Reflux esophagitis--a community-wide increase in incidence

Gastroesophageal reflux disease (GERD) is a common disease increasing in incidence and prevalence in the industrialised countries. It is a chronic disease with a large spectrum of clinical manifestations. The leading symptom is heartburn, however the disease may also present with extraesophageal symptoms or stay asymptomatic. Motility disorders of the upper GI tract with the key feature of impaired LES are the cause for pathologic gastroesophageal reflux in the terminal esophagus. The relationship of H. pylori infection with GERD is part of the current discussion. The Savary Miller classification for grading of refluxesophagitis is now proposed for substitution by the Los Angeles classification for the assessment of erosive lesions. Besides complications such as bleeding or strictures the main risk is the development of Barrett esophagus and adenocarcinoma. Proton pump inhibitors are the therapy of choice for healing as well as in longterm therapy and prophylaxis. New endoscopic interventional therapies for treatment of GERD and related diseases should be used only in controlled studies.     

The renaissance of clinical leadership

The purpose of this work was to explore clinical nursing leadership. The research was based on a critical examination of the leadership themes derived from the nursing literature of the United Kingdom, the United States of America and Australia, between 1992 and 1997. The work was also influenced by the findings from semistructured interviews undertaken with five clinical leaders in nursing from the United Kingdom, and study tours to both the United States of America and Australia. The findings support a proposed leadership model as a basis for further exploration and as a framework for contemplating clinical leadership and leadership preparation. A model is presented that identifies factors which influence leadership styles, such as external environment, internal environment, experience and understanding. Four leadership styles are outlined: transactional, transformational, connective and renaissance. These leadership styles are linked to nursing care approaches. A second model provides a basis for considering power and its impact in the workplace. Based on these findings, the contents of a leadership preparation course are outlined.     

Reflections on a renaissance of occupation

At the close of the 20th century, there is a renaissance of occupation in occupational therapy and occupational science. Kielhofner (1992) offers an intraprofessional explanation that the growing interest in occupation recaptures occupational therapy's lost identity. An extraprofessional explanation is that postmodern ideas and social practices have helped to create a societal context in which a renaissance of occupation is welcome. Postmodernism raises questions and awareness of power, diversity, temporality, and situatedness in which normative ideas of occupation as paid work can be challenged. Since occupation is of primary concern to occupational therapy and occupational science, the authors reflect on postmodernism and its influence on a renaissance of occupation in these two fields. These reflections consider what such a renaissance means for occupational therapists and occupational scientists in the 21st century.     

Regulatory T cells--the renaissance of the suppressor T cells

Immune reactions are stringently regulated and balanced by complex interactions of stimulating and suppressing mechanisms. Dysfunctions of this sophisticated immune regulatory network can lead to a variety of diseases such as autoimmunity, allergy, cancer, and pregnancy disorders. The rediscovery of suppressor T cells a decade ago--now designated as T regulatory cells--set off a huge avalanche of research activities leading to a multitude of preclinical and clinical studies. Herein, we give a comprehensive review about this research on T regulatory cells and the relevance of this suppressive T cell population for the development of innovative immune therapeutic strategies.     

Acid reflux and gastro-oesophageal reflux disease

Gastro-oesophageal reflux disease (GORD) is a common disease that is likely to increase in prevalence as the population becomes steadily more obese. Although generally benign reflux can, if untreated, lead to severe complications. This article describes the symptoms and diagnosis of acid reflux and GORD, and reviews currently available treatments ranging from lifestyle modification to surgery.