Patients and carers as teachers in psychiatric education: a literature review and discussion.

INTRODUCTION: The direct involvement of patients and carers in psychiatric education is driven by policy in the United Kingdom and Ireland. The benefits of this involvement are well known, however, it is important to consider the ethical aspects. This paper suggests how further research could explore and potentially mitigate adverse outcomes. METHOD: A literature search evaluating the role of patients and carer involvement in psychiatric education was undertaken to summarise existing evidence relating to the following: methods of involvement, evidence of usefulness, patient's/carer's views and learners' views. RESULTS: The Medline search produced 231 articles of which 31 were included in the literature review based on the key themes addressed in the paper. DISCUSSION/CONCLUSION: The available evidence is generally positive regarding the use of patients and carers in psychiatric education. However, available research is varied in approach and outcome with little information on the ethical consequences. More research is required to inform policies on teaching regarding potential adverse effects of service user involvement.

Reflection from the strong gravity regime in a lensed quasar at redshift z = 0.658.

The co-evolution of a supermassive black hole with its host galaxy through cosmic time is encoded in its spin. At z > 2, supermassive black holes are thought to grow mostly by merger-driven accretion leading to high spin. It is not known, however, whether below z ≈ 1 these black holes continue to grow by coherent accretion or in a chaotic manner, though clear differences are predicted in their spin evolution. An established method of measuring the spin of black holes is through the study of relativistic reflection features from the inner accretion disk. Owing to their greater distances from Earth, there has hitherto been no significant detection of relativistic reflection features in a moderate-redshift quasar. Here we report an analysis of archival X-ray data together with a deep observation of a gravitationally lensed quasar at z = 0.658. The emission originates within three or fewer gravitational radii from the black hole, implying a spin parameter (a measure of how fast the black hole is rotating) of a = 0.87(+0.08)(-0.15) at the 3σ confidence level and a > 0.66 at the 5σ level. The high spin found here is indicative of growth by coherent accretion for this black hole, and suggests that black-hole growth at 0.5 ≤ z ≤ 1 occurs principally by coherent rather than chaotic accretion episodes.

A 200-second quasi-periodicity after the tidal disruption of a star by a dormant black hole.

Supermassive black holes (SMBHs; mass is greater than or approximately 10(5) times that of the Sun) are known to exist at the center of most galaxies with sufficient stellar mass. In the local universe, it is possible to infer their properties from the surrounding stars or gas. However, at high redshifts we require active, continuous accretion to infer the presence of the SMBHs, which often comes in the form of long-term accretion in active galactic nuclei. SMBHs can also capture and tidally disrupt stars orbiting nearby, resulting in bright flares from otherwise quiescent black holes. Here, we report on a ~200-second x-ray quasi-periodicity around a previously dormant SMBH located in the center of a galaxy at redshift z = 0.3534. This result may open the possibility of probing general relativity beyond our local universe.

Using thiamine to reduce post-ECT confusion.

Cognitive side-effects are commonly seen following electroconvulsive therapy which convey no therapeutic benefit but are troublesome to both patient and clinician. Various efforts have been made in the past to minimize these symptoms. Although modification of technical parameters related to ECT administration has led to some limited improvement in this regard, attention is now being increasingly focussed on pharmacological approaches. A number of agents have been explored in this context, however, as far as we are aware, the use of thiamine has not yet been investigated. We present three cases of elderly patients undergoing ECT for major depression in whom thiamine administration was associated with beneficial effects on post-ECT confusion. We review the evidence suggesting that thiamine deficiency may be implicated in the confusional state following ECT and recommend that consideration be given to its use in preventing and treating this problematic side-effect, especially in elderly patients.

An investigation into the pathogenesis of vulvo-vaginal candidosis.

