Establishing a Telephone Medication Order Policy and Protocol for a Small Private Hospital in Jamaica.

OBJECTIVE: To institutionalize an evidence-based policy/protocol adapted from the Agency for Healthcare Research and Quality (AHRQ) national medication standards for managing telephone medication orders (TMO) and to determine the impact of the policy/protocol on the number of telephone medication errors (TME) on two medical units of a small private hospital in Jamaica. METHODS: Kotter's Eight-step Change Model was used to facilitate organizational change among nurses and physicians by teaching and implementing the TMO policy/protocol adapted from AHRQ standards and collecting pre-policy and post-policy frequency of TMEs. A convenience sample of 80 nurses and physicians participated in training about the policy/protocol, took post-instructional tests and participated in the implementation of the policy/protocol. Chart audits over six weeks monitored adherence to the policy/protocol. The annual monthly mean of TMEs for the prior year was compared with the number of TMEs just prior to implementation of policy/protocol and at the end of the first six weeks of implementation. RESULTS: One hundred per cent of the convenience sample of 80 nurses and doctors passed the post-instructional test; the workforce adhered fully to the protocol during six weeks of implementation, and there was a 100% reduction in TMEs between the prior year and six weeks after policy/protocol implementation. CONCLUSIONS: Kotter's eight-step framework of organizational change was a successful strategy in institutionalizing and sustaining adherence to the TMO policy/protocol, reducing the number of TMEs and positively influencing the organizational culture.

Low reproductive isolation and highly variable levels of gene flow reveal limited progress towards speciation between European river and brook lampreys.

Ecologically based divergent selection is a factor that could drive reproductive isolation even in the presence of gene flow. Population pairs arrayed along a continuum of divergence provide a good opportunity to address this issue. Here, we used a combination of mating trials, experimental crosses and population genetic analyses to investigate the evolution of reproductive isolation between two closely related species of lampreys with distinct life histories. We used microsatellite markers to genotype over 1000 individuals of the migratory parasitic river lamprey (Lampetra fluviatilis) and freshwater-resident nonparasitic brook lamprey (Lampetra planeri) distributed in 10 sympatric and parapatric population pairs in France. Mating trials, parentage analyses and artificial fertilizations demonstrated a low level of reproductive isolation between species even though size-assortative mating may contribute to isolation. Most parapatric population pairs were strongly differentiated due to the joint effects of geographic distance and barriers to migration. In contrast, we found variable levels of gene flow between sympatric populations ranging from panmixia to moderate differentiation, which indicates a gradient of divergence with some population pairs that may correspond to alternative morphs or ecotypes of a single species and others that remain partially isolated. Ecologically based divergent selection may explain these variable levels of divergence among sympatric population pairs, but incomplete genome swamping following secondary contact could have also played a role. Overall, this study illustrates how highly differentiated phenotypes can be maintained despite high levels of gene flow that limit the progress towards speciation.

Historia de Chile en la vida de un médico Alfredo Jadresic V / History of Chile in the life of a Alfredo Jadresic V., M.D

Esta obra es la autobiografía de un ex Decano de la Faculdad de Medicina de la Universidad de Chile, durante la época de la Reforma Universitaria (1968-1973), prologada por el ex Presidente Ricardo Lagos Escobar, quien fuera a la vez Secretario General de dicha Universidad en ese periodo. En un volumen con 12 capítulos, tres anexos con documentos y numerosas fotografías con importantes personajes de la vida política de Chile, esta autobiografía se puede dividir en tres partes. En la primera, el autor describe sus antecedentes familiares y su educación de pre y post grado, en Chile y en el extranjero. La segunda parte culmina con la Reforma Universitaria, el gobierno de la Unidad Popular y el golpe de Estado de 1973. La parte final trata de su exilio en Inglaterra, sus éxitos académicos y el retorno a Chile, en 1989. donde colabora en la renovación de los Estatutos de su Universidad y es nombrado Profesor Emérito.

[A journey to the foundations of classical medicine]. / Peregrinaciones a las fuentes de la medicina clásica.

The author narrates his trips, between 1951 and 2006, to the main historical sites of antique medicine, where physicians of pre-Columbian cultures of Mexico and Peru, Egypt, Greco Latin culture and Islamic civilizations, lived. The trip ends with a visit to medieval European medicine before Renaissance. A description of the main historical sites and the features of these medical and sanitary cultures is made. In antique civilizations, diseases were considered a punishment of pagan deities. Supernatural and magical influences were decisive in medical practice. The Greco Latin culture of Galen and Hippocrates freed manhood from these causes of diseases and gave a rational basis to the practice of medicine. The Islamic civilization allowed the transmission of Greco Latin culture to medieval Europe. This permitted the renaissance of European creativity and the foundation of modern scientific medicine in the sixteenth century. The author highlights the main virtues of classical Greco Latin medicine, that are the foundations of humanistic thoughts that will restrin the technological revolution of modern medicine.

