Translating an academic module into an online resource

Blended learning, which combines face-to-face sessions with online work, is used to provide flexible learning and courses for students who are geographically dispersed. Canterbury Christ Church University recognised the importance of developing an academic module for dispensing opticians across the UK and the requirement to address the needs of an increasingly diverse population of students. Following interest in the module from the Association of British Dispensing Opticians, a decision was made to reformat the module into an online resource. This article describes some of the pedagogical processes involved in developing the online resource. Quantitative and qualitative data are analysed to identify challenges and successes. The importance of developing an educational biography to achieve depth of understanding and thought is acknowledged. The article concludes that some face-to-face interaction is still necessary, not least for helping to reduce students' anxiety.     

Management of an inpatient-outpatient clinic an eight-year review

Healthcare organizations have historically separated outpatient from inpatient facilities. In order to streamline the continuity of high quality care, an outpatient burn clinic was established on our inpatient burn center in 1991. Management of the outpatient clinic required alternate staffing patterns and supply allocation plus training in managed care and third party payors. Budget decisions and health care trends affected the number of full time equivalents (FTEs). Between 1990 and 1998, a 33% RN FTE reduction occurred with an overall 22% decrease in total inpatient care providers. Clinic positions were allocated as patient volume and workload data could justify additional staff. Enhanced flexibility in assignment and use of personnel with varying skill levels led to efficient integration of inpatient and outpatient care with an overall reduction in RN FTEs. The purpose of this study is to review the changes in nursing management strategies required by this consolidation.     

Listeriosis as an obstetric complication in an immunocompromised patient

We have reported a case of maternal death associated with Listeria monocytogenes septicemia in a woman who was being treated with immunosuppressive drugs for lupus nephritis. This report, coupled with a previous case of L monocytogenes sepsis in a pregnant patient with AIDS, emphasizes that L monocytogenes infection may be an important, unrecognized pathogen in pregnant women with impaired immunity.     

Torsion of an omental lipoma presenting as an emergency

Primary omental pathology is rare. A case of torsion of an omental lipoma is reported in a 77-year-old women presenting as an emergency with lower abdominal pain. Abdominal and pelvic CT scan was of value in the pre-operative investigation.     

Refining an Alzheimer's vaccine to avoid an inflammatory response

The utility of vaccine strategies to treat neurodegenerative diseases such as Alzheimer's disease may still hold promise. Phase IIa clinical trials were halted due to a small but significant occurrence of meningoencephalitis. Knowledge gained from studies on amyloid-beta peptide (Abeta) immunotherapy will allow optimisation of new-generation vaccines, targeting highly specific epitopes while reducing undesired side effects. In harnessing and steering the immune system, an effective response can be generated against Abeta, one that might have attenuated immune responses with robust disease-altering activity.     

Maprotiline: an antidepressant with an unusual pharmacological profile

Maprotiline, which differs from other typical tricyclic antidepressants for its tetracyclic structure, is a highly selective inhibitor of norepinephrine reuptake. Despite its in vitro and in vivo inhibitory activity on NE uptake, 21 repeated daily injections of maprotiline (20 mg/kg i.p.) neither attenuated the norepinephrine-stimulated cAMP accumulation nor reduced the number of beta adrenergic recognition sites in rat frontal cortex. Also, the number of brain serotonin2 recognition sites labeled by [3H]ketanserin remained virtually unchanged in rats receiving 21 daily injections of maprotiline. [3H]Desmethylimipramine and [3H]mianserin specific binding sites were also unmodified by repeated maprotiline injections. However, after 3 weeks of daily administrations, maprotiline elicited a significant decrease in the number of [3H]flunitrazepam binding sites and a decrease in the apparent affinity of [3H]beta-carboline ethylester binding to crude synaptic membranes prepared from hippocampal and hypothalamic homogenates. These changes appear to be unrelated to modifications in the concentration of endogenous gamma-aminobutyric acid present in the membrane preparation, since the addition of 100 microM bicuculline to the incubation mixture decreases [3H]flunitrazepam binding to the same extent in saline- and maprotiline-treated rats. It is suggested that repeated maprotiline injections may elicit an increase in the hypothalamic and hippocampal tissue levels of an endogenous substance(s) which binds to the benzodiazepine/beta-carboline recognition sites.     

Validating an instrument for clinical supervision using an expert panel

Use of research instruments standardised in English-speaking countries is commonplace in non-English speaking countries. This article describes technical, linguistic and conceptual issued raised in the translation and validation of an acceptable country-specific instrument. The Manchester Clinical Supervision Scale was validated for use in clinical supervision in Finland using quantitative and qualitative methods. The approach applied was triangulation. The focus of this paper, is to describe the item validation process of the scale using an expert panel (n=11) by means of the content validity index and panel interview. The process resulted in a country-specific 33-item instrument. The study indicated that content validity index and panel discussion are easy, but reliable ways of demonstrating the instrument's content validity.     

Consequences of an unrecognized measles exposure in an emergency department

A recent measles case in a paediatric hospital ED resulted in 111 individuals (patients, family members and health‐care workers) potentially being exposed to measles. This report documents the efforts taken to contact trace and provide best practice care for all those exposed to the index case. It also provides a snapshot of community prevalence information on immunity to measles. One hundred per cent of contacted children (n= 24) eligible for vaccination were immunized, whereas 96% of adults surveyed or tested (n= 44) had assumed or proven immunity. However, six infants aged between 6 and 9 months were exposed and might have been a sufficiently large reservoir to facilitate the ongoing spread of measles in the community, if contact tracing and preventative measures had not occurred. This scenario also highlights the need to consider measles in the ED, particularly among travellers, with urgent isolation of suspected cases in the ED according to guidelines discussed.