Selection of a human chromosome 21 enriched YAC sub-library using a chromosome-specific composite probe.

The subdivision of total genomic human yeast artificial chromosome (YAC) libraries into specific chromosome clone collections will greatly facilitate the construction of an integrated genetic, physical and transcriptional map of the genome. We report the isolation of 388 YAC clones from a human library with an average insert size of 620 kilobases (kb) by the hybridization of a composite chromosome 21 probe to a high-density array of YAC clones. Roughly half of these clones hybridize to chromosome 21 by fluorescence in situ hybridization. These clones represent a twofold coverage of the chromosome. The technique offers the potential of sub-dividing whole genomic YAC libraries into their chromosomal elements to produce high-resolution tools for genome mapping.

Using self-responsibility to improve communications: one nurse's perspective.

When incomplete or poor communication occurs, it is often because one or both parties are not taking responsibility for their own thoughts, feelings, or actions. This article looks at the need for individuals to take responsibility for what they think, feel, and want, and prompts the next step of being responsible for what they then actually do and say about an issue. Examples of ineffective communication are presented along with an Awareness Grid, a tool that can help one learn to behave and to communicate in a manner consistent with who one is and what one really needs and wants. Professional and personal relationships can be strengthened and made more forthright when parties communicate honestly without the interference of inappropriate emotions, incorrect or incomplete facts, unsubstantiated ideas about another person or situation, or defensive or protective personal goals.

Telephone follow-up of ambulatory surgery patients following discharge is a nursing responsibility.

The ambulatory surgery nurse manages care for a diverse population of patients who may or may not be ideal candidates for early discharge after surgery. Integral to the nursing care is the postdischarge follow-up contact, which allows the nurse to assess the patient's level of recuperation and evaluate the care provided. A number of reasons, besides completion of the nursing process, indicate that this contact is a nursing obligation. These include compliance with national standards of care, improvement of quality of care, and reduction of the facility's liability exposure. These calls also show a sense of caring about patients and help to market the ambulatory surgery program in the community. The nurse develops a true sense of professionalism and often benefits by increased job satisfaction.

A case study: identification and treatment of narcotic depression in the ambulatory surgical patient.

The staff in a freestanding ambulatory surgical center (ASC) must be prepared to identify and treat all emergencies and untoward patient responses. This case study exemplifies some of the problems encountered with a patient who had surgery late in the day and who did not have local anesthetic infiltrated for pain control after inguinal herniorrhaphy. In a retrospective analysis and discussion of the case, the caregivers identified that, in addition to the narcotics given, this patient's lengthy postoperative course was further complicated by inadequate intravenous fluid replacement and ambulation too soon after narcotic administration. From this case study a number of lessons were identified, particularly for the freestanding ASC. These lessons relate to adequate staffing (two nurses) for late cases, the importance of the presence of the anesthesiologist at the center until all patients have been discharged, the need to assure that home conditions are adequate for patients discharged late in the day, and the staff's ability to quickly and accurately identify and treat untoward patient responses.

Patient and family education in the ambulatory surgery setting.

Ambulatory surgery reduces the time nurses can spend with patients, increases the responsibilities that patients must assume for their own care, and requires that family members or friends provide support and care soon after the patient's surgery. Such changes in the surgical process make effective and comprehensive education a particularly essential component of the nursing care process in ambulatory surgery programs. The educational process mimics the nursing process. After the patient's learning needs are assessed, a plan of action must be devised that individualizes the teaching plan to the needs of the specific patient and home caregivers. The patient must be motivated to learn and to comply with certain self-care instructions. Nurses play a pivitol role both in teaching and in evaluating the effects of that teaching for ambulatory surgical patients and their families.

Preparing for the unexpected in the ambulatory surgery unit.

Every nurse in an ambulatory surgery unit (ASU) is responsible for becoming and remaining personally prepared to respond to a multitude of emergency situations. How do nurses remain prepared? Education and training are essential, but without practice and review many skills can become rusty and knowledge can be forgotten. Periodic emergency drills are an essential part of the overall preparedness program in any ASU. Both free-standing and hospital-based units have individual, yet similar problems that they encounter when a real emergency occurs. Practicing potential emergency scenarios is one method that can help to prepare nurses for actual emergency situations. This article discusses a number of ways in which mock code drills can be made realistic and interesting.

A new component of the transcription factor DRTF1/E2F.

Transcription factor DRTF1/E2F coordinates events in the cell cycle with transcription by its cyclical interactions with important regulators of cellular proliferation like the retinoblastoma tumour-suppressor gene product (Rb) and the Rb-related protein, p107 (refs 1-8). DRTF1/E2F binding sites occur in the control regions of genes involved in proliferation, and both Rb and p107 repress the capacity of DRTF1/E2F to activate transcription (refs 11, 12; M. Zamanian and N.B.L.T., manuscript submitted). Mutant Rb proteins isolated from tumour cells are unable to bind DRTF1/E2F (refs 11-13), and certain viral oncoproteins, such as adenovirus E1A, sequester Rb and p107 in order to free active DRTF1/E2F (refs 5, 11, 12, 14, 15). Here we report the isolation of a complementary DNA encoding DRTF1-polypeptide-1 (DP-1), a major sequence-specific binding protein that is present in DRTF1/E2F, including Rb- and p107-associated DRTF1/E2F. The DNA-binding domain of DP-1 contains a region that resembles that of E2F-1 (refs 16, 17), and recognizes the same sequence. DRTF1/E2F thus appears to contain at least two sequence-specific DNA-binding proteins.