bluuebunny/crossref_metadata_2025 huggingface dataset:
Constitutively active calcineurin induces cardiac endoplasmic reticulum stress and protects against apoptosis that is mediated by α-crystallin-B
Authors: Bousette Nicolas , Chugh Shaan , Fong Vincent , Isserlin Ruth , Kim Kyoung-Han , Volchuk Allen , Backx Peter H. , Liu Peter , Kislinger Thomas , MacLennan David H. , Emili Andrew , Gramolini Anthony O.
Published: October 2010

Cardiac-specific overexpression of a constitutively active form of calcineurin A (CNA) leads directly to cardiac hypertrophy in the CNA mouse model. Because cardiac hypertrophy is a prominent characteristic of many cardiomyopathies, we deduced that delineating the proteomic profile of ventricular tissue from this model might identify novel, widely applicable therapeutic targets. Proteomic analysis was carried out by subjecting fractionated cardiac samples from CNA mice and their WT littermates to gel-free liquid chromatography linked to shotgun tandem mass spectrometry. We identified 1,918 proteins with high confidence, of which 290 were differentially expressed. Microarray analysis of the same tissue provided us with alterations in the ventricular transcriptome. Because bioinformatic analyses of both the proteome and transcriptome demonstrated the up-regulation of endoplasmic reticulum stress, we validated its occurrence in adult CNA hearts through a series of immunoblots and RT-PCR analyses. Endoplasmic reticulum stress often leads to increased apoptosis, but apoptosis was minimal in CNA hearts, suggesting that activated calcineurin might protect against apoptosis. Indeed, the viability of cultured neonatal mouse cardiomyocytes (NCMs) from CNA mice was higher than WT after serum starvation, an apoptotic trigger. Proteomic data identified α-crystallin B (Cryab) as a potential mediator of this protective effect and we showed that silencing of Cryab via lentivector-mediated transduction of shRNAs in NCMs led to a significant reduction in NCM viability and loss of protection against apoptosis. The identification of Cryab as a downstream effector of calcineurin-induced protection against apoptosis will permit elucidation of its role in cardiac apoptosis and its potential as a therapeutic target.
The Dynamics of Informal Responses to Covariate Shocks
Authors: Balgah R. A. , Buchenrieder G.
Published: October 2010

Microeconomic theory suggests differential resilience of formal and informal instruments to natural and man-made shocks. Informal risk instruments effective in managing idiosyncratic risks are predicted to collapse in the wake of covariate shocks. This position leads to two hypotheses:
The scaffolding protein EBP50 regulates microvillar assembly in a phosphorylation-dependent manner
Authors: Garbett Damien , LaLonde David P. , Bretscher Anthony
Published: October 2010

The mechanisms by which epithelial cells regulate the presence of microvilli on their apical surface are largely unknown. A potential regulator is EBP50/NHERF1 (ERM-binding phosphoprotein of 50 kD/Na+-H+ exchanger regulatory factor), a microvillar scaffolding protein with two PDZ domains followed by a C-terminal ezrin-binding domain. Using RNAi and expression of RNAi-resistant EBP50 mutants we systematically show that EBP50 is necessary for microvillar assembly and requires that EBP50 has both a functional first PDZ domain and an ezrin-binding site. Expression of mutants mimicking Cdc2 or PKC phosphorylation are nonfunctional in microvillar assembly. Biochemical analysis reveals that these mutants are defective in PDZ1 accessibility when PDZ2 is occupied, and can be rendered functional in vivo by additional mutation of PDZ2. EBP50 is not necessary for mitotic cell microvilli, and PKC activation causes a rearrangement of microvilli on cells due to phosphorylation-dependent loss of EBP50 function. Thus, EBP50 is a critical factor that regulates microvilli assembly and whose activity is regulated by signaling pathways and occupation of its PDZ2 domain.
Rescue of myogenic defects in Rb-deficient cells by inhibition of autophagy or by hypoxia-induced glycolytic shift
Authors: Ciavarra Giovanni , Zacksenhaus Eldad
Published: October 2010

The retinoblastoma tumor suppressor (pRb) is thought to orchestrate terminal differentiation by inhibiting cell proliferation and apoptosis and stimulating lineage-specific transcription factors. In this study, we show that in the absence of pRb, differentiating primary myoblasts fuse to form short myotubes that never twitch and degenerate via a nonapoptotic mechanism. The shortened myotubes exhibit an impaired mitochondrial network, mitochondrial perinuclear aggregation, autophagic degradation, and reduced adenosine triphosphate production. Bcl-2 and autophagy inhibitors restore mitochondrial function and rescue muscle degeneration, leading to formation of long, twitching myotubes that express normal levels of muscle-specific proteins and stably exit the cell cycle. A hypoxia-induced glycolytic switch also rescues the myogenic defect after either chronic or acute inactivation of Rb in a hypoxia-inducible factor-1 (HIF-1)–dependent manner. These results demonstrate that pRb is required to inhibit apoptosis in myoblasts and autophagy in myotubes but not to activate the differentiation program, and they also reveal a novel link between pRb and cell metabolism.
RAD18-mediated ubiquitination of PCNA activates the Fanconi anemia DNA repair network
Authors: Geng Liyi , Huntoon Catherine J. , Karnitz Larry M.
Published: October 2010

