bluuebunny/crossref_metadata_2025 huggingface dataset:
Site-directed, virus-free, and inducible RNAi in embryonic stem cells
Authors: Wang Jianlong , Theunissen Thorold W. , Orkin Stuart H.
Published: December 2007

RNAi is a powerful tool for interrogating gene function in ES cells. Combining the high penetrance of a microRNA-embedded shRNA (shRNA-mir) cassette with a locus-defined, inducible expression strategy, we developed a system for RNAi in mouse ES cells. An shRNA-mir cassette is targeted near the constitutively active HPRT locus under a tetracycline (tet)-regulatable promoter through Cre-mediated site-specific recombination. The major advantage of this system is that the shRNA-mir cassette can be targeted to a precise locus, allowing for control of shRNA-mir expression in an inducible fashion. Induction of an shRNA-mir directed against the pluripotency factor, Nanog, resulted in the loss of self-renewal and differentiation to parietal endoderm-like cells, which can be rescued by the introduction of an RNAi-immune version of Nanog cDNA. Knockdown efficiency can be enhanced by using multiple shRNA-mir hairpins against the target gene, which was further validated by knocking down two additional ES cell factors. This site-directed, virus-free, and tet-inducible RNAi system, designated as SDVFi RNAi in our study, presents an efficient option for controlled gene silencing in ES cells.
Coronary Calcium Scanning in Geriatric Cardiology
Authors: Gopal Ambarish , Budoff Matthew J.
Published: December 2007

Coronary artery disease (CAD) is prevalent in the elderly, often leads to disability, and is the number one cause of death in this population. Older adults represent an increasingly important and challenging subset of the population with CAD. They are more likely to have comorbid conditions, atypical presentations, and unfavorable outcomes than their younger counterparts. The available data suggest that standard pharmacologic, thrombolytic, and definitive revascularization techniques have important roles in the treatment of geriatric patients but have been underutilized. Consequently, strategies for optimizing the prevention and treatment of CAD in the elderly are important from both the individual and societal perspectives. Coronary artery calcium has been shown to be highly specific for atherosclerosis, occurring only in the intima of the coronary arteries. There is evidence to show that elevated coronary calcium scores are predictive of future cardiovascular events, both independently of and incrementally to conventional cardiovascular risk factors. This article will review such a screening method, namely coronary calcium scanning, in the field of geriatric cardiology.
Nuclear Cardiac Imaging for the Assessment of Coronary Artery Disease in the Elderly
Authors: Miller Todd D. , DiCarli Marcelo F.
Published: December 2007

Stress single photon emission computed tomography (SPECT) and positron emission tomography (PET), the standard clinical methods for measuring myocardial perfusion, have been extensively validated for diagnostic and prognostic purposes in general populations. Published data in the elderly are limited. The available data suggest that in elderly patients, SPECT is as accurate for diagnostic purposes as in younger patients and that stress SPECT is considerably more accurate for prognostic purposes when compared with standard treadmill testing. Pharmacologic stress testing can be performed in conjunction with SPECT and PET, representing another advantage of these techniques because many elderly patients cannot exercise to a high enough workload to provoke ischemia during testing.
Case Presentations of Potential Applications of Computed Tomographic Angiography in the Geriatric Population
Authors: Wann Samuel , Krystowiak Michael
Published: December 2007

Recent technical advances have enabled the use of computed tomography (CT) to visualize the beating heart, including the coronary arteries. This ability to perform noninvasive coronary angiography and to precisely evaluate other cardiovascular structures using CT may be especially valuable in the geriatric population. CT angiography can be used not only to investigate chest pain syndromes in the elderly but also for preoperative evaluation before cardiac and noncardiac surgery to detect intracardiac thrombi and tumors and to evaluate valves, the myocardium, and other cardiovascular structures, including the aorta. The authors present examples of the application of CT angiography in various older adult patients with cardiovascular disease to highlight potential applications.
Structure and sequence of the Cu, Zn superoxide dismutase gene of Chymomyza amoena: phylogeny of the genus and codon‐use evolution
Authors: Kwiatowski J. , Skarecky D. , Burgos M. , Ayala F. J.
Published: December 2007

