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Desborough J.L.,Level 11
Australian Health Review

Objective. This is a report of a qualitative health research study examining how nurse practitioners construct and implement their roles. Methods. In-depth interviews and a focus group discussion were conducted to obtain narrative data from nurse practitioners from a variety of clinical backgrounds. Data were analysed utilising the principles of grounded theory. Subjects. Seven nurse practitioners participated in face-to-face interviews and six participated in a focus group discussion. Results. The central process of 'developing legitimacy and credibility' is achieved through the processes of: 'developing Clinical Practice Guidelines', 'collaborating with the multidisciplinary team', 'communicating', and 'transitioning to practice'. Conclusion. Policy makers and those responsible for operationalising nurse practitioner roles need to support the central process of developing legitimacy and credibility vital for successful implementation. First, this involves enabling a supportive and informed process of Clinical Practice Guideline development. Second, key inter-disciplinary relationships need to be identified to facilitate collaboration and sources of mentorship for nurse practitioners. Finally, an identified period of transition will facilitate identification, development and implementation of the above processes. © 2012 AHHA. Source

Chong A.K.S.,Level 11
Singapore Medical Journal

Congenital hand deformities are common but most of these conditions are minor. Polydactyly and syndactyly are the commonest congenital hand conditions for which treatment is sought. The presence of congenital hand deformities has a significant psychological impact on both the parents and child, and in severe cases, can significantly affect limb function. This article reviews the more common hand conditions so that non-specialist physicians can diagnose them and understand their management principles. Source

Macneill P.U.,Level 11
Medical Humanities

This paper discusses various justifications for including medical humanities and art in healthcare education. It expresses concern about portrayals of the humanities and art as benign and servile in relation to medicine and the health professions. An alternative is for the humanities to take a more active role within medical education by challenging the assumptions and myths of the predominant biomedical model. Another is to challenge quiescent notions of the arts by examining examples of recent provocative work and, to this end, the paper considers the work of performance artists Stelarc and Orlan who have subjected their bodies to modifications and extensions. Their work challenges, and potentially undermines, conceptions of the body, medicine, and humanity's relationship with technology. Similarly, other artists, working with biological cultures, have raised controversial issues. Recent work of this kind defies easy understanding and resists being pressed into the service of medicine and other health professions for educational purposes by opening up topics for exploration and discussion without providing unitary explanatory frameworks. The paper goes on to discuss the implications for medical education if this is the approach to the arts and humanities in healthcare education. It suggests that there needs to be a shift in the foundational assumptions of medicine if the arts and humanities are to contribute more fully. Source

OBJECTIVES: Environmental factors such as a high-fat diet contribute to type 2 diabetes and obesity. This study examined glycemia, insulin sensitivity, and β-cell function after switching from a high-fat diet to a low-fat diet in mice. METHODS: C57BL/6J mice were fed a high-fat diet or low-fat diet for 18 months, after which mice on the high-fat diet either maintained this diet or switched to a low-fat diet for 4 weeks. Body weight and glucose and insulin responses to intraperitoneal glucose were determined. Insulin secretion (insulinogenic index: the 10-minute insulin response divided by the 10-minute glucose level) and insulin sensitivity (1 divided by basal insulin) were determined. RESULTS: After 18 months on a high-fat diet, mice had glucose intolerance, marked hyperinsulinemia, and increased body weight compared to mice on a low-fat diet (P < 0.001). Switching from a high-fat diet to low-fat diet normalized glucose tolerance, reduced but not normalized body weight (P < 0.001), increased insulin secretion (248 ± 39 vs 141 ± 46 pmol/mmol; P = 0.028) and improved but not normalized insulin sensitivity (3.2 ± 0.1 vs 1.0 ± 0.1 [pmol/L]; P = 0.012). CONCLUSION: Switching from a high-fat diet to low-fat diet normalizes glucose tolerance and improves but not normalizes insulin secretion and insulin sensitivity. These effects are more pronounced than the reduced body weight. Copyright © 2012 by Lippincott Williams & Wilkins. Source

Huynh H.,Level 11
Biochemical Pharmacology

With an annual incidence of over 660,000 deaths, hepatocellular carcinoma (HCC) is the third leading cause of cancer death globally. This disease is often diagnosed at an advanced stage, when potentially curative therapies are not feasible. HCC is highly resistant to conventional systemic therapies and prognosis for advanced HCC patients remains poor. Given the clear need, clinical development of novel therapeutic agents in HCC has begun in earnest. Our recent knowledge of the molecular mechanisms responsible of tumor initiation and progression has identified several potential molecular targets in HCC. These targets are the receptor tyrosine kinase-activated pathways, which include the Raf/MEK/ERK, PI-3K/Akt/mTOR, and Jak/Stat. Sorafenib is the multikinase inhibitor that has shown modest survival benefits in advanced HCC in two randomized controlled trials, supporting the use of molecularly targeted therapies in treatment of HCC. A number of strategies including monoclonal antibodies and tyrosine kinase inhibitors such as erlotinib, sunitinib, vandetanib, cediranib, brivanib, foretinib, and dovitinib have been developed and tested in various phases of clinical trials. The successful development of these novel targeted agents in the future will be dependent on the selection of patient populations that are most likely to derive clinical benefit, optimization of the dose used and schedules, and investigation of combined therapies. This review describes evolving molecular targeted agents, their common adverse side effects, and its potential use in management of HCC. © 2010 Elsevier Inc. Source

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