism of pathogenesis for this oral bacterium.
This paper compares three analytical methods that may be considered for monitoring workers who are exposed to carbon disulphide (CS2). An estimate of the uptake of CS2 was assessed by the measurement of "bound" CS2 in blood, CS2 in expired alveolar air, and 2-thiothiazolidine-4-carboxylic acid (TTCA) in urine. The concentration of TTCA in end-of-shift urine samples was related to exposure and appears to be a good measure of uptake of CS2.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.