Evaluating an intensive ward-based writing coach programme to improve nursing documentation: lessons learned.

AIM: This study aimed to develop a ward-based writing coach programme to improve the quality of patient information in nursing documentation. BACKGROUND: Omissions in the patient information make nursing notes an unreliable source for care planning. Strategies to improve the quality of nursing documentation have been unsuccessful. An education programme, with one-to-one coaching in the clinical environment, was tested. METHOD: A concurrent mixed methods approach including a pre-post test intervention and control design for the quantitative component combined with a qualitative approach using a focus group (eight nurses) was used. Healthcare records for 87 patients (intervention) (46 pre and 41 post) and 88 patients (control) (51 pre and 37 post) were reviewed using the Nursing and Midwifery Content Audit Tool for quality nursing documentation. Sixteen nurses from two intervention wards participated in an introductory workshop with 2 weeks of coaching. No intervention was given to the control ward. RESULTS: No significant differences were found between the wards across the 14 criteria representing quality documentation; most criteria were present in 75% or more of the records. Improvements were demonstrated in both the intervention and comparison units. Themes identified from the focus groups included the impact these changes had on nurses and patients, perceived difficulties with nursing documentation, medicolegal aspects and the attributes of an effective writing coach. CONCLUSION: Writing coaching is a supportive approach to improving nursing documentation. Also, regular auditing prompts nurses to improve nursing documentation. Further research using larger sample sizes can further confirm or refute these findings.

Avian thyroid: effect of p,p'-DDT on size and activity.

Feeding sublethal amounts of p,p'-DDT to pigeons caused an increase in thyroid weight and a reduction in colloid content of the follicles. This may reflect a hyper- or hypo-functioning gland and may be cotnnected with recent reductions in egg shell weights in wild birds. The effect was accompanied by increased liver weight.

Degradation and disappearance of ortho, para isomer of technical DDT in living and dead avian tissues.

The O,p'-DDT in technical DDT is broken down to p,p'-DDT and then to 1,1-dichloro- 2,2-bis(p-chlorophenyl)ethylene in living avian tissue. In the anaerobic conditions existing after death, O,p'-DDT is metabolized to 1,1-dichloro-2-(O-chlorophenyl)-2-(p-chlorophenyl)ethane. The absence of O,p'-DDT and metabolites in field specimens is ascribed to the rapid rate of breakdown and a masking of the 1,1-dichloro-2-(O-chlorophenyl)-2-(p-chlorophenyl)ethane residue during analysis by the relatively large amounts of 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene.

Transient activity assays of the Trypanosoma brucei variant surface glycoprotein gene promoter: control of gene expression at the posttranscriptional level.

The putative promoter of the variant surface glycoprotein (VSG) gene of Trypanosoma brucei was cloned into a plasmid containing the chloramphenicol acetyltransferase (CAT) gene. After electroporation into trypanosomes, this construct directed the expression of the CAT reporter gene. The essential region for promoter activity was found to reside within 88 bp upstream of the putative transcription start site. Transcription of the CAT construct occurred at approximately the same level in both bloodstream and procyclic forms and was resistant to alpha-amanitin. However, CAT expression appeared to be modulated in the two forms of the parasite. Sequences 3' to the gene seemed to be important in this respect, as CAT activity in bloodstream forms was readily detectable only when the 3' region of a VSG cDNA was placed downstream of the CAT gene. Two separate VSG gene promoter sequences, both cloned from T. brucei AnTat 1.3A, were equally able to direct CAT expression, which suggests that there are a number of potential VSG gene promoters in the genome, although usually only one expression site is fully active at any one time.

Expression patterns of chondrocyte genes cloned by differential display in tibial dyschondroplasia.

Tibial dyschondroplasia (TD) appears to involve a failure of the growth plate chondrocytes within growing long bones to differentiate fully to the hypertrophic stage, resulting in a mass of prehypertrophic chondrocytes which form the avascular TD lesion. Many biochemical and molecular markers of chondrocyte hypertrophy are absent from the lesion, or show reduced expression, but the cause of the disorder remains to be identified. As differentiation to the hypertrophic state is impaired in TD, we hypothesised that chondrocyte genes that are differentially expressed in the growth plate should show altered expression in TD. Using differential display, four genes, B-cadherin, EF2, HT7 and Ex-FABP were cloned from chondrocytes stimulated to differentiate to the hypertrophic stage in vitro, and their differential expression confirmed in vivo. Using semi-quantitative RT-PCR, the expression patterns of these genes were compared in chondrocytes from normal and TD growth plates. Surprisingly, none of these genes showed the pattern of expression that might be expected in TD lesion chondrocytes, and two of them, B-cadherin and Ex-FABP, were upregulated in the lesion. This indicates that the TD phenotype does not merely reflect the absence of hypertrophic marker genes, but may be influenced by more complex developmental mechanisms/defects than previously thought.

