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PubMed2004

"Modern language" or "spin"? Nursing, "newspeak" and organizational culture: new health scriptures.

A new managerial language of modernization has accompanied political restructuring of the National Health Service. Corporate goals of efficiency and audit have been integrated with the ideological manifesto of New Labour in stressing citizenship, inclusion and empowerment. Drawing on the theoretical insights of anthropology and sociology, this article critically reviews the relationship between health policy, organizational culture and nursing practise through an exploration of language in terms of "rhetoric", "jargon" and "metaphor". It is suggested that beyond the bewildering vocabulary of "buzz words" is a fundamental contradiction between the ethic of caring and the expectations of Government. Finally thought is given to the role of professional education and training where intellectual engagement with the ritual categories of "newspeak" is a subversive act.

Conflict, Psychological↗
PubMed2003

Classical Greek and Roman rhetoric and the modern audience.

The formal structuring of oral discourse or rhetoric was highly developed in antiquity. Both Greek and Roman authorities on the subject codified for orators an arrangement of material and a contextual format which have utility in the present day. The art of public lecturing should encompass relevance of material, structure of presentation and style of delivery in order to render the whole enjoyable and memorable. Teaching does not cause learning, but skilful rhetorical technique can imbue the student with a potent desire for further self-directed study. In this field, the ancient is auxiliary to the modern.

Communication↗
PubMed2004

The impact of a modern medical curriculum on students' proposed behaviour on meeting ethical dilemmas.

OBJECTIVE: To evaluate the impact of a modern medical curriculum on students' proposed behaviour on encountering ethical dilemmas. DESIGN: Cohort design. SETTING: University of Glasgow Medical School. SUBJECTS: The first intake of students into Glasgow's new curriculum (n = 238). Main outcome measure Student answers consistent with consensus professional judgement on the ethical dilemmas posed by the vignettes of the Ethics and Health Care Survey Instrument. RESULTS: The probability of giving a consensus answer was lowest pre-Year 1 and highest post-Year 1. It reduced slightly post-Years 3 and 5, but remained significantly higher than at pre-Year 1. The performance of students undertaking a 1-year intercalated BSc, however, appeared to regress on testing post-Year 4. CONCLUSIONS: While the first year of the curriculum had a positive impact on students, the remainder of the curriculum did not impact to the same extent. These findings support the recommendation that small group teaching, the predominant teaching method in Year 1, should be preferred to lecture and large group teaching, the predominant method of the remaining curricular years. Full integration of ethics and law teaching within the rest of the curriculum is recommended, particularly during the clinical years. This has training implications for all medical teachers involved in the curriculum. The assessment of ethics should be incorporated into all formal examinations. It is recommended that ethics be addressed as part of a wider approach to professionalism in order to promote integration.

Cohort Studies↗
PubMed2005

Teaching and learning population and preventive health: challenges for modern medical curricula.

OBJECTIVES: This study aimed to formally identify medical students' attitudes towards population and preventive health issues addressed in the University of Queensland's Bachelor of Medicine, Bachelor of Surgery (MBBS) programme, in response to informal student reports that population and preventive health issues were largely just matters of "common sense". METHODS: Year 2 medical students were surveyed in 1999 and 2000 using a custom-designed instrument incorporating Likert scales and requests for qualitative responses. A sample of students participated in semistructured interviews. RESULTS: A total of 341 students (71%) responded to the survey. Students' attitudes towards general population health issues were overwhelmingly positive, and more than 60% of students reported having a more positive attitude towards psychosocial and preventive health issues than they had when they commenced the MBBS programme. Just over half of the students, however, considered population and preventive health issues to be matters of common sense. Students reported poor role modelling by the faculty in relation to population and preventive health issues, with only 41% of students indicating they perceived a positive attitude towards psychosocial and preventive health issues in the School of Medicine. Qualitative data indicated that some students fear that the opportunity cost of dedicating study time to population and preventive health issues might endanger their future clinical knowledge, skills and management of patients. CONCLUSIONS: These findings have important implications for modern medical curricula. The challenge in teaching population health issues is to balance students' needs to understand and apply the principles of population and preventive health and the biopsychosocial model of patient care, with the need for them to be confident they will be able to practise safely if they do so.

Attitude of Health Personnel↗
PubMedDate not supplied

A modern approach to the gonadotropin treatment in oligozoospermia.

