The Anatomical Society's core anatomy syllabus for undergraduate nursing.

The Anatomical Society has developed a series of learning outcomes in consultation with nursing educators delivering anatomical content to undergraduate (preregistration) nursing students. A Delphi panel methodology was adopted to select experts within the field that would recommend core anatomical content in undergraduate nursing programmes throughout the UK. Using the Anatomical Society's Core Gross Anatomy Syllabus for Medical Students as a foundation, a modified Delphi technique was used to develop discipline-specific outcomes to nursing graduates. The Delphi panel consisted of 48 individuals (n = 48) with a minimum of 3 years' experience teaching anatomy to nursing students, representing a broad spectrum of UK Higher Education Institutions. The output from this study was 64 nursing specific learning outcomes in anatomy that are applicable to all undergraduate (preregistration) programmes in the UK. The new core anatomy syllabus for Undergraduate Nursing offers a basic anatomical framework upon which nurse educators, clinical mentors and nursing students can underpin their clinical practice and knowledge. The learning outcomes presented may be used to develop anatomy teaching within an integrated nursing curriculum.

Nursing students' perceptions on the use of anatomical projections as an educational tool

Human anatomy is taught in Stage 1 of undergraduate Nursing programs at a Dublin university school of nursing. Dissection room based practical sessions were recently introduced as part of this module. Nursing candidates were surveyed to assess the value of these sessions as an educational tool. Students’ reactions and concerns regarding the dissection room were also evaluated. 74 students (67 female and 7 male) responded to the questionnaire. 97% of those surveyed were of Irish nationality; other nationalities included Ivorian, Nigerian and Philipino. 54.1% of students reported that they had no previous exposure to dead bodies before entering the dissection room. The majority of students (68.9%) were apprehensive at the thought of visiting the dissection room for the practical class. Loss of appetite was reported by 10.9% of students prior to entering the dissection room. 58.1% of students surveyed reported that the smell in the dissection room disturbed them in some way. The sight of the anatomical specimens also caused some distress (14.9%) as did touching the specimens used (16.3%). 8.2% of nursing students reported dizziness as a physical symptom during the practical session. Other physical symptoms such as sweating, trembling and recurring or disturbing visual images of cadavers did cause some distress among the nursing students surveyed, although this was minimal. Two open-ended questions were asked in order to determine the value of anatomy and the use of anatomical specimens by the students. The vast majority (95%) of students reported that anatomy as a subject is relevant to the nursing profession and is important to comprehend in detail prior to commencing clinical placement. 92% of students surveyed thought that the use of anatomical specimens aids in better visualisation of internal structures. Research findings suggest that although nursing students were apprehensive about practical sessions the majority found them to be very beneficial to their learning. Practical anatomy sessions with the use of prospected specimens can be a valuable learning experience for students (AU)

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Serum osteocalcin in patients taking L-thyroxine who have subclinical hyperthyroidism.

Serum osteocalcin, an index of osteoblastic activity, is increased in hyperthyroidism. Serum osteocalcin levels are negatively correlated with bone density in patients with overt hyperthyroidism. Osteocalcin levels are also elevated in patients with multinodular goiter and subclinical hyperthyroidism. We therefore measured serum osteocalcin levels in patients taking T4 to determine if they correlated with the degree of TSH suppression. Despite an upward trend in serum osteocalcin measurements with decreasing TSH concentrations, there was no significant difference in serum osteocalcin among groups of patients with normal (0.5-5.0 mu/L), mildly reduced (0.1-0.5 mU/L), or undetectable serum TSH (less than 0.01 mU/L). However, a weak negative correlation was seen between serum TSH and osteocalcin concentrations (r = 0.29, slope = -0.28, P less than 0.05). Osteocalcin did not correlate with either serum free T4 or free T3 concentrations. Serum PTH concentrations were not different among the three patient groups. Our data suggest that osteocalcin is not a useful clinical marker for increased bone turnover in patients with subclinical hyperthyroidism due to T4 therapy. However, the trend towards higher osteocalcin levels in patients with suppressed serum TSH values, and the weak negative correlation between serum TSH and osteocalcin are consistent with findings of reduced bone density in these patients.

