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PubMed2003

Clinical Governance and the role of the lecturer/practitioner in education in one British National Health Service (NHS) Trust.

Meeting the Clinical Governance agenda is dependent fundamentally on staff education. When examined within and supported by the role of the Lecturer/Practitioner, a model of education for Clinical Governance begins to emerge. In order to implement this model and to simultaneously embrace the organizational change necessary to create a knowledgeable workforce, it is necessary to examine those factors that generate excellence in education on the ground. This paper will argue that the key determinant in developing excellence in the quality care is the presence of a rigorous system of staff education. It will argue through a short case study concerning one particular National Health Service (NHS) Trust that the role of the Lecturer/Practitioner can become instrumental in planning, assessing, maintaining and delivering quality education to clinical nurses for their roles in Clinical Governance. The paper will proceed to elucidate the interrelated factors underlying this assumption. The paper will conclude that Clinical Governance requires the recognition that service cultures and organization and styles are key to its growth. Yet although national action to support change and development are needed, there is no substitute for local inventiveness and backing. In this regard an exemplar of good practice is provided whereby the Lecturer/Practitioner role is being used as the vehicle to successfully address the issue of Clinical Governance by initiating the step change needed for excellence to occur.

Accreditation↗
PubMed2000

Student assessment in undergraduate medical education in the United Kingdom, 1998.

This report describes the results of the project 'Assessment of Undergraduate Medical Education: Re-inventing the Wheel?' funded by the Nuffield Trust. The project was initiated in order to obtain information on current assessment practices in medical schools across the UK, to determine the extent of change as a consequence of the curricular reforms recommended by the General Medical Council (GMC) in 1993 and, if necessary, to stimulate debate about assessment and provide an impetus for change. The data obtained provide a detailed profile of the timing and nature of assessments used in medical schools and provide information for comparison with the survey of basic medical education in the British Isles carried out in 1977 and any subsequent studies. The study provides confirmatory and unexpected evidence. Schools are clearly revising their curricula consistent with recommendations made by the GMC. The main components of the study were as follows: a postal questionnaire sent to all UK medical schools, a national workshop, and four case studies of innovative assessment practices.

Clinical Competence↗
PubMed2003

Nuclear DNA analyses in genetic studies of populations: practice, problems and prospects.

Population-genetic studies have been remarkably productive and successful in the last decade following the invention of PCR technology and the introduction of mitochondrial and microsatellite DNA markers. While mitochondrial DNA has proven powerful for genealogical and evolutionary studies of animal populations, and microsatellite sequences are the most revealing DNA markers available so far for inferring population structure and dynamics, they both have important and unavoidable limitations. To obtain a fuller picture of the history and evolutionary potential of populations, genealogical data from nuclear loci are essential, and the inclusion of other nuclear markers, i.e. single copy nuclear polymorphic (scnp) sequences, is clearly needed. Four major uncertainties for nuclear DNA analyses of populations have been facing us, i.e. the availability of scnp markers for carrying out such analysis, technical laboratory hurdles for resolving haplotypes, difficulty in data analysis because of recombination, low divergence levels and intraspecific multifurcation evolution, and the utility of scnp markers for addressing population-genetic questions. In this review, we discuss the availability of highly polymorphic single copy DNA in the nuclear genome, describe patterns and rate of evolution of nuclear sequences, summarize past empirical and theoretical efforts to recover and analyse data from scnp markers, and examine the difficulties, challenges and opportunities faced in such studies. We show that although challenges still exist, the above-mentioned obstacles are now being removed. Recent advances in technology and increases in statistical power provide the prospect of nuclear DNA analyses becoming routine practice, allowing allele-discriminating characterization of scnp loci and microsatellite loci. This certainly will increase our ability to address more complex questions, and thereby the sophistication of genetic analyses of populations.

Animals↗
PubMed1999

Bacterial transcription factors involved in global regulation.

