Professionalism: what is it, why should we have it and how can we achieve it?

In this paper we argue that the terms 'profession', 'professional' and 'professionalism' provide us with important insights into the practice of dentistry and the priorities for the continuing development of dentistry as a profession. More significantly, we suggest that this understanding can assist us in designing continuing professional development (CPD) programmes aimed at maintaining the professionalism of dentists throughout their working lives. A CPD framework is required to support both the new graduate to develop from novice to expert as well as support experienced practitioners to maintain their expertise within a rapidly changing environment. Rather than an onerous task, CPD should be a positive and enjoyable experience, self-motivated to improve job satisfaction and self-confidence. Research is currently being undertaken to determine what is good CPD for the practising dentist with a view to recommending strategies based on sound educational theory.

Crystal structure of human prion protein bound to a therapeutic antibody.

Prion infection is characterized by the conversion of host cellular prion protein (PrP(C)) into disease-related conformers (PrP(Sc)) and can be arrested in vivo by passive immunization with anti-PrP monoclonal antibodies. Here, we show that the ability of an antibody to cure prion-infected cells correlates with its binding affinity for PrP(C) rather than PrP(Sc). We have visualized this interaction at the molecular level by determining the crystal structure of human PrP bound to the Fab fragment of monoclonal antibody ICSM 18, which has the highest affinity for PrP(C) and the highest therapeutic potency in vitro and in vivo. In this crystal structure, human PrP is observed in its native PrP(C) conformation. Interactions between neighboring PrP molecules in the crystal structure are mediated by close homotypic contacts between residues at position 129 that lead to the formation of a 4-strand intermolecular beta-sheet. The importance of this residue in mediating protein-protein contact could explain the genetic susceptibility and prion strain selection determined by polymorphic residue 129 in human prion disease, one of the strongest common susceptibility polymorphisms known in any human disease.

Elder abuse in Canada and Australia: implications for nurses.

This paper examines the issue of elder abuse from a Canadian and Australian perspective. A research project was undertaken in Canada and Australia to identify registered nurses' knowledge about the types of abuse, skill at recognition and comfort counselling and intervening in cases of elder abuse. Although a phenomenon that has probably been in existence for many years, it is only during the last decade that elder abuse has come into prominence as an important aspect of family violence. A recent Canadian report records that elder abuse today is at the same level of publicity as wife abuse 10 years ago (Canadian Nurses Association, 1993). It is estimated that as many as 4% of the elderly population in each country are exposed to elder abuse (Podneiks and Pillemer, 1990, National Survey on Abuse of the Elderly in Canada. Ryerson Polytechnic Inst., Toronto; Kurrle et al., 1992, Modern Med. Austral., September, pp. 58-71). This takes the form of physical, emotional as well as financial abuse. Each country has an increasingly ageing population. By the year 2000 the percentage of the population over the age of 65 is predicted to be 13.6% in Canada and 11.7% in Australia (Gnaedinger, 1989, National Forum on Family Violence; Rowland, 1991, Ageing in Australia, Longman Cheshire, Melbourne). Nurses in both community practice and health care facilities have a responsibility to this elderly population to identify those being abused and those at greatest risk. This study questioned a small sample of registered nurses in both countries to identify whether nurses were adequately prepared to identify, intervene and manage patients in an abusive situation. Results show that nurses in both countries were not knowledgeable about the types of abuse, or comfortable and skilled when dealing with the types of elder abuse.