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Medical director musical chairs. A reaffirmation of my career in medical management.

Losing your job can be a traumatic event. But you can minimize the shock by taking some action steps to find another job quickly--in many cases, even a better job. Consider some advice from a seasoned physician executive who has successfully negotiated the corporate maze found in many health care organizations today.

Career Mobility↗
PubMed1992

Etiology of dentin hypersensitivity.

Hypersensitive dentin appears to be mainly the result of an activation of the dentinal pain fibres, the A-fibres, at the pulpal wall. The stimuli which activate these nerves are primarily those which remove fluid from the dentinal tubules and mobilize capillary forces, causing a rapid outward flow. Application of a cold stimulus causes the fluid to contract, resulting in a similar rapid outward flow in the pulpal region of the tubules. Hypersensitivity to cold is also marked when there is a fluid-filled gap containing bacteria in the tooth. Experiments have shown that a freshly exposed dentin surface with patent tubules is more sensitive than a surface contaminated by a smear layer. Inflammation in the adjacent pulpal region can also increase sensitivity. The development of hypersensitive cervical and occlusal surfaces is due to mechanical and acidic effects from the oral environment, toothbrush abrasion, erosive components in the diet, plaque and bacterial invasion of dentin. Sometimes dentin is exposed by restorative therapy and occasionally eccentric occlusal loads can contribute to hypersensitivity. The sensitivity may persist unless the open tubular apertures are sealed.

Dental Pulp↗
PubMed2004

G-CSF: boosting endogenous production--a new strategy?

Granulocyte colony-stimulating factor (G-CSF) has been in clinical use for over a decade. Its main applications are in adjunctive medication to chemotherapy and in mobilizing stem cells for bone marrow transplantation. However, it has additional effects in that it primes neutrophilic granulocytes for improved host defense, and reduces the release of pro-inflammatory cytokines. These effects have prompted trials for numerous other indications. New research into the production and regulation of G-CSF in health and disease may now enable tailored strategies to induce or boost G-CSF formation. Similarly, new forms of application may increase its effectiveness.

Animals↗
PubMed2000

[Will transplantation of peripheral blood stem haematopoietic cells definitively replace bone marrow transplantation?].

Findings assembled for a long time, practically from the end of the Second World War along with modern technology of genetic engineering which brought mass production of growth factors led at the beginning of the nineties of the 20th century to a rapid rise of transplantations of peripheral stem cells. Without exaggeration it may be said that the last decade of the 20th century is the decade of transplantations of peripheral stem cells. Peripheral stem cells comprise a wide range of haematopoietic cells incl. stem cells which are after a stimulus (antitumour chemotherapy or growth factors) released from bone marrow in high concentrations into the peripheral blood stream from where they can be obtained very simply by modern blood cell separators. They are suitable for autologous as well as allogenic transplantations. In autologous applications they have almost replaced bone marrow. Restoration of haematopoiesis is after their use more rapid as the transplant is richer. As regards allogenic application caution is still apparent, although even their ratio is very significant. However a higher rate of reactions of the graft to the host is feared. It seems however that this fear is not justified and that the richer transplant of peripheral stem cells can ensure a higher anti-tumourous effect of the transplantation. Peripheral stem cells are also used successfully in transplantations after so-called non-myeloablative regimes. It is beyond doubt that the use of peripheral stem cells will increase further. We may expect application of other growth factors with a higher mobilizing capacity. Peripheral stem cells will be subjected to further modifications in vitro. It will be also possible to increase their amount. A rich transplant makes it also possible to use it in transplantations from haploidentic donors. No doubt stem cell suspensions will become the objective of gene therapy.

Bone Marrow Transplantation↗
PubMed2004

Issues in career progression in microbiology.

We are three highly motivated university graduates who are looking to begin careers in microbiology. We each attained a degree in a biological science discipline, one in biochemistry, one in microbial and cellular biology and one in biomedical sciences (the last gained in South Africa). However, the career obstacles we have so far encountered require us to be Olympic hurdlers. This article highlights the issues, and the advantages and disadvantages of the options open to us. We look at each career option in turn and describe the difficulties encountered.

Career Mobility↗
PubMed2005

The utility of the environmental scan for public health practice: lessons from an urban program to increase cancer screening.

The environmental scan is a tool that can be utilized to collect data to design health programs uniquely tailored to the needs of communities. However, it remains relatively undefined, unevaluated and underutilized in the field of public health. While individual studies indicate the utility of the environmental scan for public health, it is difficult to find a theoretical framework or guidelines on how to design, implement or evaluate the process within public health practice. The purpose of this study was to elicit lessons learned to maximize the utility of the environmental scan as a tool for public health. This process occurred through the development and implementation of an environmental scan as part of the needs-assessment phase of a project to increase cancer screening among African Americans in Baltimore, MD. Data collection methods for the environmental scan included a review of community stakeholders, cancer incidence and community assets and liabilities in target communities, focus-group sessions and key informant interviews with service providers. The environmental scan was conducted in 2003 and allowed for rapid acquisition and use of information about events, trends and relationships in the neighborhoods targeted for our project and enabled researchers to move forward with implementing the cancer-screening project. The researchers conclude that the environmental scan has considerable potential to be a creative, responsive, cost-effective and mobilizing tool for public health practice. However, further application and critical review are necessary to make it a more effective public health tool and an established research methodology.