Identification and cloning of a novel phosphatase expressed at high levels in differentiating growth plate chondrocytes.

Growth plate chondrocytes progress through a proliferative phase before acquiring a terminally-differentiated phenotype. In this study we used Percoll density gradients to separate chick growth plate chondrocytes into populations of different maturational phenotype. By applying agarose gel differential display to these populations we cloned a cDNA encoding a novel 268 amino acid protein (3X11A). 3X11A contains two peptide motifs that are conserved in a recently identified superfamily of phosphotransferases. It is likely that 3X11A is a phosphatase, but its substrate specificity remains uncertain. 3X11A expression is upregulated 5-fold during chondrocyte terminal differentiation and its expression is approximately 100-fold higher in hypertrophic chondrocytes than in non-chondrogenic tissues. This suggests that 3X11A participates in a biochemical pathway that is particularly active in differentiating chondrocytes.

Cloning differentially regulated genes from chondrocytes using agarose gel differential display.

The technique of RNA differential display has been used extensively to clone differentially expressed genes from a wide variety of cells and tissues. Recently, a simplified method of cloning differential display products, separated on agarose gels, was described. Here we report an adaption of this method, using total RNA, to clone differentially expressed genes. The approach is simple and rapid, and requires only small quantities of total RNA. Utilising this approach, we have cloned three differentially regulated genes from chondrocytes stimulated to hypertrophy in vitro, and confirmed their pattern of expression by Northern blotting. These gene fragments were sequenced and found to correspond to known genes, although only one has previously been isolated from chondrocytes.

Regulation of chondrocyte terminal differentiation in the postembryonic growth plate: the role of the PTHrP-Indian hedgehog axis.

Chondrocyte differentiation during embryonic bone growth is controlled by interactions between PTHrP and Indian hedgehog. We have now determined that the major components of this signaling pathway are present in the postembryonic growth plate. PTHrP was immunolocalized throughout the growth plate, and semiquantitative RT-PCR analysis of maturationally distinct chondrocyte fractions indicated that PTHrP, Indian hedgehog, and the PTH/PTHrP receptor were expressed at similar levels throughout the growth plate. However, patched, the hedgehog receptor, was more highly expressed in proliferating chondrocytes. Although all fractionated cells responded to PTHrP in culture by increasing thymidine incorporation and cAMP production and decreasing alkaline phosphatase activity, the magnitude of response was greatest in the proliferative chondrocytes. Bone morphogenetic proteins are considered likely intermediates in PTHrP signaling. Expression of bone morphogenetic protein-2 and 4--7 was detected within the growth plate, and PTHrP inhibited the expression of bone morphogenetic protein-4 and 6. Although organ culture studies indicated a possible paracrine role for epiphyseal chondrocyte-derived PTHrP in regulating growth plate chondrocyte differentiation, the presence within the postembryonic growth plate of functional components of the PTHrP-Indian hedgehog pathway suggests that local mechanisms intrinsic to the growth plate exist to control the rate of endochondral ossification.

Microtubules are potential regulators of growth-plate chondrocyte differentiation and hypertrophy.

Terminal differentiation of growth-plate chondrocytes is accompanied by the acquisition of a spherical morphology and a large increase in cell volume. These changes are likely to be associated with rearrangement of the cytoskeleton, but little information on this aspect of chondrocyte hypertrophy is available. We report a role for microtubules in the control of chondrocyte maturation and hypertrophy. Chick growth-plate chondrocytes were fractionated into five maturationally distinct populations by Percoll density gradient centrifugation, and agarose gel differential display analysis was performed. We identified a 1200 bp cDNA fragment derived from a transcript that was most highly expressed in the hypertrophic chondrocytes. After cloning and sequencing, FASTA and BLAST analysis revealed 100% identity to chick beta7-tubulin. Differential expression was confirmed in a reverse transcription-polymerase chain reaction (RT-PCR) assay using specific primers for a 343 bp fragment from the 3' untranslated region of beta7-tubulin. Beta7-tubulin was upregulated three-fold in fully hypertrophic chondrocytes compared with the other four fractions, which all had similar levels of expression. Immunocytochemical localization of beta-tubulin in chick growth-plate sections demonstrated little staining in the chondrocytes of the proliferating zone, but intense cytoplasmic staining was present in the large hypertrophic chondrocytes. In cell culture studies, the addition of colchicine (10(-6) mol/L) resulted in a higher rate of [3H]-thymidine uptake (36.0%; p < 0.001), but lower amounts of alkaline phosphatase activity (69.1%; p < 0.001), collagen (49.1%; p < 0.01), and glycosaminoglycan (43.3%; p < 0.01) accumulation within the cell-matrix layer. Further evidence for the involvement of microtubules in chondrocyte differentiation and hypertrophy was obtained by morphological assessment of colchicine-treated growth-plate explant cultures. A partial failure of chondrocyte hypertrophy was observed, although collagen type X immunoreactivity was noted within the interstitial matrix. Further studies are required to identify the exact role of microtubules in chondrocyte hypertrophy, but the results presented here suggest that upregulation of beta-tubulin may be required for increased microtubule synthesis during changes in cell size during the hypertrophic process. In addition, as cell-matrix interactions are required for chondrocyte maturation, microtubules may promote the differentiated phenotype as a result of their role in Golgi-mediated secretion of matrix proteins.

