Practitioners' attitudes towards the use of standardized diagnostic assessment in routine practice: a qualitative study in two child and adolescent mental health services

There is tension within Child and Adolescent Mental Health Services (CAMHS) assessments between the richness of differing practitioner's perspectives and maintaining a basic level of assessment that is acceptable to all disciplines. Standardized assessments are mandatory in research, yet are rarely applied systematically across CAMHS.The use of standardized assessments in routine practice might aid the allocation of families to the practitioners best able to meet their needs and free up time for intervention. However, practitioners' attitudes towards standardized assessment will dictate the success of such an approach. Fifty practitioners working in two CAMHS completed semi-structured interviews that explored their attitudes towards the use of standardized assessments in clinical practice, which were analysed using thematic analysis. Practitioners could identify both advantages and disadvantages of the routine use of standardized assessment. While they valued standardization, opportunities for service organization and increased information, some expressed concerns related to the choice, accuracy and influence of measures, as well as labelling. Almost one-third complained about their lack of pre-registration training in working with children, let alone their assessment. Practitioners, clinicians and policy makers need to consider these issues if they wish to introduce standardized assessments into routine practice. Senior staff need to be aware how unskilled some junior practitioners feel when they start working in CAMHS and offer appropriate support and supervision.     

Evaluation of brain and kidney energy metabolism in an animal model of contrast-induced nephropathy

Contrast-induced nephropathy is a common cause of acute renal failure in hospitalized patients, occurring from 24 to 48 h and up to 5 days after the administration of iodinated contrast media. Encephalopathy may accompany acute renal failure and presents with a complex of symptoms progressing from mild sensorial clouding to delirium and coma. The mechanisms responsible for neurological complications in patients with acute renal failure are still poorly known, but several studies suggest that mitochondrial dysfunction plays a crucial role in the pathogenesis of uremic encephalopathy. Thus, we measured mitochondrial respiratory chain complexes and creatine kinase activities in rat brain and kidney after administration of contrast media. Wistar rats were submitted to 6.0 ml/kg meglumine/sodium diatrizoate administration via the tail vein (acute renal failure induced by contrast media) and saline in an equal volume with the radiocontrast material (control group); 6 days after, the animals were killed and kidney and brain were obtained. The results showed that contrast media administration decreased complexes I and IV activities in cerebral cortex; in prefrontal cortex, complex I activity was inhibited. On the other hand, contrast media administration increased complexes I and II-III activities in hippocampus and striatum and complex IV activity in hippocampus. Moreover, that administration of contrast media also decreased creatine kinase activity in the cerebral cortex. The present findings suggest that the inhibition of mitochondrial respiratory chain complexes and creatine kinase caused by the acute renal failure induced by contrast media administration may be involved in the neurological complications reported in patients and might play a role in the pathogenesis of the encephalopathy caused by acute renal failure.     

Solar-simulated skin adaptation and its effect on subsequent UV-induced epidermal DNA damage

Repeated skin exposure to ultraviolet radiation leads to increased tolerance for erythema. Whether this tolerance is accompanied by a significant protection against epidermal DNA injury has never been thoroughly investigated. In a first set of experiments we irradiated 25 healthy volunteers three times a week for 3 wk using solar-simulating tanning lamps. In addition, all individuals were exposed to a (challenge) dose of three times the initial minimal erythema dose on a small area of skin before the first and after the final exposure. On both occasions, cyclobutane pyrimidine dimers were quantified in biopsies. As expected, repeated ultraviolet exposures resulted in increased epidermal pigmentation and thickness. The ultraviolet sensitivity for erythema decreased on average by 75%. The cyclobutane pyrimidine dimer formation was reduced on average by 60%. In a second set of experiments, with a group of 13 subjects, DNA repair kinetics were assessed. Within a period of 5 d after a single, slightly erythemal dose (1.2 minimal erythema dose), levels of cyclobutane pyrimidine dimer and p53-expressing cells were determined in skin biopsies. Both markers of DNA damage were elevated upon the single ultraviolet exposure and returned to background levels after 3-4 d. This information is important when trying to minimize the risk of DNA damage accumulation after repeated exposures during a tanning course.     

Translation of biomechanics research to urogynecology

Introduction  

Pelvic floor (PF) dysfunctions represent a frequent and complex problem for women. The interaction between the vagina and its supportive structures, that are designed to support increases in abdominal pressure, can be considered a biomechanical system. Recent advances in imaging technology have improved the assessment of PF structures. The aim of this paper is to review the applications of biomechanics in urogynecology.     

Intravenous ascorbic acid (vitamin C) administration in myomectomy: a prospective,randomized, clinical trial

Background  

To assess the usefulness of using ascorbic acid (vitamin C) administration in abdominal myomectomy.     

Reversal by L-arginine of a dysfunctional arginine/nitric oxide pathway in the endothelium of the genetic diabetic BB rat

Summary We examined the effects of acute supplementation with arginine in vitro on endothelium-dependent relaxation in aortic rings taken from female genetic, diabetes-prone BB rats. Sensitivity to norepinephrine-induced contraction was unaltered in rings of diabetic BB rats compared to rings from non-diabetic littermates. In precontracted rings, acetylcholine produced a concentration-dependent relaxation which was impaired by diabetes. This relaxation was blocked by l-nitroarginine in both control and diabetic rings. Addition of 3 mmol/l l-arginine (but not d-arginine) enhanced relaxation in diabetic rings similar to that seen in control rings without arginine. l-arginine had no effect on acetylcholine-induced relaxation in control rings. In contrast, relaxation-induced by nitroglycerin in diabetic rings without endothelium was not altered by l-arginine treatment. Thus, a defect in the utilization of arginine by nitric oxide synthase exists in the endothelium of the diabetic BB rat. [Diabetologia (1997) 40: 910–915] Received: 24 February 1997 and in revised form: 17 April 1997