Evidence-based medicine : an overview

Evidence-Based Medicine (EBM) is about combining the best clinical expertise with the best available clinical information in the literature. At face value, this statement may seem simplistic, but closer scrutiny will lead to a reappraisal. The medical literature has increased exponentially to the point where the individual clinician can no longer keep abreast. The development and practice of EBM is a long-term, self-directed process which requires 5 sequential steps .In this article the author describes in the detail the searching process.peer-reviewe

Non-valvular atrial fibrillation and stroke : implications for management

Nonvalvular Atrial Fibrillation is more prevalent with increasing age. It is associated with a six-fold excess risk of stroke; and a cumulative lifetime stroke risk of 35%. 15% of ischaemic strokes are directly attributable to it. Five trials have established the safety of warfarin in reducing the risk by 70% in well selected patients, with stringent monitoring. Thromboembolism, cardiac failure, hypertension and echocardiographic abnormalities identify higher risk patients. The management of NVAF is changing from rate control, to cardioversion and anticoagulation (or use of antithrombotics) to reduce the embolic risk.peer-reviewe

Clinical audit: a synopsis

This synopsis is a brief report of the proceedings of the Clinical Audit Seminar organized by the Continuing Professional Development (CPD) Committee, held on the 29th October 2002. The seminar attracted a broad inter-professional audience, mainly consisting of doctors but also including pharmacists, nurses, and health service managers. In an effort to provide a broader focus, an effort has been made to introduce various perspectives on the topic, including one external to medicine. The idea was to try to learn concepts from other professions which could then be used to improve patient care; this practice has taken place in many industries, and is finally beginning to develop in medicine in different spheres.peer-reviewe

Clinical quality improvement and medicine

Medical practice is facing many pressures, all requiring ever-higher standards and better 'quality' in the provision of clinical care. Medicine is not alone in facing such forces, and it may be appropriate to apply the methodology used in other disciplines to address this issue; common problems are generally amenable to common solutions. The 'quality' approach was initially applied to health care in the USA, presumably because of the accent on market forces and the relationship with market share. In recent years, other health care systems have invested in this approach, applying lessons learned from management disciplines and the aviation industly. The Institute of Medicine's report on health care quality noted that 'every system is perfectly designed to obtain the results it gets' fll The European Union has thus far not included quality as a formal item on its agenda; however, with increasing mobility of patients and health professionals, there is pressure for legislative action addressing risk management and quality improvement. The development of a European approach to ensure the highest quality standards, free movement in the European Union, as well as the medical devices industry, are all areas that are raising interest. Overall, it behooves the individual clinician to be aware of developments in the area.peer-reviewe

Torsade de Pointes : a diagnostic pitfall

Torsade de pointes is an unusual arrhythmia which is found in certain well defined clinical situations. The authors present two cases of Torsade de pointes which were admitted on two consecutive days, where the diagnosis was not immediately appreciated. It is important that one should become familiar with the E.C.G. appearance and be aware of the possible aetiology so that appropriate treatment can be initiated.peer-reviewe

Plastin 1 widens stereocilia by transforming actin filament packing from hexagonal to liquid

With their essential role in inner-ear function, stereocilia of sensory hair cells demonstrate the importance of cellular actin protrusions. Actin packing in stereocilia is mediated by crosslinkers of the plastin, fascin, and espin families. While mice lacking ESPN (espin) have no vestibular or auditory function, we found that mice that either lacked PLS1 (plastin 1) or had nonfunctional FSCN2 (fascin 2) had reduced inner-ear function, with double-mutant mice most strongly affected. Targeted mass spectrometry indicated that PLS1 was the most abundant crosslinker in vestibular stereocilia, and the second-most-abundant protein overall; ESPN only accounted for ~15% of the total crosslinkers in bundles. Mouse utricle stereocilia lacking PLS1 were shorter and thinner than wild-type stereocilia. Surprisingly, while wild-type stereocilia had random liquid packing of their actin filaments, stereocilia lacking PLS1 had orderly hexagonal packing. While all three crosslinkers are required for stereocilia structure and function, PLS1 biases actin towards liquid packing, which allows stereocilia to grow to a greater diameter

Where is systemic functional grammar in the adult migrant English program?

Australia’s Adult Migrant English Program (AMEP) started in 1948. Since then it has continued to deliver language education to migrants for the purposes of settlement and attaining employment. The AMEP and its related developments in English language education have had a profound impact on ESL internationally. Arguably one of the most important contributions to the AMEP and to ESL more generally is Systemic Functional Grammar (SFG), which became the theoretical underpinning of the AMEP curriculum in the early 1990s. However, it would seem that a quarter of a century later, SFG is missing in action. This paper traces SFG’s presence in the AMEP through its inception in the Certificate in Spoken and Written English through various evolutions of the AMEP, and speculates on the implications of its apparent absence in the AMEP today.  &nbsp

Mycophenolate mofetil inhibits lymphocyte binding and the upregulation of adhesion molecules in acute rejection of rat kidney allografts.

Mycophenolate mofetil (MMF) interacts with purine metabolism and possibly with the expression of adhesion molecules. In the present study, we analysed the expression of these molecules in transplanted kidney allografts treated with RS LBNF1 kidneys were orthotopically transplanted into Lewis rats and either treated with RS (20 mg/kg/day) or vehicle. Rats were harvested 3, 5 and 7 days following transplantation. For binding studies, fresh-frozen sections of transplanted kidneys were incubated with lymph node lymphocytes (LNL) derived from transplanted rats. Additionally, immunohistology was performed with various monoclonal antibodies. In general, MMF resulted in better preservation of graft structure by 7 days. Cellular infiltration and tubular atrophy were less pronounced. At day 3, macrophages were diminished in MMF-treated animals to a high extent, while the number of T cells was almost identical to that of controls. In addition, the number of cells positive for MHC class II and LFA-1 was reduced in the MMF-treated animals. These findings correlated with the binding results. Three days following engraftment, LNL bound to MMF-treated kidneys to a lesser extent compared to controls. In conclusion, MMF resulted in a markedly reduced leucocytic infiltrate, presumably based on a reduced expression of lymphocytic adhesion molecules and an interaction with macrophages