Reducing pressure damage: care bundles and collaborative learning.

Reduction of hospital-acquired pressure ulcers is a patient and nursing priority. Although evidence-based interventions to prevent such ulcers are well known, reducing this healthcare burden has proven consistently difficult. Via case studies, this article describes how a bundle approach to pressure ulcer prevention may be adapted for use within different clinical areas. It illustrates how collaborative learning may facilitate the spread of improvement work across a health board and build improvement skills within nursing.

Patient safety education - a description and evaluation of an international, interdisciplinary e-learning programme.

Patient safety is a priority within healthcare across the globe. Delivering safer healthcare demands a system wide approach and educators have a responsibility to play a full role. This article describes how e-learning can be a means of engaging and educating an international group of critical care professionals studying at Masters level. Using online tools such as blogs, wikis and discussion boards students are introduced to quality and safety subjects and tools to help them improve care at a local level. Working together as a collaborative of different professionals has engaged the student group helping them understand their role in reducing harm and has resulted in improvements to care.

Field boundaries as barriers to movement of hover flies (Diptera: Syrphidae) in cultivated land.

Field boundaries play an important role as refuges, food sources and corridors for invertebrates and vertebrates, and increasing farmland fragmentation impacts on these functions. However, hedgerows and other structures can also impede dispersal by flying insects. The current work uses the pollen of Phacelia tanacetifolia in hover fly guts as a marker to assess hover fly movement in farm landscapes. In the United Kingdom and New Zealand, Phacelia pollen was found in the guts of Ephisyrphus balteatus and Metasyrphus corollae (United Kingdom) and Melanostoma fasciatum (New Zealand) at distances up to 200 m from the source, when there were no barriers between the flowers and the traps used to catch the flies. The rate of decline over distance in the proportion of flies containing pollen was similar for the two countries. The extent to which four replicated field boundary types impeded hover fly movement was tested using post-and-wire fences, lines of poplars (Populus spp.) with gaps, dense poplars and controls (no potential barriers). Phacelia was planted on one side of each boundary, and along the centre of the control plots. The relative presence of the pollen in flies on both sides of the barriers showed that both types of poplar boundary restricted the movement of the flies, but the fence had no effect. In a separate experiment, gravid females of M. fasciatum were captured at a greater height on a shade-cloth fence than were non-gravid females and males. The implications of this work include the functioning and persistence of metapopulations and the influence of field boundaries on population recovery of beneficial invertebrates following pesticide-induced mortality. If field boundaries contribute to a temporal asynchrony between pest and natural enemy populations, this needs to be considered along with the well-established roles of boundaries as refugia for, and sources of, beneficial arthropods.

Mechanisms of protection induced by attenuated simian immunodeficiency virus.

To determine whether attenuated simian immunodeficiency virus (SIV) vaccines confer protection against superinfection via secondary cellular immune responses, we searched for markers of immune activation following rechallenge. Productive infection with either attenuated SIVmacC8 or wild-type SIVmacJ5 resulted in a transient increase in T-lymphocyte CD25 and Mafa-DR expression. A pronounced increase in the frequency of FAS+ CD8+ lymphocytes was observed following SIVmacJ5 infection only. A transient increase in lymphocytes positive for intracellular IFN-gamma and IL-4 was observed following primary infection with either virus. In contrast, lymphocytes positive for intracellular IL-2 were reduced. Following SIVmacJ5 challenge of SIVmacC8-infected vaccinees, no evidence of detectable superinfection was obtained. Rechallenge of vaccinees did not alter the frequency of activated peripheral T-lymphocytes, perturb cytokine profiles, or generate an anamnestic antibody response. These data do not support the hypothesis that protection conferred by live attenuated SIV is mediated by the induction of vigorous T-cell responses upon rechallenge.