The effect of trypanocidal drugs on the transmission of Trypanosoma brucei brucei by Glossina morsitans centralis.

The effects of trypanocidal drugs on Trypanosoma b. brucei infections in Glossina m. centralis have been investigated. Pentamidine and suramin exhibited no significant effects but both berenil and samorin reduced the number of salivary gland infections in comparison with controls. Berenil at concentrations of 10, 1.0 and 0.1 microgram/ml significantly reduced the number of mature infections when fed to flies throughout the whole period of trypanosome development. A similar result was obtained with samorin at 0.1 microgram/ml. Subsequent experiments showed that administration of both drugs at an early stage was more effective in preventing the maturation of infection than a later but more prolonged administration. Reported drug levels in the blood of different experimental host animals are of the same magnitude as those used here. It is suggested that repeated feeding of T. b. brucei infected Glossina on drug-treated hosts may reduce transmission, although alternative bloodmeal sources would reduce this effect. These influences are worthy of investigation in the field.

Fluid mechanics of bloodmeal uptake by Leishmania-infected sandflies.

The fluid mechanics of blood flow in the pharynx and cibarium of Phlebotomus papatasi are described using a simple static model. The flow is characterized as viscous laminar. The Hagen-Poiseuille equation is used to assess the effects of attached parasites in the foregut of Leishmania-infected sandflies on blood flow. The reductions in flow rate imposed by parasite colonization of the pharynx and cibarium will reduce the ability of an infected fly to take a bloodmeal, thus encouraging further probing, enhancing transmission. Regurgitation of the contents of the foregut is also possible. This will aid the deposition of infective forms from the foregut. Transmission by means of regurgitation of parasites from the midgut is considered unlikely.

Parathyroid hormone-related peptide expression in tibial dyschondroplasia.

Parathyroid hormone-related peptide (PTHrP) has a key role in the growth of long bones, as it is a negative regulator of growth plate chondrocyte terminal differentiation. We have examined the distribution and gene expression levels of PTHrP in the growth plates of broiler chickens with tibial dyschondroplasia (TD) in order to determine whether increased expression of PTHrP is responsible for the delayed chondrocyte differentiation that is characteristic of this skeletal disorder. PTHrP protein distribution and gene expression levels were assessed by immunocytochemistry and reverse transcriptase-polymerase chain reaction, respectively. In growth plates of normal birds, PTHrP was found to be distributed throughout all maturational zones of the growth plate. In cartilage proximal to the TD lesion, PTHrP immunostaining and the level of PTHrP gene expression were similar to that observed in normal birds. In contrast, many chondrocytes within the centre of the TD lesion stained poorly for PTHrP and this was reflected in the lower levels of PTHrP mRNA detected in lesion cells. These results suggest that alterations in PTHrP distribution and gene expression are not primarily responsible for the delayed chondrocyte differentiation and hypertrophy noted in dyschondroplasia, but are a result of secondary changes due to the pathology of the condition.

Frequency-crossing phonon spectrometer techniques.

An ac technique for measuring magnetothermal conductivities using frequency crossing has been developed and shows a 13-fold increase in signal-to-noise ratio over the conventional dc technique. The ac technique employs low-frequency field modulation coupled with phase-sensitive detection and a 45-fold improvement in signal-to-noise ratio may be obtained by modulation over the half-width of the frequency crossing signal. A further increase of approximately 3 would be obtainable by increasing the modulation frequency and overcoming technical problems. The limit of detection and instrument revolution may be as low as 10 in. spins and a few megahertz, respectively.

