Factors associated with asymptomatic non-chlamydial non-gonococcal urethritis in heterosexual men: findings from a case-control study.

The significance of asymptomatic non-chlamydial non-gonococcal urethritis (NCNGU) is unclear. Organisms associated with NCNGU, e.g. Mycoplasma genitalium, for which there is no widely available test, are linked to reproductive sequelae in women but UK guidance no longer recommends urethral smear microscopy to screen for asymptomatic NCNGU. This case-control study of heterosexual male genitourinary (GU) medicine clinic attenders aimed to identify clinical, demographic and sexual behaviour factors associated with asymptomatic NCNGU so that we could determine whether the presence or absence of symptoms provides a rational basis for deciding to whom we should offer microscopy and whom we should treat. Men with asymptomatic NCNGU were very similar to men with symptomatic NCNGU, except for more consistent condom use. Asymptomatic and symptomatic NCNGU could be different ends of the same clinical syndrome. Until the microbiological basis of NCNGU is understood, we recommend treatment of men with NCNGU irrespective of symptoms.

STIFCompetency: development and evaluation of a new clinical training and assessment programme in sexual health for primary care health professionals.

UK sexual health services are shifting from hospital-based clinics into primary care, creating a need for high quality clinical sexual health training for non-specialists. Here we describe development, evaluation and costing of a new competency-based training programme, the Sexually Transmitted Infection (STI) Foundation Competency (STIFCompetency) programme, based on the Department of Health's toolkit for delivering more specialized sexual health in primary care. We used an action research paradigm with two iterative cycles. Evaluation was to Kirkpatrick's third level with triangulation of results between trainers and trainees, and different methods, including portfolio evaluation, nominal group technique process, semi-structured interviews, Likert questionnaires and chlamydia testing rates. All 13 primary care clinicians completed the training successfully (median 20 hours) and rated STIFCompetency highly. Trainers needed to reduce their clinical workload to accommodate the training. Average cost per trainee was £1125, reflecting the need for direct observation of competence across a wide range of clinical skills.

Achieving successful partner notification: putting together the pieces of the puzzle.

Partner notification as a public health measure to reduce transmission of sexually transmitted infections (STIs) is a cornerstone of STI control in most countries. The success of any partner notification strategy is conditional on its acceptability and feasibility to both patients and health-care professionals, its compliance with relevant professional and legislative guidance, and its cost-effectiveness.

Is accelerated partner therapy a feasible and acceptable strategy for rapid partner notification in the UK?: a qualitative study of genitourinary medicine clinic attenders.

Partner notification (PN) in the UK is of limited effectiveness. Expedited partner therapy improves PN outcomes but does not comply with existing UK professional guidance. We developed two new strategies, known as accelerated partner therapy (APT), based on elements of PN practice for which there is evidence of efficacy, and which conform to UK prescribing guidance. We explored the acceptability and feasibility of these models qualitatively in genitourinary medicine clinic attenders. Both strategies were viewed favourably. Preference was influenced by age, relationship type, whether participants were delivering or receiving APT and whether the sex partner was aware of the participant's clinic visit. APT provides a new approach to PN, which has strong patient support and complies with existing UK regulations. The complex factors that influence patients' choice of PN method suggest that provision of a range of PN options including APT may be central to improving the effectiveness of PN in the UK.

Application of electron spin resonance spectroscopy and spin probes to investigate the effect of ingredients on changes in wheat dough during heating.

The change in microviscosity of the aqueous and lipid phases of wheat flour dough, during heating and subsequent cooling, has been measured using novel spin probes based on the isoindolin-yloxyl structure. The spin probes, water and/or lipid soluble, were used with combinations of dough ingredients: diacetyl tartaric acid ester of monoglycerides (DATEM), salt, yeast, and sodium ascorbate. The lipid soluble probe showed that DATEM does not produce a homogeneous phase with endogenous lipids but is found in a separate, less mobile phase. Also, the lipids were shown not to be involved in the baking process, although DATEM may be incorporated into the gelled starch matrix. The water soluble probe enabled starch gelatinization to be investigated in detail and showed that gelatinization produces a reduction of dielectric constant. The technique is appropriate for the detailed examination of the behavior of different ingredients during baking and also potentially to examine interactions between ingredients and flour components in dough.

Microstructural effects on microbial survival: phase-separating dextran solutions.

Evolving microstructure in a model dextran solution is shown to exert a major influence on the survival of Escherichia coli K-12 frag 1 and Salmonella typhimurium LT2. The microstructure results from microscopic phase separation, which develops over several hours resulting in hardening of the solution into a glassy state. The microstructure is characterized by an array of physical methods including image analysis, electron spin resonance and bulk rheology, and it is shown that bacterial survival depends on the formation of microscopic. water-rich domains and not primarily on bulk water activity or hardness.

Green tea polyphenols react with 1,1-diphenyl-2-picrylhydrazyl free radicals in the bilayer of liposomes: direct evidence from electron spin resonance studies.