Environmental Exposure↗
PubMed1991

The DeSyGNER data access element: a readily reusable component for the construction of data-compatible multimedia programs.

Dynamic assembly of applications from diverse and possibly disparate collections of information components is a key element for powerful information management environments. Traditional methods of application development hinder flexible integration of information components because they treat computer programs as single, isolated units of functionality where inter-application connections and sharing of intra-application information components are achieved only by special cooperation between program authors. Although many programmers strive to develop re-usable program code, it is rare that independently developed components can be readily combined into new applications. One of the major reasons for this is that there is no overall agreement as to the types of segments written, how the segments communicate, or how their data is stored. We have created a multimedia applications development architecture called DeSyGNER (the Decision Systems Group Nucleus of Extensible Resources) that provides a type-independent definition of the fundamental information-bearing unit for the construction of data-compatible applications. By incorporating a common high-level architecture and an intrinsically modular object-oriented design, DeSyGNER applications process information in smaller, isolatable, and more mobile and reusable units than do monolithic computer programs.

Computer Graphics↗
PubMed1989

[Dynamic transfixation in unstable dislocation fracture of the proximal interphalangeal joint].

Unstable fracture dislocations of the PIP-joint are difficult to manage, because the primary joint destruction and the necessity of immobilisation often result in joint stiffness and the loss of immobilisation may promote chronic subluxation. In the case described in the article we treated the unstable fracture dislocation with a dynamic transfixation with a "force couple splint" following the open reconstruction and internal fixation of the destroyed joint. The application of this dynamic transfixation allowed early active mobility exercising of the PIP-joint during bone healing and produced an excellent result.

Adolescent↗
PubMed1989

Assessment of tibial torsion and rotational deformity with a new fluoroscopic technique.

No conventional technique for routine assessment of tibial torsion and the twist of the distal versus the proximal articular axis of the tibia after reduction of a fracture has yet gained general acceptance. Considering the demands for availability, simplicity, applicability, and precision, a new method employing a mobile C-arm fluoroscope equipped with a protractor is used for assessment. After fracture reduction and stabilization by a mechanical method of fixation or by a conservative method with a plaster cast, the rotational situation of the tibia can be determined before the patient leaves the operating room. Measurements can be performed under sterile conditions. The method was applied clinically and in a study of tibial torsion in normal adults. The standard error of a single measurement was less than 1 degree. The maximum difference in tibial torsion between the legs of the same normal individual reached 15 degrees.

Adolescent↗
PubMed1985

[Significance of ultrasound study in accident surgery].

Diagnosis via sonography has recently become firmly established also in accident surgery because of its manifold possibilities of application. The fact that the equipment is very mobile is of particular advantage in this field. It enables detection of intra-abdominal and intra-thoracic lesions, and to diagnose sequelae as well as associated diseases, especially in polytraumatised patients. If applied to the limbs, it becomes possible to discover particularly well all changes in the soft parts, such as haematomas, abscess formation, or effusions. This supplies important pointers towards deciding whether surgery should be performed, and in what way. The importance that sonography has gained in accident surgery is illustrated by the multifarious case reports covering a broad spectrum of different accidents and lesions.

Accidents↗
PubMed1987

Effect of prenatal insulin and glucagon injection on the glycogen content of rat placenta and fetal liver.

The placental glycogen content per g wet weight decreases after the 16th day of gestation but remains nearly constant till the 21st day of gestation when expressed per placenta as whole organ. Injection of insulin to rat fetuses at the 21st day of gestation gives rise to hypoglycemia and an increase of the glycogen content in liver and in placenta. Intrauterine glucagon application makes fetuses hyperglycemic in consequence of a mobilization of the placental glycogen stores. Hepatic glucose production appears in later stages because of the low activity of glucose 6-phosphatase as demonstrated by the effect of glucagon on the hepatic glucose 6-phosphate concentration.

Animals↗
PubMed1987

Ten years of freedom from smallpox: lessons and experiences. Dedicated to the tenth anniversary of worldwide freedom from smallpox.

Many lessons and experiences were learned during the global programme of smallpox eradication, the most important being those which could be generalized and applied to other health programmes. This does not mean imitating or implementing smallpox eradication techniques to other diseases, since each infection requires its own strategy. It is difficult to dissect out the single key element or to equate the various factors responsible for the success, as these always worked together, in combination, depending one on others. For global eradication, the element of essential importance was international cooperation and close coordination of activities between nations. This would be impossible without proper mechanisms dedicated to international cooperation in the field of health, provided by the World Health Organization, which also assured mobilization of world resources for national programmes and application of appropriate techniques across international borders. The established specific, practical and measurable goals, objectives and targets made every programme worker clearly understand what was to be accomplished and to find his own role in achieving these objectives. Operational techniques had to be flexible, modified appropriately from country to country to make them suitable to present epidemiological situations, local administrative and health structures as well as to demographic and geographic patterns. It was the effective system of surveillance and outbreak-containment that ultimately proved to have been the key to eradication. However, application of skillful management, sound epidemiological principles, advanced technology and adequate logistic support contributed significantly to the achievement of the final goal.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