The Fanconi anemia (FA) network is important for the repair of interstrand DNA cross-links. A key event in FA pathway activation is the monoubiquitylation of the FA complementation group I (FANCI)–FANCD2 (ID) complex by FA complementation group L (FANCL), an E3 ubiquitin ligase. In this study, we show that RAD18, another DNA damage–activated E3 ubiquitin ligase, also participates in ID complex activation by ubiquitylating proliferating cell nuclear antigen (PCNA) on Lys164, an event required for the recruitment of FANCL to chromatin. We also found that monoubiquitylated PCNA stimulates FANCL-catalyzed FANCD2 and FANCI monoubiquitylation. Collectively, these experiments identify RAD18-mediated PCNA monoubiquitination as a central hub for the mobilization of the FA pathway by promoting FANCL-mediated FANCD2 monoubiquitylation.
Aurora B kinase controls the targeting of the Astrin–SKAP complex to bioriented kinetochores
Authors: Schmidt Jens C. , Kiyomitsu Tomomi , Hori Tetsuya , Backer Chelsea B. , Fukagawa Tatsuo , Cheeseman Iain M.
Published: October 2010

During mitosis, kinetochores play multiple roles to generate interactions with microtubules, and direct chromosome congression, biorientation, error correction, and anaphase segregation. However, it is unclear what changes at the kinetochore facilitate these distinct activities. Here, we describe a complex of the spindle- and kinetochore-associated protein Astrin, the small kinetochore-associated protein (SKAP), and the dynein light chain LC8. Although most dynein-associated proteins localize to unaligned kinetochores in an Aurora B–dependent manner, Astrin, SKAP, and LC8 localization is antagonized by Aurora B such that they target exclusively to bioriented kinetochores. Astrin–SKAP-depleted cells fail to maintain proper chromosome alignment, resulting in a spindle assembly checkpoint–dependent mitotic delay. Consistent with a role in stabilizing bioriented attachments, Astrin and SKAP bind directly to microtubules and are required for CLASP localization to kinetochores. In total, our results suggest that tension-dependent Aurora B phosphorylation can act to control outer kinetochore composition to provide distinct activities to prometaphase and metaphase kinetochores.
Family-wide characterization of the DENN domain Rab GDP-GTP exchange factors
Authors: Yoshimura Shin-ichiro , Gerondopoulos Andreas , Linford Andrea , Rigden Daniel J. , Barr Francis A.
Published: October 2010

A key requirement for Rab function in membrane trafficking is site-specific activation by GDP-GTP exchange factors (GEFs), but the majority of the 63 human Rabs have no known GEF. We have performed a systematic characterization of the 17 human DENN domain proteins and demonstrated that they are specific GEFs for 10 Rabs. DENND1A/1B localize to clathrin patches at the plasma membrane and activate Rab35 in an endocytic pathway trafficking Shiga toxin to the trans-Golgi network. DENND2 GEFs target to actin filaments and control Rab9-dependent trafficking of mannose-6-phosphate receptor to lysosomes. DENND4 GEFs target to a tubular membrane compartment adjacent to the Golgi, where they activate Rab10, which suggests a function in basolateral polarized sorting in epithelial cells that compliments the non-DENN GEF Sec2 acting on Rab8 in apical sorting. DENND1C, DENND3, DENND5A/5B, MTMR5/13, and MADD activate Rab13, Rab12, Rab39, Rab28, and Rab27A/27B, respectively. Together, these findings provide a basis for future studies on Rab regulation and function.
Cyclin-dependent kinase 5 activity is required for T cell activation and induction of experimental autoimmune encephalomyelitis
Authors: Pareek Tej K. , Lam Eric , Zheng Xiaojing , Askew David , Kulkarni Ashok B. , Chance Mark R. , Huang Alex Y. , Cooke Kenneth R. , Letterio John J.
Published: October 2010

Cyclin-dependent kinase 5 (Cdk5) is a ubiquitously expressed serine/threonine kinase. However, a requirement for Cdk5 has been demonstrated only in postmitotic neurons where there is abundant expression of its activating partners p35 and/or p39. Although hyperactivation of the Cdk5–p35 complex has been found in a variety of inflammatory neurodegenerative disorders, the potential contribution of nonneuronal Cdk5–p35 activity has not been explored in this context. We describe a previously unknown function of the Cdk5–p35 complex in T cells that is required for induction of experimental autoimmune encephalomyelitis (EAE). T cell receptor (TCR) stimulation leads to a rapid induction of Cdk5–p35 expression that is required for T lymphocyte activation. Chimeric mice lacking Cdk5 gene expression in hematopoietic tissues (Cdk5−/−C) are resistant to induction of EAE, and adoptive transfer of either Cdk5−/−C or p35−/− encephalitogenic lymphocytes fails to transfer disease. Moreover, our data reveal a novel mechanism involving Cdk5-mediated phosphorylation of the actin modulator coronin 1a on threonine 418. Cdk5-deficient lymphocytes lack this posttranslational modification of coronin 1a and exhibit defective TCR-induced actin polarization and reduced migration toward CCL-19. These data define a distinct role for Cdk5 in lymphocyte biology and suggest that inhibition of this kinase may be beneficial in the treatment of T cell–mediated inflammatory disorders.
SCAM analysis of Panx1 suggests a peculiar pore structure
Authors: Wang Junjie , Dahl Gerhard
Published: October 2010