Free radical scavenging reactions of green tea polyphenols (GTP) were investigated with electron spin resonance (ESR) spectroscopy in the phospholipid bilayer of liposomes, using 1, 1-diphenyl-2-picrylhydrazyl (DPPH) radical as a model. The results showed that (1) GTP reacts with DPPH radicals in the bilayer of liposomes of both 1-hexadecanoyl-2-[(cis,cis,cis,cis,cis,cis)-4,7,10, 13,16,19-docosahexaenoyl]-sn-glycero-3-phosphocholine (DHAPC) and 1, 2-di[cis-9-hexadecenoyl]-sn-glycero-3-phosphocholine) (DPPC); and (2) GTP protects DHAPC liposomes effectively from the oxidation initiated by DPPH radicals. These results provide direct evidence that GTP reacts with free radicals in the model membrane and support the hypothesis that GTP protects unsaturated phospholipids from oxidation by reacting directly with the radicals.

Differential regulation of nucleoside and nucleobase transporters in Crithidia fasciculata and Trypanosoma brucei brucei.

The regulation of the activity of purine transporters in two protozoan species, Crithidia fasciculata and Trypanosoma brucei brucei, was investigated in relation to purine availability and growth cycle. In C. fasciculata, two high-affinity purine nucleoside transporters were identified. The first, designated CfNT1, displayed a K(m) of 9.4 +/- 2.8 microM for adenosine and was inhibited by pyrimidine nucleosides as well as adenosine analogues; a second C. fasciculata nucleoside transporter (CfNT2) recognized inosine (K(m) = 0.38 +/- 0.06 microM) and guanosine but not adenosine. The activity of both transporters increased in cells at mid-logarithmic growth, as compared to cells in the stationary phase, and was also stimulated 5-15-fold following growth in purine-depleted medium. These increased rates were due to increased Vmax values (K(m) remained unchanged) and inhibited by cycloheximide (10 microM). In the procyclic forms of T. b. brucei, adenosine transport by the P1 transporter was upregulated by purine starvation but only after 48 h, whereas hypoxanthine transport was maximally increased after 24 h. The latter effect was due to the expression of an additional hypoxanthine transporter, H2, that is normally absent from procyclic forms of T. b. brucei and was characterised by its high affinity for hypoxanthine (K(m) approximately 0.2 microM) and its sensitivity to inhibition by guanosine. The activity of the H1 hypoxanthine transporter (K(m) approximately 10 microM) was unchanged. These results show that regulation of the capacity of the purine transporters is common in different protozoa, and that, in T. b. brucei, various purine transporters are under differential control.

Selected spin probes for the electron spin resonance study of the dynamics of water and lipids in doughs.

New water-soluble and lipid-soluble spin probes suitable for the ESR investigation of the physical states and interactions of components of dough have been developed. This paper reports some preliminary findings on the suitability of these probes for this type of investigation. Rotational correlation times have been measured for the spin probes in water, dough, oil, and a starch/water mixture. An increase in rotational correlation time of the spin probe corresponds to an increase in microviscosity of the medium. Changes observed in correlation times of the water-soluble spin probes in doughs and in water/starch mixtures clearly correspond to a gelatinization process when the mixtures are heated above 60 degrees C. These irreversible changes, clearly important in the baking process, were monitored by following the change of mobility of a spin probe in doughs over a wide temperature range. The similarity of the results from the two sets of experiments suggests that the phenomenon of the increase of correlation times with temperature in doughs is attributable to the starch component. The lipid-soluble spin probe was found to be located preferentially in the lipid phase of the dough.

A crossover trial evaluating an educational-behavioural joint protection programme for people with rheumatoid arthritis.

Joint protection (JP) is a self-management technique widely taught to people with rheumatoid arthritis (RA). JP education aims to enable people with RA to reduce pain, inflammation, joint stress and reduce risks of deformity through using assistive devices and alternative movement patterns of affected joints to perform everyday activities. Previous studies evaluating JP education methods common in the UK have identified JP adherence is poor. A group education programme was developed using the Health Belief Model and Self-efficacy Theory. Strategies used to maximise JP adherence included goal-setting, contracting, modelling, homework programmes, motor learning theory, recall enhancing methods and mental practice. A crossover trial (n = 35) was conducted. Adherence with JP was measured using an objective observational test (the Joint Protection Behaviour Assessment). Significant improvements in use of JP were recorded at 12 and 24 weeks post-education (P < 0.01). No significant changes in measures of pain, functional disability, grip strength, self-efficacy or helplessness occurred post-education, although this may have been due to the small sample size recruited. In conclusion, JP adherence can be facilitated through the use of educational-behavioural strategies, suggesting this approach should be more widely adopted in clinical practice.

The assessment of depression in aphasic stroke patients: the development of the Stroke Aphasic Depression Questionnaire.

OBJECTIVE: The Stroke Aphasic Depression Questionnaire (SADQ) was developed to detect depressed mood in aphasic patients in the community. DESIGN: Correlation analysis between new questionnaire and established measures. SETTING: Patients at home. METHODS: Seventy stroke patients who had been discharged from hospital were assessed on the SADQ, the Hospital Anxiety and Depression Scale and the Wakefield Depression Inventory. The SADQ was also administered to 17 aphasic patients on two occasions at a four-week interval. RESULTS: Results indicated that scores on the SADQ were significantly related to other measures of depression (r(s) = 0.22-0.52, p <0.05). A shortened 10-item version showed higher validity (r(s) = 0.32-0.67, p <0.01). Test-retest analysis indicated the SADQ is reliable over a four-week interval (r(s) = 0.72, p <0.001). CONCLUSIONS: The SADQ may be used for assessing depressed mood in aphasic patients in the community though further validation is required.