The presence of intricate global cell regulation mechanisms may be one reason for the exceptional environmental and evolutionary success of microbes. Promoters, the cis-acting signals, are responsive to several stimuli related to growth, stress and substrate specificity. Their response is mediated by a wide variety of trans-acting regulators that sense the environment and the physiological state of the cell and adjust the transcription of specific genes. One of the main transcriptional regulation webs operates in the transition from affluent to barren conditions, with sigmaS being the chief actor in a company of players that stage a competition for the sparsely available RNA polymerase molecules. In this role, sigmaS may be assisted by several factors, including nucleoid-related proteins and metabolites. In addition, the levels of sigmaS itself are regulated by mechanisms that include inactivation and degradation. Several transcription factors, belonging to different regulatory pathways, may operate in the same promoter. In such a case, the final transcriptional output depends both on the interplay of effectors and on the properties of the recruitment of the effector-RNA polymerase complex to the promoter. RNA polymerase itself is also capable of establishing selective interactions with activators and specific promoter regions through the carboxy-terminal domain of its alpha subunit (alphaCTD). Transcriptional regulation controls pervade such crucial events in the life of bacterial cells as Escherichia coli cell division, Bacillus subtilis sporulation and Caulobacter crescentus differentiation. These examples suggest that bacteria have been particularly inventive in adapting gene expression regulation to survive under a diversity of environments and have done so by exploiting the malleable molecular mechanisms involved in transcription, developing complexities that may match those found in eukaryotic cells.

Adaptation, Physiological↗
PubMed2001

From oocyte maturation to the in vitro cell cycle: the history of discoveries of Maturation-Promoting Factor (MPF) and Cytostatic Factor (CSF).

This article briefly reviews the classical cell cycle studies using oocytes and zygotes of mainly amphibians in the past century. The discussions are focused on the investigations into the cytoplasmic factors that regulate meiosis during oocyte maturation and the initiation of mitosis during fertilisation, which were carried out in the author's lab between 1967 and 1987. This chronicle traces the development of the problems and the direction in which their solutions were attempted in the course of these investigations. The author tries to answer the following questions: why he decided to study oocyte maturation, how he discovered progesterone as a maturation-inducing hormone, how he discovered and characterised the cytoplasmic regulators of the cell cycle, Maturation-Promoting Factor (MPF) and Cyto-Static Factor (CSF), and how he invented the method of observing cell cycle processes in a cytoplasmic extract in vitro.

Animals↗
PubMed2002

History of the microscope and development of microsurgery: a revolution for reproductive tract surgery.

In the mid-1970s urologists in the field of paediatric and andrologic surgery felt that operating loupes did not provide sufficient magnification for their surgical work. Thus, urology finally introduced the operating microscope in the operating room, which was rather late in comparison to other surgical disciplines. Almost three decades later we can hardly imagine performing a vasovasostomy, a testicular autotransplantation or a penile reconstruction without the use of this sophisticated instrument. The following article from the history of medicine reveals the main steps in the technical development of the microscope, from early magnifying tools to the pioneering inventions of Carl Zeiss (1816-1888) and his successful company in Jena, Germany in the 19th century. Finally, the clinical application of microsurgery in the 20th century is described, focusing on reconstruction of the reproductive tract in andrology and gynaecology.

Female↗
PubMed1995

Pressure-controlled palpation: a new technique which increases the reliability of manual palpation.

The objective of the present study was to investigate whether the reliability of tenderness evaluation can be increased by using a new technique called "pressure-controlled palpation" (pcp). The technique has been made possible by a newly invented piece of equipment called a palpometer, with which a pressure-sensitive plastic film attached to the index finger records the pressure exerted. In 15 patients with chronic tension-type headache and in 15 healthy volunteers, 2 investigators studied myofascial tenderness using conventional palpation and pressure-controlled palpation. Tenderness was scored on a 4-point scale in each of the examined pericranial regions. The sum of tenderness scores recorded by two observers using conventional palpation differed significantly (p = 0.0003), while results did not differ between observers using pressure-controlled palpation (p = 0.89). During palpation with seven different pressure intensities a positive and linear relation between pressure and pain intensity was found (p = 0.00006). Pain intensity reported by the subjects correlated highly with tenderness scored by the observer (rs = 0.95, p < 0.0001). These results demonstrate for the first time that tenderness scores can be compared between observers if palpation pressure is controlled. Pressure-controlled palpation represents a major improvement on current palpation techniques and should be standard in future research on myofascial pain disorders.

Adult↗
PubMed2002

Structure, function and evolution of the gas exchangers: comparative perspectives.