Vertebrates express two families of gap junction proteins: the well-characterized connexins and the pannexins. In contrast to connexins, pannexins do not appear to form gap junction channels but instead function as unpaired membrane channels. Pannexins have no sequence homology to connexins but are distantly related to the invertebrate gap junction proteins, innexins. Despite the sequence diversity, pannexins and connexins form channels with similar permeability properties and exhibit similar membrane topology, with two extracellular loops, four transmembrane (TM) segments, and cytoplasmic localization of amino and carboxy termini. To test whether the similarities extend to the pore structure of the channels, pannexin 1 (Panx1) was subjected to analysis with the substituted cysteine accessibility method (SCAM). The thiol reagents maleimidobutyryl-biocytin and 2-trimethylammonioethyl-methanethiosulfonate reacted with several cysteines positioned in the external portion of the first TM segment (TM1) and the first extracellular loop. These data suggest that portions of TM1 and the first extracellular loop line the outer part of the pore of Panx1 channels. In this aspect, the pore structures of Panx1 and connexin channels are similar. However, although the inner part of the pore is lined by amino-terminal amino acids in connexin channels, thiol modification was detected in carboxyterminal amino acids in Panx1 channels by SCAM analysis. Thus, it appears that the inner portion of the pores of Panx1 and connexin channels may be distinct.
Integrated Cerebral Protection Combined Antegrade and Retrograde Cerebral Perfusion during Deep Hypothermic Circulatory Arrest
Authors: Gammie James S. , Landree Britney , Griffith Bartley P.
Published: October 2010

Objective

Aortic arch surgery requires temporary interruption of cerebral perfusion. Hypothermic circulatory arrest (HCA) is an established method of central nervous system protection for limited periods of absent cerebral blood flow. Adjuncts to increase the safe duration of circulatory arrest include either retrograde cerebral perfusion (RCP) or antegrade cerebral perfusion (ACP), with most complex aortic operations now performed using HCA with ACP. We reasoned that optimal cerebral protection might be achieved with a combination of ACP and RCP (integrated brain protection) and present an early clinical experience that supports this approach.

Methods

The integrated brain protection strategy included sequential overlapping periods of RCP, ACP, and RCP during HCA. Moderate systemic hypothermia (25°C) was used. Patient data were gathered through retrospective chart review.

Results

Between 2008 and 2009, six consecutive patients underwent ascending aortic graft replacement for acute type A dissection using HCA and integrated brain protection. The mean minimum systemic temperature was 22.9 ± 1.8°C, the mean total HCA time was 34 ± 5 minutes, and the mean duration of ACP and RCP was 22 ± 6 and 7 ± 5 minutes, respectively. Patients were awake and followed commands 10.1 ± 3.4 (range, 5–13) hours after operation, and there was no evidence of temporary neurologic dysfunction. There was no operative mortality.

Conclusions

Integrated brain protection using both RCP and ACP during HCA is a promising approach for the safe performance of complex aortic surgery and is worthy of evaluation in larger clinical series.
Peripheral Insertion Techniques for the Impella 5.0 Circulatory Support System
Authors: Bashir Jamil , Klas Matt , Cheung Anson
Published: October 2010

Objective

The Impella 5.0 is a peripherally inserted short-term left ventricular assist device. It is typically inserted through a large peripheral artery such as the common femoral artery. We describe both a graft technique and a purse-string technique in detail.

Methods

In the course of introducing this technology to our hospital, we independently developed two techniques for the insertion of the device. These novel insertion techniques are different from those described by the manufacturer.

Results

The techniques described have distinct advantages that may be helpful to physicians inserting the device. Common areas of difficulty with insertion of the device and solutions to these problems are also described.

Conclusions

Insertion techniques for the Impella 5.0 are described in detail.
Simultaneous Robotic-Assisted Mitral Valve Repair and Percutaneous Coronary Intervention
Authors: Adams Corey , McClure R. Scott , Goela Aashish , Bainbridge Daniel , Kostuk William J. , Kiaii Bob
Published: October 2010

We present a case report of a robotic-assisted mitral valve repair with simultaneous percutaneous coronary intervention. A 58-year-old man presented with New York Heart Association class III symptoms from severe mitral regurgitation and significant stenosis of the right coronary artery. In a hybrid operating theater, the patient underwent placement of a bare metal stent in the right coronary artery followed immediately by robotic-assisted mitral valve repair. Both procedures were successful and occurred in a timely fashion. The patient experienced no immediate postoperative complications and was discharged home on postoperative day 5. At 2-week follow-up, he had returned to his normal activities of daily living and at 1 year remained asymptomatic. This case report demonstrates the benefits of minimally invasive robotic mitral valve repair in allowing for successful repair, early postoperative return to activity, minimal incision pain, and high patient satisfaction. It further highlights the potential benefit of a hybrid operating theater in allowing surgical and percutaneous coronary intervention procedures to be delivered in a safe and efficient manner.
Nanostructural analysis of GaN tripods and hexapods grown onc-plane sapphire
Authors: Lee Sanghwa , Sohn Yuri , Kim Chinkyo , Lee Dong Ryeol , Lee Hyun-Hwi
Published: October 2010

