How should medical schools prepare medical students for leading the NHS?

The NHS is an evolving landscape. While the level of clinical knowledge conferred to medical students remains constant, their competence in other skills, such as leadership, needs to be enhanced in order for them to successfully work within the health-care system. The importance of leadership is considered at the start and end of a medical degree - when applying to medical school with various examples of leading a team, and upon balancing scenarios of leadership when sitting the situational judgement test in final year. In the interim, however, more teaching needs to be delivered to ensure that medical students are prepared for leading the NHS. Through enabling students to engage, identify and align with being a leader, they become increasingly aware of their future role and will improve service delivery.

Multicity HIV seroprevalence in street youth, Ukraine.

We conducted the first systematic, community-based, multicity assessment outside the USA of HIV seroprevalence, risk factors and linkage into clinical services among 929 street youth. After city-wide mapping, we used time-location sampling and randomly selected 74 venues in Odesa, Kyiv and Donetsk, Ukraine. Rapid HIV testing with post-test counselling was offered to all eligible youths aged 15-24 years. Overall, 18.4% (95% confidence interval 16.2-20.2) were HIV positive and 85% had previously unknown status. Rates were identical by sex. Subgroups with highest rates included orphans (26%), youths with histories of exchanging sex (35%), sexually transmitted infections (STIs) (37%), injection drug use (IDU) (42%) and needle sharing (49%). Independent predictors, similar across age groups and city, included being orphaned, time on the street, history of anal sex, STIs, exchanging sex, any drug use, IDU and needle sharing. Two-thirds (68%) of HIV-positive youths were linked to services. This high-risk population has many immediate needs.

Meta-analysis: budesonide treatment for collagenous colitis.

BACKGROUND: Collagenous colitis is typified by chronic watery diarrhoea and characteristic histological alterations of the colonic mucosa without endoscopic abnormalities. Budesonide, a corticosteroid with high first-pass metabolism has been examined in collagenous colitis, but studies to date have had small numbers, and relatively low statistical power. AIM: A meta-analysis of existing published trials was undertaken to evaluate the treatment effect of budesonide in collagenous colitis. METHODS: All pertinent literature sources were searched for published reports in English of budesonide use in collagenous colitis. MEDLINE and EMBASE databases were reviewed, as well as bibliographies from published articles and available abstracts from relevant meetings. Literature that met prespecified criteria was selected for the meta-analysis. RESULTS: Three trials were included in the meta-analysis. Budesonide significantly decreased stool frequency (budesonide vs. placebo OR: 20.1, 95% CI: 7.0-57.5, P < 0.0001). In general, budesonide treatment was well-tolerated. CONCLUSIONS: Budesonide is clinically effective short-term in collagenous colitis, and seems to be relatively well-tolerated. Clinicians can consider this drug as a reasonable option for patients with this disorder.

Efficacy of high-velocity low-amplitude manipulative technique in subjects with low-back pain during menstrual cramping.

Previous studies have shown that dysmenorrhea produces low-back pain and an electromyographic (EMG) pattern typical of trauma-induced low-back pain. To determine the effects of high-velocity low-amplitude osteopathic manipulative treatment (OMT) on this type of low-back pain, 12 dysmenorrheic subjects were assigned to a group receiving OMT or to a group not receiving OMT (or both). Eight subjects participated in both groups, the other four being equally distributed between groups. Osteopathic manipulative treatment significantly decreased EMG activity during extension of the lumbar spinae erector muscles and abolished the spontaneous EMG activity. These EMG changes coincided with the patient's report of alleviated low-back pain and menstrual cramping. Osteopathic manipulative treatment did not change the creatinine kinase, lactate dehydrogenase or lactate-dehydrogenase isoenzyme activity, or myoglobin concentration.

Comparative study of cephalexin hydrochloride and cephalexin monohydrate in the treatment of skin and soft tissue infections.

