Adoptive transfer of anti-idiotypic T cells cure mice of disseminated B cell lymphoma

There is extensive interest in idiotypic vaccination as a treatment of lymphoma. An alternative approach is the adoptive transfer of in vitro generated T cells. This strategy has been used to treat posttransplantation EBV-related diseases. The ability to generate in vitro T cells to peptides derived from immunoglobulin idiotypes raises the possibility of directly using such cells as a treatment of lymphoma. Investigating the adoptive transfer of specific T cells to idiotype derived peptides in a murine lymphoma model is therefore an important part of the clinical translation of this alternative approach. We have generated an idiotype-specific T cell line, able to recognise a defined, naturally processed idiotype-derived epitope. This line has been used to successfully treat mice with disseminated lymphoma supporting the clinical use of idiotype specific T cells.     

Seasonal variation in morbidity and mortality related to atrial fibrillation

OBJECTIVE: To determine whether there is seasonal variation in hospitalisations and deaths due to atrial fibrillation (AF) and to examine possible contributors to such variability. METHODS: We used the linked Scottish Morbidity Record scheme, which provides individualised morbidity and mortality data for the entire Scottish population. RESULTS: Between 1990 and 1996, there were a total of 33,582 male and 34,463 female hospitalisations related to AF. Significantly more admissions occurred in winter compared to summer (P<0.0001). In women, the peak number of admissions (106 per day) occurred in December (12% more than average) and the lowest number (89) in June (6% less than average). The respective figures for men were 10% more (101), 2% less (90). In both sexes, the greatest variation occurred in those aged >85 years-peak winter rates being 35-39% higher than average. A similar phenomenon was evident in relation to mortality in these patients. The average number of men who died during December was 22% higher, and in August 12% lower, than average, P<0.001. In women, the equivalent figures were 28% higher (December) and 14% lower (August), P<0.001. The winter peak of AF admissions did not, however, coincide with the lowest temperatures, and other factors such as seasonal variation in respiratory infection, may account for the monthly variation observed in hospitalisations for AF. CONCLUSIONS: There is substantial seasonal variation in AF hospitalisations and deaths, particularly in the elderly.     

Objective assessment of urinary incontinence in women: comparison of the one-hour and 24-hour pad tests

OBJECTIVE: To compare the performance and clinical usefulness of the one-hour and 24-hour pad tests in terms of the relationship with reported symptoms and urodynamic diagnosis. METHODS: 341 women aged 40 years and over reporting lower urinary tract symptoms who were recruited to a nurse led continence service, and went on to receive urodynamics, a one-hour and a 24-hour pad test and completed a urinary diary. RESULTS: For both pad tests, there was a significant difference in the amount of urine leaked between the different urodynamic diagnoses (p<0.0001, for the one-hour and p=0.001 for the 24-hour test). Women with sphincter incompetence leaked significantly more than women with detrusor instability, or those with no abnormality. There was a significant difference between the proportion of women dry on a one-hour pad test and those dry on a 24-hour pad test (26.0% versus 38.4%, difference 12.4%; CI 5.5; 19.4). There is a positive relationship between amount of urine leakage and symptom severity expressed in terms of number of incontinent episodes for both pad tests. CONCLUSION: Both pad tests bore little relationship to the underlying urodynamic diagnosis but there was a positive relationship with symptom severity. The 24-hour pad test appears to be clinically a more useful too than the one-hour test. The two types of pad test are probably assessing incontinence in different ways. We suggest that the minimum data set should include structured questions, diaries and the 24-hour pad test.     

Evaluation of a hidden occupational healthcare risk: the portable X-ray

In 2002, the services industry, of which healthcare is a part, led the US in nonfatal injuries by industry division with 27.3%. Health services--Standard Industrial Classification (SIC) code 80--was the primary contributor, with more than 623,000 recordable cases. Hospitals (SIC code 806) led the total number of cases and incidence rates of nonfatal occupational injuries and illnesses for industries with more than 100,000 reported cases, with more than 321,000 cases and an incidence rate of 9.7. In particular, back injuries associated with patient care were identified as a leading injury associated with healthcare incidents. This study focuses on the portable radiograph (x-ray). The tasks required to place and position the cassette beneath the patient offer similar risk factors as a typical patient transfer. The study includes a literature review, process mapping, staff involvement, and a technical evaluation of options to consider that may reduce the exposure. The 3 techniques that registered the highest in the force to place the cassette were the pillowcase around the cassette, the plastic slider sheet around the cassette, and the "typical" placement, respectively. The techniques that used additional staff to roll or lift the patient registered the lowest amount of force for the cassette placement. Initial analysis of this data reveals that there is the potential for risk to staff members'shoulders and upper torsos when performing portable chest x-ray procedures. The study revealed that further research into safer techniques and devices is warranted, as incidents have been reported, yet no associated published research was identified to offer advice on the topic of portable x-ray ergonomics.     