A critical review of the gonadotropin therapy in male infertility or hypofertility is presented. In the author's opinion, the poor and conflicting results so far obtained wih this kind of treatment are mainly due to inadequate selection of the patients admitted to the treatment itself. The author stresses some points concerning the modern knowledge on the physiology of gonadotropin secretion in males; points that must be borne in mind in approaching this type of treatment, and which in some way revolutionize the old concept of "low" or "high" plasma gonadotropin levels. In this concern, the gonadotropin therapy can be applied not only to the hypogonadotropic hypogonadism, as for the past, but also to the spermatogenic arrests and to the idiopathic oligospermiogenesis wtih "normal" gonadotropin levels. The author then exposes the rigid criteria adopted in the Andrologic Center of the 5th Medical Clinic of the University of Rome for the selection of the patients to be admitted to the treatment; criteria which are based on hormonal, morphological and seminal parameters. In the final part the results are reported obtained in the selected patients with a treatment schedule with associated HMG + MCG (150--300 I.U. as FSH per week and 2000--6000 I.U. as LH per week for 12--16 weeks). The results seem very encouraging: in 85% of the patients a quantitative and qualitative amelioration of the spermatogenesis was obtained; in 30% of these cases an outcome of pregnancies in the partner has been documented so far.

Chorionic Gonadotropin↗
PubMed2004

Potential for protein deposition and threonine requirement of modern genotype barrows fed graded levels of protein with threonine as the limiting amino acid.

The study was conducted to estimate the actual genetic potential for daily protein deposition of growing barrows [genotype: Piétrain x (Duroc x Landrace)]. Twenty-four pigs with an average initial body weight (BW) of 43.7 +/- 0.7 kg were used in a N-balance study. Semi-purified diets with graded levels of crude protein (45.8, 94.2, 148.0, 198.9, 255.5 and 300.2 g/kg DM) were used, based on a constant mixture of wheat, soya bean protein concentrate and potato protein concentrate as protein sources. The amino acid pattern of the diets was according to the ideal amino acid ratio for growing pigs (Wang and Fuller, 1989), with the exception of threonine (adjusted as limiting amino acid). N-balance data were used to estimate daily N-maintenance requirement (NMR = 446 mg N/BW0.67 kg/day) by regression method and the theoretical maximum of daily N-retention (PDmaxT = 3115 mg N/BW0.67 kg/day) based on N-utilization model of Gebhardt (1966) using program Mathematica 3.0. The results indicate that PDmaxT of pigs under study is much higher than results from earlier studies with older genotypes. In summary, pigs of modern genotype have a very high genetic potential for daily protein deposition and these actual data are important basic informations for estimation of amino acid requirement within the model used. Threonine requirement data depending on threonine efficiency and protein deposition (8.96, 10.45 and 12.22 g/day for 130, 145 and 160 g daily protein deposition; 50 kg body weight) are discussed.

Animal Feed↗
PubMed1993

Radiation therapy for early stage seminoma of the testis. Analysis of survival and gastrointestinal toxicity in patients treated with modern megavoltage techniques over 10 years.

Seventy-seven patients treated with megavoltage irradiation to the para-aortic and/or pelvic nodal areas, for stage I and non-bulky (< 5 cm) stage II seminoma of the testis, were studied at the Royal Adelaide Hospital from 1981 to 1990. The aim was not only to assess overall and relapse-free survival, but also early and late gastrointestinal toxicity in a group of patients treated in a uniform manner using modern techniques. The 10 year actuarial survival was 96.1% for all patients, being 95.6% for stage I and 100% for stage II. The 10 year actuarial complication rate for all late gastrointestinal effects was 9.1%. This consisted of a 6.5% risk of peptic ulceration and a 2.6% risk of chronic diarrhoea at 10 years. At least one acute gastrointestinal effect occurred during radiotherapy in the vast majority of patients (90.9%). Analysis of the effect of age (< or = 34 years vs > 34 years), stage (I vs II) and dose of radiation (< or = 30 Gy vs > 30 Gy), showed none of these variables to have a significant influence on overall survival or on the incidence of late complications. The results of these findings are discussed in the light of recent studies of a surveillance policy following orchidectomy for stage I seminoma of the testis. Given that gastrointestinal toxicity is the major toxicity associated with the treatment of stage I patients, the data from this study should assist clinicians and their patients to arrive at an informed decision regarding adjuvant radiotherapy.

Adult↗
PubMed1998

Modern management of childhood diabetes: a role for computerized devices?