We have cloned and sequenced the Cu, Zn superoxide dismutase gene of Chymomyza amoena. The coding sequence has the same length as in Drosophila species and in Ceratitis capitata. There are two introns, located at the same sites as in Ceratitis. The second intron is absent in Drosophila: this places Chymomyza outside the Drosophila lineage, contrary to proposals based on anatomical and other evidence. The nucleotide or amino acid distances support a phylogeny in which Ceratitis first branches off the common stem, then Chymomyza splits before the divergence of the two major Drosophila subgenera. The estimated divergence times are 58 million for Chymomyza‐Drosophila; 48 million years for the Drosophila subgenera. During the intervening 10 million years, the Drosophila lineage lost the second intron and evolved distinct codon‐preferences: the G + C use in the third coding positions is increased by 69% in Drosophila relative to Chymomyza or Ceratitis.
Intrapopulation nestclusters of maternal mtDNA lineages in the polygynous ant Leptothorax acervorum (Hymenoptera: Formicidae)
Authors: Stille M. , Stille B.
Published: December 2007

Analysis of restriction fragment length polymorphism (RFLP) in mitochondrial DNA (mtDNA) in a population of Leptothorax acervorum demonstrates substantial population substructuring. Digestion with four restriction endonucleases, Haelll, Mbol, Mspl and Rsal, gave six, four, three and two different patterns, respectively. Seven composite haplotypes were obtained from the observed cleavage patterns. Uniform aggregations of nests from the same maternal lineage (i. e. with the same haplotype) were found which suggests that nestfounding by a process of budding‐off is common. Groups of nests seem to actively exclude other haplotypes from establishing nests within their territory. Fstatistics suggests that individuals mate at random within the population.
PCR with arbitrary primers: approach with care
Authors: Black W. C.
Published: December 2007

New techniques have recently been described that employ the polymerase chain reaction (PCR) to amplify arbitrary regions of a genome using a single primer. The techniques reveal polymorphisms in insect taxa that lack allozyme variation and, for the first time, permit genetic polymorphisms to be rapidly analysed in small arthropods (e.g. mites, endoparasitic wasps). The methods have been used in identification of sub‐species and cryptic species, and have applications in population genetics and genetic fingerprinting. They are fairly inexpensive, do not require the use of radioactivity, are relatively simple to learn and can easily be adapted to most laboratories. However, their application is not without technical problems and practical limitations. The purpose of this note is to indicate the critical factors to consider before launching into their use. We chiefly emphasize that most polymorphisms revealed by these methods segregate as dominant markers. Furthermore, application of these techniques requires extensive standardization and may not prove to be reproducible among various laboratories especially those employing different types of thermal cyclers. There are some unique features of these polymorphisms to consider when using them in genetic fingerprinting. In addition, because the techniques amplify arbitrary regions of genomes, similarly sized fragments amplified between two species may not be homologous. This argument and empirical observations suggest that PCR with arbitrary primers will have limited application in molecular systematics above the intraspecific level.
A centromeric satellite DNA of the unisexual Bacillus atticus (Insecta: Phasmatodea)
Authors: Mantovani B. , Batistoni R. , Nardi I. , Scali V.
Published: December 2007

In the parthenogenetic Bacillus atticus atticus, widespread over most of the Mediterranean basin, a highly repeated satellite DNA (BaB300) has been detected and analysed. Bgl II, Taq I and Alu I restriction enzymes cut 316 bp long repeating units from the BaB300 family. These are non‐coding, AT rich and well conserved in the three isolated populations studied. By in situ hybridization, the satellite has been located in the centromeric heterochromatin of a subset of medium‐and small‐sized chromosomes, including the Xs. Related sequences have been found in the bisexual B. grandii grandii and in its specific hybrid B. whitei (=B. rossius/grandii grandii), while they are absent from B. rossius redtenbacheri. These data support the genetic affinity relationships within the genus Bacillus inferred from morphological, allozymic and karyological data. They also encourage further comparisons among Bacillus hybrids, in order to trace their parental genomes in the hybrid nuclei, and within the B. atticus complex (i.e. additional samples of B. a. atticus and diploid/triploid cytotypes of B. a. carius) to study repetitive DNA turnover in unisexual organisms.
A cytoplasmic actin gene from the silkworm Bombyx mo/7 is expressed in tissues of endodermal origin and previtellogenic germ cells of transgenic Drosophila
Authors: Horard B. , Bello B. , Abraham E. G. , Coulon‐Bublex M. , Garel A. , Mounier N.
Published: December 2007