Chondrocytes and longitudinal bone growth: the development of tibial dyschondroplasia.

Growth plate cartilage is central to the process of bone elongation. Chondrocytes originating within the resting zone of the growth plate proceed through a series of intermediate phenotypes: proliferating, prehypertrophic and hypertrophic, before reaching a terminally differentiated state. Disruption of this chondrocyte maturational sequence causes many skeletal abnormalities in poultry such as tibial dyschondroplasia (TD), which is a common cause of deformity and lameness in the broiler chicken. Cell and matrix components of the growth plate have been studied in order to determine the cause(s) of the premature arrest of chondrocyte differentiation and retention of prehypertrophic chondrocytes observed in TD. Chondrocyte proliferation proceeds normally in TD, but markers of the differentiated phenotype, local growth factors, and the vitamin D receptor are abnormally expressed within the prehypertrophic chondrocytes above, and within, the lesion. Tibial dyschondroplasia is also associated with a reduced incidence of apoptosis, suggesting that the lesion contains an accumulation of immature cells that have outlived their normal life span. Immunolocalization studies of matrix components suggest an abnormal distribution within the TD growth plate that is consistent with a failure of the chondrocytes to fully hypertrophy. In addition, the collagen matrix of the TD lesion is highly crosslinked, which may make the formed lesion more impervious to vascular invasion and osteoclastic resorption. Recent studies have applied the techniques of differential display and semiquantitative reverse transcriptase-polymerase chain reaction to RNA obtained from discrete populations of growth plate chondrocytes of different maturational phenotypes. This strategy has allowed us to compare phenotypically identical cell fractions from normal and TD growth plates in an attempt to identify possible candidate genes for TD.

KVP meter errors induced by plastic wrap.

The purpose of this study was to determine whether erroneous kVp meter readings, induced by plastic wrap, affected the actual kVp (output) of a dental X-ray machine. To evaluate the effect of plastic wrap on dental X-ray machine kVp meters, a radiation output device was used to measure output in mR/ma.s. An intraoral dental X-ray unit (S.S. White Model #90W) was used to make the exposures. First, the kVp meter was not covered with plastic wrap and output readings were recorded at various kVp settings with the milliamperage and time held constant. Secondly, the same kVp settings were selected before the plastic wrap was placed. Milliamperage and time were again held to the same constant. The X-ray console was then covered with plastic wrap prior to measuring the output for each kVp. The wrap possessed a static charge. This charge induced erroneous kVp meter readings. Out-put readings at the various induced kVp settings were then recorded. A kVp of 50 with no wrap present resulted in the same output as a kVp of 50 induced to read 40 or 60 kVp by the presence of wrap. Similar results were obtained at other kVp settings. This indicates that the plastic wrap influences only the kVp meter needle and not the actual kilovoltage of the X-ray machine. Dental X-ray machine operators should select kVp meter readings prior to placing plastic wrap and should not adjust initial settings if the meter is deflected later by the presence of wrap. The use of such a procedure will result in proper exposures, fewer retakes, and less patient radiation. If plastic wrap leads to consistent exposure errors, clinicians may wish to use a 0.5% sodium hypochlorite disinfectant as an alternative to the barrier technique.

Frequency of allergic contact dermatitis to isoeugenol is increasing: a review of 3636 patients tested from 2001 to 2005.

BACKGROUND: Isoeugenol is an important fragrance allergen. The cosmetic industry was recommended voluntarily to reduce concentrations of isoeugenol in finished cosmetic products from 0.2% to 0.02% in 1998. It was suspected that this would reduce the incidence of patch test positivity in individuals undergoing routine patch testing after approximately 2-3 years (the Dillarstone effect). OBJECTIVES: To review our patch test data since the change in practice by industry, to see if there has been an observable decrease in isoeugenol contact sensitivity. METHODS: We retrospectively analysed all subjects patch tested to isoeugenol 1% pet. in the St John's Department of Cutaneous Allergy over a period of 5 years, commencing 3 years after the changes. RESULTS: We identified 3636 subjects, 97 of whom were positive for isoeugenol. Year-on-year incidence shows an increasing trend, with an overall incidence of 2.67%. Using the exact Cochran-Armitage test, this ascending trend is statistically significant (P = 0.0182). Seventy-two of 97 isoeugenol-positive subjects were also positive to fragrance mix I. Other fragrances positive in these 97 patients included Myroxylon pereirae (30%), Evernia prunastri (22%) and eugenol (15%). CONCLUSIONS: We suspect that the increasing trend may be due to allergen substitution with compounds chemically related to isoeugenol, or which hydrolyse to isoeugenol itself.