An analysis and comparison of commonly available United Kingdom prescribing resources.

BACKGROUND AND OBJECTIVE: Safe prescribing requires accurate and practical information about drugs. Our objective was to measure the utility of current sources of prescribing guidance when used to inform practical prescribing decisions, and to compare current sources of prescribing guidance in the UK with idealized prescribing guidance. METHODS: We developed 25 clinical scenarios. Two independent assessors rated and ranked the performance of five common sources of prescribing guidance in the UK when used to answer the clinical scenarios. A third adjudicator facilitated review of any disparities. An idealized list of contents for prescribing guidance was developed and sent for comments to academics and users of prescribing guidance. Following consultation an operational check was used to assess compliance with the idealized criteria. The main outcome measures were relative utility in answering the clinical scenarios and compliance with the idealized prescribing guidance. RESULTS: Current sources of prescribing guidance used in the UK differ in their utility, when measured using clinical scenarios. The British National Formulary (BNF) and EMIS LV were the best performing sources in terms of both ranking [mean rank 1·24 and 2·20] and rating [%excellent or adequate 100% and 72%]. Current sources differed in the extent to which they fulfilled criteria for ideal prescribing guidance, but the BNF, and EMIS LV to a lesser extent, closely matched the criteria. DISCUSSION: We have demonstrated how clinical scenarios can be used to assess prescribing guidance resources. Producers of prescribing guidance documents should consider our idealized template. Prescribers require high-quality information to support their practice. CONCLUSION: Our test was helpful in distinguishing between prescribing resources. Producers of prescribing guidance should consider the utility of their products to end-users, particularly in those more complex areas where prescribers may need most support. Existing UK prescribing guidance resources differ in their ability to provide assistance to prescribers.

Adsorption of hydrophobin/ß-casein mixtures at the solid-liquid interface.

The adsorption behaviour of mixtures of the proteins ß-casein and hydrophobin at the hydrophilic solid-liquid surface have been studied by neutron reflectivity. The results of measurements from sequential adsorption and co-adsorption from solution are contrasted. The adsorption properties of protein mixtures are important for a wide range of applications. Because of competing factors the adsorption behaviour of protein mixtures at interfaces is often difficult to predict. This is particularly true for mixtures containing hydrophobin as hydrophobin possesses some unusual surface properties. At ß-casein concentrations ⩾0.1wt% ß-casein largely displaces a pre-adsorbed layer of hydrophobin at the interface, similar to that observed in hydrophobin-surfactant mixtures. In the composition and concentration range studied here for the co-adsorption of ß-casein-hydrophobin mixtures the adsorption is dominated by the ß-casein adsorption. The results provide an important insight into how the competitive adsorption in protein mixtures of hydrophobin and ß-casein can impact upon the modification of solid surface properties and the potential for a wide range of colloid stabilisation applications.

Bacterial N-acyl-homoserine-lactone-dependent signalling and its potential biotechnological applications.

N-acyl homoserine lactones are bacterial signalling molecules involved in regulating diverse metabolic functions, particularly those relating to virulence, in concert with cell density. Each aspect of the signalling pathway, from production and recognition of the signal to expression of the target genes, offers a potential opportunity for exploitation. Attention is now focusing on the development of novel methods for bacterial enumeration, modulation of bacterial virulence and flexible, coordinated expression of heterologous genes through the use of N-acyl-homoserine-lactone-based systems.

Alphabetic Phonics: An organization and expansion of orton-gillingham.

Alphabetic Phonics is a sequential language curriculum designed to assure that all students can achieve literacy. This curriculum is a 1980's organization and extension of the Orton-Gillingham-Childs multisensory teaching of the structure of English. Alphabetic Phonics allows 95 percent of the auditory, visual, and kinesthetic learners in a regular classroom to master written English. The curriculum includes modern behavioral, psychological, and educational theories and practice. Developed initially as remediation for dyslexics, Alphabetic Phonics is succeeding both with small groups of severely blocked dyslexics and as prevention in regular classrooms in the primary grades. Administrators, classroom teachers, clinicians, remedial, and resource room specialists, as well as speech and language therapists representing small and large schools (public and private; remedial and accelerated) have traveled to Texas from forty states and six foreign countries during the past ten years to earn graduate credit in one or more of the four month-long Introductory Courses held each year. Teachers report that cultural minority students and those learning English as a second language benefit especially from reading instruction which emphasizes the foundations of English and time-on-task activities to effect mastery. Outreach programs and multimedia tools are being developed and implemented to broaden the programs availability to groups with varied needs.

