Self-administered medication packet for patients experiencing a vaginal birth.

A patient satisfaction survey at Missouri Baptist Medical Center revealed that patients experiencing a vaginal delivery needed to wait for their medications and did not consistently receive adequate information about medications. Furthermore, a chart review noted that physicians ordered a wide variety of medications for their patients but that the patients did not always use all their medications. A review of patients' accounts determined that their medications were costly. A multidisciplinary team using the FOCUS-PDCA quality improvement model designed and implemented a self-administered medication packet. Outcomes included continued patient satisfaction with decreases in cost, narcotic use, and medication errors.

Postpartum teaching priorities: the viewpoints of nurses and mothers.

OBJECTIVE: To compare mothers' and nurses' perceptions of postpartum learning needs and effective teaching modalities. DESIGN: Cross-sectional research design. Mothers were given a questionnaire during their postpartum stay to rate how important it was for them to learn about 44 maternal-infant topics before discharge. Nurses rated similar items on the basis of their perception of what is most important for mothers to learn during their postpartum stay. SETTING: Postpartum units in six hospitals that are part of a large midwestern health care system. PARTICIPANTS: English-speaking women who delivered either vaginally or by cesarean section without complications and the nurses on their postpartum units. MAIN OUTCOME MEASURES: Identification of preferred topics and methods for postpartum teaching. RESULTS: Mothers and nurses agreed that topics related to immediate physical health needs were most important. Unmarried mothers considered topics related to personal care and mobility as particularly important. First-time mothers rated more topics as important than did experienced mothers. Individual teaching was rated most effective by both groups. Classroom teaching and the use of audiovisual media were considered less effective. CONCLUSIONS: This study supports postpartum education that focuses on the physical needs of mothers and infants, as well as individual teaching models. The special learning needs of new mothers, including those who are not married, must be considered.

Molecular cloning and genetic analysis of the rfb region from Shigella flexneri type 6 in Escherichia coli K-12.

The rfb gene cluster which determines the biosynthesis of the Shigella flexneri serotype 6 O-antigen specificity has been cloned in pHC79, generating plasmids pPM3115 and pPM3116. These plasmids mediate expression, in Escherichia coli K-12, of lipopolysaccharides (LPS) immunologically similar to the S. flexneri type 6 LPS as judged by SDS-PAGE and Western-immunoblot analysis using S. flexneri type 6 specific antisera. Thus, unlike other S. flexneri serotypes, no additional loci are required for serotype specificity. This expression is independent of E. coli K-12 rfb genes. Southern-hybridization analysis using the 16.2-kb BglII probe from S. flexneri type 6 rfb region detected very little sequence homology in S. flexneri serotypes 1-5, however, some homology was detected with E. coli O2 and O18, but not in E. coli 0101 strains, Salmonella and Vibrio cholerae.

Genetic analysis of the rfb region of Shigella flexneri encoding the Y serotype O-antigen specificity.

The gene cluster (rfb region) which determines the biosynthesis of the Shigella flexneri O-antigen of the Y serotype specificity was cloned from a S. flexneri serotype 2a strain. Two plasmids, pPM2212 and pPM2213, which conferred O-antigen biosynthesis were generated from separate cosmid clones by deletion with Clal. These plasmids expressed O-antigen in Escherichia coli K12 like that of the parental strain, as assessed by reactions to antisera in colony and Western immunoblots, sensitivity to bacteriophage Sf6, and by silver staining of lipopolysaccharides separated by sodium dodecyl sulphate/polyacrylamide gel electrophoresis. These plasmids also mediated O-antigen expression in an E. coli K12 rfb-delete background, indicating that all the necessary genes have been cloned. A detailed restriction map of the region has been constructed and analysis of various subclones has allowed the limits of the coding region for O-antigen biosynthesis to be defined to a maximum of 11 kb. Expression of these plasmids demonstrates a novel phenotype associated with control of lipopolysaccharide chain length. The gene(s) responsible maps adjacent to, but separate from, those associated with the biosynthesis of the O-antigen unit. Analysis of plasmid-encoded proteins in minicells and maxicells has facilitated the construction of a physical map. Finally, plasmid pPM-2212 was used to probe a collection of S. flexneri serotypes by Southern hybridization. With the exception of serotype 6, which appears to be unrelated, a similar pattern was found in all serotypes.

Molecular cloning and expression in Escherichia coli K-12 of the O101 rfb region from E. coli B41 (O101:K99/F41) and the genetic relationship to other O101 rfb loci.

The gene cluster (rfb region) which determines the synthesis of O101 lipopolysaccharide (LPS) O-antigen was cloned from the Escherichia coli O101:K99:F41 reference strain B41 to give plasmid pPM1301. The smallest subclones represented by pPM1305 and pPM1330 expressed O-antigen in E. coli K-12 similar to (but not identical to) B41, as judged by immunogold electron microscopy and silver staining of LPS separated by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). At least six proteins were detected by minicell analysis of proteins encoded by pPM1305, which suggests that O-antigen synthesis is genetically complex. Restriction and deletion analysis demonstrated that a minimum of 8.9 kb and a maximum of 11.8 kb are required for O101 O-antigen biosynthesis in E. coli K-12. Examination of LPS banding patterns of other O101 isolates by SDS-PAGE suggested heterogeneity of LPS structure. Southern DNA hybridization analysis using radiolabelled subclones of pPM1305 demonstrated that there was close relationship among the O101 ETEC isolates.

Demonstration of clonal variation amongst O-antigen serotype variants of Escherichia coli O2 and O18 using DNA probes to the rfb region of the E. coli strain B41 (O101:K99/F41).

The confirmation at the DNA level of the existence of clonal variants within Escherichia coli O2 and O18 serotypes has been shown by Southern hybridization analysis of restriction endonuclease digested genomic DNA and subsequent probing with contiguous subclones of the E. coli O101 rfb region. The O101 rfb subclones are believed to represent a conserved region of DNA (Heuzenroeder et al. Molec. Microbiol, in press) and identify serotype variants by means of restriction fragment length polymorphisms (RFLP) within homologous DNA of O2 and O18 E. coli. A number of different restriction enzymes have been used singly and in combination to digest the genomic DNA, thereby allowing construction of restriction maps of the region displaying homology to the O101 rfb region subclones. This analysis further substantiates previously defined evolutionary relationships between O2 and O18 E. coli. These simple probes appear to be able to provide the same clonal information as a battery of isoenzyme, outer membrane protein (OMP) and lipopolysaccharide (LPS) analyses.