A cytoplasmic actin gene from Bombyx mori introduced into Drosophila melanogaster by P‐element mediated transformation, is efficiently transcribed in larvae, pupae and adults of the host. The exogenous mRNA has the same size as the one observed in the Bombyx cells and the intron located within the coding region is properly excised, indicating a correct recognition of the exogenous sequences by the Drosophila transcriptional and splicing machineries. The expression of the Bombyx gene in Drosophila tissues was determined by transforming flies with a hybrid gene in which a large part of the Bombyx actin coding sequences was replaced by those of the bacterial lac Z gene. This chimaeric gene is specifically and highly expressed, from the embryo to the adult of the transgenic lines, in tissues of endodermal origin, the midgut and its derivatives, i.e. gastric caeca, the outer layer of the proventriculus, and in the Malpighian tubules. This gene is also expressed, at a lower level, in germ cells but restricted to the sixteen cell cysts during previtel‐logenesis. The expression of the Bombyx gene during development of transgenic flies was compared to that of the two Drosophila endogenous cytoplasmic actin genes and the results are discussed.
Molecular taxonomy using single‐strand conformation polymorphism (SSCP) analysis of mitochondrial ribosomal DNA genes
Authors: Hiss R. H. , Norris D. E. , Dietrich C. H. , Whitcomb R. F. , West D. F. , Bosio C. F. , Kambhampati S. , Piesman J. , Antolin M. F. , IV W. C. Black
Published: December 2007

Single‐strand conformation polymorphism (SSCP) analysis detects single point mutations in DNA molecules. We demonstrate that SSCP analysis of mitochondrial ribosomal DNA (rDNA) genes is a sensitive taxonomic tool because these genes often differ at numerous sites among closely related species. Using conserved primers, portions of the 12S or 16S rDNA genes were amplified using the polymerase chain reaction (PCR) in congeneric species of ticks, leaf hoppers, mosquitoes, and closely related endoparasitic wasps. SSCP was performed and products were visualized with silver staining. Species‐specific patterns were observed in all taxa. Intraspecific variation at the level of single nucleotide substitutions was detected. SSCP diagnostics are less expensive and time consuming to develop than PCR with species‐specific primers, and, unlike PCR with arbitrary primers, there is minimal concern with DNA contamination from non‐target organisms.
High‐level expression of the bacterial opd gene in Drosophila melanogasten improved inducible insecticide resistance
Authors: Benedict M. Q. , Scott J. A. , Cockburn A. F.
Published: December 2007

The bacterial parathion hydrolase gene (opd) was expressed in transformed D. melanogaster under the control of an hsp70 promoter. Transformed lines carrying chimaeric genes designed for either cytoplasmic or secretory expression exhibited high‐ or low‐level heat‐shock‐inducible transient resistance to paraoxon respectively. Greatest levels of resistance occurred approximately 12–16 h after heat shock and well after periods of maximal transcription. Insecticide resistance conferred by the cytoplasmic form of opd is expressed as a semidominant trait.
Molecular polymorphism as a tool for differentiating ground beetles (Carabus species): application of ubiquitin PCR/SSCP analysis
Authors: Boge A. , Gerstmeier R. , Einspanier R.
Published: December 2007

Differentiation between Carabus species (ground beetle) and subspecies is difficult, although there have been extensive studies. To address this problem we have applied PCR in combination with SSCP analysis focussing on the evolutionally conservative ubiquitin gene to elaborate a new approach to molecular differentiation between species. We report that Carabidae possess an ubiquitin gene and that its gene has a multimeric structure. Differential SSCP analysis was performed with the monomeric form of the gene to generate a clear SSCP pattern. Such PCR/SSCP resulted in reproducible patterns throughout our experiments. Comparing different Carabus species (Carabus granulatus, C. irregularis, C. violaceus and C. auronitens) we could observe clear interspecies differences but no differences between genders. Some species showed some remarkable differences between the individuals. We suggest that the ubiquitin PCR‐SSCP technique might be an additional tool for the differentiation of ground beetles.
Isolation, cloning and deduced amino acid sequence of a novel glycoprotein from the haemolymph of the hawkmoth Manduca sexta
Authors: Samaraweera P. , Law J. H.
Published: December 2007

