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PubMed2003

Thrombophilia and arterial disease. An up-to-date review of the literature for the vascular surgeon.

Thrombophilia may be defined as the tendency to arterial or venous thrombosis. Thrombophilia can be acquired or hereditary. Acquired conditions leading to arterial thrombosis are commonly encountered in vascular surgical practice, but less well known is the potential influence of genetic factors. In recent years, evidence has accumulated for a crucial role of genetic factors in the pathogenesis of venous thrombosis, many previously unknown genetic defects having been recently identified. The role of genetic predisposition for the pathogenesis of arterial occlusive disease on the other hand is unknown, although recent publications suggest a definite link. This may have implications for the vascular surgeon in the management of patients with arterial disease. A medline search was performed in order to identify papers published between 1990-2002 on thrombophilia, arterial disease and peripheral arterial occlusive disease (PAOD). With regard to venous thrombosis we obtained a much wider knowledge about genetic defects leading to thrombophilia. This has altered the diagnostic and therapeutic approach to patients with venous thrombosis, and has had an important influence on counselling and screening of family members, especially females of childbearing age. With regard to arterial thrombosis, certain thrombophilic disorders have a definite pathophysiological role. Hyperhomocysteinaemia, inherited or acquired, has been demonstrated to be an independent risk factor for athero-thrombosis. The antiphospholipid antibody syndrome (APS), an acquired condition, also predisposes to arterial thrombosis. Other thrombophilic conditions, such as prothrombin gene G20210A variant or factor V Leiden, have been investigated, but current evidence does not unequivocally support the hypothesis of a pathophysiological role in athero-thrombosis. Routine screening for thrombophilia in patients with athero-thrombosis is therefore not generally recommended on the basis of current evidence, but there is a role for selective screening.

Arterial Occlusive Diseases↗
PubMed2024

Evaluation of the Master's in Genomic Medicine framework: A national, multiprofessional program to educate health care professionals in NHS England.

PURPOSE: Genomic medicine is revolutionizing health care but requires health care professionals to update their understanding of genomics and its application to clinical practice for successful implementation. To meet this need, Health Education England developed the Master's in Genomic Medicine, a national multiprofessional program to increase genomic literacy in the National Health Service workforce. This study summarizes an evaluation of the program, which will inform its future development. METHODS: Underpinned by Moore's evaluation framework, a mixed methods approach was used to characterize (1) learner demographics, (2) perceptions of the program, (3) knowledge and/or qualifications achieved, and (4) the outcome(s) for practice in the workplace. RESULTS: Learners were a diverse cohort of health care professionals, including doctors, health care scientists, nurses and midwives. Participant satisfaction was high for all elements of the program, including the curriculum, learning environment(s), and multiprofessional cohort(s), despite the challenges of engaging working professionals in part-time learning. Both learners and their managers reported enhanced genomic practice after completion of their studies. CONCLUSION: The Master's in Genomic Medicine program is an effective approach to professional education in genomic medicine. This broad multiprofessional learning complements training aimed at specific groups of health care professionals.

Humans↗
PubMed1975

[Present status of experimental animals in Japan (author's transl)].

The movement for modernization of experimental animals in Japan started around 1950. Since that time, a quarter of a century has passed. This article outlines the present status of experimental animals in Japan and makes comparisons with various other countries. Number of animals used: According to three surveys performed in the past (1956, 1960 and 1970), the numbers used of many species are increasing (Table 1). However, it can not be said simply that the numbers are increasing every year. Taking the United States where surveys are performed every year as an example (Table 3), it is evident that the peaks for use of some species are past (the same tendencies were seen in India and Sweden which have conducted more than four surveys in the past (Table 4). The same tendencies would probably also be seen in Japan if surveys were conducted annually. Quality of animals: It is easy to procure genetically and microbiologically controlled rats and mice. However, investigations into the establishment, production and supply of other species of such high quality are insufficient. This situation is almost the same as that in European countries. Miscellaneous: The present status of other items related to experimental animals is as follows: Facilities and equipment: Higher level facilities were first provided in companies, followed by testing and research institutes. At present, medical universities are providing such facilities. Feed: Pellet type diets are widely used for the various species. Care and management: In April, 1974, "The Law for the Protection and Control of Animals" came into force. This law includes regulations concerning animal experimentation but investigations concerning these standards have just begun. Training of technicians and specialists: The Japan Experimental Animal Research Association provides a correspondence course, tests and recognition for technicians. About 10 veterinary colleges have undergraduate or postgraduate courses for the training of specialists but these are elective except in two or three cases.

