Developing caring connections: mentorship in the academic setting.

The mentoring connections that we have experienced in our school of nursing have eased difficult situations and have promoted self-awareness, personal and professional growth, and leadership behaviors. Various circumstances result in behaviors reflective of issues of culture, race, self-esteem and knowledge, values, ethics, experience, and conflict management. Some of these issues are related to oppressed group behavior, inadequate communication and conflict resolution skills, lack of exposure to diverse academic and professional experiences, and a need to learn management of feelings in effective ways. As faculty, administrators, students, and alumni, we struggle with those issues, knowing that resolution of them is beyond the traditional modes of teaching-learning, academic relationships and professional socialization. We wish that we and our students and alumni will experience an increased connectedness to the school and profession. We also wish that we might, as a result of our mentor connections, individually and collectively develop self-determination, self-esteem and confidence, leadership skills, and inner directness. The Mentor Connection Program was initiated in response to these strong wishes and has been a motivating framework for the reciprocal growth in us all. As for the future, we will continue our research and evaluation studies, refine the matching criteria, support and expand the mentoring dyads, strengthen faculty-faculty mentoring relationships, and seek funding resources for expansion and research. We are seeing the positive effects of active mentoring on students, faculty, and alumni on issues related to teaching and learning, support, hardiness, and self-reflection. Mentors produce leaders. Nursing's collective leadership will, we believe, depend to a large extent on our mentoring relationships with each other.

Role of glutamine in bacterial transcytosis and epithelial cell injury.

BACKGROUND: L-Glutamine is the principal energy source for small intestinal enterocytes. Diminution of intestinal function, mucosal atrophy, and increased bacterial translocation have been noted during total parenteral nutrition (TPN). In a rat model of glutamine starvation, we previously showed that luminal glutamine is essential for optimal intestinal function. In this study, we examined the effect of apical vs basolateral glutamine on bacterial translocation in a Caco-2 cell culture system and bacteria-induced tissue injury in a weanling rabbit ileal loop model. METHODS: Caco-2 cells were grown in a transwell system. After confluence, apical and basolateral chambers received defined media, and glutamine deprivation was carried out over a 4- to 48-hour period. Escherichia coli transcytosis and structure/function studies were then performed. In a second series of experiments, the effect of intraluminal glutamine supplementation was evaluated in an E. coli-induced tissue injury model in weanling rabbit ileal loops. RESULTS: Expression of disaccharidases, glucoamylase, and Na+/K(+)-adenosine 5'-triphosphatase (ATPase) were significantly reduced when cells were deprived of glutamine from the apical side, and there was increased bacterial translocation across the monolayer. Transepithelial epithelial resistance (TEER) across the monolayer was also reduced in the glutamine-free cultures. Glutamine replenishment over 24 to 48 hours restored the original functions. Basolateral deprivation had a smaller effect on the Caco-2 cells. Typical necrotic mucosal injury caused by E. coli in the ileal loops was blocked by co-infiltration of the loops with glutamine. CONCLUSIONS: This study demonstrates for the first time that the supply of glutamine from the apical side is of critical importance for maintaining optimal structure and function of the enterocytes. The effects are not acute or energy related. These observations have important clinical implications in the management of patients under critical care, including premature infants and patients receiving TPN, for whom lack of glutamine from the luminal side could produce mucosal dysfunction, resulting ultimately in severe atrophic/necrotic complications.

Escherichia coli transcytosis in a Caco-2 cell model: implications in neonatal necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) is a serious gastrointestinal disorder of preterm infants. Other than an association with prematurity and gastrointestinal feeding, no single factor or mechanism has been consistently linked to this disease. We have previously demonstrated that Escherichia coli isolates obtained from the stool of infants with NEC caused NEC-like injury in a weanling rabbit ileal loop model; this injury, in turn, could be blocked by coinfection with selected Gram(+) bacteria (Enterococcus faecium) isolated from asymptomatic controls. Using Caco-2 cells in a trans-well system, we now demonstrate that the same E. coli isolates can cross epithelial cell monolayers in the absence of ultrastructural change or damage. These results with E. coli contrast with those seen with Salmonella typhimurium, which passed through the monolayer at a higher rate and were associated with striking ultrastructural damage. Transcytosis of E. coli was reduced 3-5-fold in the presence of E. faecium previously shown to block NEC-like injury in the loop model. There was a mild increase in the rate of E. coli transcytosis when studies were conducted with younger, undifferentiated cells; these immature cells had no brush border, had decreased production of brush border-specific enzymes, but retained well defined tight junctions, as demonstrated by transepithelial electrical resistance and electron microscopy. A further reduction/ complete blockage of E. coli transcytosis was observed when E. faecium was used as the coinfectant in studies with these undifferentiated cells. We hypothesize that the ability of E. coli to cross epithelial cell layer is a critical initial step in the cascade of events which lead ultimately to NEC; blockage or reduction in E. coli transcytosis in the presence of certain Gram(+) organisms may play a significant role in prevention of NEC.

The natural history of cervical intraepithelial neoplasia as determined by cytology and colposcopic biopsy.

The smears preceding the histologic diagnosis of cervical intraepithelial neoplasia (CIN 3) were examined in 100 consecutive cases from an intensively screened population. In 60 patients, negative cytology has been recorded prior to the development of dysplasia; in 27 this had occurred within two years of the histologic diagnosis. These findings suggest that the transition time from epithelial normality to CIN 3 may be shorter than has been generally assumed; therefore, the intensity and frequency of screening should be reviewed.

An immunohistochemical study of the distribution of epithelial antigens in the uterine cervix.

Neoplastic and nonneoplastic tissue from human uterine cervixes was stained immunohistochemically for three epithelial antigens--epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), and cytoplasmic keratin. Anti-EMA serum stained four of 21 nonneoplastic cases and all cases of cervical intraepithelial neoplasia (CIN) (25) and invasive carcinoma (16); CEA was positive in six of ten of the nonneoplastic specimens, 19 of 23 CIN specimens, and six of seven invasive carcinomas tested. Cytoplasmic keratin did not survive fixation in formal saline and for this antigen tissue had to be fixed in methacarn; all the tissues examined were positive.

Changing pattern of cervical intraepithelial neoplasia seen in a family planning clinic.

PIP: The files of 55,411 patients who attended the Margaret Pyke Center, the largest family planning center in Europe, between January 1971-December 1980, were examined. There was over the years a dramatic increase in the number of cases of cervical intraepithelial neoplasia and of invasive carcinoma. In 1980, 4% of women had abnormal smears at presentation. There is evidence that age, parity, and social class of the population examined have remained unchanged. No data were available on changes in sexual practice, contraceptive use, or the incidence of venereal diseases. These figures must be considered in the light of the frequency and success of cytological screening during the past few years.^ieng

Medical mismanagement or patient vacillation?

KIE: One theme of London University lawyer Ian Kennedy's 1980 Reith Lectures on medical ethics was the need to change the emphasis in physician patient relations from paternalism on the part of doctors to self determination on the part of patients. Bamford, a specialist in obstetrics and gynecology, demonstrates how reality can fall short of the ideal by presenting a case where decisions made by a patient after thorough consultation and counseling with her doctors were consistently inappropriate to her needs.^ieng