It is now widely accepted that effective interpersonal communication is at the heart of quality health care delivery but that current standards in medicine must be improved (Numann 1988; Cowan et al. 1992). One approach acknowledged by the General Medical Council (1991) devotes more attention during training to the theme of communication, and quite significant modifications of the undergraduate medical curriculum are presently taking place. This article documents the results of a postal survey of the 26 UK Schools of Medicine, designed to illuminate current practices and future plans in respect of communication skills training (CST). As such, it takes advantage of the present period of ongoing curricular innovation and change to extend and update earlier reviews (Whitehouse 1991; Frederikson & Bull 1992). A total of 19 responses was received. Following preliminary analysis, the four schools who had already implemented their new curriculum were selected for further in-depth investigation by means of telephone interviews. In addition to reporting frequencies and percentages for responses to questions, cross-tabulations were carried out to explore relationships between certain of the findings. Apart from some consistency in CST teaching methods adopted, the overall picture to emerge is one of considerable variability in such areas as course content, timing, duration and assessment. Foremost among the difficulties encountered in implementing CST appeared to be lack of adequate physical resources and suitably trained staff. Future plans were often sketchy and inchoate. Results are discussed and tentative recommendations for the further development of CST in the medical curriculum proffered.
Background/Question/Methods:
Evergreen plants, growing in seasonally cold environments, must cope with a severe imbalance between light absorption and its utilization, as low temperatures during winter inhibit photosynthetic carbon reduction. In such conditions photoprotective mechanisms are critical, including the leaf antioxidant systems of plants. In a previous study examining Taxus cuspidata, we found significant increases in the enzyme glutathione reductase (GR) and the metabolite glutathione (GSH) during winter, but no increases in the enzymes superoxide dismutase, ascorbate peroxidase (APX) or the metabolite ascorbate (ASC). These results led to the hypothesis that GR and GSH serve an important role during winter stress that was separate form their role in the ascorbate glutathione cycle. The goal of this study was to examine the seasonal response of several species of conifers in order to determine if the differences in the antioxidant response observed in Taxus would occur generally in conifers during winter, or if there are species specific effects. We collected needle tissue in summer and winter from three conifer species: eastern white pine (Pinus strobus L.), balsam fir [Abies balsamea (L.) P. Mill], and white cedar (Thuga occidentalis L.). We analyzed the activity of both GR and APX and the amount of GSH and ASC.
Results/Conclusions:
Our results demonstrated significant increases in the antioxidant enzyme GR in all species in response to winter stress. The antioxidant enzyme APX showed significant winter increases in two species (pine and cedar) but not the third (fir). Preliminary results of the antioxidant metabolites glutathione and ascorbate show similar results. Our data suggest that the different species examined utilize different strategies for coping with excess excitation energy during winter. Pine and cedar apparently boost their overall antioxidant enzyme capacity and their utilization of the ascorbate glutathione cycle. Balsam fir shows a similar response to Taxus cuspidata, where glutathione reductase activity is significantly increased but ascorbate peroxidase activity is not. These results suggest a role for reduced glutathione in winter-stressed fir that is independent of its role in the ascorbate glutathione cycle.
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