The crystallographic and structural characteristics of GaN tripods and hexapods grown onc-plane sapphire substrates were investigated using synchrotron X-ray scattering and microscopic analysis. The core structure of a GaN hexapod is revealed to be in the zincblende phase with an inversion domain, and a refined crystallographic analysis of tripods and hexapods with synchrotron X-ray scattering shows the existence of the zincblende phase in wurtzite-based protruding nanorods. The atomistic model combined with this crystallographic analysis reveals that the core size of a hexapod is much smaller than the diameters of the protruding nanorods. This refined structural analysis can be utilized in tailoring the opto-electronic characteristics of GaN multipods.
Field-induced phase transition in Bi1/2Na1/2TiO3-based lead-free piezoelectric ceramics
Authors: Hinterstein Manuel , Knapp Michael , Hölzel Markus , Jo Wook , Cervellino Antonio , Ehrenberg Helmut , Fuess Hartmut
Published: October 2010

The origin of the electric field-induced strain in the polycrystalline ceramic 0.92Bi1/2Na1/2TiO3–0.06BaTiO3–0.02K1/2Na1/2NbO3was investigated usingin situhigh-resolution X-ray and neutron diffraction techniques. The initially existing tetragonal phase with pseudocubic lattice undergoes a reversible phase transition to a significantly distorted rhombohedral phase under electric field, accompanied by a change in the oxygen octahedral tilting froma0a0c+toa−a−a−and in the tilting angle. The polarization values for the tetragonal and rhombohedral phases were calculated based on the structural information from Rietveld refinements. The large recoverable electric field-induced strain is a consequence of a reversible electric field-induced phase transition from an almost nonpolar tetragonal phase to a ferroelectrically active rhombohedral phase.
High level of population genetic structuring in lake‐run brown trout, Salmo trutta, of the Inari Basin, northern Finland
Authors: Swatdipong A. , Vasemägi A. , Niva T. , Koljonen M.‐L. , Primmer C. R.
Published: October 2010

Rivers draining into (Lake) Inarijärvi, northern Finland, sustain a number of lake‐run brown trout, Salmo trutta, populations but, as with most lake‐run S. trutta systems, the level of population genetic structuring among populations is unknown. To address this and to assist fish stock management in the region, the population genetic structure of S. trutta collected from 28 sampling sites in rivers flowing into Inarijärvi was studied using 13 microsatellite loci. Populations were clustered into three separate groups, largely corresponding to geographic regions, with between‐region FST values ranging from 0·11 to 0·16. The significant differentiation observed between most populations within each region also implies that individual populations should be recognized as separate management units and actions to improve, and subsequently maintain, conditions for natural spawning should be prioritized. The results of this study further indicate that the trout from each of these regions may have different biological characteristics, such as local‐lake feeding behaviour among the western populations and strong isolation among the northern stocks. As a consequence, further research is warranted to better understand the level of ecological uniqueness of lake‐run S. trutta populations.
A simulation‐based evaluation of two proposed alternatives to Luer devices for use in neuraxial anaesthesia*
Authors: Cook T. M. , Payne S. , Skryabina E. , Hurford D. , Clow E. , Georgiou A.
Published: October 2010

The National Patient Safety Agency has issued a Patient Safety Alert with the aim of eliminating Luer connectors from equipment for lumbar puncture and subarachnoid injections by 1 April 2011, and from all neuraxial and regional anaesthesia equipment in 2013. B‐link (UK) Ltd and InterVene Ltd have produced non‐Luer connectors for neuraxial devices: the Neurax® and Spinalok® respectively. Using an adult spinal simulator, 59 experienced clinicians performed neuraxial procedures using these devices and reported on specific performance characteristics and overall usability. Cross‐connectivity between non‐Luer and Luer connectors was also examined. The median (IQR [range]) overall assessment scores (0–10 scale) of usability for the standard, Neurax and Spinalok systems were 8 (8–9 [7–10]), 6 (5–7 [0–8]) and 7 (6–8 [1–9]) for spinal procedures and 8 (8–9 [6–10]), 7 (5–8 [1–9]) and 4 (3–6 [0–9]) for epidural procedures, respectively. Both study systems scored significantly lower than standard equipment for overall performance of spinal and epidural procedures, although the performance of non‐Luer devices was mostly rated ‘adequate’ or better. Both non‐Luer connectors could cross‐connect with one or more Luer connectors. Following feedback to the manufacturers, both systems have been modified and cross‐connectivity apparently has been eliminated. Our results indicate that clinicians may not find non‐Luer devices immediately ‘user‐friendly’. More importantly, some cross‐connectivity with Luer devices was possible. Our findings illustrate that introducing equipment that is fully compliant with the National Patient Safety Agency alert poses a significant challenge to manufacturers and clinicians. We conclude that before introducing any non‐Luer device into widespread use, independent, formal evaluation should be carried out.
Ocean distribution and habitat associations of yearling coho (Oncorhynchus kisutch) and Chinook (O. tshawytscha) salmon in the northern California Current
Authors: PETERSON WILLIAM T. , MORGAN CHERYL A. , FISHER JOSEPH P. , CASILLAS EDMUNDO
Published: October 2010

