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Biomedical subjects

L Turnberg

Publications and source records attributed to L Turnberg.

10 recordsLinked to original sources
PubMed2003

Common sense and common consent in communicable disease surveillance.

The need to protect the public against the spread of communicable (infectious) disease provides a good example of the need for a commonsense approach to the use of confidential data. Laboratories need to notify different professionals in order to trace the sources of outbreaks of infection and eradicate the cause. It is often not possible to obtain consent from individual patients, given the rapid time scale required. In doing so, however, laboratory staff and others would contravene the Data Protection Act in passing on information without consent. Section 60 of the Health and Social Care Act was designed to overcome barriers to research relying on data accumulated in the past and this type of public health work. But this is proving a sluggish procedure. It is an awkward solution to the problem of data use without specific consent. This problem will be overcome only when the public can have sufficient trust in safeguards that are in place to protect their safety and confidentiality so that these important activities can be pursued without specific informed consent.

Communicable Disease Control↗
PubMed1991

Cellular basis of diarrhoea. The Croonian lecture 1989.

A wide range of different stimuli is perceived by the intestinal epithelium. They include luminal factors, especially bacterial toxins, and agonists such as inflammatory mediators and neuro peptides, acting from the interstitial fluid surrounding the epithelial cells. It is likely that in any individual patient with diarrhoea there is a range of stimuli acting upon the epithelium. Specific receptors on the apical and basolateral membrane, activated by these stimuli, transduce the perceived signals to stimulate a series of membrane-bound enzyme systems. They in turn generate second messengers which are liberated into the cytoplasm. These include cyclic adenosine monophosphate, cyclic guanosine monophosphate, inositol triphosphate (which goes on to liberate free calcium), and diacyl glycerol. Each of these second messengers activates a different protein kinase, each of which then induces the phosphorylation of a series of cytoplasmic and membrane-bound proteins. Each of the protein kinases is likely to influence the activity of the others so that their effects are closely integrated. The final common pathways through which intestinal secretory stimuli pass involve the opening of an anion channel in the apical membrane, together with the stimulated uptake of chloride at the basolateral membrane. Anions, especially chloride and possibly bicarbonate, are then secreted into the lumen, and sodium and water passing between the cells accompany them. The net result is secretion of salt and water, which lies at the centre of a number of diarrhoeal diseases.

Diarrhea↗
PubMed1987

Evidence that PGE2 stimulates intestinal epithelial cell adenylate cyclase by a receptor-mediated mechanism.

These studies were performed to examine whether prostaglandin E2 stimulates intestinal epithelial secretion via a receptor-mediated or non-receptor-mediated activation of adenylate cyclase. Solubilization of epithelial cell adenylate cyclase with Lubrol PX, which separates the receptor moiety of the cyclase from the remainder of the complex, inhibited the prostaglandin E2 stimulation of the cyclase. A similar result was obtained with VIP, which activates adenylate cyclase via a receptor-mediated mechanism, whereas fluoride, gamma S-GTP, and forskolin, which activate the cyclase via non-receptor-mediated mechanisms, all stimulated solubilized adenylate cyclase. In addition, prostaglandin E2 and VIP both showed a dependence on GTP for adenylate cyclase stimulation while fluoride and forskolin did not. These data suggest that prostaglandin E2 activates intestinal mucosal adenylate cyclase by a receptor-mediated mechanism. The presence of such receptors lends support to the possibility that prostaglandins have a physiological role in the control of mucosal transport.

Adenylyl Cyclases↗
PubMed1982

Effects of morphine on net water absorption, mucosal adenylate cyclase activity and PGE2 metabolism in rat intestine.

Morphine (10 mg/kg s.c.) was shown to increase net basal water and electrolyte absorption in rat ileum and colon perfused in vivo. These effects were significantly greater in the ileum. Under the same conditions of dosage and time course of administration the activities of relevant mucosal enzymes were studied. Ileal mucosal adenylate cyclase stimulated by prostaglandin E2 (PGE2) in vitro was inhibited by morphine pretreatment. Colonic stimulated cyclase activity was unaffected as were basal activities in both regions. Morphine did not alter the activities of enzymes involved in PGE2 metabolism and is unlikely to act by modulating endogenous PG levels. Transport ATPase activities, were also unchanged in morphine treated animals. These results are discussed in relation to the mechanism of action of morphine on intestinal mucosa.

Adenylyl Cyclases↗
PubMedDate not supplied

Science, society and the perplexed physician.

In a time of changing attitudes to science and medicine, Lord Turnberg asks whether there is a future for the physician. The population has never been healthier, but, paradoxically, the public seems to be more afraid then ever of death and illness. As more information becomes available in the public arena, anxious patients want certainty when choices almost always have to be offered in the absence of certainty. The author speculates that in this brave new world the need for physicians will increase rather than the reverse. However, physicians must recognise that effective communication, empathy, and compassion are as essential to their role as scientific knowledge and understanding.

Anxiety↗
PubMedDate not supplied

Continuing medical education in the NHS.

Knowledge and skills gained during training soon become outdated unless doctors continue to educate themselves. Patients do, and managers should, expect doctors to be up-to-date. It is a professional obligation in which the royal colleges are leading the way.

Certification↗