Over the evolutionary continuum, animals have faced similar fundamental challenges of acquiring molecular oxygen for aerobic metabolism. Under limitations and constraints imposed by factors such as phylogeny, behaviour, body size and environment, they have responded differently in founding optimal respiratory structures. A quintessence of the aphorism that 'necessity is the mother of invention', gas exchangers have been inaugurated through stiff cost-benefit analyses that have evoked transaction of trade-offs and compromises. Cogent structural-functional correlations occur in constructions of gas exchangers: within and between taxa, morphological complexity and respiratory efficiency increase with metabolic capacities and oxygen needs. Highly active, small endotherms have relatively better-refined gas exchangers compared with large, inactive ectotherms. Respiratory structures have developed from the plain cell membrane of the primeval prokaryotic unicells to complex multifunctional ones of the modern Metazoa. Regarding the respiratory medium used to extract oxygen from, animal life has had only two choices--water or air--within the biological range of temperature and pressure the only naturally occurring respirable fluids. In rarer cases, certain animals have adapted to using both media. Gills (evaginated gas exchangers) are the primordial respiratory organs: they are the archetypal water breathing organs. Lungs (invaginated gas exchangers) are the model air breathing organs. Bimodal (transitional) breathers occupy the water-air interface. Presentation and exposure of external (water/air) and internal (haemolymph/blood) respiratory media, features determined by geometric arrangement of the conduits, are important features for gas exchange efficiency: counter-current, cross-current, uniform pool and infinite pool designs have variably developed.

Adaptation, Physiological↗
PubMed1999

Removal of digoxin and doxorubicin by multidrug resistance protein-overexpressed cell culture in hollow fiber.

BACKGROUND: Drug removal by hemoperfusion is not effective because of its lower capacity and nonspecificity. We invented a new hybrid type of hemodialysis system. METHODS: An immortalized proximal tubular cell line (PCTL) overexpressing human multidrug resistance protein-1 (MDR-1) was cultured either on polus filter membranes or on hollow fiber modules. The modules were incubated in an incubator conditioned with 95% O2/5% CO2 that was kept at 37 degrees C. At 10 days on culture, the drug-transporting capacity of these systems was examined. RESULTS: MDR was successfully expressed in the PCTL as evaluated by Western blot. Basolateral to apical transport of 3H-digoxin, a substrate of MDR, was examined by using the cells cultured on a microporous membrane. PCTL-MDR showed a 10-fold increase in MDR protein and a 12-fold increase of 3H-digoxin transport through a cell layer on a microporous membrane. The increase of the transport was abolished by the addition of 5 microM verapamil, an inhibitor of MDR, to the apical side. When digoxin or doxorubicin was infused in the capillary side of the hollow fiber modules after 10 days on culture, the largest portion of the drugs was transported to the pericapillary side (P < 0.001). This transport was also abolished by an addition of verapamil to the pericapillary side. Transport of para-aminohippurate was not different between two cells, and inulin was not transported in this system. CONCLUSION: The hybrid hollow fiber system can selectively remove a significant amount of drugs that have an affinity to MDR from the medium, and perfuse them to the capillary side in vitro.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1999

Long-term epilation with long-pulsed neodimium:YAG laser.

BACKGROUND: Unwanted body hair can represent a severe cosmetic disturbance. The traditional methods used to epilate often have limitations, side effects, and unsatisfactory results. In recent years, various light sources (lasers and others) have been developed for long-term epilation of unwanted hair. OBJECTIVE: This study evaluates, on a large number of patients, the efficiency and safety of a long-pulsed low-potency Nd-Yag laser invented specifically for long-term hair removal. METHODS: Some 208 subjects needing epilation were divided into three groups and treated during an 11-month period. Group A included 79 patients with a normal distribution of unwanted hair; Group B 67 patients with constitutional hypertrichosis; and Group C 62 patients with hirsutism. Treatment sessions were performed with a fluence of 23-56 J/cm2 at 1-month intervals until obtaining desirable results. Follow-ups ranged from 1 to 6 months. In 3 patients 4-mm diameter punch biopsy specimens were obtained before the first session and again after 6 hours. A third biopsy was performed after 3 months. RESULTS: Every session resulted in a 20-40% hair loss, depending on the color of hair. Complete epilation was obtained in 4 to 6 sessions. Only white hair was not receptive to laser light, and its growth was not modified. No patients, including dark-complexioned patients, had blistering, hypo-or hyperpigmentation. No pain was present during treatment except for the axillary area. In the specimen obtained after 6 hours, very extensive necrosis of the hair follicular and sebaceous gland epithelium was evident. Histologic findings of the biopsies taken after three months showed complete disappearance of hair and moderate fibrosis. CONCLUSION: This study proves that the long-pulsed Nd:Yag laser treatment produces an excellent prolonged epilation with no relevant side effects. This laser light, having a 1064 nm wavelength, is minimally absorbed in superficial skin layers, and pronounced scattering up to 5 mm occurs targeting the deeper follicles.

