Dialogues and dialetics: limits to clinician-manager interaction in healthcare organizations

This paper examines clinician-manager interactions within healthcare organizations in the U.K. and contrasts the notions of dialetics and dialogues within such interactions. We draw particularly on Bakhtin's work on dialogue to frame our focal research question, which considers the extent to which clinician-manager interactions are dialogic. Using data drawn from a thirty-two month study of five U.K. healthcare organizations we suggest that clinician-manager interactions are more dialectic than dialogic in their orientation. Further, we suggest that, despite the appearance of dialogical possibility between clinicians and non-clinicians, the tendency to dialectic positioning reinforces opposition between these groups and we conclude that local, rather than system-wide interventions, offer the best means of disrupting these dialectics and fostering productive dialogues.     

雷公藤内酯醇的结构修饰

为降低雷公藤内酯醇的毒性,寻找高效低毒的抗炎免疫化合物,对雷公藤内酯醇(trip-tolide,1)的结构进行了修饰,合成了九个雷公藤内酯醇衍生物。初步活性测定显示雷公藤氯内酯(tri-pchlorolide,2)和雷公藤溴内酯醇(tripbromolide,3)的免疫抑制活性与雷公藤内酯醇近似,但毒性有所降低。其他化合物的活性大大低于雷公藤内酯醇。     

Wilms'' tumour and renal dysplasia: an hypothesis

The incidence of renal dysplasia in a series of Wilms' tumours is presented. The distribution of such lesions is discussed, together with their course of development and regression. The kidney is regarded as a particularly suitable organ for studying the relation between dysplasia and neoplasia. A schema is suggested for this association with regard to Wilms' tumour.     

PERSISTENT MULLERIAN DUCT SYNDROME

SUMMARY Persistent müllerian duct syndrome is a rare form of male pseudohermaphroditism. It is usually diagnosed in the early years of life. A case is reported of normal male appearance with bilateral undescended testicles and a right inguinal hernia. On exploration a uterus, two fallopian tubes and a testis were found in the hernial sac. As these patients have an increased risk of gonadal tumours they should be kept under long-term review.     

赛庚啶对离体大鼠心脏缺钙/复钙损伤(钙反常)的保护作用

离体大鼠心脏经无钙灌流(灌流液为不含Ca²⁺的K-H液,通以95%O₂和5%CO₂的混合气体)5min后,用正常K-H液进行复钙灌流20min,可导致心肌细胞内酶(CPK,LDH)及蛋白的大量漏出,心脏变苍白,甚至出现心脏挛缩,心肌组织抗氧自由基酶(SOD,GSH-Px)活性明显降低,但MDA含量无明显改变。赛庚啶(2.5～5μmol/L)能明显减少心脏Ca²⁺反常时心肌组织内酶及蛋白的漏出,显著保护心肌组织抗氧自由基酶的活性。     

SEVEN COMMON DUCT STONES AT CHOLECYSTECTOMY AFTER A CLEAR DUCT ON ERCP

SUMMARY A clear common bile duct at ERCP does not guarantee a clear common bile duct when laparoscopic cholecystectomy is performed at a later date.