Developing unplanned care teams in Scotland: evaluating outcomes.

Mental health nursing, along with other professional groups, has had to adapt to new ways of delivering health services, often in response to government policy. Consequently, traditional professional boundaries and roles are being rapidly and consistently expanded, often requiring coordinated responses across strategic, educational and clinical domains to ensure service users experience high-quality mental health interventions. This paper explores and evaluates such a coordinated response in developing unplanned care services in Scotland. The evaluation, placed within a framework of realistic evaluation, highlights not only the efficacy of the provided training and education for new roles within unplanned care, but also that emotionally intelligent capabilities are required to successfully implement the level of change currently being experienced within the UK mental health services.

Glycosylation and misfolding of PrP.

The TSEs (transmissible spongiform encephalopathies) are not only devastating neurological diseases but also provide a biochemical conundrum; how can a disease agent replicate in the apparent absence of genetic material? The prion hypothesis proposes that the TSE agent is a misfolded form of the host glycoprotein PrP (prion protein). However, a number of questions regarding the hypothesis remain to be addressed. We are using gene-targeted PrP transgenics models to investigate these issues. Here we discuss our recent results that examine the importance of PrP's N-glycans to the misfolding of the protein.

Endoscopic plantar fasciotomy versus traditional heel spur surgery: a prospective study.

A comparative study of endoscopic plantar fasciotomy versus traditional type heel spur surgery has been performed involving 76 patients and 92 procedures. Sixty-six of those procedures consisted of endoscopic fasciotomy, whereas 26 involved traditional type surgery. Those patients in which the endoscopic fasciotomy was performed had significantly less postoperative pain, returned to regular activities 4 weeks earlier, and had fewer complications postoperatively than those patients involving traditional heel spur surgery. An overview of the surgical technique involving endoscopic fasciotomies is presented, as well as factors influencing the postoperative outcome, such as duration of preoperative symptoms, extent of conservative care, and obesity.

Giant cell tumor of the talus with secondary aneurysmal bone cyst.

Giant cell tumors of the talus are very uncommon. Secondary aneurysmal bone cyst changes are well documented in the literature with giant cell tumors being one of the most common underlying lesions. However, no previous case of this combination has been documented in the podiatric literature. The diagnosis of these lesions can be very challenging since they share many common features. Although previous reports describe a higher recurrence rate of giant cell tumors when found in the small bones of the hands and feet, reported cases of this entity in the talus indicate a less aggressive natural history with rare malignant transformation. A case report and review of the literature are presented.

Active specific immunotherapy potential for the treatment of large bowel cancer.

Active specific immunotherapy, harnessing the strength and specificity of the host immune response to destroy neoplastic cells, may offer an ideal surgical adjuvant treatment modality for human colon cancer. Unfortunately, achievement of this goal has been obscured by 1) the effect of excess residual disease to interfere with the host's destructive response, 2) the weak nature of tumor resistance, 3) the potential adverse effect of concomitant treatments such as chemotherapy, and 4) the present limitation of poorly defined immunogens to induce, as well as insensitive assay systems to detect, host sensitizaion. Recent immunologic and chemical research revealing distinctive surface membrane structures on colon cancer cells suggests that a controlled trial of irradiated, autochtonous cell vaccines (without mycobacterial adjuvants) may provide a new therapeutic tool for Dukes B2 and C stages of human colon cancer.

Cell surface changes associated with malignant transformation of bladder epithelium in vitro.

Three properties of cell surface membranes of normal bladder epithelium and of two malignant urothelial lines transformed in vitro by Dr. Y. Hashimoto and Dr. H. S. Kitagawa were analyzed by means of morphological and chemical tools. Under scan electron microscopy, normal bladder epithelium displayed an appearance devoid of the pleomorphic, abundantly distributed, microvillous structures seen on the neoplastic cells. The molecular weight profiles of proteins dispersed from purified plasma membrane fractions demonstrated quantitative differences in the content of three molecular-weight classes between the native and the transformed cells. More striking differences were seen upon two-dimensional analysis of proteins solubilized from these two cell types, using 3 M KCl. These findings suggest that further investigations of the chemical moieties appearing on the cell surface early after transformation may enhance our understanding of proteins amenable for chemical and/or immunological attack to achieve control of the progression of bladder neoplasia.

Cell surface alterations on colon adenocarcinoma cells.

By the use of five independent techniques, cell surface alterations distinctive of malignant as compared to normal colon cells were detected on in vivo surgical specimens and on cultured cell lines established in our laboratory. The findings, which were distinctive of the malignant as compared to the normal cell included: (a) polymorphism of surface microvilli on scan electron microscopy; (b) decreased susceptibility to infection with vaccinia and reovirus, but not to herpes, adeno- or echovirus: (c) production of large quantities of carcinoembryonic antigen; (d) presence of specific membrane proteins on sodium dodecyl sulfate-polyacrylamide gel analysis of plasma membranes purified from cell homogenates by ultracentrifugation in polyethylene glycol-dextran partitions; and (e) reaction with specific, cytotoxic, rabbit heteroantisera. Solubilized extracts of the malignant cells formed precipitin lines with the heteroantisera, suggesting that the distinctive antigens could be released from the cell surface. These results suggest that human colon carcinomas bear tumor-distinctive proteins and offer the prospect of specific immunodiagnostic reagents and immunotherapeutic tools.