A low‐abundance haemolymph protein from adult male Manduca sexta was purified to homogeneity. The 29,000 Da glycoprotein is synthesized in the fat body, is present in both male and female, and is present during all stages of development. Antiserum against the 29 kDa protein was raised in a rabbit and used to screen an M. sexta larval fat body cDNA library. An 880 base pair clone was isolated and found to contain the full‐length transcript. Sequencing of the cDNA revealed an open reading frame of 699 bases beginning from the possible translation initiation site. The deduced 233‐amino acid polypeptide contains an apparent 17‐amino acid signal peptide and three potential N‐glycosylation sites. The function of the 29 kDa protein is unknown.
Complete sequence of a mariner transposable element from the predatory mite Metaseiulus occidentalis isolated by an inverse PCR approach
Authors: Jeyaprakash A. , Hoy M. A.
Published: December 2007

Degenerate primers designed and synthesized based on two conserved regions of the mariner transposase open reading frame were used to amplify a 454 bp DNA fragment from M. occidentalis. Two inverse primers were then synthesized and used to amplify flanking genomic DNA fragments from M. occidentalis by a ligation‐mediated inverse PCR. The complete mariner element (Moc 1) was 1284 bp long, including the imperfect 28 bp inverted terminal repeat sequences, and shared 59% similarity to an active 1286 bp long D. mauritiana mariner element (Mos 1). Insertions, deletions and substitutions were observed in the Moc 1 sequence at several positions. No intact open reading frame was detected and the Moc 1 element is considered inactive. Stringent Southern blot hybridizations revealed at least twelve copies of mariner sequences similar to Moc 1 in the colonies tested.
Overlapping Lsp‐2 gene sequences target expression to both the larval and adult Drosophila fat body
Authors: Beneš H. , Neal K. C. , Willis R. L. , Gadde D. , Castleberry A. B. , Korochkina S. E.
Published: December 2007

The Larval serum protein‐2 gene (Lsp‐2) of Drosophila melanogaster encodes one of the major hexameric haemolymph proteins of third‐instar larvae and a major component of adult serum. Regulated transcription of Lsp‐2 results in high‐level, ecdysone‐stimulated expression throughout the larval fat body and low‐level, spatially restricted expression in the adult fat cells. To localize cis‐acting regulatory se quences responsible for the stage‐ and tissue‐specific activity of Lsp‐2, the expression of Lsp‐2–IacZ fusion genes was studied by P element‐mediated germline transformation of Drosophila. A 230 base pair larval enhancer, which includes an ecdysone response element (EcRE), specifically targets gene activity to the larval fat body. Although the adult mode of Lsp‐2 expression depends on the larval enhancer, additional negative regulatory elements dictate both tissue‐specificity and unique spatial restriction within the adult fat body. Implications of these findings for the identification of fat body‐specific gene regulatory units in other insects are discussed.
Differential induction of antibacterial transcripts in Drosophila susceptible and resistant to parasitism by Leptopilina boulardi
Authors: Coustau C. , Carton Y. , Nappl A. , Shotkoski F. , Ffrench‐Constant R.
Published: December 2007

Two welldescribed elements of the Immune response of insects include encapsulation of metazoan parasites (blood‐cell‐mediated) and the production of antibacterial peptides (humoral and/or cellular). However, the possible functional interrelationship between cellular encapsulation and antibacterial responses, and the extent to which the two components may be co‐regulated, are poorly understood. We used a novel approach involving strains of Drosophila resistant (R) or susceptible (S) to the wasp parasitold Leptopilina boulardi to study the expression of three genes involved in the antibacterial response: Dorsal‐related immunity factor (Dil), Cecropin (CecA1) and Diptericin (Dip). Both S and R strains produced high levels of all antibacterial transcripts upon bacterial injection. However, when parasitized the R strain showed no induction whilst the S strain did. This lack of antibacterial transcript induction in the parasitized R strain not only clarifies the separation of these two types of immune response but also raises the fascinating possibility of a link in their genetic regulation.
Cloning and expression analysis of Aedes aegypti opsin: adaptation of an in situ hybridization protocol for mosquitoes
Authors: Graf R. , Godknecht A. , Nakano M. , LJ X. , Ackermann U. , Helbiing P.
Published: December 2007

