Pharmacology and therapeutic potential of pattern recognition receptors.

Pharmacologists have used pathogen-associated molecular patterns (PAMPs), such as lipopolysaccharide (LPS) for decades as a stimulus for studying mediators involved in inflammation and for the screening of anti-inflammatory compounds. However, in the view of immunologists, LPS was too non-specific for studying the mechanisms of immune signalling in infection and inflammation, as no receptors had been identified. This changed in the late 1990s with the discovery of the Toll-like receptors. These 'pattern recognition receptors' (PRRs) were able to recognise highly conserved sequences, the so called pathogen associated molecular patterns (PAMPs) present in or on pathogens. This specificity of particular PAMPs and their newly defined receptors provided a common ground between pharmacologists and immunologists for the study of inflammation. PRRs also recognise endogenous agonists, the so called danger-associated molecular patterns (DAMPs), which can result in sterile inflammation. The signalling pathways and ligands of many PRRs have now been characterised and there is no doubt that this rich vein of research will aid the discovery of new therapeutics for infectious conditions and chronic inflammatory disease.

A three-dimensional soft tissue analysis of 16 skeletal class III patients following bimaxillary surgery.

A three-dimensional soft tissue study of the results of surgery in a group of 16 skeletal Class III adult patients following orthognathic surgery was carried out using laser scans (Arridge et al., 1985). The patient group was compared to a control group of the same population. Laser scans were taken prior to surgery, 3 months post-surgery, and at least 1 year after retention. Preoperative comparison to the control groups revealed that the facial disproportion related to both the maxilla and the mandible. Le Fort I advancements resulted in broadening of the lateral aspects of the nose, advancement of the dorsum, and overcorrection of the alar bases. There was a degree of change over the cheeks bilaterally, because of alterations in the general drape of the soft tissues. There was a degree of overcorrection in the female group following mandibular set back but the male group were still more prognathic, when compared to the control group. There was a marked degree of relapse in the mandible from 3 months to 1 year postoperatively, with a resultant anterior movement of the maxillary arch. Laser scanning has proved to be a simple non-invasive method of measuring three-dimensionally, and is a very useful tool in auditing surgical outcome and measuring surgical relapse.

Nurses' knowledge, attitudes, and beliefs regarding organ and tissue donation and transplantation.

The acute shortage of human organs and tissues for transplantation has been attributed in part to health professionals, including nurses, for their reluctance to recognize and refer suitable candidates for donation. In 1988, nurses' knowledge, attitudes, and beliefs regarding organ and tissue donation and transplantation were assessed using a 70-item questionnaire. Respondents included 1,683 nurses employed in 62 rural and urban hospitals in the Midwest. Only 365 respondents (21.7 percent) reported having requested tissue donations and 243 (14.4 percent) reported having requested organ donations. However, of those who requested tissue or organ donations, 270 (74 percent) obtained consents for tissues and 150 (61.7 percent) obtained consent for organ donations. Respondents were knowledgeable about organ and tissue donation (mean score of 7.5 on a 0 to 10 knowledge scale with 10 as highest) and reported attitudes and beliefs were moderately positive. Factors that were significantly correlated with the number of requests made for organs and tissues and the number of consents obtained included nurses' knowledge, attitudes, and beliefs about donation; nurses' perception of their own confidence in their ability to request tissues and organs; being a supervisor; and working in an emergency department.

Tapping patient satisfaction: a strategy for quality assessment.

Participant satisfaction is an important measure of program effectiveness. In hospitals, patient satisfaction is a measure that is compatible with quality assurance. This article focuses on the revision, implementation and analysis of a patient satisfaction questionnaire that was designed as a tool for assessing the quality of non-physician encounters in a small hospital. The Patient Satisfaction Questionnaire (PSQ), which contained a 30-item rating scale, was designed to collect data about admissions, nursing care and seven other hospital services. The 686 PSQs that comprised a 4-month sample of 2156 instruments (31.8%) completed in a selected year were analyzed. Results show no less than 90% of patient ratings reflecting satisfaction. In addition, open-ended responses were overwhelmingly laudatory. The content and process of this collaborative effort demonstrate compatibility between research and management when goals and purposes are clearly delineated.

Comprehensive prenatal care for pregnant teens.

Comprehensive teen-age pregnancy programs have endeavored to reduce associated morbidity and mortality. Positive results have been reported, but significant findings have been elusive. This article describes a rural program and compares the pregnancy outcomes of 60 matched nonparticipants. The study determined a relationship existed between participation in the program and maternal complications, birth weight, gestational age, Apgar score, and perinatal morbidity. Participants were matched perfectly on socioeconomic status and age, and near-perfectly on year of delivery. Subjects also were matched on ethnicity, marital status, and residence. Participation and fewer maternal complications of anemia, infections, and eclampsia were significantly related. Remaining dependent variables were not significantly related, but low birth weight (six vs. 11) and prematurity (six vs. nine) were lower for participants. Suggestions for researchers of teen pregnancy programs are included.

Defining and measuring patient satisfaction with medical care.

This paper describes the development of Form II of the Patient Satisfaction Questionnaire (PSQ), a self-administered survey instrument designed for use in general population studies. The PSQ contains 55 Likert-type items that measure attitudes toward the more salient characteristics of doctors and medical care services (technical and interpersonal skills of providers, waiting time for appointments, office waits, emergency care, costs of care, insurance coverage, availability of hospitals, and other resources) and satisfaction with care in general. Scales are balanced to control for acquiescent response set. Scoring rules for 18 multi-item subscales and eight global scales were standardized following replication of item analyses in four field tests. Internal-consistency and test-retest estimates indicate satisfactory reliability for studies involving group comparisons. The PSQ well represents the content of characteristics of providers and services described most often in the literature and in response to open-ended questions. Empirical tests of validity have also produced generally favorable results.

Consumer perceptions of health care services: implications for academic medicine.

The factor analytic development of various measures of consumer perceptions regarding characteristics of doctors and health care services is described. Index scores meeting factor analytic and reliability criteria were used to study the importance of consumer perceptions in relation to behavioral outcomes. Numerous dimensions of consumer perceptions were identified and described, including beliefs about doctor conduct in terms of quality of care and humaneness of health care delivery as well as satisfaction with such enabling components as the continuity of care, availability and convenience of services, and various access mechanisms (cost, payment mechanisms, and ease of emergency care facilities). Measures of these perceptions were shown to be related to differences in several estimates of health services utilization. The use of the index scores which have met empirical criteria is in contrast to the common practice of using individual questionnaire items as the unit of analysis in health care research. Findings are discussed in relation to program planning and evaluation in medical education, and suggestions for future research are noted.