Animal Feed↗
PubMed2004

Developing the young academic surgeon.

In the past, the process of developing the young academic surgeon was arguably less strategic, one that was often not deliberately managed and monitored, leading in some cases to academic drift and disillusionment. Once upon a time it was assumed that greatness was genetic and that the next triple threat would emerge when a pre-programmed set of genes was turned on. Today, as the complexities and vicissitudes of our work increase, it is practically impossible for even the most gifted young person to be successful without careful attention to career development. Faculty development must be deliberate and strategic--every junior faculty member is unique and will require a customized career development plan that is well thought out, linked to measurable goals, monitored routinely and buttressed by effective mentoring. This approach will require time and commitment--precious commodities that are in short supply as the demands on our time are only escalating. By recruiting the right people (those who fit with the organization's values and goals) and providing the right environment, we can optimize the growth and satisfaction of our young faculty and, in so doing, create departments that are leaders in carrying out our missions of research, education and patient care. We cannot afford to have our young people fail--it is simply too costly, both from a financial and a human perspective.

Academic Medical Centers↗
PubMed2005

Developing the young academic surgeon.

In the past, the process of developing the young academic surgeon was arguably less strategic, one that was often not deliberately managed and monitored, leading in some cases to academic drift and disillusionment. Once upon a time it was assumed that greatness was genetic and that the next triple threat would emerge when a pre-programmed set of genes was turned on. Today, as the complexities and vicissitudes of our work increase, it is practically impossible for even the most gifted young person to be successful without careful attention to career development. Faculty development must be deliberate and strategic--every junior faculty member is unique and will require a customized career development plan that is well thought out, linked to measurable goals, monitored routinely and buttressed by effective mentoring. This approach will require time and commitment--precious commodities that are in short supply as the demands on our time are only escalating. By recruiting the right people (those who fit with the organization's values and goals) and providing the right environment, we can optimize the growth and satisfaction of our young faculty and, in so doing, create departments that are leaders in carrying out our missions of research, education and patient care. We cannot afford to have our young people fail--it is simply too costly, both from a financial and a human perspective.

Academic Medical Centers↗
PubMed2003

Increasing the pool of academically oriented African-American medical and surgical oncologists.

BACKGROUND: In the United States, breast cancer mortality rates are significantly higher among African-American women than among women of other ethnic backgrounds. Research efforts to evaluate the socioeconomic, environmental, biologic, and genetic mechanisms explaining this disparity are needed. METHODS: Data regarding patterns in the ethnic distribution of physicians and oncologists were accumulated from a review of the literature and by contacting cancer-oriented professional societies. This information was evaluated by participants in a national meeting, "Summit Meeting Evaluating Research on Breast Cancer in African American Women." Results of the data collection and the conference discussion are summarized. RESULTS: Ethnic minority specialists are underrepresented in academic medicine in general, and in the field of oncology in particular. This fact is unfortunate because ethnic minority students are more likely to express a commitment to providing care to medically underserved communities and, thus, they need to be better represented in these professions. Correcting these patterns of underrepresentation may favorably influence the design and implementation of culturally and ethnically sensitive research. CONCLUSIONS: Efforts to improve the ethnic diversity of oncology specialists should begin at the level of recruiting an ethnically diverse premed and medical student population. These recruitment efforts should place an emphasis on the value of mentoring.

Black or African American↗
PubMed2006

Psychological workload and weight gain among women with and without familial obesity.

