Wound healing and repair: a review of the art and science

This chronological review of the major biological events that occur secondary to injury of mucoperiosteal tissue from either simple surgical wounding or trauma discusses the materials used to repair the compromised tissue surgically. Suturing techniques and post-surgical wound maintenance also are reviewed. The physiological stages of wound healing, factors affecting wound healing, and wound repair techniques are discussed.     

Medicine--a healing or a dying art?

That medicine is a science is the popular belief, and this has been reinforced by the advent of 'evidence-based medicine', which assumes that scientific proof is required to support medical practice. However, the view of science implied is a narrow one, foreign both to pure scientists and to artists, and the art of medicine is devalued by the approach. There are both important differences and important similarities between science and the arts. The arts should contribute to evidence-based practice and education along with science, and have a role in many aspects of medical practice.     

Empowerment as a source of healing: redefining the art of nursing management

Empowerment amounts to a social process of recognizing, promoting and enhancing staff nurse abilities to meet self needs, solve their own problems and mobilize the necessary resources to gain mastery over their own professional lives. Healing, to be made whole, is a process of getting in touch with that which is impeding our realization of wholeness. Empowerment as a source of organizational healing conveys the message that in order to realize wholeness, nurses are dependent upon personal and organizational resources. As nurses learn multiple ways to interact with the work environment, they find the path to a wholeness that incorporates physical, emotional, intellectual, and spiritual aspects of themselves. As the value of wholeness is realized individually, interactions with the environment spontaneously manifest these attributes and the message permeates the nursing community. As the nursing community is empowered, it is increasingly able to empower the individual. This expanding energy can result in a synergistic pattern that brings phenomena together, and interrelates them, creating a new and greater whole from the disparate, seemingly conflicting parts. When nurses as individuals and groups are able and willing (empowered) to invest energy to that which impacts their lives so that they can move toward wholeness (heal), positive energy exponentially intensifies and permeates the environment to envelop all.     

The impact and promise of the cognitive revolution.

Opening a new era in science, psychology's cognitive revolution contradicts traditional doctrine that science has no use for consciousness to explain brain function. Subjective mental states as emergent interactive properties of brain activity become irreducible and indispensable for explaining conscious behavior and its evolution and get primacy in determining what a person is and does. Dualistic unembodied consciousness is excluded. A modified 2-way model of interlevel causal determinism introduces new principles of downward holistic and subjective causation. Growing adoption in other disciplines suggests the 2-way model may be replacing reductive physicalism as the basic explanatory paradigm of science. The practice, methods, and many proven potentials of science are little changed. However, the scientific worldview becomes radically revised in a new unifying vision of ourselves and the world with wide-ranging humanistic and ideologic as well as scientific implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The American revolution.

"A revolution of psychological thought and practice was made by Thorndike, Watson, Holt, Hunter, Lashley, Cattell, Terman, Yerkes… Tolman and Skinner between 1898 and 1938." The 1st of 2 stages in the revolution "has been complete for some time, largely in the form of Behaviorism and the study of learning, and it is high time for the rebels to get on with the second one: a behavioristic or learning-theory analysis of the thought process. I propose then to consider a particular aspect of the problem, namely, self-awareness and certain fantasies about the self." Major sections are: Setting and Scope; Theory and the S-R Formula; Mind, Consciousness, and Mediating Process; Hallucination, Body Image, and the Self; and The Problem of Analysis. From Psyc Abstracts 36:02:2AD35H. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond parallel play: Science befriending the art of method acting to advance healing relationships.

Research underscores the central role of factors in healing that appear to relate to the therapeutic relationship. These nonspecific or common factors and placebo effects are often overshadowed by an emphasis in the field on particular empirically supported therapies. Yet relationship variables account for a greater proportion of the variance in treatment outcomes than the technical intervention employed, representing a notable blind spot in our science and, by extension, our practice. As a consequence, clinical instruction in psychology and in the health professions more broadly generally lacks adequate specificity with respect to how to cultivate a healing relationship. Through the elaboration of several techniques derived from theatrical traditions, the authors propose that method acting and similar schools of drama provide a method for honing clinical skills in these areas that is amenable to empirical scrutiny. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The art of stained glass: metaphor for the art of nursing

The aesthetic is a way of knowing the meaning of and the meaning in the art of nursing. The art of creating stained glass offers a personal metaphor for nursing's essence; the art of caring. Both arts aim to fulfil the potential of their subjects to achieve a harmony that goes beyond their individual components. Stained glass artistry and caring in nursing require technical expertise, yet technical skill and knowledge are not the substance of either art. Both transcend space and time, and the art of stained glass and the art of nursing are influenced by the artist's/nurse's personal, social and cultural history. Just as the artisan transforms the glass and lead and is transformed in the creative moment, so does the caring transaction transform both patient and nurse. This personal reflection explores the nature of caring in nursing as mirrored by the author's work with stained glass.     