Yearling juvenile coho and Chinook salmon were sampled on 28 cruises in June and September 1981–85 and 1998–07 in continental shelf and oceanic waters off the Pacific Northwest. Oceanographic variables measured included temperature, salinity, water depth, and chlorophyll concentration (all cruises) and copepod biomass during the cruises from 1998–07. Juvenile salmonids were found almost exclusively in continental shelf waters, and showed a patchy distribution: half were collected in ∼5% of the collections and none were collected in ∼40% of the collections. Variance‐to‐mean ratios of the catches were high, also indicating patchy spatial distributions for both species. The salmon were most abundant in the vicinity of the Columbia River and the Washington coast in June; by September, both were less abundant, although still found mainly off Washington. In June, the geographic center‐of‐mass of the distribution for each species was located off Grays Harbor, WA, near the northern end of our sampling grid, but in September, it shifted southward and inshore. Coho salmon ranged further offshore than Chinook salmon: in June, the average median depth where they were caught was 85.6 and 55.0 m, respectively, and in September it was 65.5 and 43.7 m, respectively. Abundances of both species were significantly correlated with water depth (negatively), chlorophyll (positively) and copepod biomass (positively). Abundances of yearling Chinook salmon, but not of yearling coho salmon, were correlated with temperature (negatively). We discuss the potential role of coastal upwelling, submarine canyons and krill in determining the spatial distributions of the salmon.
Differential expression of odorant receptor genes involved in the sexual isolation of two Heliothis moths
Authors: Vásquez G. M. , Fischer P. , Grozinger C. M. , Gould F.
Published: October 2010

Moth sexual communication systems are highly diverse, but the mechanisms underlying their evolutionary diversification remain unclear. Recently, genes coding for odorant receptors (ORs) OR6, OR14, OR15 and OR16 have been genetically associated with species‐specific male response to female pheromone blends in Heliothis virescens (Hv) and Heliothis subflexa (Hs). Quantitative real‐time PCR analysis indicates that expression of HvOR6, HsOR6, HvOR14, HsOR14, HvOR15 and HsOR15 is male biased, which supports the hypothesis that they have a role in mediating female sex pheromone detection. The genes HvOR14, HvOR15 and HvOR16 are expressed at higher levels than their corresponding orthologues HsOR14, HsOR15 and HsOR16 in male antennae, while HvOR6 and HsOR6 transcripts are equally abundant in male antennae. The lack of higher expression of any of the receptor genes in H. subflexa antennae suggests that interspecific sequence differences, rather than gene regulation differences, underly the species‐specific male response to pheromone components.
Nurses’ medication work: what do nurses know?
Authors: Folkmann Louise , Rankin Janet
Published: October 2010

Aims.  The aim of this study is to provide an overview of the way that medication work is conceptualised in the literature and introduce a cautionary note into the enthusiasm with which nurses’ medication work is currently being reformed.

Background.  This article is an overview outlining how nurses’ medication work is discursively organised and known about authoritatively. There is a great deal of safety and coordination work that nurses undertake in relation to the ‘task’ of administering medications that remains hidden and misunderstood in the dominant ways that knowledge about medication administration is structured. Technological innovations are eagerly embraced, but we posit that these strategies may be having an impact on nursing work with medications in unknown and potentially deleterious ways. We develop a critical analysis of the discursively limiting frameworks of biomedical science, law, management and safety through which nurses’ medication practices are currently framed. This analysis provides insight into the ideologies and power relations that are taken up by nurses. The analytic work presented here informs an institutional ethnographic study that, at the time of this publication, is currently in the first stage of data collection. The study promises to contribute new knowledge about medication work as nurses know it.

Design.  A discursive paper including a selective critical analysis of the descriptive, theoretical and empirical literature.

Methods.  Databases were searched using the keywords medication work, medication administration and medication error.

Conclusion.  The enthusiasm with which technological innovations are being introduced must be tempered with equal attention to the impact that this has on nursing work.

Relevance to clinical practice.  The way that medication work is conceptualised is constraining and covers over much of what actually happens in everyday nursing practice. Technological innovations change practice, often in unintended or unknown ways. Explicating the actuality of medication work offers an enhanced understanding and allows nurses to appraise critically the ways their work has been transformed.
Factors which influence nurse practitioners ability to carry out physical examination skills in the clinical area after a degree level module – an electronic Delphi study
Authors: McElhinney Evelyn
Published: October 2010

Aims and objectives. The aim of the study was to identify the factors that influence nurse practitioners ability to practice physical examination skills in the clinical area.

Background. The changing health care needs of the population require new ways of working for many health professionals. Physical examination (core skills of inspection, palpation, percussion and auscultation) of patients is a fairly new role for nurses in secondary care in the United Kingdom. However, implementing new roles in the clinical area can be challenging for the practitioners involved, and several factors have been identified which are seen to help or hinder their success.

Design. A Delphi study was undertaken using blind copy email over six weeks in 2008.

Method. The participants included a purposive sample of 21 nurses from 10 clinical areas who had completed a degree level module in physical examination as part of a nurse practitioner pathway.

Results. This study generated valuable opinion of factors that can help or hinder the ability of nurses to practice physical examination in the clinical area. The results highlight the importance of individual self‐confidence, role clarity, effective educational preparation and support from other disciplines to the nurse practitioners ability to carry out this new role.