The design of spin probes for electron magnetic resonance spectroscopy and imaging.

The problems that have to be addressed in designing suitable spin probes are manifold. In this article it will be shown that some the properties the probes need to possess are (i) a simple EMR spectrum (in some types of imaging or oximetry a single line is desirable), (ii) sharp lines with no unresolved splittings, to provide maximum sensitivity to detection, (iii) chemical, metabolic and thermal stability, (iv) easy possible synthesis to permit substitution with isotopes, prosthetic groups or groups to control the partition coefficients in lipid/water systems, and (v) electronic anisotropy, if rotational correlation times are to be determined, for example for the measurement of local viscosity.

Evaluation of cognitive behavioural treatment for depression after stroke: a pilot study.

OBJECTIVE: To evaluate cognitive behavioural therapy in the treatment of depressed stroke patients. DESIGN: A series of AB single case experimental design studies. SUBJECTS: Stroke patients who had been admitted to hospital. METHODS: Patients were identified from a hospital register of stroke patients and sent the Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale to determine whether they were depressed. Those who were depressed were sent the BDI weekly during a four-week baseline period. They were then treated and continued to complete the BDI weekly over a three-month treatment period. Patients were also assessed pre- and post-treatment on measures of functional independence. INTERVENTION: Cognitive behaviour therapy. RESULTS: Of the 626 patients on the Stroke Register, 373 returned questionnaires and 155 were identified as depressed. Of these 136 were visited and 19 agreed to take part. The outcome was evaluated using three methods: visual inspection, comparison of patients during baseline and treatment phases and proportion of scores below lowest baseline. This showed that four patients consistently showed beneficial treatment effects, six patients showed some benefit and nine no benefit. For the group as a whole there was a significant decrease in depression during the treatment period on the BDI (p = 0.02) but no significant change in functional abilities. CONCLUSION: Cognitive behavior therapy is an appropriate treatment for some depressed stroke patients and beneficial for some patients. Further evaluation of this treatment with stroke patients is warranted.

Philosophy and models in critical care nursing.

In 1991 a new philosophy and nursing model was developed in the adult intensive care unit. A team approach over several months, through the exploration of attitudes, values and beliefs, gave rise to the unit philosophy. The philosophy identified the beliefs of the nursing team which then, along with identified knowledge and goals for practice, directed us towards an appropriate nursing model. The Mead model, an adaptation from Roper, Logan & Tierney's model, was chosen and then adapted further. We believe the resulting model, although not perfect, guides our practice, reflects our beliefs, and is practical and 'user friendly'.

Heart health (continuing education credit).

Promoting heart health is an important component of preventive health care today. It involves health promotion issues which potentially fall within the remit of every practising nurse, such as helping clients to reduce blood pressure and blood cholesterol levels, weight, stress, salt and alcohol intake, and to stop smoking.

An investigation into whether nurses change their learning style according to subject area studied.

The aim of this study was to investigate whether nurses' preferred learning styles varied according to subject area studied. Thirty nurses in a postgraduate centre specializing in cardiothoracic care were interviewed using a semi-structured technique. The results suggest that there is a change in learning style as different subjects are studied. Other factors emerging were the importance of previous learning experience, the wish to share, to be acknowledged and the need for close links between theory and practice. This calls for nurse teachers to examine their practice, to update and undertake professional development and also to establish close clinical links.

An examination of the implications of adopting a process approach to curriculum planning, implementation and evaluation.

A process may be seen as that which has purpose, organization and structure, facilitating an act of moving forward. Thus, a process reflects Bruner's view of education as facilitating cognitive growth and as a way in which individuals explore and gain mastery over a complex world. A process approach is not without its problems, namely in that some nursing skills require a precise, predetermined outcome best achieved by the use of behavioural objectives. A curriculum promoting growth and continued learning calls for increased funding, which may cause problems in today's financial climate. Exploration of concepts calls for careful planning of practical experience and may be difficult where supernumerary status is not fully implemented. However, a process approach may reduce the theory practice gap and lead to a reflective and proactive practitioner. On-going education of clinical staff is required and increased communication between educational and clinical staff. This approach may lead to a more holistic view of nursing education and achievement measured in not only quantitative but also qualitative terms. Solving the problems that a process approach may present may cause nursing education to be enhanced.

An examination of the factors influencing the choice of one college of nursing in choosing an institute of higher education with which to link.

This paper examines the factors influencing the choice of one College of Nursing when linking with an Institute of Higher Education, from which general principles can be drawn. The College is situated in Central London, within a Special Health Authority at a post graduate centre. The College currently offers courses in clinical nursing leading to English National Board certification, but is hoping to expand its courses in the near future. Influencing factors are examined in the light of the final decision using Roby's Deliberative Model.