Ultrastructural study of the skin after facial chemical peels and the effect of moisturization on wound healing

Ultrastructural changes occurring in the skin at early times after chemical peels as well as effects on the wound healing with moisturization after these peels have been examined. This study evaluated the changes seen in the skin 3 days and 5 days after 35% trichloroacetic acid peels, and the effect of moisturization on this healing was evaluated. Biopsies at 3 days showed an outermost layer of necrotic stratum corneum and stratum granulosum and an underlying layer of new stratum corneum. There were increased cytoplasmic vacuoles in the keratinocytes of the stratum spinosum, stratum granulosum, and stratum basale layers. There was extensive intercellular spacing between the basal keratinocytes. At 5 days the necrotic layer of stratum corneum and stratum granulosum was gone. The lower epidermis at 5 days showed less intercellular spacing, and there was less vacuolization within keratinocytes. In seven of eight patients treated with moisturization after the peel (p = 0.0325), the ultrastructural changes at 5 days were consistent with a more advanced state of healing compared with those that were treated dry. Ultrastructural morphology at this time showed less intercellular spacing and fewer cytoplasmic vacuoles, indicative of an advanced state of wound repair. These moisturized skin specimens had returned to an almost normal state of structure compared with the skin that had been treated dry.     

The future of dentistry--the evidence revolution

An increasing demand for evidence-based practice will transform the way we treat our patients in the next decade. This represents both a threat and a golden opportunity for GDPs. I believe that we should grasp this opportunity and in partnership with our academic colleagues, develop a national programme of general practice research.     

The art of nursing

The specific motility patterns of the forestomach of ruminants, composed of three structurally distinct compartments (rumen, reticulum, omasum), require an elaborate intramural innervation. To demonstrate the complex structure of the enteric nervous system (ENS), whole mount preparations obtained from different sites of the bovine forestomach were submitted to immunohistochemical procedures in which neuronal (protein gene product 9.5, neurofilament 200) and glial (protein S-100, glial fibrillary acid protein) markers were applied. Immunohistochemistry performed on whole mounts allowed a detailed two-dimensional assessment of the architecture of the intramural nerve networks. Generally, the myenteric and submucosal plexus layers were composed of ganglia and interconnecting nerve fiber strands, whereas the mucosal plexus consisted of an aganglionated nerve network. However, the texture of the ENS showed considerable regional differences concerning the ganglionic size, shape and density and the arrangement of nerve fiber strands. The myenteric plexus of the ruminal wall, showing a low ganglionic density and wide polygonal meshes, contrasted with the nerve network within the ruminal pillar which consisted of ropeladder-like nerve fiber strands and parallel orientated ganglia. The highest ganglionic density was observed at the reticular groove, the most prominent ganglia were found within the omasal wall. Branches of the vagal nerve frequently ramified within the myenteric plexus layers. The submucosal plexus of the rumen was divided into an external and internal layer; the reticular submucosal plexus followed the cristae and cellulae reticuli, the omasal submucosal (sublaminar) plexus showed intra- and parafascicular ganglia apart from ganglia located at the junctions of the nerve network. The mucosal plexus of the rumen consisted of thin nerve fascicles ramifying between the ruminal papillae, and reticular mucosal nerve fibers passed throughout the base of the cellulae reticuli. The highly specialised nerve network of the intralaminar omasal plexus showed radial and transverse trajectories reflecting the spatial arrangement of the intralaminar musculature. The demonstrated structural complexity of the ENS reflects the functional complexity of the ruminant forestomach and indicates the relatively high degree of autonomy in coordinating the different motility patterns required for the processing of the ingesta.     

The art of mentoring

While the golden era of mentoring may have been the age of apprentice ships in medicine, the birth of the clinical clerkship in the late 1800s provided the structure for the relationship between faculty and medical student. The last few decades, however, have seen a dramatic change in the availability of faculty to mentor students in clinical teaching settings despite a 600% increase in the number of clinical full-time medical school faculty. This work explores some of the reasons for this deterioration in mentoring and looks at the role of the mentor in professional development, specifically in the area of medical education. Recommendations for implementing structured mentoring programs within a department of surgery are provided. The article concludes with discussion of individual characteristics of the effective mentor in surgical education.