Hallucinations and Development of Dementia in Parkinson's Disease.

Neuropsychiatric symptoms are common in Parkinson's disease (PD). We investigated the relationship between neuropsychiatric symptoms and current and future diagnosis of PD dementia (PDD). Individuals with PD who had a study partner were enrolled (n = 696). Study partners were administered the Neuropsychiatric Inventory or Neuropsychiatric Inventory Questionnaire at baseline. Participants were assigned a cognitive diagnosis at baseline and follow up visits. Hallucinations were significantly associated with a diagnosis of PDD cross-sectionally (p < 0.001) and with shortened time to dementia longitudinally among initially nondemented participants (n = 444; p = 0.005). Screening for hallucinations may be useful for assessing risk of dementia in participants with PD.

A diminutive chromosome 21 centromere in acute lymphoblastic leukemia.

A chance observation of a tiny constitutional variant for the centromere of chromosome 21 in two patients with acute lymphoblastic leukemia (ALL), suggested a possible correlation with the cytogenetic findings in their leukemic cells. Interphase FISH revealed three 13/21 centromeric signals and a single MLL signal in the blast cells of each patient. Metaphase FISH with dual-color application of whole-chromosome paint (wcp) and centromeric probes for chromosome 21 showed two copies of chromosome 21, one with a tiny centromeric signal which corresponded to the invisible centromere in the interphase cells. Patient 2700 had a normal karyotype in his bone marrow at diagnosis. All metaphases from his stimulated peripheral blood also had the tiny chromosome 21 centromere, proving it to be a constitutional variant. Patient 3314 showed the abnormal karyotype 46,XY,inv(1)(p?q?),del(11)(q?),del(12)(p?),inc in his bone marrow. Interphase FISH revealed only one copy each of the ABL and ETV6 genes, in addition to the loss of the MLL signal. The question arises, is there an association between the diminutive centromeric signals for chromosome 21 and the chromosomal instability demonstrated by the deletions of key genes from the leukemic blasts of these two patients?

Developing the skills to implement evidence based practice - a joint initiative between education and clinical practice.

The current political climate stresses the need for health care to be seen to be effective. A joint initiative between a college of nursing and an acute hospital Trust was formed to develop an Evidence Based Practice course. The course aimed to achieve a clear and identifiable outcome that could be used to enhance patient care. Before starting the course the students identified a clinically related question to explore. The course itself introduced the concept of evidence based practice, emphasising the practical skills of information searching and retrieval and of dissemination techniques. The course culminated in a formal presentation, attended by clinical and education staff, and management, including non-executive directors. Discussion followed each presentation to debate how the changes suggested could be implemented, including what resources might be needed. This paper will discuss the development of the course, its content and the benefits for the students, the sponsoring Trust and for patient care. Examples will be given to illustrate the success of the initiative and discussion will take place around the importance of the close partnership that has to be forged between the Trust and college.