The flip-flop HuR: part of the problem or the solution in fighting cancer?

Chronic inflammation has long been appreciated to play a critical role in tumor development and maintenance. Among the mechanisms involved in coordinating the initiation and resolution of inflammation are those responsible for modifying mRNA stability and/or translation. Several studies have linked the RNA-binding protein HuR, which increases mRNA stability, with malignant transformation. However, in this issue of the JCI, Yiakouvaki et al. compellingly demonstrate in mice that increased HuR activity in myeloid cells has a protective role in the onset of pathologic intestinal inflammation (i.e., colitis) and colitis-associated cancer (CAC). These observations highlight the need to understand the roles of HuR in distinct cell populations in vivo and suggest that enhancing HuR activity may be of clinical benefit in protecting against pathologic inflammation and cancer.     

The role of health informatics in clinical audit: part of the problem or key to the solution?

The concepts of quality assurance (for which clinical audit is an essential part), evaluation and clinical governance each depend on the ability to derive and record measurements that describe clinical performance. Rapid IT developments have raised many new possibilities for managing health care. They have allowed for easier collection and processing of data in greater quantities. These developments have encouraged the growth of quality assurance as a key feature of health care delivery. In the past most of the emphasis has been on hospital information systems designed predominantly for the administration of patients and the management of financial performance. Large, hi-tech information system capacity does not guarantee quality information. The task of producing information that can be confidently used to monitor the quality of clinical care requires attention to key aspects of the design and operation of the audit. The Myocardial Infarction National Audit Project (MINAP) utilizes an IT-based system to collect and process data on large numbers of patients and make them readily available to contributing hospitals. The project shows that IT systems that employ rigorous health informatics methodologies can do much to improve the monitoring and provision of health care.     

Obesity epidemic in school age children: is school part of the problem or a partner in the remedy?

If we are to be advocates for health in our schools, we must first know where the problems lie--and that requires data. The newest, and best so far, is BMI charts instead of height and weight graphs to assess the general nutritional health of students. To ascertain if your school measures up to national guidelines, use the school health index.     

Is fever after infection part of the illness or the cure?

An increase in temperature above the normal range of 35.6 degrees C-38.2 degrees C (Ryan and Levy 2003) can indicate the presence of infection or sepsis. When the body detects infection, a series of responses to control infection are initiated that result in a rise in systemic temperature. Research suggests that this rise in temperature can be regarded as a cure, in that it is part of the autonomic response to remove infection and create a favourable environment for antibiotics. Nevertheless, it remains common practice to try to reduce fever with medication and physical cooling methods. This article explores the physiological changes that occur during bacterial sepsis that result in increased temperature, and discusses the pros and cons of administering antipyretic medication. The aim is to enable nurses to understand and support patients who present with fever.     

Stents in the femoral artery: aid or problem?

Percutaneous transluminal angioplasty (PTA) is a well-established technique in the treatment of symptomatic femoropopliteal artery stenoses and obstructions. It is a method of treatment with excellent initial technical and clinical results. However, the long-term results of PTA alone must be considered as unsatisfactory as recurrences are frequently observed. In the past, femoropopliteal stenting appeared to be a promising tool to prevent recurrence and to increase patency rates, but it did not produce better results than PTA alone. For this reason, alternative therapeutic strategies such as brachytherapy, drug-eluting pharmastents and gene therapy were developed. Several investigators are beginning to explore their potential use. This article reviews the present possibilities of PTA and stenting in the femoropopliteal region and considers potential future concepts. In this context, the current clinical literature is discussed.     

Research governance: panacea or problem?

Clinical research must meet contemporary professional, legal and ethical standards. Research governance aims to improve quality whilst safeguarding the interests of the public. Research on humans is covered by several internationally recognised ethical codes designed to protect persons from the hazards of experimental treatment. However, to date there is no overarching statutory framework that regulates health and social care research, which is governed by common law principles. The recent European Union Clinical Trials Directive aims to harmonise regulation of clinical trials and protect the interest of study participants. Approval by the new Central Office for Research Ethics Committees (COREC) is now a mandatory requirement for research projects in the UK to ensure stringent ethical standards. Research that involves NHS patients, staff, resources or premises is subject to a framework for research governance that monitors performance and adverse incidents and delineates lines of responsibility and accountability. Researchers at all levels must be fully aware of these new initiatives and of their responsibilities. NHS organisations should acknowledge and commit to clinical research as an intrinsic component of high quality health service delivery.     

Violence: part of the job for Australian nurses?

According to a recent Australian Institute of Criminology report (1999) the health industry is the most violent industry in Australia. In this paper the authors aim to highlight violence as an important professional issue for Australian nurses that is currently concealed as 'part of the job'. National and international studies bring attention to the severity of the problem for nurses with a particular focus on emergency nurses. Some of the issues identified and discussed include increased waiting times and frustration; increasing use of weapons; inadequate systems of security; culture of silence; inadequate support for emergent mental health needs; lack of reporting; lack of institutional concern and systems of support, and; demands of triage nursing. The nature of workplace violence in emergency departments in New South Wales and South Australia will be explored based on the authors' research. A research pathway to explore national impact and implications of violence for nurses and nursing practice in general will be outlined.     

Substituting warfarin products: what's the source of the problem?

Many clinicians have expressed concerns about the bioequivalence of warfarin products, and data suggest that substituting warfarin products may increase the risk of major bleeding and thromboembolic complications. Anecdotal reports and some retrospective studies have reported differences in anticoagulation control after a warfarin product substitution. But the best available evidence-prospective, randomized, blinded clinical trials-has failed to validate these observations. Indeed, interpatient and intrapatient variability in anticoagulation control observed before and after warfarin product substitution is very similar. So, while differences in product standardization, bioavailability, and bioequivalence make a convenient explanation, the problem lies elsewhere. Perhaps poor communication, fractionated systems of care, and errors are the culprits.