AMEE Guide No 26: clinical teaching in ambulatory care settings: making the most of learning opportunities with outpatients.

Increasing student numbers and changes in healthcare delivery are making inpatient settings less ideal for teaching undergraduate students. As the focus of healthcare provision shifts towards ambulatory care, increasing attention must now be given to developing opportunities for clinical teaching in this setting. This Education Guide describes the opportunities to be made available by introducing clinical teaching into ambulatory care venues not usually used for undergraduate teaching as well as different models for maximizing student/patient interaction in traditional outpatient clinics.

Direct observation of organic contaminant uptake, storage, and metabolism within plant roots.

Two-photon excitation microscopy (TPEM) is used to visualize and track the uptake and movement of anthracene and phenanthrene from a contaminated growth medium into living unmodified roots of maize and wheat over a 56-day period. The degradation of anthracene was also directly observed within the cortex cells of both species. The power of this technique is that neither the plant nor the compound require altering (staining or sectioning) to visualize them, meaning they are in their natural form throughout the experiment.

Regional left ventricular perfusion and function in patients presenting to the emergency department with chest pain and no ST-segment elevation.

Aims: We hypothesized that the assessment of left ventricular regional function (RF) and myocardial perfusion (MP) will provide incremental value over routine evaluation in patients who present to the emergency department (ED) with chest pain (CP) and no ST-segment elevation.

Methods And Results: In addition to routine clinical evaluation, patients with suspected cardiac CP and no ST-segment elevation were evaluated in the ED for RF and MP using contrast echocardiography (CE). Cardiac-related death, acute myocardial infarction, unstable angina pectoris, congestive heart failure (CHF), and revascularization were considered as events within 48 h (early).

Epidemiology of gastro-oesophageal reflux disease: a systematic review.

A systematic review of the epidemiology of gastro-oesophageal reflux disease (GORD) has been performed, applying strict criteria for quality of studies and the disease definition used. The prevalence and incidence of GORD was estimated from 15 studies which defined GORD as at least weekly heartburn and/or acid regurgitation and met criteria concerning sample size, response rate, and recall period. Data on factors associated with GORD were also evaluated.

Cardiac findings during uncomplicated acute influenza in ambulatory adults.

Background: Previous studies have reported abnormal cardiac findings in up to 43% of ambulatory adults with influenza. This study was conducted to determine the frequency, magnitude, and duration of myocardial dysfunction in such persons.

Methods: We enrolled 30 previously healthy young adults without known cardiovascular disease who presented to the clinic View Article and Find Full Text PDF

Real-time visualization and quantification of PAH photodegradation on and within plant leaves.

Vegetation plays a key role in the environmental cycling and fate of many organic chemicals. A compound's location on or within leaves will affect its persistence and significance; retention in surface compartments (i.e.

Gastro-oesophageal reflux disease--current concepts in management.

Background: Gastro-oesophageal reflux disease (GORD) is defined as recurring symptoms or mucosal damage resulting from exposure of the distal oesophagus to reflux of gastric contents. In the past, GORD has been managed with a 'step up' approach beginning with antacids and progressing to H2 antagonists or proton pump inhibitors (PPI) as required.

Objective: This article presents a systematic approach to the management of GORD.

A family of acetylcholine-gated chloride channel subunits in Caenorhabditis elegans.

The genome of the nematode Caenorhabditis elegans encodes a surprisingly large and diverse superfamily of genes encoding Cys loop ligand-gated ion channels. Here we report the first cloning, expression, and pharmacological characterization of members of a family of anion-selective acetylcholine receptor subunits. Two subunits, ACC-1 and ACC-2, form homomeric channels for which acetylcholine and arecoline, but not nicotine, are efficient agonists.

Thiamine pyrophosphate biosynthesis and transport in the nematode Caenorhabditis elegans.