OBJECTIVE: To monitor yeasts isolated from women during and between episodes of recurrent vulvo-vaginal candidosis (VVC) to determine whether vaginal relapse or re-infection occurred. METHODS: Women presenting at the genitourinary medicine clinic with signs and symptoms of VVC were recruited to the study (n = 121). A vaginal washing, high vaginal swab (HVS) and rectal swab were taken and the women treated with a single 500 mg clotrimazole pessary. Women were asked to re-attend after 1, 4, and 12 weeks, or when the VVC recurred, when vaginal washings and HVS were repeated. Candida isolates recovered were strain typed using the Ca3 probe and their similarity assessed. Antifungal susceptibility to fluconazole and clotrimazole were determined. RESULTS: Of the women recruited, 47 completed the study, either returning for four visits or suffering a recurrence during the study period. Of the 22 women who experienced recurrence, the same strain was responsible for the initial and recurrent episode in 17 women. For the remaining five women, four had strain replacement and one had a change of species. None of the isolates recovered from the women demonstrated resistance to either clotrimazole or fluconazole. CONCLUSIONS: Our findings support the theory of vaginal relapse and thus may support the use of more prolonged courses of antifungal therapy initially to increase the chances of eradication of the yeast.

Combined cervical swab and urine specimens for PCR diagnosis of genital Chlamydia trachomatis infection.

OBJECTIVES: Sampling of both the cervix and urine increases the chance of detection of Chlamydia trachomatis compared with sampling either site alone. We determined the effect of combining urine and cervical swab specimens in the clinic setting on the sensitivity of C trachomatis polymerase chain reaction (PCR) testing. METHODS: For each of 100 women attending a genitourinary medicine clinic with high likelihood of genital C trachomatis infection, one endocervical swab was placed in transport medium and another in one of two aliquots of first void urine. Four PCR assays per patient (urine + swab, swab alone, and urine alone both pre- and post-freeze-thawing) were processed by automated C trachomatis PCR (Cobas, Amplicor). An inhibition control was included with each assay to identify specimens containing PCR inhibitors. RESULTS: 71% of women were Amplicor C trachomatis PCR positive (according to the results of at least one specimen). PCR test results were concordant for 95/100 patients, and of the five discordant result sets there was only one major discrepancy. Inhibitors of PCR were present in 22/400 specimens from 20 patients, and 16/22 were cervical swabs (p < 0.001). CONCLUSIONS: Combining a cervical swab with a urine specimen is acceptable for PCR testing for genital C trachomatis infection, and has the potential to increase further the cost effectiveness of DNA based screening for C trachomatis genital infection.

Vaginal yeasts in the era of "over the counter" antifungals.

OBJECTIVE: To establish whether there has been any rise in the prevalence of non-albicans Candida species isolated from vaginal swabs since the introduction of "over the counter" antifungal treatments. METHOD: A retrospective review looking at all positive vaginal yeast isolates collected from women attending one genitourinary medicine clinic during the 6 year period from 1993 to 1998 inclusive. All positive vaginal yeast isolates were included, regardless of whether or not the patients were symptomatic. Isolates from HIV positive women were excluded from the analysis. RESULTS: No increase in non-albicans vaginal yeast isolates was shown during the period studied. The proportion of non-albicans yeasts remained constant at approximately 5% of the total yeasts isolated. The most common non-albicans yeast isolated was C glabrata. CONCLUSION: There is no evidence from this study to suggest that the increasing use of "over the counter" antifungal treatment has selected for atypical, possibly inherently azole resistant, strains of vaginal yeasts in HIV seronegative women.

Biological effects of recombinant human tumor necrosis factor and its novel muteins on tumor and normal cell lines.

We investigated optimal conditions for cytotoxicity to tumor cell lines by recombinant human tumor necrosis factor (rhTNF) and the effect of amino-terminal deletions on the bioactivity of the rhTNF molecule. Two of four deletion muteins (-4 and -7) of rhTNF exhibit 2- to 3-fold enhancement of cytotoxicity/cytostasis against a variety of human carcinomas, a fibrosarcoma, and a melanoma cell line with no toxicity on normal fibroblastic and epithelial cultures. Of the two other muteins the -8 displayed equivalent and/or increased cytotoxicity/cytostasis while the -10 was consistently less cytotoxic than the parent on the same cell lines. Continuous exposure to TNF for greater than or equal to 96 h led to maximal cytotoxicity to tumor lines (99.99% with L929 cells) with no evidence of recovery. Pretreatment with actinomycin D (0.003-10 micrograms/ml for 1 h) rendered 82% of rhTNF-resistant cell lines (both tumor and normal) susceptible to its cytotoxic action within 24 h. However, the highest nontoxic concentrations of Actinomycin D necessary for rendering normal cell lines susceptible to TNF action were about 10-3000-fold higher than those necessary for converting resistant tumor cell lines. Similarly, preinfection of L929 cells with vesicular stomatitis virus (multiplicity of infection, 10(-2)-10(-4) for 1 h) rendered the cells 2-10-fold more susceptible to the cytotoxic action of rhTNF in 18 h. Our data suggest that rhTNF and its muteins represent potentially useful anticancer agents; however, adequate dosing and prolonged exposure may be critical in demonstrating cytotoxicity/cytostasis. The data also show that although normal and tumor cell lines became susceptible to cytotoxicity by rhTNF and actinomycin D, combination therapy of the two agents may be possible at defined concentrations.

