Vertical banded gastroplasty: a treatment for morbid obesity

Stomach stapling to aid the morbidly obese patient with weight loss has been available for years. Unfortunately, some methods of bariatric surgery (e.g., gastric bypass surgery) can lead to serious complications. This article discusses vertical banded gastroplasty (VBG) and presents on overview of morbid obesity and its inherent medical problems, the screening process and the physical and psychological needs of patients undergoing bariatric procedures, the anatomy and physiology of normal digestion, and the perioperative nursing considerations in caring for a patient undergoing VBG.

A microsphere-based assay for multiplexed single nucleotide polymorphism analysis using single base chain extension

A rapid, high throughput readout for single-nucleotide polymorphism (SNP) analysis was developed employing single base chain extension and cytometric analysis of an array of fluorescent microspheres. An array of fluorescent microspheres was coupled with uniquely identifying sequences, termed complementary ZipCodes (cZipCodes), which allowed for multiplexing possibilities. For a given assay, querying a polymorphic base involved extending an oligonucleotide containing both a ZipCode and a SNP-specific sequence with a DNA polymerase and a pair of fluoresceinated dideoxynucleotides. To capture the reaction products for analysis, the ZipCode portion of the oligonucleotide was hybridized with its cZipCodes on the microsphere. Flow cytometry was used for microsphere decoding and SNP typing by detecting the fluorescein label captured on the microspheres. In addition to multiplexing capability, the ZipCode system allows multiple sets of SNPs to be analyzed by a limited set of cZipCode-attached microspheres. A standard set of non-cross reactive ZipCodes was established experimentally and the accuracy of the system was validated by comparison with genotypes determined by other technologies. From a total of 58 SNPs, 55 SNPs were successfully analyzed in the first pass using this assay format and all 181 genotypes across the 55 SNPs were correct. These data demonstrate that the microsphere-based single base chain extension (SBCE) method is a sensitive and reliable assay. It can be readily adapted to an automated, high-throughput genotyping system. [Primer sequences used in this study are available as online supplementary materials at www.genome.org.]

GPs' recognition of, and response to, influences on patients' medicine taking: the implications for communication

BACKGROUND

Research evidence suggests that patients' beliefs about medicines influence medicine taking. Therefore, it is important that GPs are able to both identify and take account of such beliefs in the consultation.

OBJECTIVES

The purpose of this study was to explore GPs' awareness of asthma patients' beliefs about medicine, and of the ways in which friends and family, television programmes and the Campaign for Asthma may influence these beliefs. We also wanted to consider how GPs believe they would feel, and their likely behaviour, when a patient refers to these influences in the consultation.

METHOD

Four events, drawn from 17 semi-structured interviews previously conducted with patients recently prescribed oral steroids (prednisolone), were used to compose a narrative account of a hypothetical patient's behaviour. The narrative described a series of scenarios to which GPs were asked to respond. It was sent to all GPs in Derbyshire (n = 476).

RESULTS

The response rate was 69%. Half judged that the scenarios which presented the patients' beliefs about medicine, the influence of friends and family and the television were not 'realistic'. GPs also reported feeling more 'supportive' and 'sympathetic' towards the Campaign for Asthma as a source of patient information than they were towards opinions based on advice given by patients' family and friends.

CONCLUSION

Developing 'common ground' in the consultation will be problematic if GPs are not aware of, and sympathetic towards, the ways in which patients use information from a range of sources to formulate beliefs that then affect their medicine-taking behaviour. GPs should be encouraged to open up their discussions with patients so as to encourage the development of a partnership in which each party is aware of, and respects, the other's point of view.

Multiplexed single nucleotide polymorphism genotyping by oligonucleotide ligation and flow cytometry

BACKGROUND

We have developed a rapid, high throughput method for single nucleotide polymorphism (SNP) genotyping that employs an oligonucleotide ligation assay (OLA) and flow cytometric analysis of fluorescent microspheres.

METHODS

A fluoresceinated oligonucleotide reporter sequence is added to a "capture" probe by OLA. Capture probes are designed to hybridize both to genomic "targets" amplified by polymerase chain reaction and to a separate complementary DNA sequence that has been coupled to a microsphere. These sequences on the capture probes are called "ZipCodes". The OLA-modified capture probes are hybridized to ZipCode complement-coupled microspheres. The use of microspheres with different ratios of red and orange fluorescence makes a multiplexed format possible where many SNPs may be analyzed in a single tube. Flow cytometric analysis of the microspheres simultaneously identifies both the microsphere type and the fluorescent green signal associated with the SNP genotype.

RESULTS

Application of this methodology is demonstrated by the multiplexed genotyping of seven CEPH DNA samples for nine SNP markers located near the ApoE locus on chromosome 19. The microsphere-based SNP analysis agreed with genotyping by sequencing in all cases.

CONCLUSIONS

Multiplexed SNP genotyping by OLA with flow cytometric analysis of fluorescent microspheres is an accurate and rapid method for the analysis of SNPs.

Assisting elderly people with medication--the role of home carers

In 1991, home carers in Derbyshire were asked to participate in a questionnaire survey in order to estimate the demand for home carers to assist elderly clients with specific medication tasks. The results indicate that 17% of regular clients require assistance with medication, and that 86% of home carers are expected to assist with at least one medication task. Home care aides received considerably more requests than home helps to assist with such tasks. The findings are discussed in relation to the way home carers perceive 'personal care'. The type of personal care tasks that home carers are expected to perform should be more clearly defined, and the findings highlight the importance of providing pharmaceutical advice and training to home carers.