Conclusion. Several factors reported by the participants concur and add to factors reported in previous studies of new role implementation. There appears to be a continued need for clear job descriptions, role clarity, authority and autonomy to practice for nurse practitioners undertaking physical examination.

Relevance to clinical practice. Physical examination knowledge and skills are part of the role of nurse practitioners. This study highlights several factors which need to be addressed to ensure practitioners are able to carry out this new role on return to the clinical area.
Depression among Chinese stroke survivors six months after discharge from a rehabilitation hospital
Authors: Chau Janita P‐C , Thompson David R , Chang Anne M , Woo Jean , Twinn Sheila , Cheung Sze K , Kwok Timothy
Published: October 2010

Aim and objective.  The primary aim was to examine the prevalence of poststroke depression in Chinese stroke survivors six months after discharge from a rehabilitation hospital. A second aim was to determine whether six‐month poststroke depression was associated with psychological, social and physical outcomes and demographic variables.

Background.  There has been increasing recognition of the influence of depression on poststroke recovery. While some previous studies report associations between depression and social, psychological, physical and clinical outcomes, few studies had sufficient sample sizes for regression analysis thereby limiting the clinical applicability of their findings.

Design.  A cross‐sectional design was used.

Method.  Data were collected from 124 male and 86 female stroke survivors (mean age 71·7, SD 10·2 years). The Geriatric Depression Scale was used to measure depression, the State Self‐esteem Scale to measure state self‐esteem, the London Handicap Scale to measure participation restriction, the Social Support Questionnaire to measure satisfaction with social support and the Modified Barthel Index to measure functional ability.

Results.  Forty‐two survivors (20·5%) reported mild and 33 (16·1%) reported severe depression. The presence of depression was associated with low levels of state self‐esteem, social support satisfaction and functional ability. Logistic regression analysis revealed that these variables were statistically significant in predicting the probability of having depression (p < 0·05).

Conclusions.  Analyses in the present study revealed distinct patterns of correlates of depression, and the results were in agreement with prior studies that depression has a consistent positive association with physical disability, living arrangements and social support and no significant association with the different types of brain lesion.

Relevance to clinical practice.  There is a need, routinely, to assess stroke survivors for depression and, where necessary, to intervene with the aim of enhancing psychological and social well‐being.
A critical review of the literature on early rehabilitation of patients with post‐traumatic amnesia in acute care
Authors: Langhorn Leanne , Sorensen Jens C , Pedersen Preben U
Published: October 2010

Aims and objectives.  To identify the effect of early rehabilitation of patients with post‐traumatic amnesia in patients with traumatic brain injury, to review and critically assess evidence related to the timing of intervention and to identify the effect on outcome of a specific neurological rehabilitation in acute care.

Background.  Up to 70% of patients with traumatic brain injury will experience post‐traumatic amnesia. Although duration of post‐traumatic amnesia is correlated negatively with outcome for patients with traumatic brain injury, there is limited evidence relating to what influence timing and effect may have on enhancing early rehabilitation patient outcomes.

Design.  A critical literature review.

Methods.  Searches for systematic reviews were undertaken in Medline, CINAHL, Cochrane, PSYC INFO and Neurotraume databases. The efficacy of intervention and timing was classified based on a hierarchy of study designs for questions about health care interventions based on soundness of design.

Results.  Six reviews and 11 original studies were included and comprised the review. Many studies used weak designs and small sample size, thus limiting their ability to control confusing variables and outcomes. Few studies included papers with the information about timing and effect of early post‐traumatic amnesia intervention. Only one study showed an effect of a reality orientation programme in acute care. Although there was no significant detail reported on the possibility of reducing the post‐traumatic amnesia period, the study showed clinical relevance.

Conclusion.  This review highlights the limited evidence of the effect of early rehabilitation of patients with post‐traumatic amnesia. Future research should be conducted to identify the effectiveness of early intervention.

Relevance to clinical practice.  Although nurses are treating patients with post‐traumatic amnesia without systematic assessment, the limited evidence available does little to direct nurses as to the best approach to start early rehabilitation of post‐traumatic amnesia to promote good outcomes.
Predictors of disability in Taiwanese patients with rheumatoid arthritis
Authors: Lee Hui‐Chen , Tsai Yun‐Fang , Luo Shue‐Fen , Tsay Pei‐Kwei
Published: October 2010

Aim.  The purpose of this study was to explore predictors of disability in patients with rheumatoid arthritis in Taiwan.

Background.  Rheumatoid arthritis is a chronic inflammatory disease affecting mainly the joints. However, little information is currently available on the disability of Asian patients with rheumatoid arthritis.

Design.  Cross‐sectional survey.

Method.  Patients (150) were recruited by convenience sampling from those regularly visiting rheumatologic outpatient clinics at three teaching hospitals and a medical centre in northern Taiwan. Data were collected on demographic and disease‐related characteristics, depressive tendency, pain and disability using a basic patient‐information form, the Center for Epidemiological Survey Depression Scale, Chinese version of the Brief Pain Inventory‐short form and the Chinese version of the Health Assessment Questionnaire, respectively.

