Simple sequence repeat marker development and genetic mapping in quinoa (Chenopodium quinoa Willd.).

Quinoa is a regionally important grain crop in the Andean region of South America. Recently quinoa has gained international attention for its high nutritional value and tolerances of extreme abiotic stresses. DNA markers and linkage maps are important tools for germplasm conservation and crop improvement programmes. Here we report the development of 216 new polymorphic SSR (simple sequence repeats) markers from libraries enriched for GA, CAA and AAT repeats, as well as 6 SSR markers developed from bacterial artificial chromosome-end sequences (BES-SSRs). Heterozygosity (H) values of the SSR markers ranges from 0.12 to 0.90, with an average value of 0.57. A linkage map was constructed for a newly developed recombinant inbred lines (RIL) population using these SSR markers. Additional markers, including amplified fragment length polymorphisms (AFLPs), two 11S seed storage protein loci, and the nucleolar organizing region (NOR), were also placed on the linkage map. The linkage map presented here is the first SSR-based map in quinoa and contains 275 markers, including 200 SSR. The map consists of 38 linkage groups (LGs) covering 913 cM. Segregation distortion was observed in the mapping population for several marker loci, indicating possible chromosomal regions associated with selection or gametophytic lethality. As this map is based primarily on simple and easily-transferable SSR markers, it will be particularly valuable for research in laboratories in Andean regions of South America.

History and evolution of the role of the medical director.

Federal regulations that were published in 1974 required a physician to be employed full or part time as the medical directory by a skilled nursing facilities. Negotiation was needed in each facility to reconcile the traditional role of the physician who care for individual patients with the new role of the physician who would be involved in decisions regarding the care of groups of residents. Professional and provider organizations attempted to define the new role, which developed through experience, networking, and educational opportunities. A consensus conference held in January 1988 identified the functions and tasks associated with medical direction, and, subsequently, educational opportunities focusing on the competencies associated with performing these tasks and functions were developed. This article traces the history and evolution of the formalization of the medical director's role.

The incidence of attempted CPR in nursing homes.

We studied the frequency with which cardiopulmonary resuscitation (CPR) is attempted on residents of American nursing homes. Each author (all members of the Clinical Practice Committee of the American Geriatrics Society) completed a questionnaire in 1989 about policy and practice regarding CPR during 1988 in each of three to seven nursing homes, by questioning the medical or nursing director or the administrator. Because of the vagaries of nursing home record-keeping, data from some homes were allowed when they were "accurate to within 10%." Data from 58 nursing homes, totalling 10,836 bed-years were available. In 33 of these homes, accounting for 5,425 bed-years, CPR was never attempted. CPR was more likely to be foregone in nursing homes with religious affiliation than in nursing homes without (13 of 17 vs 18 of 38; chi 2 = 4.0; P less than 0.05). Religious affiliation was unknown for three nursing homes. Academic affiliation (10 of 16 vs 20 of 37 in non-affiliated nursing homes) and non-profit status (14 of 19 vs 16 of 23 in for-profit nursing homes) did not significantly affect the likelihood that CPR would never be used. In 31 of 54 nursing homes with explicit do not resuscitate (DNR) policies, CPR was never performed, compared to 2 of 4 homes without such policies. For nursing homes with complete data, there were 1,196 deaths in 32 facilities where CPR was never attempted compared to 1,294 deaths for 24 nursing homes with CPR. For 22 nursing homes without CPR, there were 2,172 emergency room transfers compared to 1,363 emergency room transfers in 18 nursing homes where CPR was attempted.(ABSTRACT TRUNCATED AT 250 WORDS)

Global brain failure in a nursing home resident population.

Data from a Minneapolis Professional Standards Review Organization (PSRO) are used to explore the frequency of global brain failure, a group of diseases, in a population of nursing home residents. Findings are related to three other studies of the same or similar phenomena. Approximately 15 per cent of all patients in the Minnesota database exhibit global brain failure as measured by functional impairment on mental and physical indices. Thirty per cent of the patients in the database are incontinent. These findings raise ethical issues concerning the care management of the global brain failure patient who has an irreversible and gradually fatal disease.

Update on the medical director concept.

Physicians have a legal and ethical responsibility to provide leadership in the care of our institutionalized elderly. In the nursing home, this responsibility includes three components: providing care for individual patients (attending physician), providing care for groups of individuals (medical director) and monitoring and evaluating utilization and quality of care (Utilization Review Committee). Individual physicians, administrators and staff must define the tasks of the medical director to meet the needs of each particular nursing home.

The family physician and nursing home care.

In fulfilling the need for physician involvement in the care of the elderly in long-term facilities, family physicians can function in three roles. First, they can apply their knowledge and skills to the complex multisystemic problems they encounter as attending physicians. Second, they can develop and organize services as medical directors. Third, they can help to assure quality of care through service on utilization review committees.

Utilization review committee as a peer review mechanism.

The appropriate utilization and the quality of care in long-term care facilities should be documented and monitored. This is best accomplished at the local level by physicians and other professionals serving on Utilization Review Committees. Paper compliance to regulation of state or federal agencies is a poor substitute for active involvement of the professionals at the local level.

Training objectives of a well developed geriatrics program.

The Department of Family Practice and Community Health of the University of Minnesota Medical School is composed of six affiliated units. Each unit is allied with a hospital complex and operates an independent family practice clinic. Since each unit has unique demographic characteristics, general objectives for training residents in geriatric medicine have been developed. Cognitive, attitudinal and skill objectives also have been identified. The unit director implements the general objectives by using the special strengths of that particular unit.