Biomedical subjects
Publications and source records attributed to Roger James.
The identification, synthesis and SAR of a novel series of glucokinase activators is described. The interplay between lipophilicity, potency and physical properties is discussed, and compound 22 highlighted as having a suitable balance. In vivo pharmacokinetic and acute efficacy studies on this compound are also presented.
Distinctive anatomical features can be witnessed in the ankle/foot complex, affording specific pathological conditions. Disorders of the ankle/foot complex are multifactoral and features in both the clinical anatomy and biomechanics contribute to the development of ankle/foot pain. The superior tibiofibular, distal tibiofibular, talocrural, subtalar, and midtarsal joint systems must all participate in function of the ankle/foot complex, as each biomechanically contributes to functional movements and clinical disorders witnessed in the lower extremity. A clinician's ability to effectively evaluate, diagnose, and treat the distal lower extremity is largely reliant upon a foundational understanding of the clinical anatomy and biomechanics of this complex complex. Thus, clinicians are encouraged to consider these distinctions when examining and diagnosing disorders of the ankle/foot.
Diagnosis, interpretation, and subsequent management of ankle/foot pathology can be challenging to clinicians. A sensitive and specific physical examination is the strategy of choice for diagnosing selected ankle/foot injuries and additional diagnostic procedures, at considerable cost, may not provide additional information for clinical diagnosis and management. Because of a distal location in the sclerotome and the reduced convergence of afferent signals from this region to the dorsal horn of the spinal cord, pain reference patterns are low and the localization of symptoms is trustworthy. Effective management of the painful ankle/foot is closely linked to a tissue-specific clinical examination. The examination of the ankle/foot should include passive and resistive tests that provide information regarding movement limitations and pain provocation. Special tests can augment the findings from the examination, suggesting compromises in the structural and functional integrity of the ankle/foot complex. The weight bearing function of the ankle/foot compounds the clinician's diagnostic picture, as limits and pain provocation are frequently produced only when the patient attempts to function in weight bearing. As a consequence, clinicians should consider this feature by implementing numerous weightbearing components in the diagnosis and management of ankle/foot afflictions. Limits in passive motion can be classified as either capsular or non-capsular patterns. Conversely, patients can present with ankle/foot pain that demonstrates no limitation of motion. Bursitis, tendopathy, compression neuropathy, and instability can produce ankle/foot pain that is challenging to diagnose, especially when they are the consequence of functional weight bearing. Numerous non-surgical measures can be implemented in treating the painful ankle/foot, reserving surgical interventions for those patients who are resistant to conservative care.
Interprofessional education among health care professionals has been recommended as a way to improve the quality of services. This paper analyses the results of an evaluative study of a practitioner-led, interprofessional programme for preregistration health care students, the Trust-Based Education and Training Programme, developed by South West London and St George's Mental Health NHS Trust in collaboration with several local universities.
The UK is facing a major shortage of registered nurses. One government strategy for addressing this shortage has been the nationwide increase in the nursing student population. Large student cohorts have resulted in placements being overcrowded with students and, as a consequence, the quality of learning experiences has diminished. A mental health NHS trust in London in partnership with local higher education institutes has created a framework to relieve the pressure on placements. This article discusses the implementation of the framework and outlines the results, challenges and recommendations.