Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist.

Background/aims: : This study aimed to design a structured simulation training curriculum for upper endoscopy and validate a new assessment checklist.

Materials And Methods: A proficiency-based progression stepwise curriculum was developed consisting of didactic, technical and non-technical components using a virtual reality simulator (VRS). It focused on: scope navigation, anatomical landmarks identification, mucosal inspection, retro-flexion, pathology identification, and targeting biopsy.

The management of short-term intestinal failure in obese patients.

The prevalence of obesity in the general population is high and it is inevitable that artificial feeding will be needed from time to time in the obese patient, particularly in the critical care setting. Against a background of generous endogenous stores of energy as adipose tissue and the ability of obese individuals to survive starvation longer than non-obese individuals, emphasis is placed on preserving lean body mass and optimizing physiological function. Insulin resistance is typical of the obese individual and is exacerbated by stress; overfeeding is dangerous, particularly if it results in hyperglycaemia.

Endoscopic suturing.

Suturing at flexible endoscopy might extend the range of less invasive surgical procedures that can be performed without incision. The development of sewing machines that can place single and multiple stitches in the gastrointestinal tract is outlined. Methods of tying knots and cutting thread at flexible endoscopy have also been developed.

The shapes and relative movements of the femur and tibia at the knee.

Unlike the situation at the hip, controversy continues as to the shape of the bones in the knee (for example, are the femoral condyles helical in sagittal section?) and as to the way in which the femur moves on the tibia (for example, does the femur roll-back during flexion?). Although the replaced knee is unlikely to achieve normal kinematics, it seems desirable to understand how far it departs from normal. A knowledge of the normal is also important in the management of ligament injuries.

Profile of placental alkaline phosphatase expression in human malignancies: effect of tumour cell activation on alkaline phosphatase expression.

Cellular alkaline phosphatases (ALP) are increasingly recognised as important markers for monitoring tumour cell behaviour in human malignancies. Colorimetric, flow-cytometric, and immunocytochemical assays were employed to assess the influence of activation on expression of cellular ALP in human tumour cell lines. The results showed the following: (1) Testis tumour biopsies (16/16) unlike bladder (0/14) and head and neck (0/16) tumours showed positive staining for ALP, particularly the placental type, i.

Concordance between tumour cell activation by epidermal growth factor and alteration of cell sensitivity to cisplatin and lymphokine-activated killer cell activity.

In this study the impact of epidermal growth factor (EGF) on chemosensitivity and susceptibility to lymphokine-activated killer (LAK) cytolysis on six cell lines (one super expressing EGFr i.e. HN5, three high expressing i.

Caring for people with HIV in Zambia: are traditional healers and formal health workers willing to work together?

This study of traditional healers and formal health workers determined their knowledge and practices in the field of HIV/AIDS and examined their training needs and attitudes to collaboration, in preparation for planning joint training workshops. Several misconceptions concerning symptoms and transmission of HIV disease were found in both groups, particularly among traditional healers. Twenty healers (51%) and four formal health workers (15%) claimed a cure existed for AIDS.

Imipenem for the treatment of melioidosis.

Melioidosis is a protean disease caused by Burkholderia pseudomallei. It is rare in the UK and is generally only seen in patients with a travel history to endemic areas such as Thailand, Singapore and Malaysia. Cases may present with disseminated bacteraemic, non-disseminated bacteraemic, multi-focal bacteraemic or localized disease.

An ambulant porcine model of acid reflux used to evaluate endoscopic gastroplasty.

Background: There is a lack of suitable models for testing of therapeutic procedures for gastro-oesophageal reflux disease. Endoscopic sewing methods might allow the development of a new less invasive surgical approach to treatment of gastrointestinal disorders.

Aims: To develop an animal model of gastro-oesophageal reflux for testing the efficacy of a new antireflux procedure, endoscopic gastroplasty, performed at flexible endoscopy without laparotomy or laparoscopy.

Thyroid disease in pregnancy.

This review article provides a broad overview of thyroid disease and pregnancy.

The natural history of tibial radiolucent lines in a proximally cemented stemmed total knee arthroplasty.

A total of 207 tibial components in total knee arthroplasty (TKA) have been reviewed at a maximum of 10 years after replacement. Twelve knees developed aseptic femoral loosening and were reviewed separately from the remaining 195. All tibial components were fixed with cement confined to the proximal surface of the implant combined with an uncemented stem.

