Skills for the beginning family medicine investigator.

The purpose of this study was to identify the necessary skills for a beginning researcher in family medicine, utilizing the views of those currently conducting research in the specialty. A Delphi study, involving three questionnaires, was conducted to determine skills needed in the following areas: designing a research project, conducting a research project, statistical knowledge and/or skills, and computer skills. Participants were 32 family physicians who had published at least one article in the Journal of Family Practice (1983-84) or Family Medicine (1983-84). The Delphi technique was successful in achieving consensus among study participants. A total of 77 skills were identified in the four areas as being at least somewhat important to the beginning family medicine investigator. Thirty-eight of these skills were identified as important to extremely important.

A clinical and microbiological study of cats with protruding nictitating membranes and diarrhoea: isolation of a novel virus.

Fifty cats with the syndrome of protruding nictitating membranes and diarrhoea were compared clinically and microbiologically with nine cats with diarrhoea alone and 17 healthy cats. A novel torovirus-like agent was isolated from 11 cats, including seven of the cats with protruding nictitating membranes and diarrhoea.

Parasites of Chamois in New Zealand.

Abstract Sir, - Andrews'((2)) checklist of helminth parasites of wild ruminants in New Zealand recorded the presence of 10 species of gastrointestinal nematodes in chamois (Rupicapra rupicapra rupicapra L.) from "Central South Island". In October 1978 we examined 28 freshly-shot chamois cadavers from the Harper-Avoca watershed in the headwaters of the Rakaia River. Six of the nematode species reported by Andrews were found again; viz. Ostertagia ostertagi, O. circumcincta, O. trifurcata, Nematodirus filicollis, Oesophagostomum venulosum and Trichuris ovis. The 4 species found by Andrews that were not recovered by us from the animals we examined were: Trichostrongylus axei, T. vitrinus, Spiculotragia spiculoptera and S. asymmetrica. On the other hand we found 4 helminths not encountered by Andrews: 3 nematodes: Nematodirus spathiger (Railliet, 1896), N. abnormalis (May, 1920), and Chabertia ovina (Fabricius, 1794), and 7 specimens of the cestode Moniezia expansa (Rud., 1805). Nematodirus spathiger was the most commonly encountered Nematodirus species, but generally the numbers of all 3 species encountered were low as might be expected in a sample of adult and almost year-old animals. It is probable that most of the adults had acquired some measure of immunity((3)), and the most susceptible group, the kids, would not be born until late November. Because peptic digestion was not used to recover juveniles from the intestinal submucosa, only small numbers of adults were obtained.

Do parents or surrogates have the right to demand treatment deemed futile? An analysis of the case of Baby L.

Do parents or surrogates have the right to demand treatment deemed futile? An analysis of the case of Baby L The purpose of this discussion paper is to address and analyse the ethical issues arising from the following questions: Do parents or surrogates of newborn infants have the right to demand treatment deemed 'futile'? Should the religious beliefs of the infant's parents be given special consideration when deciding on the correct course of action? The case of Baby L, an infant born with severe disability will be used to aid the analysis. It is argued that health care providers have no obligation to provide 'futile' treatment based on the surrogates' right to autonomy, but an obligation may arise from a duty of benevolence. However, acting from a duty of benevolence can ignore considerations of justice and fairness and does not always prompt the right course of action. Any decision regarding treatment options will involve ranking the beliefs and values of the parents or surrogate against the integrity of the health care team and the interest of society as a whole. The consequences of continuing or discontinuing life-sustaining treatment for the infant, the parents and the health care team will also be considered and examined.

Children visiting family and friends on adult intensive care units: the nurses' perspective.

Recent surveys show that children are still restricted from visiting their critically ill family and friends on many adult intensive care units throughout the country. The purpose of this small-scale exploratory pilot study was to examine and describe the experiences and perceptions of trained nurses towards children visiting within this setting. The aim of the study was to gain greater insight and understanding into the reason why, despite evidence to support the benefits to children of visiting their critically ill family and friends, they remain discouraged and restricted. It is hoped that the study will act as an initial enquiry to generate themes and further research questions. A qualitative research approach was adopted and in-depth focused interviews used as a method of data collection. The participants of the study were trained nurses working on an adult intensive care unit in a district general hospital in England. A total of 12 individual interviews were conducted which were audiotaped in full and analysed using a method of thematic content analysis. The value of the research is to promote family-centred care within an adult intensive care environment to meet the neglected needs of the well children of the critically ill person. The findings suggest that the participants in the study attempted to offer valuable support to children visiting their critically ill family and friends, but, despite an open visiting policy, children rarely visited within this setting. The desire of the well parent to protect and shield the child from the crisis of critical illness was perceived by the participants to be the main reason why they did not visit. To provide family-centred care within an adult intensive care setting has many implications for practice and several of these important issues are discussed. These include the educational and training needs of nursing staff and the importance of adopting a collaborative team approach to providing care for the critically ill person and their family. The need to generate research and literature from within the United Kingdom's health care system has also been identified and recommendations for further studies are proposed.