Syllable division: Prerequisite to dyslexics' literacy.

Skill in reading long words is prerequisite to dyslexics' literacy. Instant recognition of printed symbols is easy for those readers with photographic memories, but dyslexics often fail to recognize visually many long words which are actually familiar to them auditorially. Scientific, automatic, multisensory procedures for dividing longer words into easily read syllables can enable students to translate visual symbols rapidly and thereby to read, write, or spell accurately words of any length.Over one thousand dyslexics, aged seven to fifteen, guided the interdisciplinary team at Texas Scottish Rite Hospital in Dallas to develop, observe results, and test specific structured, sequential steps in working out longer words. The ten-year study (1965-1975) in the Language Laboratory of the Hospital established the Alphabetic Phonics curriculum which is now used successfully, not only in remedial groups but in regular classes of any size or age, in public and private schools in 45 states and six foreign countries.The newly-established Aylett Royall Cox Institute in Dallas prepares teachers and Master Instructors to train both students and other teachers. Comparable Alphabetic Phonics Teacher Training Centers are already established in Houston and Lubbock, Texas, in Oklahoma City, and at Columbia University Teachers College in New York.

Advancing the profession of occupational health nursing: AAOHN's strategic planning process.

1. AAOHN's strategic plan for 1993-98 was developed through a collaborative effort with emphasis on member input. 2. A model for the strategic plan which emphasized data acquisition and analysis was developed. 3. A revised mission statement and standards for occupational health nursing practice, along with expanded scope of practice, were developed.

Job security for occupational health and safety professionals in the 21st century. What you need to know about the institute of medicine (2000) report.

The IOM study does an admirable job of discussing trends affecting the future of workers and the workplace. Based on theses trends, there will be vast unmet needs, as well as tremendous opportunities, for occupational health and safety professionals, particularly occupational health nurses, to help meet these needs. Individual occupational health and safety professionals will do well to study the trends, assess their current knowledge and skills, and seek the education and training required to develop and enhance the necessary competencies. They will need to: pay special attention to areas of behavioral health, work organization, communication (especially risk commnication), management, team learning, work force diversity, information systems, prevention interventions, health care delivery systems, and evaluation methods (IOM, 2000). They will need to develop, document, and communicate new and creative models for providing occupational health and safety services. Also, see the Advisory, "Job Security for the 21st Century," on page 164A.

Expanding horizons. Integrating environmental health in occupational health nursing.

1. Environmental hazards are ubiquitous. Many exist in the workplace or occur as a result of work process exposures. 2. Environmental health is a natural component of the expanding practice of occupational health nursing. 3. AAOHN's vision for occupational and environmental health will continue to set the standard and provide leadership in the specialty.

BANs to rINNS.

Medical errors are increasingly being highlighted as an unnecessary cause of morbidity and mortality. Such situations are increasingly likely to occur if each country has its own improved name for each individual drug, particularly as healthcare staff are becoming increasingly mobile across the world. Standardization of drug names will help reduce the risk of such errors. However because of the change between BANs and rINNS there is potential for short-term problems. Healthcare staff need to be aware of such problems to try and minimize the damage they could potentially cause. In the longer term these name changes will hopefully prevent errors from occurring.

A new microbiological approach to the assessment of underarm deodorants.

Synopsis A general survey of odour generation in the axillae is given, with particular reference to the role of topically applied antimicrobial agents in odour suppression. A new apparatus is described which will allow a rapid and reliable quantification of in vivo antimicrobial action and which may be usefully employed in optimization of individual systems to achieve effective deodorancy. Findings are presented on the antimicrobial efficacy of deodorant compositions and correlated with practical olfactory studies.

A combined three-year and four-year medical program with modified admission requirements.

More flexible admission requirements have made it possible to admit students to the first year of a program leading to the B.Med.Sc. degree at the end of two years and to the M.D. degree in four years, saving one to three years by means of earlier entry following high school. More advanced students may enter at the beginning of second year and complete a three-year M.D. program. Encouraging preliminary results have been obtained.

Mitral regurgitation occurring during methsergide (Sansert) therapy.

The case history of a young woman who developed severe mitral regurgitation after four years of methysergide therapy is reported. Replacement of the mitral valve was required. A brief review of the toxic effects of methysergide is given and special reference is made to lesions of the heart valves that have occurred during methysergide therapy.