Thiamine (vitamin B1) is required in the diet of animals, and thiamine deficiency leads to diseases such as beri-beri and the Wernicke-Korsakoff syndrome. Dietary thiamine (vitamin B1) consists mainly of thiamine pyrophosphate (TPP), which is transformed into thiamine by gastrointestinal phosphatases before absorption. It is believed that TPP itself cannot be transported across plasma membranes in significant amounts.

Four years of lamivudine treatment in Chinese patients with chronic hepatitis B.

Background And Aims: This study assessed the efficacy and safety of up to 4 years of lamivudine treatment and the clinical relevance of the emergence of YMDD-variant hepatitis B virus (HBV).

Methods: Fifty-eight Chinese adult patients with chronic hepatitis B (CHB) were randomized to lamivudine 100 mg/day for up to 5 years and were monitored for YMDD-variant HBV, hepatitis B e antigen (HBeAg) seroconversion (loss of HBeAg and detectable antibody to HBeAg) and serum alanine aminotransferase (ALT) concentrations. Four-year data are reported here.

Clinical strategies -- interactive case discussions.

Interactive case discussions held during the symposium illustrate the practical challenges and dilemmas faced in the management of Barrett's oesophagus. Opinions of the faculty and audience varied widely on how proton pump inhibitor therapy should be used, especially in patients with short-segment Barrett's oesophagus. The therapeutic goal that received most support was to achieve sufficient acid control to keep the patient symptom free and heal any oesophagitis.

Review article: towards the optimization of symptom evaluation in reflux disease.

A recent workshop has taken stock of the processes used for the evaluation of reflux disease symptoms. Such evaluations are vital both for routine clinical practice and for the critical assessment and comparison of therapeutic options. The workshop endorsed the importance of the assessment of symptom patterns for the diagnosis of reflux disease.

Radial distribution of dilated intercellular spaces of the esophageal squamous epithelium in patients with reflux disease exhibiting discrete endoscopic lesions.

Introduction: Dilatation of intercellular spaces of the esophageal squamous epithelium has been suggested as a marker of early acid reflux-induced damage. This change is a potentially useful addition to histomorphological changes that represent so called minimal endoscopic lesions. We have assessed dilatation of intercellular spaces with regard to: (1) interobserver variability, and (2) whether the incidence of this varies between 'red streaks' and the adjacent normal looking squamous epithelium.

Natural history of gastro-oesophageal reflux disease diagnosed in general practice.

Background: Cross-sectional studies indicate that gastro-oesophageal reflux disease symptoms have a prevalence of 10-20% in Western countries and are associated with obesity, smoking, oesophagitis, chest pain and respiratory disease.

Aim: To determine the natural history of gastro-oesophageal reflux disease presenting in primary care in the UK.

Methods: Patients with a first diagnosis of gastro-oesophageal reflux disease during 1996 were identified in the UK General Practice Research Database and compared with age- and sex-matched controls.

A novel analytical approach for visualizing and tracking organic chemicals in plants.

Vegetation plays a key role in the environmental fate of many organic chemicals, from pesticides applied to plants, to the air-vegetation exchange and global cycling of atmospheric organic contaminants. Our ability to locate such compounds in plants has traditionally relied on inferences being made from destructive chemical extraction techniques or methods with potential artifacts. Here, for the first time, two-photon excitation microscopy (TPEM) is coupled with plant autofluorescence to visualize and track trace levels of an organic contaminant in living plant tissue, without any form of sample modification or manipulation.

Paradoxical impact of body positioning on gastroesophageal reflux and gastric emptying in the premature neonate.

Objectives: To combine manometry and impedance to characterize the mechanisms of gastroesophageal reflux (GER) and to explore their relation to the rate of gastric emptying (GE) and body position.

Study Design: Ten healthy preterm infants (35 to 37 weeks' postmenstrual age) were studied with the use of a micromanometric/impedance assembly. Episodes of GER were identified by impedance, and the mechanism(s) of GER triggering and GER clearance were characterized.

A critical review of the diagnosis and management of Barrett's esophagus: the AGA Chicago Workshop.