Adolescent↗
PubMed2000

Dermatologist and electrologist perspectives on laser procedures by nonphysicians.

BACKGROUND: As hair removal technology continues to evolve and new equipment comes to market, conflicts may develop between dermatologists and electrologists regarding the professional control and use of these devices. METHODS: A total of 1004 Fellows of the American Academy of Dermatology and 719 electrologists from the southern United States were anonymously surveyed about clinical laser procedures (CLPs). RESULTS: Compared to electrologists, dermatologists were more likely to support clinical laser regulations that placed licensed physicians in control (P =.001) and preferred that a delegating physician be physically present on the premises when CLPs were performed (P =.001). If a laser device was invented for permanent hair removal that was identical to traditional needle/probe electrolysis in every respect except energy type ("laser fiberoptic probe," LFP), electrologists were more likely than dermatologists to support independent use of this device by electrologists (P =.001). A greater percentage of electrologists from Texas, a state without electrolysis licensing, were more likely to support the unlicensed use of the LFP and CLPs than electrologists from states requiring electrolysis licensing. CONCLUSIONS: These data are consistent with previously published literature and permit a greater understanding of the multiple attitudinal, regulatory, and ethical issues involved when considering delegated and independent CLPs by electrologists.

Allied Health Personnel↗
PubMed2000

Powered liposuction.

BACKGROUND: Although Arpad and Giorgio Fischer initially employed blades within cannulas in their early research while inventing liposuction, hollow cannulas have become the standard instrument for this procedure for the last quarter century. Ultrasonic liposuction was developed in the 1990s to facilitate the passage of cannulas through subcutaneous tissue while liquefying fat. However, these instruments had a number of drawbacks including seromas and tissue burns. Powered cannulas were introduced in 1995 by Gross for "liposhaving." This technique was used on the neck with open surgery under direct observation. OBJECTIVE: Based on these principles, a new powered liposuction device has been designed for body liposuction. METHOD: An oscillating blade within a cannula facilitates removal of fat, especially in fibrous areas such as male flanks and breasts. This instrument has proven to be safe in numerous body areas. Powered reciprocating cannulas also have been recently introduced. These simulate the "to and fro" motion of manual liposuction and appear to be safe. CONCLUSION: Powered liposuction may provide the advantages of ultrasonic liposuction with fewer complications.

Catheterization↗
PubMedDate not supplied

Ancient origins of axial patterning genes: Hox genes and ParaHox genes in the Cnidaria.

Among the bilaterally symmetrical, triploblastic animals (the Bilateria), a conserved set of developmental regulatory genes are known to function in patterning the anterior-posterior (AP) axis. This set includes the well-studied Hox cluster genes, and the recently described genes of the ParaHox cluster, which is believed to be the evolutionary sister of the Hox cluster (Brooke et al. 1998). The conserved role of these axial patterning genes in animals as diverse as frogs and flies is believed to reflect an underlying homology (i.e., all bilaterians derive from a common ancestor which possessed an AP axis and the developmental mechanisms responsible for patterning the axis). However, the origin and early evolution of Hox genes and ParaHox genes remain obscure. Repeated attempts have been made to reconstruct the early evolution of Hox genes by analyzing data from the triphoblastic animals, the Bilateria (Schubert et al. 1993; Zhang and Nei 1996). A more precise dating of Hox origins has been elusive due to a lack of sufficient information from outgroup taxa such as the phylum Cnidaria (corals, hydras, jellyfishes, and sea anemones). In combination with outgroup taxa, another potential source of information about Hox origins is outgroup genes (e.g., the genes of the ParaHox cluster). In this article, we present cDNA sequences of two Hox-like genes (anthox2 and anthox6) from the sea anemone, Nematostella vectensis. Phylogenetic analysis indicates that anthox2 (= Cnox2) is homologous to the GSX class of ParaHox genes, and anthox6 is homologous to the anterior class of Hox genes. Therefore, the origin of Hox genes and ParaHox genes occurred prior to the evolutionary split between the Cnidaria and the Bilateria and predated the evolution of the anterior-posterior axis of bilaterian animals. Our analysis also suggests that the central Hox class was invented in the bilaterian lineage, subsequent to their split from the Cnidaria.

Amino Acid Sequence↗
PubMed2003

Can hand-carried ultrasound devices be extended for use by the noncardiology medical community?