Opsin is a G protein coupled photoreceptor that actlvates a signal transduction cascade in the ommatidia. Its primary and secondary structure Is conserved both In insects and vertebrates as exemplified by the Drosophiia opslns. Through serendipitous cloning of a PCR fragment, we have Identified an opsln cDNA. The latter was used to clone full length cDNAs from a mosquito head library. the main purpose of cloning was to have a positive control probe to establish an In situ hybridization protocol for less abundant probes. Opsin‐mRNA is localized specifically to the visual receptor cells in the ommatida. No other cells in the brain or the remainder of the body are positive. This is confirmed by Northern blot analysis.

The sequence of the receptor, of which we have found two different transcripts, confirms Its typical topology, including the seven transmembrane spanning regions and the intracellular carboxy terminus that has potential phosphorylatlon sites.

Our in situ hybridization protocol combines several procedures: the most important points are: (a) the immediate processing of sections after cutting, and (b) the sections are never allowed to dry out once the procedure was started. Our protocol has a much higher sensitivity, using approximately 50times lower concentrations of probe compared to published protocols. In addition to the detection of opsin‐mRNA, It has been successfully applied to the detection of the low abundant Insulin receptor homologue. Furthermore, Aedes aegypti probes were visualizing a similar tissue specificity when applied to the malaria mosquito Anopheles albimanus.
Identification of insect cell lines by DNA amplification fingerprinting (DAF)
Authors: McIntosh A. H. , Grasela J. J. , Matted R. L.
Published: December 2007

Fingerprint profiles were generaed from twenty insect cell lines spanning the Orders, Lepldoptera, Diptera, Coleoptera and Homoptera employing DNA amplification fingerprinting (DAF) with arbitrarily selected prlmers. The fingerprint pattern is a stable characteristlc of the cell line because high and low passages generated the same profile. In addition, insect hosts and homologous cell lines generated similar profiles. All cell lines could be distinguished from each other with the following exceptions: Plutella xylostella (BCIRL‐PX2‐HNU3) and Mamestra brassicaee (IZD‐MB‐0503) produced identical patterns to Trichoplusia ni (TN‐CL1). Also Spodoptera exigua (UCR‐SE‐1C) produced the same profile as Spodoptera frugiperde (SF9) and the parent cell line IPLB‐SF21. All these cases of identical patterns are believed to be due to cross contamination or mislabelling of cultures. DAF will serve as an additional, valuable and rellable technique for the identification of insect cell lines.
Inducible immune factors of the vector mosquito Anopheles gambiae: biochemical purification of a defensin antibacterial peptide and molecular cloning of preprodefensin cDNA
Authors: Richman A. M. , Bulet P. , Hetru C. , Barillas‐Mury C. , Hoffmann J. A. , Kafatos F. C.
Published: December 2007

Larvae of the mosquito vector of human malaria, Anopheles gambiae, were inoculated wlth bacteria and extracts were biochemically fractionated by reverse‐phase HPLC. Multiple induced polypeptides and antibacterial activities were observed following bacterial infection, including a member of the Insect defensin family of antibacterial proteins. A cDNA encoding An. gambiae preprodefensin was isolated using PCR primers based on phyiogeneticaiiy conserved sequences. The mature peptide is highly conserved, but the signal and propeptide segments are not, relative to corresponding defensin sequences of other insects. Defensin expression is Induced in response to bacterial infection, in both adult and larval stages. in contrast, pupae express defensin mRNA constitutively. Defensin expression may prove a valuable molecular marker to monitor the An. gambiae host response to infection by parasitic protozoa of medical importance.
Isolation of a cluster esterase genes associated with organophosphate resistance in Lucilia cuprina
Authors: Newcomb R. D. , East P. D. , Russell R. J. , Oakeshott J. G.
Published: December 2007