Results.  Our sample had moderate pain severity (Mean = 4·32, SD 1·68) and pain disturbance (Mean = 3·49, SD 2·15). The mean disability score was 0·61 (SD 0·66), representing mild disability. Regression analysis revealed that patients’ disability was significantly predicted by disease stage (stage IV, III, or II), depressive tendency, duration of disease and education level (primary school), explaining 79·2% of the total variance in disability.

Conclusion.  The results of this study not only provide clinicians with predictive information of disability from rheumatoid arthritis, but also help them take suitable action on patients’ depressive status according to their disability condition.

Relevance to clinical practice.  The controllable predictor of disability in this study was depressive tendency. Thus, the authors recommend that clinicians regularly screen patients with rheumatoid arthritis for depressive tendency and teach self‐care methods to minimise depressive symptoms.
Pre‐admission education in surgical rheumatology nursing: towards greater patient empowerment
Authors: Johansson Kirsi , Katajisto Jouko , Salanterä Sanna
Published: October 2010

Aims and objectives.  This study compared the pre‐admission education received by two groups of rheumatoid arthritis (RA) patients scheduled for hip arthroplasty. The specific aim was to compare these patients’ knowledge about care‐related issues and sense of certainty about that knowledge, empowering learning experience, length of admission discussion, length of hospital stay and number of health problems.

Background.  Previous studies have shown that surgical pre‐admission education is beneficial, but there is no evidence on the relative effectiveness of different methods of education.

Design.  We used a pre–post‐test design with two groups of surgical RA patients (Group I pre‐admission education via telephone and standard written educational material, n = 29; Group II standard written educational material, n = 30).

Methods.  The data were collected with previously used instruments (OPKQ, MEQ), and demographic and clinical variables were asked.

Results.  The mean score for knowledge about care‐related issues and sense of certainty about that knowledge for Group I and for Group II showed no statistically significant differences at baseline and at admission. At discharge, however, a significant difference was seen between the scores – in favour of Group II. On the other hand, patients in Group I were found to be more empowered in all areas than patients in Group II.

Conclusions.  Written educational material seems to be a good choice for pre‐admission patient education compared with telephone counselling, particularly when patients are knowledgeable about care‐related issues before admission. However, education via telephone is experienced by patients as more empowering than written educational material.

Relevance to clinical practice.  To increase patient’s knowledge written educational material can be recommended for use, but to increase patient’s empowerment telephone education is better.
Let me talk – an advance care planning programme for frail nursing home residents
Authors: Chan Helen YL , Pang Samantha MC
Published: October 2010

Aims and objectives.  This study attempted to test the plausibility of engaging frail nursing home residents in advance care planning (ACP).

Background.  Advance care planning fosters communication among individuals, family and health professionals regarding end‐of‐life care. Yet, such practice seldom takes place in a timely fashion because of its sensitive nature; thus, the concerns of these residents are often left unattended.

Design.  This was a one‐year quasi‐experimental study to test the feasibility of the Let Me Talk ACP programme, with its design being inspired by literature and our earlier work, among frail nursing home residents.

Method.  Three assessments were conducted at six‐month intervals to monitor the programme effects. The storytelling approach, which allowed participants to thread together their past, present and future, was the key feature of the programme.

Results.  Findings showed that the treatment preference stability was significantly higher in the intervention group (κ = 0·53, p ≤ 0·001). Significantly more participants in this group also communicated their treatment preferences to their family or caregivers (p = 0·012), with an odds ratio of 4·52. The programme also had a positive effect on mitigating participants’ existential distress.

Conclusions.  The programme was found effective in clarifying participants’ treatment preferences and encouraging them to communicate their preferences to significant others. However, it was also found that involving participants’ family in open discussion remained difficult. Extensive promotion in the community is therefore necessary.

Relevance to clinical practice.  It is recommended that such ACP programmes should be integrated into nursing home care practice, as they can be initiated in a relaxed atmosphere and maintained as an ongoing process. The trusting relationship between the nurse in the homes and the residents enables in‐depth discussion. The nurse is also well placed to play the facilitator role in guiding the process, providing information and mediating the family discussion.
Comparing Point of Care International Normalised Ratio testing with laboratory testing methods in a cardiac inpatient population
Authors: Giles Michelle T , Parker Vicki , Bevan Heather , Wright Ian MR
Published: October 2010

Aims and objective.  To compare agreement between International Normalised Ratio results from Point of Care testing with laboratory testing for cardiac inpatients receiving warfarin sodium.

Background.  Availability of point of care technology for International Normalised Ratio testing offers considerable benefits to patients and health care staff across a range of context.

Design.  Prospective comparison study.

Method.  Setting – Four cardiac wards in a regional referral hospital in New South Wales, Australia. Participants – 50 cardiovascular inpatients receiving warfarin therapy, including those patients being converted from intravenous heparin sodium. Intervention‐Point of Care International Normalised Ratio testing via finger prick using the CoaguChek®XS attended within one hour of laboratory International Normalised Ratio testing. Paired International Normalised Ratio results were compared using spearman rank and Mann–Whitney rank sum. Bland–Altman plots were used to demonstrate agreement.

