Developing and implementing clinical practice tools: the legal and ethical implications.

The complexity of health care is ever increasing, as is the volume of research and literature available. In response there has been a corresponding emphasis on basing clinical decisions on the best available research evidence. The development and implementation of clinical practice tools is cited as a means of ensuring research utilisation as well as moderating variations in clinical practice. It is important that nurses contribute to the development of these clinical tools in order to actively shape their own practice. Nurses therefore need to have an understanding of the terminology and processes involved, and the implications for practice. This paper outlines definitions of the various clinical tools, the development process, and the legal and ethical implications of clinical practice tools.

The complement component C1s catalysed hydrolysis of peptide 4-nitroanilide substrates.

The kinetic parameter kcat/Km has been determined for the hydrolysis of peptide 4-nitroanilides, catalysed by complement component C1s. Substrates based on the C-terminal sequence of human C4a (Leu-Gln-Arg) were synthesised. Replacement of the glutamine residue by glycine or serine increased kcat/Km. Substitution of valine for the leucine residue increased kcat/Km, while substitution of glycine or lysine for the leucine residue decreased kcat/Km slightly. D-Val-Ser-Arg 4-nitroanilide is the most reactive 4-nitroanilide substrate towards C1s, so far. These results are discussed in relation to the amino acid sequences near the bonds cleaved by C1s in C4, C2 and C1 inhibitor.