Peregrinaciones a las fuentes de la medicina clásica / A journey to the foundations of classical medicine

The author narrates his trips, between 1951 and 2006, to the main historical sites of antique medicine, where physicians of pre-Columbian cultures of Mexico and Peru, Egypt, Greco Latin culture and Islamic civilizations, lived. The trip ends with a visit to medieval European medicine before Renaissance. A description of the main historical sites and the features of these medical and sanitary cultures is made. In antique civilizations, diseases were considered a punishment of pagan deities. Supernatural and magical influences were decisive in medical practice. The Greco Latin culture of Galen and Hippocrates freed manhood from these causes of diseases and gave a rational basis to the practice of medicine. The Islamic civilization allowed the transmission of Greco Latin culture to medieval Europe. This permitted the renaissance of European creativity and the foundation of modern scientific medicine in the sixteenth century. The author highlights the main virtues of classical Greco Latin medicine, that are the foundations of humanistic thoughts that will restrin the technological revolution of modern medicine.

Peregrinaciones a las fuentes de la medicina clásica / A journey to the foundations of classical medicine

The author narrates his trips, between 1951 and 2006, to the main historical sites of antique medicine, where physicians of pre-Columbian cultures of Mexico and Peru, Egypt, Greco Latin culture and Islamic civilizations, lived. The trip ends with a visit to medieval European medicine before Renaissance. A description of the main historical sites and the features of these medical and sanitary cultures is made. In antique civilizations, diseases were considered a punishment of pagan deities. Supernatural and magical influences were decisive in medical practice. The Greco Latin culture of Galen and Hippocrates freed manhood from these causes of diseases and gave a rational basis to the practice of medicine. The Islamic civilization allowed the transmission of Greco Latin culture to medieval Europe. This permitted the renaissance of European creativity and the foundation of modern scientific medicine in the sixteenth century. The author highlights the main virtues of classical Greco Latin medicine, that are the foundations of humanistic thoughts that will restrin the technological revolution of modern medicine. (AU)

Development of the new lung allocation system in the United States.

This article reviews the development of the new U.S. lung allocation system that took effect in spring 2005. In 1998, the Health Resources and Services Administration of the U.S. Department of Health and Human Services published the Organ Procurement and Transplantation Network (OPTN) Final Rule. Under the rule, which became effective in 2000, the OPTN had to demonstrate that existing allocation policies met certain conditions or change the policies to meet a range of criteria, including broader geographic sharing of organs, reducing the use of waiting time as an allocation criterion and creating equitable organ allocation systems using objective medical criteria and medical urgency to allocate donor organs for transplant. This mandate resulted in reviews of all organ allocation policies, and led to the creation of the Lung Allocation Subcommittee of the OPTN Thoracic Organ Transplantation Committee. This paper reviews the deliberations of the Subcommittee in identifying priorities for a new lung allocation system, the analyses undertaken by the OPTN and the Scientific Registry for Transplant Recipients and the evolution of a new lung allocation system that ranks candidates for lungs based on a Lung Allocation Score, incorporating waiting list and posttransplant survival probabilities.

Evolución de las universidades chilenas 1981-2004 / The evolution of Chilean universities from 1981 to 2004

In 1981, a supreme decree allowed the creation of private universities in Chile. As a consequence, 50 new universities were created in one decade, under the surveillance of the Council for Superior Education. This paper analyzes the evolution of this expansion process, that resulted in an admission of 370,000 students to 60 universities along the country, during 2004. At the moment, 42% of the universities, designed as traditional, receive state financing and 58% are private. Twenty six percent are owned by the state, 52% are secular and 22% are confessional. The 25 traditional universities are complex organizations of a high academic level. New private universities are only devoted to teaching and some have obtained their autonomy. Some have improved the quality of their academic staff, perform research and impart doctorate degrees. However, most are small and with a limited academic staff. Traditional universities are stratified in a superior level. Eight private universities and some regional institutions, that are becoming complex and performing research activities, are stratified in a middle level. Two thirds of the private universities are in the lower level. The expansion of superior education is a sign of the social and cultural progress that Chile has experienced.

The preparation, characterisation and solubility characteristics of a hydrogen-bonded complex between acyclovir and cytosine.

Acyclovir and cytosine form a Crick-Watson hydrogen-bonded complex in dimethylsulphoxide (DMSO). For the complex formation Acyclovir + cytosine reversible complex the equilibrium constant, K, was determined using NMR spectroscopy to be K = 1.00 +/- 0.07 mol-1 dm3 at 21 degrees C in DMSO. The acyclovir-cytosine complex was formed in DMSO, then diluted with octan-1-ol to leave a 95.3% v/v octan-1-ol/47% v/v DMSO solution, and demonstrated a 12-fold increase in the saturated solubility of acyclovir. This was compared to a solution of acyclovir alone treated in the same manner. This suggests that a complex species of acyclovir with cytosine has a greater lipophilic character than acyclovir alone. Attempts to increase the octan-1-ol/water partition coefficient for acyclovir produced no significant increase with the presence of cytosine. It was argued that no complexation would occur in water due to the rapid exchange of the protons that are involved in the hydrogen-bonded complex. Experiments to isolate the solid acyclovir-cytosine Crick-Watson hydrogen-bonded complex were performed. Spectra and T1 relaxation times obtained during subsequent solid-state 13C NMR experiments provided evidence that a solid complex can be isolated.