Results.  One hundred and seventeen blinded paired tests were carried out, 44 on patients receiving intravenous heparin. Laboratory and Point of Care International Normalised Ratio testing were highly significantly correlated (r = 0·953, p < 0·0001, n = 117). There was close agreement between Point of Care International Normalised Ratio and laboratory International Normalised Ratio results for patients receiving warfarin regardless of whether they were receiving heparin sodium. There was a mean bias of +0·2 units (95% CI 0·145–0·246). The presence of diabetes significantly reduced the difference between paired tests. Bias significantly increased above an International Normalised Ratio of 4·5 units. Ninety‐seven per cent of all values fell between 20% limits of agreement after accounting for the mean bias of +0·2 units.

Conclusion.  Results indicated Point of Care International Normalised Ratio testing can be used for clinical decision making for cardiovascular inpatients receiving warfarin. Clinical guidelines need to be developed and tested in appropriate population groups and across different contexts, because of the potential for significant patient benefit.

Relevance to clinical practice.  Point of Care International Normalised Ratio results in time and procedural efficiency, care responsiveness, cost saving, increased patient comfort and reduced handling errors (Pharmacotherapy 22; 2002: 677), as well as the potential for continuity of care.
Subgroups of haemodialysis patients in relation to fluid intake restrictions: a cluster analytical approach
Authors: Lindberg Magnus , Wikström Björn , Lindberg Per
Published: October 2010

Aims.  To determine whether definable subgroups exist in a sample of haemodialysis patients with regard to self‐efficacy, attentional style and depressive symptomatology and to compare whether interdialytic weight gain varies between patients in groups with different cognitive profiles.

Background.  Theory‐based research suggests that cognitive factors (e.g. self‐efficacy and attentional style) and depressive symptomatology undermine adherence to health protective regimens. Preventing negative outcomes of fluid overload is essential for haemodialysis patients but many patients cannot achieve fluid control, and nursing interventions aimed to help the patients reduce fluid intake are ineffective. Understanding the interaction between cognitive factors and how this is related to adherence outcomes might therefore lead to the development of helpful nursing interventions.

Design.  Explorative cross‐sectional multicentre survey.

Methods.  The sample consisted of 133 haemodialysis patients. Data were collected using structured questionnaires. A brief self‐report form and data on interdialytic weight gain was also used. Two‐step cluster analysis was used to identify subgroups. One‐way analysis of variance (anova) or Pearson’s chi‐square test was used for comparing subgroups.

Results.  Three distinct subgroups were found and subsequently labelled: (1) low self‐efficacy, (2) distraction and depressive symptoms and (3) high self‐efficacy. The subgroups differed in fluid intake, but not in age, dialysis vintage, gender, residual urine output or in receiving any fluid intake advice.

Conclusions.  Clinically relevant subgroups of haemodialysis patients could be defined by their profiles regarding self‐efficacy, attentional style and depressive symptoms.

Relevance to clinical practice.  Based on this study, we would encourage clinical practitioners to take into account cognitive profiles while performing their work. This is especially important when a targeted nursing intervention, which aims to encourage and maintain the patient’s fluid control, is introduced.
Anxiety, depressive symptom and suicidal ideation of outpatients with obsessive compulsive disorders in Taiwan
Authors: Hung Tzu‐Chi , Tang Hwa‐Sheng , Chiu Chen‐Huan , Chen Ying‐Yeh , Chou Kuei‐Ru , Chiou Hsien‐Chih , Chang Hsiu‐Ju
Published: October 2010

Aims and objectives.  The major aims of this study were to explore the differences in anxiety, depressive symptoms and suicidal ideation between high and low obsessive compulsive symptom groups, as well as predictors for suicidal ideation among outpatients with obsessive compulsive disorder.

Background.  Obsessive compulsive disorder is often accompanied by anxiety, depression and even suicidal ideation. However, there have been very few studies exploring the inter‐relationships among anxiety, depressive symptoms and suicidal ideation for patients with obsessive compulsive disorder.

Design.  This study employed a cross‐sectional comparative research design.

Methods.  A sample of 128 outpatients with obsessive compulsive disorder was recruited from a medical teaching hospital in Northern Taiwan. The major study instruments included the Beck Anxiety Inventory, Beck Depression Inventory II, Yale‐Brown Obsessive Compulsive Scale (Y‐BOCS) and the Beck Scale for Suicide Ideation. We divided outpatients into two groups: outpatients with Y‐BOCS scores higher than 15 were placed in the high obsessive compulsive symptom group, while outpatients with Y‐BOCS score lower than or equal to 15 were placed in the low obsessive compulsive symptom group. Statistical methods included Pearson’s product–moment correlation, independent samples t‐test, chi‐square test and multiple regressions.

Results.  Results revealed that obsessive compulsive disorder outpatients with high Y‐BOCS scores also had higher rates of being single and having an earlier onset age, poorer disease control, higher levels of anxiety, depressive symptoms and suicidal ideation. The predictors for suicidal ideation were anxiety and depressive symptoms.

Conclusions.  Obsessive compulsive disorder patients with higher obsessive compulsive symptoms are at greater risk of higher levels of anxiety, depressive symptoms and suicidal ideation. In addition to depression, anxiety symptoms contribute significantly to suicidal ideation among patients with obsessive compulsive disorder.

Relevance to clinical practice.  Standard nursing care of patients with obsessive compulsive disorder should incorporate assessing levels of obsessive compulsive symptoms to identify the severity of anxiety, depressive symptoms and suicidal ideation more accurately.