PCR primers designed from the α‐esterase gene cluster of Drosophiia melanogaster have been used to isolate fragments from eight esterase genes In the Australian sheep blowfly, Lucilia cuprina. Phyio‐genetic analysis suggests that three are homologues of the αE7, αE8 and αE9 genes of the α‐esterase cluster of D. melanogaster. A further three are also probably α‐esterases, whereas the remaining two more closely resemble β‐esterases. Transcripts for five of the α‐esterase genes were detected by PCR in adult midgut, consistent with a role for these enzymes in digestion andlor detoxification. Based on the tissue distribution of these transcripts, LcαE7 may possibly encode the esterase, E3, which is involved in organophosphate resistance.
Peritrophic matrix proteins of Anopheles gambiae and Aedes aegypti
Authors: Moskalyk L. A. , Oo M. M. , Jacobs‐Lorena M.
Published: December 2007

Little is known about the composition and function of the mosquito peritrophic matrix (PM), a physical barrier that pathogens must traverse to complete their life cycles. Anopheies gambiae and Aedes aegypti PM proteins induced by blood or by a protein‐free meal have been characterized by the use of 2‐D gel electrophoresis and lectin‐binding affinity assays. More than forty proteins have been identified in both species. Over half of the PM proteins of both mosquitoes migrate identically. Many PM proteins appear to be giycosylated, primarily by high mannose N‐linked glycosyi groups.
Caring research and concepts: a selected review of the literature
Authors: LEA AMANDAH , WATSON ROGER
Published: December 2007

A selected review of the literature on caring in nursing is presented. The review relies on the work of the major theorists in this area.

The major conceptualizations of caring are compared and contrasted, along with some of the research approaches which have been applied to investigate the phenomenon of caring in nursing.

The outcome of quantitative and qualitative research on caring is described and the justification for an extension of the quantitative work, through the development of an appropriate inventory and the application of multivariate statistical analysis, is discussed.
Paediatric nursing and research ethics: is there a conflict?
Authors: LOWES LESLEY
Published: December 2007

This paper briefly outlines the major ethical issues which need to be considered when conducting paediatric research.

An overview of ethical theories and principles will highlight the difficulties which may be experienced when making decisions about children's competency to consent to participate in research.

The congruency of the paediatric nurse as ‘researcher’ and ‘practitioner’ will be examined. Does the nurse involved in paediatric research experience a conflict between a commitment to research and safeguarding the interests and well‐being of the child.
Staff perspectives on the role of the nurse in rehabilitation wards for elderly people
Authors: WATERS KAREN R. , LUKER KAREN A.
Published: December 2007

The increasing demand for cost‐effective and efficient health care may create a demand for more demonstrably effective hospital‐based rehabilitation services, with the explicit goal of enabling patients to return home after short admissions; thus rehabilitation is centre stage.

This paper reports the findings from a study of the rehabilitation of elderly people in hospital; in particular it focuses on an aspect of the process of care: namely staff perceptions of rehabilitation work, with particular emphasis on the role of the nurse.

A conversational style of interviewing was used with 56 staff respondents from two rehabilitation wards for elderly people.

Findings suggest that therapists are often seen as experts, and nursing is viewed as separate from rehabilitation, and hence nurses are an under‐utilized resource in this field.

It is suggested that there is a need to examine further the reality of multidisciplinary teamwork in rehabilitation, particularly with respect to maximizing the potential contribution of nurses, with the end goal of improving patient outcomes.
Creating consensus about nursing outcomes. II. Nursing outcomes as agreed by patients, nurses and other health professionals
Authors: MILLAR BRIAN , MAGGS CHRISTOPHER , WARNER VICKI , WHALE ZOE
Published: December 2007

The questions ‘what is it that you want from nursing?’ and ‘how would you know when you have got what you want from nursing?’ were put to patients, nurses and other health professionals.

The patients identified essential qualities of nurses.

Problems within the nursing group are identified. The view of each group on the other's work is discussed.

Areas of consensus related to respect, communication, competence, co‐operation and context.