OBJECTIVE: High job demands and low job influence may be associated with subsequent weight gain. Predisposition to obesity may further modify such associations. The purpose of the study was to determine whether familial predisposition to obesity modified associations between psychological workload and 6-year weight changes among nurses. RESEARCH METHODS AND PROCEDURES: A total of 6404 Danish nurses 45 to 65 years old, who belonged to the workforce in both 1993 and 1999, answered a questionnaire on psychological workload, body weight, and familial obesity. Women were considered to be predisposed to obesity if they were overweight and had at least one obese parent. Parents' body shape was reported using pictograms. RESULTS: An increased psychological workload, reflected by high job demands and low influence in job, was associated with an increased body weight. This was particularly the case for nurses being predisposed to obesity, suggesting a synergy between familial obesity predisposition and the psychological workload environment. An interaction test among job demands, familial predisposition to obesity, and weight gain on adjusted data was made. The test showed p = 0.05. The adjusted interaction test among influence in job, familial predisposition to obesity, and weight gain showed p = 0.02. Predisposed nurses who were busy in their job gained 4.4 kg, whereas other nurses gained only 3.2 kg during the 6 years. Similarly, nurses predisposed to obesity with low influence in job had a higher body weight gain (5.4 vs. 3.2 kg) compared with other nurses. DISCUSSION: High psychological workload due to high job demands and low influence in job seems to predict weight gain in general and, in particular, among those nurses with a familial predisposition to obesity.

Causality↗
PubMed2006

[The state of health of oncology nurses characterized by genetic and immunotoxicologic biomarkers].

Statistical data indicate a chronic shortage of work-force due to overwork, ill health state and increased risk of chronic noninfectious diseases in Hungarian health care personnel, which needs investigations in order to decrease the risk. Nurses of oncology units, often exposed to carcinogens when preparing and handling cytostatic drugs, are especially at high risk. In the present publication we report a complex clinical, geno- and immunotoxicology risk assessment of altogether 500 nurses, performed during the last 10 years at various oncology units in Hungary. The obtained results indicate that the health status of nurses at oncology units is better than the Hungarian average, especially of hypertonia and type II diabetes. However, the prevalence of iron deficiency anemia and different thyroid gland diseases is significantly higher than those of the controls matched for sex and age. The results suggest that iron deficiency can potentiate the resistance to insulin, i.e. the persistence of iron deficiency may increase the serum glucose levels and thus the risk of diabetes. Among the studied geno- and immunotoxicology biomarkers, the frequency of chromosome aberrations, sister chromatid exchange and B lymphocytes was significantly increased compared to the matched controls. The obtained alterations demonstrate the occupational exposure of the nurses to cytostatic drugs, thus the introduction of more strict hygienic controls and compliance with the European Union chemical safety regulations is necessary.

Adult↗
PubMed2002

Maternal and child health graduate and continuing education needs: a national assessment.

OBJECTIVES: The purpose of this report is to describe the methodology and results of a recent national assessment of long-term graduate and short-term continuing education needs of public health and health care professionals who serve or are administratively responsible for the U.S. maternal and child health population and also to offer recommendations for future training initiatives. METHODS: The target of this needs assessment was all directors of state MCH, CSHCN and Medicaid agencies, as well as a 20% random sample of local public health departments. A 7-page needs assessment form was used to assess the importance of and need for supporting graduate and continuing education training in specific skill and content areas. The needs assessment also addressed barriers to pursuing graduate and continuing education. Respondents (n = 274) were asked to indicate the capacity of their agency for providing continuing education as well as their preferred modalities for training. RESULTS: Regardless of agency type, i.e., state MCH, CSHCN, Medicaid or local health department, having employees with a graduate education in MCH was perceived to be of benefit by more than 70% of the respondents. Leadership, systems development, management, administration, analytic, policy and advocacy skills, as well as genetics, dentistry, nutrition and nursing, were all identified as critical unmet needs areas for professionals with graduate training. Education costs, loss of income, and time constraints were the identified barriers to graduate education. More than 90% of respondents from each agency viewed continuing education as a benefit for their staff, although the respondents indicated that their agencies have limited capacity to either provide such training or to assess their staffs need for continuing education. Program managers and staff were perceived in greatest need of continuing education and core public health skills, leadership, and administration were among the most frequently listed topics to receive continuing education training support dollars. Time away from work, lack of staff to cover functions, and cost were the top barriers to receiving continuing education. While attending on-site, in-state, small conferences was the continuing education modality of first preference, there was also considerable interest expressed in web-based training. CONCLUSIONS: Six recommendations were developed on the basis of the findings and address the following areas: the ongoing need for continued support of both graduate and continuing education efforts; the development of a national MCH training policy analysis center; the incorporation of routine assessments of training needs by states as part of their annual needs assessments; the promotion of alternative modalities for training, i.e., web-based; and, the sponsorship of academic/practice partnerships for cross-training.

Child↗