Comparative expression of major histocompatibility complex (MHC) antigens on CD5+ and CD5- B cells in patients with chronic lymphocytic leukaemia (CLL).

The aim of this study was to investigate the expression of major histocompatibility complex (MHC) antigens on CD5+ and CD5- B cells of 13 patients with chronic lymphocytic leukaemia (CLL). This was carried out using a series of monoclonal antibodies (MAbs) against polymorphic and monomorphic class I and class II antigens, as well as to the transferrin receptor and assessed by flow cytometry and direct and indirect immunofluorescence. The expression of these molecules was assessed as mean fluorescent intensity (MFI).

Susceptibility testing of Klebsiella spp.--an international collaborative study in quality assessment.

In order to compare the prevalence of antibiotic resistance in different geographical areas, it is necessary to ensure agreement between laboratories on the assignment of strains to 'susceptible' and 'resistant' categories. An international quality assessment was performed to investigate the performance of susceptibility testing of Klebsiella spp. Ninety-five strains of klebsiellae were selected from clinical isolates at the London Hospital Medical College (LHMC).

The role of lateral cephalometric radiography and fluoroscopy in assessing mandibular advancement in sleep-related disorders.

Mandibular advancement splints are successful in managing obstructive sleep apnoea (OSA) in selected subjects. For these to be effective, some improvement in the dimensions of the oropharyngeal airway must occur. Twenty subjects with proven obstructive sleep apnoea were examined using lateral cephalometric radiography and a fluoroscopic technique.

A comparison between single-dose fosfomycin trometamol (Monuril) and a 5-day course of trimethoprim in the treatment of uncomplicated lower urinary tract infection in women.

This study is a comparison of the microbiological and clinical efficacy of single-dose fosfomycin trometamol therapy and a 5 day course of trimethoprim in the treatment of uncomplicated urinary tract infection in female patients. Urine dip-slide samples were obtained from 547 female patients aged 18-65 by 22 General Practitioners (GPs) participating in the study from 21 centres in the UK. All patients were diagnosed as having a urinary tract infection by their GP on the basis of history and clinical examination.

Iodinated methacrylate copolymers as X-ray opaque denture base acrylics.

Objectives: The purpose of this study was to evaluate novel iodinated methacrylate copolymers as X-ray opaque denture base resins.

Methods: The synthesis of specific monomers and suspension copolymerization with methyl methacrylate to produce copolymer beads. The resulting beads were processed in an identical manner to standard PMMA to produce test-pieces for mechanical testing.

Melanoma excision by general practitioners in north-east Thames region, England.

A retrospective study of pathology reports of melanomas excised by general practitioners (GPs) was undertaken in the course of a population-based study of melanoma, with a telephone survey of the current practice of those GPs who had excised melanomas. The objectives of this study were to identify all cases of cutaneous melanoma excised by GPs in the North-East Thames Region between 1989 and 1993, and to review the management of those patients. The main outcome measures of the study were: (i) the patterns of distribution of GP excisions within the region; (ii) the histological subtypes of melanomas excised, the accuracy of the pre-excision clinical diagnosis and the adequacy of treatment of the GP-treated tumours compared with the control group; and (iii) the reported current practice in the management of pigmented skin lesions by the GPs who had excised melanomas.

Human small bowel motor activity in response to liquid meals of different caloric value and different chemical composition.

Previous animal studies have shown that the nature and duration of postprandial motility in the small bowel depend both on the caloric load and the chemical composition of a meal. It is not clear whether this is also true for the human small bowel. Therefore we investigated the motor activity of the human small bowel in response to nutrient liquids of different caloric value and different chemical composition.

Intra-articular pressure profile of the knee joint in a spectrum of inflammatory arthropathies.

Objectives: The intra-articular pressure (IAP) rises significantly after isometric quadriceps contraction in patients with rheumatoid synovitis, a process that may temporarily impede synovial blood flow and cause oxidative injury. In acute traumatic knee effusions (ATE) pressure rises are trivial. This study compared the IAP profiles of patients with ATE with three different populations--an acute synovitis on the background of a chronic inflammatory arthropathy, a chronic low grade inflammatory arthropathy, and an acute intermittent inflammatory arthropathy.