Rationing scarce life-sustaining resources on the basis of age.

AIMS: The aim of this paper is to analyse critically the use of age as a criterion to ration scarce life-sustaining resources within the intensive care environment. BACKGROUND: Insufficient funding to meet the escalating costs of health care has resulted in a scarcity of life-sustaining resources. Although an explicit policy of rationing by age within the United Kingdom (UK) has not been formulated, decisions to withhold or withdraw treatment are already being made on the basis of patients' biological age rather than medical need. METHOD: Three contrasting arguments are analysed: the 'equal worth', 'fair innings' and 'prudential lifespan' arguments. CONCLUSIONS: In certain circumstances rationing by age is both morally permissible and justified. However, the capacity to benefit from treatment has to be considered whatever the age of the individual and any measure of benefit needs to take a broad range of medical, ethical and economic factors into account. If age is to be used, as a criterion to ration limited resources explicit, national guidelines need to be developed and applied consistently to ensure that arbitrary differences in the treatment older people receive does not occur.

Purification, properties and specificity of the restriction endonuclease from Bacillus stearothermophilus.

The restriction endonuclease BstI was purified from 70kg of Bacillus stearothermophilus. The final product is at least 97% pure as judged by sodium dodecyl sulphate/polyacrylamide-gel electrophoresis; this major protein species co-migrates with the enzyme activity on native polyacrylamide-gel electrophoresis and isoelectric focusing. Pure restriction endonuclease BstI has a subunit mol.wt. of 26,000 and is probably a loosely associated dimer. The enzyme shows maximum activity at pH values between 7 and 9.5, and in the presence of 0.5-2mM-Mg2+. NaCl inhibits the restriction enzyme activity. Restriction endonuclease BstI cleaves DNA in a position identical with that cleaved by endonuclease BamHI (for Bacillus amyloliquefaciens), i.e.: (formula: see text). In the presence of high concentrations of enzyme, DNA cleavage occurs at secondary sites. This side-specificity is enhanced by the addition of glycerol. Preliminary studies indicate that these sites are of the type: (formula: see text).

Affinity chromatography of aminoacyl-transfer ribonucleic acid synthetases. Small organic ligands.

The usefulness of affinity chromatography for the purification of aminoacyl-tRNA synthetases was explored by using column ligands derived from the corresponding amino acid and aminoalkyladenylate, a non-labile analogue of the aminoacyladenylate reaction intermediate. Four modes of attachment of the aminoalkyladenylate to Sepharose were studied. The interaction between amino acid derivatives and the corresponding aminoacyl-tRNA synthetases is too weak to allow their use as ligands for affinity chromatography. Attachment of the aminoalkyladenylate via the alpha-nitrogen atom of the amino acid or via C-8 of the nucleotide abolishes synthetase binding, and immobilization via the oxidized ribose ring is only marginally useful. However, attachment of the aminoalkyladenylate to the matrix via N-6 of the nucleotide allows strong and specific synthetase binding, and the use of such columns permits the isolation of homogeneous synthetase from crude mixtures. The effect of non-specific adsorption and the utility of pre-columns and of specific substrate elution are investigated and discussed.

Affinity chromatography of aminoacyl-transfer ribonucleic acid synthetases. Cognate transfer ribonucleic acid as a ligand.

The use of tRNA affinity columns for the purification of aminoacyl-tRNA synthetases was investigated. A purification method for valyl-tRNA synthetase from Bacillus stearothermophilus is described that uses two affinity columns, one containing the pure cognate tRNA, and the other containing all tRNA species except the cognate tRNA. A method for the rapid preparation of the two columns was developed, which does not require prior isolation of cognate tRNA but makes use of the ability of the target synthetase to select its cognate tRNA. The usefulness of tRNA columns is compared with that of affinity columns derived from the aminoalkyladenylate reported in the preceding paper [Clarke & Knowles (1977) Biochem J. 167, 405-417].

Affective changes in faculty development fellows in family medicine.

The authors investigated the perceptions of 20 faculty development fellows in family medicine to determine whether they were more comfortable in clinical teaching roles after completing a fellowship. The fellows were asked to rate themselves and the ideal clinical teacher at the beginning and end of the fellowship. Comparisons of the fellows' pretest and posttest results were made on each of three factors (authority, sensitivity, and capability) that had been identified as characteristic of the ideal clinical teacher in family medicine. The results of the ratings indicated that the fellows changed their perceptions of themselves as clinical teachers substantially on two of the factors during the fellowship. In addition, on the posttest the fellows' perceptions of themselves matched their own profiles of ideal clinical teachers and on two of the factors matched the profile of an ideal clinical teacher of a sample of 215 clinical teachers in family medicine.