Measurement of thyrotropin in clinical and subclinical hyperthyroidism using a new chemiluminescent assay.

A new commercially available chemiluminescent TSH assay demonstrates an 8- to 10-fold increase in sensitivity over a sensitive immunoradiometric assay, allowing increased ability to distinguish partial from more complete thyrotroph suppression. Sera were analyzed from 145 patients who had TSH concentrations below 0.08 mU/L in the immunoradiometric assay. Most patients with overt hyperthyroidism had undetectable TSH concentrations in the chemiluminescent assay. Three groups of patients were identified, in which a large subgroup had undetectable values in the immunoradiometric assay and detectable values in the chemiluminescent assay (12 of 17 patients under treatment for hyperthyroidism who had recently normalized their serum thyroid hormone levels, 33 of 68 patients taking L-T4, and 4 of 8 patients with endogenous subclinical hyperthyroidism). In addition, several patients with undetectable basal and detectable TRH-stimulated TSH values in the immunoradiometric assay had detectable basal TSH values in the chemiluminescent assay. The utility of first generation TSH immunometric assays was their ability to distinguish hyperthyroidism from euthyroidism. The clinical utility of increasingly sensitive TSH assays will be to distinguish degrees of thyrotroph suppression in subclinical hyperthyroidism.

Triiodothyronine (T3) regulation of thyrotropin subunit gene transcription is proportional to T3 nuclear receptor occupancy.

We have investigated the relationship between T3 nuclear receptor occupancy and the T3-mediated responses of TSH subunit gene expression. Hypothyroid mice bearing TtT 97 thyrotropic tumors were injected daily for 12 days with 0-10 micrograms T3/100 g BW, ip. T3 levels were measured in plasma and in tumor nuclei, and the maximal T3-binding capacity of tumor nuclei and the fractional occupancy of T3 nuclear receptors at each dose were calculated. T3-mediated decreases in TSH secretion were half-maximal at a dose of 0.2-0.3 micrograms/100 g BW, which resulted in plasma T3 levels of 0.98-1.2 ng/ml. Responses at the TSH subunit gene levels followed a similar pattern. Transcription of TSH beta and alpha-subunit genes was decreased maximally from 384 to 26 ppm for TSH beta and from 424 to 112 ppm for alpha-subunit. Inhibition of transcription was half-maximal at plasma T3 concentrations of 0.8 and 1.0 ng/ml for TSH beta and alpha-subunit, respectively. The half-maximal effective doses of T3 for decreases in TSH gene transcription were in good agreement with the amount of T3 necessary to saturate 50% of nuclear T3 receptors in the tumor, calculated at 1.07 ng/ml T3. A plot of fractional decrease in TSH subunit gene transcription vs. fractional T3 nuclear receptor occupancy demonstrated a straight line relationship for both TSH beta and alpha-subunit. Thus, the response of both TSH subunit genes to T3, a decrease in TSH beta and alpha-subunit gene transcription, is directly proportional to nuclear T3 receptor occupancy.

Monoclonal antibody to human thyrotropin.

Using the technique of somatic cell fusion, a monoclonal antibody to human TSH (hTSH) has been produced. The monoclonal antibody (anti-hTSH 1/1) has an affinity (Kd = 4.04 x 10(-9) M/liter) for hTSH which is slightly less than that of the polyclonal antisera (Kd = 9.8 x 10(-10) M/liter) derived from the same mouse used for the fusion experiment. The beta-subunit of hTSH displays nearly complete cross-reaction, but has a lower affinity (Kd = 2.6 x 10(-8) M/liter) for the monoclonal antibody. hCG and its alpha- and beta-subunits as well as human LH do not cross-react with this antibody. The high specificity of this antibody will make it useful as an immunofluorescent probe of hTSH-secreting cells as well as in the immunoabsorption and purification of hTSH.