ABSTRACT
Several transgenic mouse models have been developed which facilitate the transmission of chronic wasting disease (CWD) of cervids and allow prion strain discrimination. The present study was designed to assess the susceptibility of the prototypic mouse line, Tg(CerPrP)1536(+/-), to bovine spongiform encephalopathy (BSE) prions, which have the ability to overcome species barriers. Tg(CerPrP)1536(+/-) mice challenged with red deer-adapted BSE resulted in 90% to 100% attack rates, and BSE from cattle failed to transmit, indicating agent adaptation in the deer.
Subject(s)
Deer/metabolism , Disease Models, Animal , Encephalopathy, Bovine Spongiform/metabolism , Mice , Prions/metabolism , Wasting Disease, Chronic/metabolism , Animals , Cattle , Central Nervous System/metabolism , Central Nervous System/pathology , Disease Susceptibility , Encephalopathy, Bovine Spongiform/pathology , Encephalopathy, Bovine Spongiform/transmission , Female , Male , Mice, Transgenic , Species Specificity , Wasting Disease, Chronic/pathology , Wasting Disease, Chronic/transmissionABSTRACT
OBJECTIVE: To determine if nurse practitioners and physicians followed recommended practice guidelines prior to the initiation of antibiotics among long-term care (LTC) residents with suspected urinary tract infections (UTIs). METHODS: A retrospective review of 1-year reported cases of UTIs in 2 rural southern nursing homes. RESULTS: There were 175 cases of UTI reported in the 2 homes, but 6 cases were reported in error. Only 4 of the 169 remaining cases met the diagnostic criteria for UTI. The remaining 169 cases received inappropriate antibiotics. Some of these cases may represent asymptomatic bacteria rather than UTI. Problems were identified with the methods used to collect urine sample that were sent to the laboratory for culture. CONCLUSION: We found that in 2 nursing homes, almost all of the reported cases of UTI did not meet the accepted diagnostic criteria. Also, there was inappropriate antibiotic therapy for most of these residents. Nurse practitioners and physicians should accurately determine the presence of UTI and document in the medical record prior to initiating antibiotic. Urine specimens should be collected using appropriate methods. Nursing homes should only report to the Centers for Medicare and Medicaid Services (CMS) those cases that meet the diagnostic criteria as a UTI.
ABSTRACT
PURPOSE: To determine the effectiveness of two dissemination and implementation strategies to implement a national guideline for epilepsy management in primary care settings. METHODS: Three-arm cluster-randomized controlled trial. The participants were general practitioners from 68 practices in Tayside, Scotland, and 1,133 of their patients with self-reported epilepsy treated with antiepileptic medications (AEDs). Practices were randomized blind to a control, intermediate, or intensive intervention. CONTROL: Postal dissemination of a nationally developed clinical guideline. Intermediate intervention: Postal dissemination of the guideline supported by interactive, accredited workshops, and dedicated, structured protocol documents. Intensive intervention: Intermediate intervention plus a nurse specialist who supported and educated practices in the establishment of epilepsy review clinics. The primary outcome was the SF-36 health-related quality-of-life instrument. Secondary measures were a battery of prevalidated epilepsy-specific quality-of-life instruments. These were administered at baseline and after the intervention phase. Process of care was assessed by case-note review on number of review meetings and counseling sessions for epilepsy before and after the interventions. RESULTS: None of the intervention groups showed any change in the primary or secondary outcome measures or process-of-care measures. CONCLUSIONS: None of the intervention strategies led to improvements in patient quality of life or quality of epilepsy care. Further research is needed to discover why the interventions failed, to identify barriers to adoption of guidelines, and to develop strategies that might improve implementation and uptake in the future.
