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In vitro toxicity testing for antibacterials against human keratinocytes.

The use of cultured human keratinocytes in an in vitro comparison of topical antibacterial toxicity for epithelial cells was examined. The complement of three assessments allows testing of epithelial migration, growth, and survival. The three assessments included (1) flow cytometry for determination of cell survival, (2) a comparison of confluent cell culture growth after antibacterial exposures, and (3) an evaluation of cell migration using a technique of dermal explants to study radial migration. A comparative ranking of the toxicities of the various topical antibacterials was determined with the three assessments. This has confirmed anecdotal reports that many of the topical antibacterials are cell-toxic and may inhibit wound healing. This information can be directly extrapolated to the clinical setting, unlike many of the animal data for wound healing that currently exist.

Anti-Bacterial Agents

Rendezvous in Rhamu. Teaching and learning with traditional birth attendants in rural Kenya.

When Carol Steele came to Rhamu, Kenya, in 1983 as a Quaker, Peace, and Service volunteer, there was little or no contact or cooperation between the Government Health Center personnel and the traditional birth attendants of the surrounding villages. The two groups were worlds apart in thinking, attitudes, and practices. The government center was viewed as alien by the people, with nothing to offer them except emergency care. The health center personnel viewed the traditional birth attendants as uneducated, unskilled women, who jealously kept clients away from the professional obstetric care the clinic provided. It was Carol Steele's plan to bring these diverse groups together in a professional, trusting relationship. Her success in accomplishing this task is the theme of this article.

Anecdotes as Topic

Varied acceptance of clinical trial results.

The subject of varied acceptance of clinical trial results is discussed in the context of review of trials with which I have been involved and my subjective evaluation of their impact on the practice of clinical medicine. My experience goes back to 1949 and a World Health Organization trial of hyperimmune gamma globulin against rabies. This was followed by a large trial of secondary prevention of poliomyelitis. I participated in the planning and initiation of the first chronic disease trial, the University Group Diabetes Program (UGDP). The latter lasted for 15 years and its ramifications continue to this day. My next trial was the Coronary Drug Project (CDP), a complex trial with more than 8,000 patients. The trials of aspirin and aspirin combined with persantine (the CDPA, AMIS, PARIS I, and PARIS II) followed. My last three trials were a trial of photocoagulation in diabetic retinopathy (DRS), a six-country trial of the antiarrhythmic drug mexiletine (IMPACT), and a study involving two diagnostic procedures for pulmonary embolism (PIOPED). When one considers, in retrospect, the plethora of trials one is struck by the uniform absence of a priori considerations of the impact on medical practice, or likely lack thereof, of possible outcomes.

Anecdotes as Topic

Damaged goods: oral narratives of the experience of disability in American culture.

In a field project on oral narratives, I documented personal experience stories from 33 persons with visible, physical disabilities. These stories reveal informants' perceptions of how popular American notions about disability frame social interactions between disabled and nondisabled individuals, how such interactions affect the self-images of disabled persons, and how the predictability of such interactions constitutes a disabled experience that may be uniform across American culture.

Adult

On the relation of injury to pain. The John J. Bonica lecture.

Pain is better classified as an awareness of a need-state than as a sensation. It serves more to promote healing than to avoid injury. It has more in common with the phenomena of hunger and thirst than it has with seeing or hearing. The period after injury is divided into the immediate, acute and chronic stages. In each stage it is shown that pain has only a weak connection to injury but a strong connection to the body state.

Acute Disease

Puncture wounds to the foot.

Puncture wounds to the foot are common presenting problems in most busy emergency departments. Although seemingly benign, the sequelae after simple puncture wounds to the foot can include cellulitis, retained foreign bodies, or even osteomyelitis. Inadequate scientific research on this topic has left only anecdotal or retrospective reports for review in the medical literature. Antibiotics, radiographs, or surgical exploration in the management of puncture wounds to the foot all lack clinical studies to support their use. This review summarizes the literature and points to the inconsistencies in the management of puncture wounds to the foot.

Cellulitis

The staple.

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Anecdotes as Topic

Experiences of nurse-researchers in gaining access to subjects for clinical nursing research.

This study investigated the experiences of nurse researchers in gaining access to potential research subjects within health care agencies. Responders were nurse researchers who were primary authors of clinical nursing research studies that had been published in nursing research journals between the years 1985 and 1989. A survey was mailed to 211 responders and returned by 99 (47 per cent). Eighty-six were employed primarily by educational institutions. Responses to the survey indicated that these nurse researchers experienced political and procedural obstacles in gaining access to potential research subjects within health care agencies.

Anecdotes as Topic

An innocent tale.

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Anecdotes as Topic