Involvement of 5-hydroxytryptamine in the blood pressure changes evoked by electrical stimulation of the median raphe nucleus.

Electrical stimulation of the median raphe nucleus (MRN) in urethane-anaesthetised rats decreased systemic blood pressure at low intensities of stimulation (5-25 microA) and increased it with higher intensities (20-150 microA). Prazosin (0-5-5.0 micrograms/Kg i.v.) dose-dependently attenuated pressor responses concurrently with a reduction in the responsiveness of peripheral alpha-adrenoceptors to phenylephrine (500ng i.v.). Methiothepin (5-10 micrograms/Kg i.v.) abolished depressor responses and reduced the pressor effects without altering the response to phenylephrine. Ketanserin (5-10 micrograms/Kg i.v.) abolished depressor changes and potentiated pressor responses. High doses (20-200 micrograms/Kg) produced a decrease in pressor responses but correspondingly lowered BP and reduced the response to phenylephrine. The results suggest the presence of 5-HT-containing links between the MRN and the peripheral cardiovascular effector systems.

A novel method of guideline development for the diagnosis and management of mild to moderate hypertension.

BACKGROUND: There are large numbers of clinical guidelines available covering many clinical areas. However, the variable quality of their content has meant that doctors may have been offered advice that has been poorly researched or is of a conflicting nature. It has been shown that local involvement in guideline development increases the likelihood of their use. AIM: To develop a guideline to be used by general practitioners in six practices in Birmingham from existing evidence-based guidelines. METHOD: Recommendations from the four most cited international hypertension guidelines, and the more recently published New Zealand guidelines, were divided into subject areas and tabulated to facilitate direct comparison. Where there was complete or majority (> or = 3/5) agreement, the recommendation was taken as acceptable for inclusion in the new guideline. Where there was disagreement (< or = 2/5), recommendations were based on the best available evidence following a further MEDLINE literature search and critical appraisal of the relevant literature. Each recommendation was accompanied by a grade of evidence (A-D), as defined by the Canadian Hypertension Society, and an 'action required' statement of either 'must', 'should', or 'could', based on the Eli-Lilly National Clinical Audit Centre Hypertension Audit criteria. The recommendations were summarized into a guideline algorithm and a supporting document. The final format of both parts of the guideline was decided after consultation with the practice teams. The practices individually decided on methods of data collection. RESULTS: The guideline was presented as a double-sided, A4 laminated sheet and an A4 bound supporting document containing a synthesis of the original guidelines in tabular form, a table of the resulting recommendations, and appendices of current literature reviews on areas of disagreement. The content of the final Birmingham Clinical Effectiveness Group (BCEG) guideline differed minimally from any of the original guidelines. CONCLUSION: The main strength of this method of guideline development may lie, not in the actual content of the resulting guideline, but in the strength of ownership felt by the BCEG and the practices following its development. While the full process is unlikely to be possible for general practitioners working outside an academic environment, the techniques used could provide a framework for practitioners to adapt national and international guidelines for use at a local level.

Nursing in a diverse community: a narrative review.

Almost 6% of Britain's population are of black or minority ethnic origin. There is increasing recognition that the health needs of such groups are not adequately met within the current health care system. One factor in reducing health inequalities is for health professionals to become culturally aware in order to serve these communities effectively. This literature review focuses on pre-registration nursing programmes that address cultural sensitivity as part of basic training. The studies were selected by a computerized search of a number of databases and a hand search of selected nursing journals. The papers were reviewed under the following headings: setting, programme design, conceptual framework, curricula content, student assessment, and course evaluation. The programmes presented were undertaken predominantly in the USA. Either few programmes exist in the UK, or the programme details have not been published. Although, in the UK, cultural sensitivity training appears in its infancy, there are positive signs of change.

Cross-cultural communication in medicine: questions for educators.

Most research into medical communication has had a western setting. It has been undertaken by western researchers and been influential in shaping communication skills curricula. However we know much less about what communication is effective under other circumstances. This article highlights gaps in our knowledge from research in this field, and poses attendant questions for debate by medical educators. We consider the following key aspects of debate on cross-cultural work. (i) To what extent can our understanding of general principles in other cultures be summarized and presented for teaching in a way which does not descend into caricature? Alternatively, can features of other cultures be presented in ways which do not descend into particularity? (ii) Can such paradigms as "patient-centredness" be transferred from culture to culture? Should they be presented across cultures as features of "good" consultations? (iii) What use can be made of the role of interpreters for teaching purposes? What importance does it have to the educator that a doctor may not be a native speaker of the majority language of the culture in which s/he is operating? (iv) Although the language of illness, and particularly metaphors associated with illness, are studied in other cultures, the way in which illness is metaphorized in British English is seldom discussed. What can educators learn and teach from a study of such matters? (v) What are the implications for communication skills teachers of the need to present materials within a culturally diverse environment?

Educating medical students for work in culturally diverse societies.

CONTEXT: Recent attention has focused on whether government health service institutions, particularly in the United Kingdom, reflect cultural sensitivity and competence and whether medical students receive proper guidance in this area. OBJECTIVE: To systematically identify educational programs for medical students on cultural diversity, in particular, racial and ethnic diversity. DATA SOURCES: The following databases were searched: MEDLINE (1963-August 1998); Bath International Data Service (BIDS) Institute for Scientific Information science and social science citation indexes (1981-August 1998); BIDS International Bibliography for the Social Sciences (1981-August 1998); and the Educational Resources Information Centre (1981-August 1998). In addition, the following online data sets were searched: Kings Fund; Centre for Ethnic Relations, University of Warwick; Health Education Authority; European Research Centre on Migration and Ethnic Relations, University of Utrecht; International Centre for Intercultural Studies, University of London; the Refugee Studies Programme, University of Oxford. Medical education and academic medicine journals (1994-1998) were searched manually and experts in medical education were contacted. STUDY SELECTION: Studies included in the analysis were articles published in English before August 1998 that described specific programs for medical students on racial and ethnic diversity. Of 1456 studies identified by the literature search, 17 met the criteria. Two of the authors performed the study selection independently. DATA EXTRACTION: The following data were extracted: publication year, program setting, student year, whether a program was required or optional, the teaching staff and involvement of minority racial and ethnic communities, program length, content and teaching methods, student assessment, and nature of program evaluation. DATA SYNTHESIS: Of the 17 selected programs, 13 were conducted in North America. Eleven programs were exclusively for students in years 1 or 2. Fewer than half (n = 7) the programs were part of core teaching. Only 1 required program reported that the students were assessed on the session in cultural diversity. CONCLUSIONS: Our study suggests that there is limited information available on an increasingly important subject in medical education. Further research is needed to identify effective components of educational programs on cultural diversity and valid methods of student assessment and program evaluation.