Technology is increasingly relevant in everyday life and it can be very interesting to apply it also in the field of diabetes as it can be one way of ensuring better care. In the Diabetes Control and Complications Trial, the intensively treated patients were seen fortnightly in hospital and contacted even more frequently by telephone during the day as well as at night. For these reasons, health reforms are undergoing a radical change in an attempt to reduce the spiraling costs of health care provision. Therefore, it can be useful to use information technology (IT) in diabetes care. The European Federation for Medical Informatics recently established some Special Issues to advance IT initiatives that may be able to address the problem of adjusting the insulin dose and controlling blood glucose (BG) levels, as well as assisting in the provision of modern-day diabetes care. The Special Issues can be classified under the following headings: databases, algorithms, decision support, models and education. It can be useful to develop a prototype computer system that can be applied to different areas of clinical diabetes care; computerized out-patients' clinical databases that store patients' clinical and biochemical data; statistical and graphical analysis programs that help the clinician; dietary analysis programs which examine food composition and dietary exchanges and help devise meal plans; hand-held insulin dosage adjustment computers that advise patients on a day-by-day or even meal-by-meal basis; expert systems and question and answer programs for patients' education, and finally games for children. These systems have the potential to be useful tools in many aspects of diabetes care but their utilization by the vast majority of the health care community has been extremely limited. Nonetheless, computers cannot substitute for the pediatric diabetes team, which remains the major determinant for better care of diabetes in children and adolescents.

Algorithms↗
PubMed2005

Pelvic recurrence in stage I seminoma: a new phenomenon that questions modern protocols for radiotherapy and follow-up.

OBJECTIVE: To highlight the increased risk for pelvic relapse in patients with stage 1 seminoma treated with adjuvant radiotherapy limited to para-aortic template alone. PATIENTS AND METHODS: Over a four-year period, three patients presented with early pelvic recurrence after radical orchidectomy and adjuvant irradiation for stage 1 seminoma. In each case, radiotherapy had been limited to the para-aortic region with omission of the ipsilateral hemi pelvis. RESULTS: Pelvic recurrences occurred on the ipsilateral tumor side. Durable complete remission was achieved in each case; however, treatment was complex and there was associated morbidity. CONCLUSION: This significant incidence of pelvic recurrence questions the validity of modern radiotherapy protocol which excludes the ipsilateral pelvis from the radiation field.

Adult↗
PubMed1976

A brief review of the concepts related to certain modern analytical methods and their use in medical science.

A number of sophisticated analytical methods are avialable in Australia and are in current use in medical research. Some basoc knowledge is required to understand the concepts behind their use, and expertise is necessary for interpretation of the results. In this brief review, the principles behind a number of modern analytical methods such as emission spectroscopy, electron microprobe, mass spectroscopy, infra-red spectroscopy, and X-ray diffraction, have been described in simple terms. These techniques may be used in the analysis of biological specimens. a number of illustrations of their use in medical research have been given.

Chemistry Techniques, Analytical↗
PubMed1985

Diabetic control and the effect of changing a diabetic clinic to modern management.

The feasibility and effects of changeover from traditional to modern methods of diabetic management in insulin-dependent diabetics (IDDs) are described. Patients were asked to switch from urine testing to home blood glucose monitoring, from carbohydrate restricted to high carbohydrate-high fibre diets and from one to two injections of insulin per day with the help of a diabetic education sister. Most patients (81%) changed immediately to blood glucose monitoring and after 6 months none wanted to go back to urine tests and 58% changed to a high fibre diet. Subjects in the 'monitoring' group had a significant improvement in HbA1 (mean +/- S.E.M. 14.1 +/- 0.4% to 11.4 +/- 0.5% and 11.8 +/- 0.5% at 4 and 8 months, respectively, p less than 0.01), without any increase in frequency of hypoglycaemia, whereas the rest showed no change. No subject was hospitalized for hyperglycaemia. In conclusion, these newer management techniques can be successful in the majority of IDDs. They are easy to apply, highly acceptable and effective.

Attitude to Health↗
PubMed1996

'Reductive' analysis in the light of modern infant research.