Echocardiography (echo) is a powerful, noninvasive, inexpensive diagnostic imaging technique that provides important information in a variety of cardiovascular diseases. Echo provides rapid information regarding ventricular and valvular function in the clinical management of patients. Smaller, relatively inexpensive hand-carried cardiac ultrasound (HCU) devices have become commercially available, which can be used for diagnostic cardiac imaging. Because of their relative ease of use, portability, and affordable cost, these new hand-held systems have made point-of-care (bedside) echocardiography available to all medical personnel. The rate-limiting step to the widespread use of this technology is the lack of personnel with echo training at the immediate contact point with patients. Although extensive training and experience are needed to acquire and interpret a complete echo, training medical personnel to perform and interpret a limited echo (defined as a brief, diagnosis focused exam) may fully exploit the potential of echo as a point-of-care diagnostic tool and may be accomplished in a short period of time. Presently there are guidelines for independent competency in echocardiography and HCU echo established by several professional organizations and as a result of these rigorous guidelines, other noncardiology medical professionals who could practically derive the greatest benefit are discouraged and virtually precluded from utilizing echo during the initial encounter with the patient. However, there is now a growing body of literature in a diverse group of noncardiology medical personnel that demonstrates that it is possible to quickly and effectively train them to perform and interpret limited echocardiograms. Medical students, medical residents, cardiology fellows with limited experience, emergency department physicians, and surgical intensive care unit staff have all been evaluated after only brief, focused training periods, and investigators found that HCU echo provided important new information, changed therapeutic management, and was vastly superior to the physical exam alone with an acceptable overall level of accuracy. The contribution of echocardiography to the field of cardiovascular disease since its invention has been significant and the newer compact, portable, ultrasound systems have the potential to revolutionize the utilization and availability of echocardiography. To maximize integration of echo into medical practice, physicians and physician extenders could be trained to perform and interpret limited echo to complement their clinical examination and improve their diagnostic skills. The challenge is to provide practical training programs to assure competency in performing point of care echocardiograms.

Emergency Service, Hospital↗
PubMed2005

[Luca: the last universal common ancestor].

One of the most important outcomes of modern biology has been the demonstration of the unity of life. All living beings are in fact descendants of a unique ancestor commonly referred to as Luca (the Last universal common ancestor). The discovery - nearly 30 years ago by Carl Woese - that present-day life on our planet can be assigned to only three domains: two of prokaryotic nature (Archaea and Bacteria), and one eukaryoyic (Eucarya), has given birth to a new field of investigation aimed at determining the nature of Luca. Today, thanks to the accumulation of genomic data, we can loop back into the past and infer a few characters of Luca by comparing what present-day organisms have in common. For example, it is now clear that Luca was a cellular organism provided with a cytoplasmic membrane, and that it harboured already a quite sophisticated translation apparatus. However, the inference of other characters of Luca from comparative genomics is less straightforward: for instance, a few key molecular mechanisms for DNA replication are non-homologous across the three domains and their distribution is often puzzling. This evidence has been embraced by proponents of the hypothesis that Luca harboured an RNA genome and that its replacement by DNA and the appearance of the corresponding molecular systems would have occurred independently in the three life domains after their divergence. However, an equally likely scenario would be that of a Luca with a DNA genome and of a subsequent replacement of its DNA-replication systems by non-homologous counterparts either in the bacterial or in the archaeal/eukaroytic branch. Nevertheless, including the viral world into the picture of the tree of life may thus provide us with precious insights into our most distant past since the invention and spread potential of viruses may have played a key role in early evolution.

Archaea↗
PubMed2001

Remembrance of past images of Trichinella.

The development of achromatic microscopy and the invention of photography were contemporaneous with the earliest investigations on trichinellosis. The former was more important than the latter to 19th century studies on Trichinella. A selection of images, diverse but not comprehensive, is presented to illustrate the early history of trichinellosis.

Animals↗
PubMed2002

Anaesthetic team and the role of nurses--North American perspective.

Anaesthesia is an American invention but the development of anaesthesia practice took two paths at its inception. The American-based ether anaesthetic technique allowed for non-physician personnel to administer the drug. As nurses already played a role in assisting surgeons, it was logical for them to assist in the anaesthetic. This article discusses the historical events leading to the development of nurse anaesthesia practice in the USA. The current status of physician and nurse anaesthetist interactions--both harmonious and acrimonious--are presented.

Anesthesiology↗