Enhancing clinician participation in quality improvement training: implementation and impact of an evidence-based initiative to maximise antenatal clinician participation in training regarding women's alcohol consumption during pregnancy.

BACKGROUND: There are significant challenges in ensuring sufficient clinician participation in quality improvement training. Clinician capability has been identified as a barrier to the delivery of evidence-based care. Clinician training is an effective strategy to address this barrier, however, there are significant challenges in ensuring adequate clinician participation in training. This study aimed to assess the extent of participation by antenatal clinicians in evidence-based training to address alcohol consumption during pregnancy, and to assess differences in participation by profession. METHODS: A 7-month training initiative based on six evidence-based principles was implemented in a maternity service in New South Wales, Australia. Descriptive statistics described participation in training (% attending: any training; six evidence-based principles of training; all principles). Regression analyses examined differences by profession. RESULTS: Almost all antenatal clinicians participated in some training (182/186; 98%); 69% participated in ≥1 h of training (µ = 88.2mins, SD:56.56). The proportion of clinicians participating in training that satisfied each of the six principles ranged from 35% (training from peers and experts) to 82% (training was educational and instructional). Only 7% participated in training that satisfied all principles. A significantly higher proportion of midwifery compared to medical clinicians participated in training satisfying five of the six training principles. CONCLUSIONS: A training initiative based on evidence-based principles resulted in almost all clinicians receiving some training and 69% participating in at least 1 h of training. Variability between professions suggests training needs to be tailored to such groups. Further research is required to determine possible associations with care delivery outcomes. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry, No. ACTRN12617000882325 (date registered: 16/06/2017).

[Can amyloidosis regress?]. / L'amylose peut-elle régresser?

Amyloidosis always worsens in the absence of treatment. Suitable treatments may improve the prognosis, but results depend on the type of amyloidosis. AA amyloidosis can improve according to clinical and biological criteria after the treatment of underlying disease, or after colchicine therapy in familial mediterranean fever. Histological regression is very unusual. A small clinical improvement or at least a stabilisation can be observed in familial amyloidosis with mutation in plasma transthyretin, after liver transplantation. However, the follow-up is short and the mortality is high. In AL amyloidosis, the survival is usually less than 15 months. Some patients have a better survival when they receive chemotherapy similar to that given in multiple myeloma. This could indicate an amyloidosis improvement, or at least a stabilisation.

Training mental health nurses to provide motivational interviewing on an inpatient eating disorder unit.

This study examined whether: (1) brief training in motivational interviewing (MI) can prepare mental health nurses (MHNs) to provide MI to patients; and (2) this MI impacts on patients with respect to premature discharge. Six MHNs on an inpatient eating disorder unit were trained in MI, and their treatment adherence and competence were evaluated at post-training and 2-month follow-up. Premature discharge was examined by comparing a 3-month period in 2009 before MI administration with 2010 when MI was being administered. MHNs significantly improved their MI adherence and competence. Satisfaction with the training was high as was patient satisfaction with MI. Premature discharge rates significantly decreased. Brief training in MI is sufficient to significantly increase competency and adherence in the practice of MI by MHNs, which may in turn be effective in improving patients' treatment adherence by reducing premature discharge rates. Future research will need to utilize a randomized controlled design in order to further investigate these findings.

Cloned Drosophila alcohol dehydrogenase genes are correctly expressed after transfection into Drosophila cells in culture.

We have obtained correct transcription of the cloned alcohol dehydrogenase (Adh) gene of Drosophila melanogaster after DNA-mediated gene transfer into Drosophila cells in culture. Supercoiled plasmids, each containing various regions of the Adh gene cloned in pBR327, were introduced into Schneider line 2 (SL2) cells by the calcium phosphate-DNA transfection technique. Although these cells do not normally express their endogenous Adh genes, they do express the exogenous genes as shown by primer extension and nuclease S1 analyses of RNA isolated 48 hr after transfection. The resulting alcohol dehydrogenase (ADH) transcripts, both the larval and adult types, have the correct 5' ends and are properly spliced. The transfected cells have also acquired ADH enzyme activity. The levels of enzyme activity and of ADH protein crossreacting material in cells transfected with different Adh plasmids correlate directly with the level of ADH transcripts. When a mutant Adh gene cloned from an ADH-negative mutant fly with a defect in the splicing of ADH RNA is transfected into the Schneider line 2 cells, the resulting ADH RNA is not spliced properly and there is no synthesis of ADH; thus, the mutant gene transfection into cell culture mimics the mutant phenotypes observed in the mutant fly.

Expression of transfected human interferon-gamma DNA: evidence for cell-specific regulation.

The production of interferon-gamma (IFN-gamma) has been limited to two specific cell types of the immune system, T cells and large granular lymphocytes. Interleukin 2 (IL 2) appears to be the primary physiologic stimulus for IFN-gamma production in vitro, but other agents, such as antigens, phorbol myristic acetate, concanavalin A, or other plant lectins, may also act as effective inducing agents for IFN-gamma production. Little is known, however, as to the role, if any, that genetic factors may play in the induction process. We now report that, on stable transfection of the genomic human IFN-gamma 8.6 Kb BamH DNA fragment into a mouse T lymphoblast cell line, both mRNA expression and synthesis of human IFN-gamma were stimulated by both the physiologic ligand IL 2 and phorbol ester. In contrast, we have been unable to induce with extracellular stimulants IFN-gamma production or cytoplasmic mRNA after introduction of this gene into NIH 3T3 fibroblasts, thus suggesting that the extracellular regulation of the expression of IFN-gamma may be controlled by a developmental mechanism(s) intrinsic for cells of lymphoid lineage.