Indicators or measures of the consensus areas are reported.
Residents' perspectives of their first 2 weeks in a long‐term care facility
Authors: IWASIW CARROLL , GOLDENBERG DOLLY , MacMASTER ELSIE , McCUTCHEON SUSAN , BOL NANCY
Published: December 2007

This study investigated residents' perspectives of their first 2 weeks in a long‐term care facility (LTCF). Twelve residents were interviewed to determine their experiences during the first 2 weeks, their needs, priorities and expectations, and their views about how relocation from home could be facilitated. The constant comparative method of qualitative analysis (Glaser & Strauss, 1967) was used.

Qualitative analysis of the audiotaped interviews revealed four main categories: emotional reactions, transition activities, reflecting on their situation, and connecting with a personal philosophy.

Residents' responses indicated that if they had actively participated in the decision to be admitted, the adjustment to the LTCF was easier. Connecting with a personal philosophy was also a significant factor.

Nursing implications include recognition of the importance of preparing residents for admission, involving them in the decision, and listening to their perspectives throughout the relocation experience.
When touch is not the best approach
Authors: DAVIDHIZAR RUTH , GIGER JOYCE NEWMAN
Published: December 2007

Health care professionals have long believed in the value of nonverbal components of communication and the highly significant roles such factors as distance, space, and touch can play in therapeutic relationships.

The value of touch is not appreciated by all health care professionals or considered appropriate or desirable by some patients.

While touch has been described as the most important of all the senses, the astute professional must be cognizant of the times when touch should not be used.
The nursing record as a research tool to identify nursing interventions
Authors: HALE C.A. , THOMAS L.H. , BOND S. , TODD C.
Published: December 2007

This paper describes a study which was designed to test the feasibility of using retrospective case note abstraction of data from nursing records to identify the nursing interventions given to two groups of patients: those who had suffered a myocardial infarction and those who had sustained a fractured neck of femur.

The aim of the study was to assess whether the data obtained from the records were an accurate reflection of the nursing care given to patients. This was done by comparing what was recorded in the notes for specific areas of care with what the nursing staff said they did.

The specific areas of care for patients suffering a myocardial infarction were: pain, mobility, anxiety, patient education. The specific areas of care for patients sustaining a fractured femur were: pressure areas, pain, nutrition, mobility and rehabilitation, information and teaching.

Data were collected in three ways:

using a retrospective data abstraction tool to examine the case notes of a particular patient;

interviewing a nurse who had looked after the same patient;

interviewing a senior ward nurse to obtain information about ward policies arid practices to obtain a profile of the care usually given to these groups of patients.

In this paper we present some of our findings and discuss the methodological and logistical problems of using this method.
Increased parental participation in a paediatric surgical day‐care unit
Authors: KRISTENSSON‐HALLSTRÖM INGER , ELANDER GUNNEL , MALMFORS GERHARD
Published: December 2007

Day care is currently a common way of providing treatment for minor and average paediatric surgical procedures.

The purpose of this study was to assess possible benefits of increasing parental involvement in the care of operated children in a day‐care surgery unit.

By giving parents information and education about post‐operative care, the goal was to facilitate recovery and minimize time spent in hospital.

Results show that parents in the intervention group were well prepared to assume a greater part of the care of their children.

Children in the intervention group appeared to have less pain and fewer children vomited post‐operatively than children in the control group.
Nutrition: a hard nut to crack. An exploration of the knowledge, attitudes and activities of qualified nurses in relation to nutritional nursing care
Authors: PERRY LIN
Published: December 2007

Provision of adequate nutrition is recognized as essential, yet malnutrition continues to be reported in patients admitted to hospital.

The effects of malnutrition in hospital patients have been well documented; however, most work relating to nutritional management has been produced by members of Nutrition Support Teams, nurse specialists and interested clinicians, whilst the majority of hospitals are still without such specialist posts.

This study used two data collection methods to gain information about the attitudes, nutritional knowledge base and nutrition‐related nursing care in a large trust hospital in the South of England.

A survey of care plans for documentation of nutrition‐related nursing activities, carried out on the day of discharge for all patients from five wards over a period of a fortnight (totalling 141 sets of documentation), was followed by a questionnaire to all qualified nurses on these and a further four wards (110 nurses).

Results demonstrated that nurses generally felt that nutritional assessment was primarily their responsibility.