Dynamic joint loading following hamstring and patellar tendon anterior cruciate ligament reconstruction

This study compared lower limb dynamic joint loading after hamstring (HS) and patellar tendon (PT) anterior cruciate ligament (ACL) reconstruction. A three-dimensional motion analysis and force plate system were used to determine sagittal plane kinematics and kinetics in 20 subjects who had undergone ACL reconstruction (10 HS, 10 PT) whilst they performed both horizontal and vertical hopping tasks. Results for both activities showed significantly smaller knee flexion angles and external flexion moments in the operated than the non-operated limbs in PT subjects but no difference between limbs in HS subjects. There was no difference in the summated moment (hip plus knee plus ankle) between limbs for either graft type. The peak vertical ground reaction force was greater in the operated than the non-operated limb in PT subjects during the horizontal hop. These data show functional knee kinematic and kinetic differences between the two graft types that point to an earlier or better functional recovery in patients undergoing ACL reconstruction with HS graft than PT graft.     

Foot morbidity following toe to hand transfers

Toe-to-hand transfers to replace missing fingers have become a common reconstructive practice in our clinic. The purpose of this article is to evaluate morbidity of the donor site on the foot following the transfer. A group of 72 patients were assessed; 95 feet were examined post-transfers, i.e., 23 patients had transfers from both feet. The groups were arranged according to the numbers of patients as follows: group A (37 cases), second toe from one foot; group B (17 cases), second toes from both feet; group C (6 cases) with wrap-around flap; and group D (5 cases), the whole big toe. This was followed by group E (7 patients), who had the combination of the second and third toes harvested simultaneously, the great toe or wrap-around flap in combination with harvesting the second toe from the same or contralateral foot. Scar quality of the donor site, standing on tiptoe and tiptoeing, discomfort after prolonged walking, stair climbing, need to change the shoe size, and participation in special activities, such as sports and overall patient satisfaction, were evaluated. The least significant problems occurred in patients with the second toe harvested, they had minimum complaints with static loading and minor complaints with dynamic loading. Patients with the second toes harvested from both feet also had minimum complaints with static loading and minor complaints in dynamic loading. More problems were observed with both static and dynamic loading in the patients with the great-toe transfer. The biggest troubles were reported by the patients with the wrap-around flap or in case of multiple toe transfers. Only one patient from the sample had to seek medical help of a specialist due to some problems following the toe harvest. In the retrospective subjective evaluation of patient satisfaction and benefits of the operation, all patients declared that they would undergo the reconstruction again despite the problems encountered at the donor site.     

Gender,work-home conflict,and morbidity amongst white-collar bank employees in the United Kingdom

Most research on work-home conflict focuses solely on women. This study compares men and women’s perceptions of the extent to which paid work interferes with family life, and examines associations between work-home conflict and health. Data were collected from 2,176 full-time white-collar employees of a British bank. We did not find any significant gender differences in perceptions of work-home conflict. However, predictors of work-home conflict did vary by gender; having children and being in a senior position were more strongly related to work-home conflict for women than for men, while working unsociable hours was more important for men than for women. Work-home conflict was strongly associated with reporting fair or poor self-assessed health, a high number of reported physical symptoms and minor psychological morbidity (GHQ-12). These associations were equally strong for men and women. Our results suggest that work-home conflict is a problem for men as well as women.     

Developing a secure-enough base: teaching psychotherapists in training the relationship between attachment theory and clinical work

I present an account of a post-graduate training module I have developed for psychotherapy training students at The Centre for Attachment-based Psychoanalytic Psychotherapy entitled From Attachment Theory to Clinical Practice. I situate my interest in this work in my own life and my background in education. In describing the curriculum content, I focus in particular on an educational process that enables students to engage with the concepts from attachment theory which are both relevant to their own lives and their future work as psychotherapists. I show how the findings of the Adult Attachment Interview can be understood more deeply through a project the students are asked to present and evaluate. The article also includes some personal reflections on my experience of attachment research training from a clinician's perspective as a way to think about the divide between these two worlds. I conclude with a consideration of the strengths and limitations of attachment theory to understanding the effects of inequalities of power relations on the formation of intimate bonds.     

Can the Internet widen participation in reproductive medicine education for professionals?

BACKGROUND: Traditional campus-based models of education are unsuitable to many, particularly if in full-time employment supporting families, whereas the Internet now permits new models of education. Following an iterative process of development and evaluation in 2001, the University of Bristol launched a masters programme covering reproduction and development delivered principally over the Internet. METHODS: Students attend short biannual residential workshops and the rest of the course is delivered online. In 2003, the 20 active students were invited to complete a structured online questionnaire. RESULTS: The 18 students completing the questionnaire identified distance learning as the key factor in their course selection. Most students felt that residential workshops aided subsequent electronic communication. Discussion of ideas is an essential component of postgraduate courses and web-based discussion forums appeared to provide an acceptable medium for this. The use of web-based audio lectures and computer-assisted assessments was well received. Also these systems may reduce disadvantages overseas students encounter when completing assessments in their non-native language. CONCLUSIONS: The overall positive response from students (and their tutors) to using the Internet for multiprofessional reproductive medicine education is encouraging and has wider potential in the future.