Cures and partial regression of murine and human tumors by recombinant human tumor necrosis factor.

We tested the effect of recombinant human tumor necrosis factor (TNF) on the growth of the murine methylcholanthrene induced fibrosarcoma and the human ovarian carcinoma (NIH:OVCAR-3) in mice. The mice received multiple doses (25-250 micrograms/kg) of TNF starting 7-10 days after s.c. transplantation of tumors when they were easily palpable. TNF was administered i.v. every other day for a total of 6 injections per mouse, or i.p. daily for 7 days. Complete tumor regression was observed in the methylcholanthrene induced tumor bearing mice in 90% of the mice treated with TNF (100 micrograms/kg), 67% treated with TNF (50 micrograms/kg), and 34% treated with TNF (25 micrograms/kg). Tumors which did not completely regress were growth retarded during the course of TNF treatment. All mice given the highest TNF dose are still alive and tumor free (currently over 400 days), whereas the median survival of control mice was 28-39 days. Partial regression was observed in 100% of mice bearing the ovarian carcinoma treated i.p. with 250 micrograms/kg. Injections of TNF i.v. resulted in higher percentage of cures than i.p. injections at similar dose levels. These results suggest that tumor necrosis factor represents a likely potent drug against solid tumors and that the method of administration is critical in optimizing its use in cancer.

Anticaries and antiplaque potential of free-fatty acids in vitro and in vivo.

The efficacy of several fatty acids as antimicrobial, antiplaque, and anticaries agents, as well as their ability to inhibit hydroxyapatite dissolution were examined. All effectively inhibited bacterial growth. Lauric, linoleic, and oleic acids decreased plaque formation and lauric acid inhibited hydroxyapatite dissolution. When used in the food, lauric acid decreased caries in rats, but not significantly.

Differentiation of fluorescent pseudomonads by their effect on milk agar.

Eighty-six clinical isolates of fluorescent pseudomonads that did not produce pyocyanin on Diagnostic Sensitivity Test Agar or Cetrimide Agar were identified on the basis of their antibiotic sensitivity, production of pigment on King's "A" medium, growth at 42 degrees C, production of lecithinase and hydrolysis of gelatin. The identity of the strains was confirmed in tests with the ammonium salt sugars ethanol, glucose and mannitol. These tests were adequate for distinguishing between the three important fluorescent pseudomonads. The detection of casein hydrolysis on milk agar was assessed as a rapid method of distinguishing P. aeruginosa from the other species of fluorescent pseudomonads but proved unhelpful when compared with, or included in, a small set of tests. Most strains of P. aeruginosa and P. fluorescens hydrolysed casein.

Schizophrenia and coeliac disease--the nature of the relationship.

To test the hypothesis of an association between schizophrenia and coeliac disease, the sera of 380 chronic schizophrenic in-patients in two mental hospitals in the West of Ireland have been screened for the presence of reticulin antibodies. Antibodies were found in 26 patients. Twenty-one of these patients were further studied by proximal duodenal mucosal biopsy. None of the biopsies showed the morphological and histological features found in untreated coeliac disease. The incidence of reticulin antibodies in schizophrenic patients and controls is similar. The findings of this study lead to the rejection of the hypothesis of a positive genetic relationship between schizophrenia and coeliac disease.

Lumbo-sacral fusion with spring fixation.

A method of posterior lumbo-sacral fusion is described in which springs are used to fix the grafts and to maintain immobilisation. Fifty patients with lumbar disc degeneration or spondylolisthesis have been reviewed. The results have been assessed clinically by grading the symptoms before and after operation. Stay in hospital has been short and return to work rapid. There has been a high proportion of good results.