Background & Aims: The diagnosis and management of Barrett's esophagus (BE) are controversial. We conducted a critical review of the literature in BE to provide guidance on clinically relevant issues.

Methods: A multidisciplinary group of 18 participants evaluated the strength and the grade of evidence for 42 statements pertaining to the diagnosis, screening, surveillance, and treatment of BE.

Human septin-septin interactions as a prerequisite for targeting septin complexes in the cytosol.

Septins are a cytosolic GTP-binding protein family first characterized in yeast, but gaining increasing recognition as critical protagonists in higher eukaryotic cellular events. Mammalian septins have been associated with cytokinesis and exocytosis, along with contributing to the development of neurological disorders. Ten different septins, divided into four groups, have been identified in mammals, and individual septins are capable of interacting with each other to form macromolecular complexes.

Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux.

To date, most concepts on the frequency of gastro-oesophageal reflux episodes and the efficiency of the antireflux barrier have been based on inferences derived from measurement of oesophageal pH. The development of intraluminal impedance monitoring has highlighted the fact that pH monitoring does not detect all gastro-oesophageal reflux events when little or no acid is present in the refluxate, even if special pH tracing analysis criteria are used. In November 2002, a workshop took place at which 11 specialists in the field of gastro-oesophageal reflux disease discussed and criticised all currently available techniques for measurement of reflux.

Phase II study of docetaxel in combination with epirubicin and protracted venous infusion 5-fluorouracil (ETF) in patients with recurrent or metastatic breast cancer. A Yorkshire breast cancer research group study.

This study was originally designed as a phase I/II study, with a dose escalation of docetaxel in combination with epirubicin 50 mg m(-2) and 5-fluorouracil (5-FU) 200 mg m(-2) day(-1). However, as dose escalation was not possible, the study is reported as a phase II study of the combination to assess response and toxicity. A total of 51 patients with locally advanced or metastatic breast cancer were treated on this phase II study, with doses of docetaxel 50 mg m(-2), epirubicin 50 mg m(-2) and infusional 5-FU 200 mg m(-2) day(-1) for 21 days.

Symptom evaluation in reflux disease: workshop background, processes, terminology, recommendations, and discussion outputs.

There has been no published indepth systematic evaluation of the best approaches to symptom evaluation in gastro-oesophageal reflux disease (GORD). A two day international multidisciplinary workshop was therefore held in Marrakech, Morocco, in September 2002 to address these issues. The aim of the workshop was to critically review the data regarding the reliability, processes, and priorities for symptom evaluation in GORD patients.

Impact of endoscopic suturing of the gastroesophageal junction on lower esophageal sphincter function and gastroesophageal reflux in patients with reflux disease.

Objectives: Plication of the gastroesophageal junction by endoscopic suturing has been reported to improve symptoms and reduce acid exposure in patients with gastroesophageal reflux disease (GERD). The mechanisms underlying these effects are not well defined. The aims of our study were to determine the impact of endoscopic suturing of the gastroesophageal junction on lower esophageal sphincter (LES) function in patients with GERD.

Genomic organization of an avermectin receptor subunit from Haemonchus contortus and expression of its putative promoter region in Caenorhabditis elegans.

Avermectins and milbemycins are believed to exert their anthelmintic effects by binding to glutamate-gated chloride channels (GluCls). Two GluCl subunits have been localized in the pharynx in Caenorhabditis elegans, and the pharynx has been implicated as a major target for avermectins in C. elegans.

The role of transesophageal echocardiography in atrial fibrillation.

Transesophageal echocardiography (TEE) is very useful in the evaluation and management of selected patients with atrial fibrillation, primarily by clear visualization of left atrial appendage thrombus. Insights gained from two-dimensional and Doppler interrogation of the appendage include recognition of the association of dense spontaneous contrast and reduced mechanical appendage function with increased risk of thromboembolism. TEE-guided cardioversion has been shown to be safe and effective for a subset of patients, provided it is performed by experienced operators familiar with imaging the appendage and recognizing artifacts.