From a Jungian viewpoint the findings of modern infant research can be seen as dealing in minute detail with the process by which the Self, the archetype of order, becomes incarnated in the infant and organizes the individual's development and maturation in accordance with the facilitating environment. Viewing Lichtenberg's 'groundplan of the infant-environment system' as archetypal, the paper traces the impact of this groundplan on the interactive field in analysis. Descriptions are offered of key issues in infant research, such as the growing sense of self (emerging self, core self, subjective and verbal self) with its various interpersonal needs and experiences (Stern 1985), the motivational systems (Lichtenberg 1989), the precursors of fantasy life i.e. the 'RIGs' (representations of interactions that have been generalized') (Stern 1985), and the categorical and vitality affects. The paper's main concern, however, is the practical application of these findings to the analytic situation, in so far as they cultivate a deeper sensitivity to and understanding of the emotional nuances, the 'metacommunications', so to speak, beneath the discourse of manifest issues and 'contents' of the unconscious.

Adult↗
PubMed1984

The pelvis as a passageway. II. The modern human pelvis.

Following on from part I on evolution and adaptations of the pelvis, this paper suggests that variations in the shape and size of both ancient and modern human pelves may be better explained by nutritional factors than by hormonal influences or race.

Body Height↗
PubMed1993

Basic accessibility in modern housing--a key to the problems of care in the domestic setting.

The purpose of this study was to investigate public grants for housing adaptation in modern housing and to explore attitudes to accessibility problems. Grants for housing adaptation in apartments in blocks of flats built during the 1980s in a Swedish urban district were investigated over a 3-year period. Twenty-nine apartments had been adapted, in most cases by making a few simple alterations. Interviews with key persons in the building process stated that the most common measures would have cost less if they had been planned as 'basic accessibility'. The most important reasons why accessibility problems still persisted were building traditions, lack of knowledge about disability, and technical problems. Occupational therapists have a wide knowledge of housing adaptation. Adding their competence to the planning process would most likely increase activity and improve quality of life for disabled individuals. This study indicates that positive effects on the public economy could be achieved by putting 'basic accessibility' into practice.

Aged↗
PubMed1999

Modern antioestrogens and the coming revolution in women's health care.

This review will focus on antioestrogens and selective oestrogen receptor modulators (SERMS). The more traditional SERMS, clomiphene citrate and tamoxifen, will be reviewed along with such modern drugs as raloxifene and faslodex, with emphasis upon their actions on breast, uterus, bone and lipids. The future potential of these medications, in the management of oestrogen-dependent gynaecological conditions such as endometriosis, dysfunctional uterine bleeding, fibroids and breast cancer will be discussed.

Bone and Bones↗
PubMed1989

Treatment of varicose veins: modern concepts and methods.

Varicose veins have been a somewhat neglected entity. Treatment usually consists of routine stripping of the main trunks and excision of all distal tributaries, resulting in many unsightly scars. Modern diagnostic methods trace the origin of the reflux causing the condition. If the saphenofemoral or saphenopopliteal junction is involved, limited surgery is done, followed by sclerotherapy of the varicose tributaries later. Many cases can be treated with sclerotherapy only. A description of the new concepts is given. A diagnostic classification is presented, together with the corresponding methods of treatment.

Clothing↗
PubMedDate not supplied

Responding to challenges in modern combat casualty care: innovative use of advanced regional anesthesia.

BACKGROUND: The war in Iraq has resulted in a high incidence of severe extremity injury requiring multiple surgical procedures and extensive rehabilitation. We describe the use of advanced regional anesthesia to meet this significant medical challenge. METHODS: From March 2003 to December 2004, 4,100 casualties have been evacuated to Walter Reed Army Medical Center (WRAMC). Of 1,400 inpatients, 750 have been battle-injured with 500 having extremity injuries. Of these, 287 (57%) received surgical care incorporating regional anesthesia including single-injection peripheral nerve blocks and continuous peripheral and epidural infusion catheters. Wounding, surgical, anesthetic, and outcomes data have been prospectively collected. RESULTS: Over 900 operations (mean 4+/-2/patient) were performed on 287 casualties prior to arrival at WRAMC, and 634 operations (mean 2+/-1/patient) were performed at WRAMC. Thirty-five percent of this cohort was amputees. In the study group, 646 advanced regional anesthesia procedures, including 361 continuous peripheral nerve blocks (CPNBs), were performed with a mean catheter infusion time of 9 days (1-34). Catheter-related complications occurred in 11.9% of casualties and were technical or minor in nature. Catheter-related infection rate was 1.9%. In 126 casualties with indwelling CPNB catheters, a significant decrease in pain score over 7 days was apparent (mean 3.7+/-0.2 to 2.2+/-0.2, P<0.001). CONCLUSION: Advanced regional anesthetic techniques allowed for safe perioperative surgical anesthesia and analgesia in the management of the modern combat casualty.

Adolescent↗