In two prospective, randomized multicenter double-blind studies with a dosage of either 250 mg given four times a day (study A) or 500 mg given two times a day (study B), the comparative efficacy and safety of cephalexin hydrochloride (LY061188; Keftab) and cephalexin monohydrate (Keflex) for treatment of skin and soft tissue infections were determined. In study A, 97 patients received cephalexin hydrochloride and 101 patients received cephalexin monohydrate. In study B, 75 patients received cephalexin hydrochloride and 70 patients received cephalexin monohydrate. Diagnoses included abscesses, cellulitis, wound infections, and infected dermatitis, and were comparable in the different treatment groups. Pathogens were isolated from 82% of patients enrolled; the majority of isolates were of Staphylococcus aureus, Streptococcus pyogenes, other staphylococcal species, and a few gram-negative bacteria. In study A, 68 of 71 (95.7%) evaluable patients who received cephalexin hydrochloride responded satisfactorily; 73 of 81 (90%) patients who received cephalexin monohydrate also responded satisfactorily. In study B, 56 of 58 (96.5%) evaluable patients who received cephalexin hydrochloride responded satisfactorily; 47 of 50 (94%) patients who received cephalexin monohydrate also responded satisfactorily. An adverse clinical event leading to discontinuation of the treatment drug developed in 17 of 343 (4.95%) patients in both studies. No differences were noted between the two drugs. Skin eruptions, pruritus, and mild gastrointestinal symptoms were the common adverse effects. These data suggest that cephalexin hydrochloride, a new formulation of cephalexin, is a safe and effective antimicrobial agent for treatment of a variety of skin and subcutaneous infections in a dosage of either 250 mg four times a day or 500 mg twice a day.

Protein and colloid osmotic pressure changes with albumin and/or saline replacement during plasma exchange.

Colloid osmotic pressure (COP) has been used as a predictor of fluid egress from the vascular space and edema development in the lungs and elsewhere. We investigated the relative safety, as predicted by the COP, of 5 percent albumin plus saline and 5 percent albumin alone as replacement fluids during plasma exchange. Fifty-three one and one-half plasma volume exchanges were performed in 15 patients with a variety of diagnoses using intermittent flow cell separators. On specimens obtained, before, during, and after each plasma exchange, the COP was measured directly with a membrane oncometer , and total protein, albumin, and protein electrophoresis were determined using standard biochemical techniques. COP dropped significantly with one to one 5 percent albumin replacement but even more with one-half 5 percent albumin and one-half saline replacement during the exchange. COP did not fall below 12.5 torr at the end of the plasma exchange, even with one-half saline replacement, compared to the 10 to 12 torr level at which pulmonary edema might be expected. The fall in COP during exchange when saline was given first did approach this range but rapidly reversed itself with albumin administration. Clinically, no evidence of tissue or pulmonary edema was observed. Recovery in total protein and COP between plasma exchanges was significant.

Glycine enhancement of caudate neuronal activities: relationship with the dopaminergic nigrostriatal pathway.

Glycine microinjection into the substantia nigra zona compacta (SNC) in lightly anesthetized rats produced a marked and rapid decrease in spontaneous discharges of SNC neurons and a simultaneous enhancement of caudate nucleus (CN) activities. In animals pretreated with the dopamine receptor blocker, haloperidol, intranigral microinjection of glycine produced a dissociation of the nigral inhibition and caudate excitation. The SNC neurons were similarly suppressed while the CN neurons exhibited no discernible change in firing frequency. A possible role was suggested for glycine as an inhibitory neurotransmitter acting on the cells of origin of the nigrostriatal pathway.

Morphine suppression of substantia nigra zona reticulata neurons in the rat: implicated role for a novel striatonigral feedback mechanism.

In lightly anesthetized rats, systemic administration of morphine exerted a naloxone-reversible suppression of spontaneously discharging neurons located primarily in the substantia nigra zona reticulata, either at rest or after their activation by microinjection of dopamine into the caudate nucleus. Inactivation of these neurons within the striatonigral feedback pathway is suggested to complement a direct action on the nigrostriatal dopaminergic cells by the opiate, resulting in the morphine suppression of caudate neuronal activities.

Successful treatment of psoriasis of the nails.

Psoriasis of fingernails and toenails presents a challenge that has not been met by the available therapeutic modalities. Three cases of treatment with x-ray therapy of varying intensities are presented herein. Cure was acheived in all three cases with no x-ray sequelae.