Whilst there was evidence of knowledgeable and proactive nursing care, it also appeared that there were fairly widespread deficiencies in the knowledge, communication and co‐ordination required to ensure consistent good practice.
An exploratory study from the patients' perspective of living with allergies
Authors: ZERNIKE WENDY , CORISH TRACIE , HENDERSON SYLVIA
Published: December 2007

Allergic disease is one of the most prevalent chronic medical conditions in the world.

Allergen avoidance has been accepted as a form of treatment for allergic disease; however, the success of treatment is often dependent on how patients choose to manage their condition.

The purpose of this study was to explore how allergic conditions affect the lives of allergy sufferers and what information they believe would be useful to other allergy sufferers in the management of their allergic condition.

Patients suffering from non‐life‐threatening allergies stated that their allergy affected many aspects of their life, such as their work, their social life, their emotional state, their physical appearance and, hence, their interactions with others. The chronic symptoms of their condition caused the greatest concern to patients. Many of these participants ‘accepted their condition’ and undertook controlling measures as part of their daily life.

In contrast, patients suffering from life‐threatening allergies stated that their allergy did not affect their life. Knowledge of their allergic condition was more important than acceptance.

The findings elicited from allergy sufferers identified how nurses can educate patients about their condition and assist them in learning to live with their condition.
Evaluating the introduction of primary nursing: the use of a care plan audit
Authors: WEBB CHRISTINE , PONTIN DAVID
Published: December 2007

A care plan audit was carried out as part of an action research project involving the introduction of primary nursing.

The audit tool was based on the Roper, Logan and Tierney Activities of Living model and the nursing process.

The audit showed that few changes in documentation had taken place as a result of the introduction of primary nursing.

The volume of communications had increased but much of this was not documented on care plans.

Other positive changes as a result of introducing primary nursing were found, and both patients and nurses were aware of these.
Better late than never? An evaluation of community nursing services for children in the UK
Authors: BRADLEY SUSAN F.
Published: December 2007

The development of community nursing services for children in the UK was first suggested by Platt in 1959; until recently, however, such services have been rare and children have spent many unnecessary and potentially traumatic days in hospital.

This paper considers the development of community nursing services for children in the UK.

It identifies factors which have promoted the growth of these schemes, and examines the effectiveness of services from professional, managerial and economic perspectives.

The viewpoint of the consumer – the child and family themselves – is also considered.
Moving from hospital into a care home – the nurse's role in supporting older people
Authors: MORGAN DEBRA , REED JAN , PALMER ANTHONY
Published: December 2007

Discharge planning has received much attention in the nursing literature over the past few years, and there has been particular concern over the discharge of older people back into their domestic environment.

The practical and logistical problems of managing such a discharge are considerable, but in this paper we argue that discharging older people from hospital to care homes is equally problematic, though in different ways.

This is a neglected area of research, perhaps because discharge into a care home seems to present fewer organizational problems.

There is, however, an extensive body of literature from a range of different disciplines which suggests that the loss of home and entry into a strange environment can be very stressful.

This paper outlines this literature and explores the implications for nursing practice.
Evaluation in clinical practice: problems, precedents and principles
Authors: Mclntyre Neil
Published: December 2007

‘Audit’ is now in widespread use in our National Health Service, but there is little documentation of improvement resulting from audit. If it is to be used to identify mistakes in clinical practice, we must be prepared to admit them, or to have our work evaluated by others; such openness is uncommon. Understandably, doctors are concerned about possible litigation, under‐ mining of their authority, and/or interference with their methods of practice. Furthermore, few are willing to comment adversely on the work of others.

There is confusion about the best method(s) of audit. Outcome and process audit serve different purposes. Outcome audit measures the effect of care on patients' health, but in individual cases a poor outcome may result after impeccable medical care and a good outcome after poor care. Outcome audit requires a large patient group, is costly, and is of value for a limited number of conditions. Appropriate standards are needed to judge the results; it may be fallacious to compare outcomes in different settings, and with different patient groups. Furthermore, outcome audit is of little value for auditing the care given by individual doctors, and this limits its value in clinical education.

Process audit deals with the appropriateness of clinical actions, on the assumption that they affect outcome. It can detect poor performance when outcome audit would be unlikely to identify poor outcome. For common or well‐defined problems, process audit can make use of clear criteria, for example agreed protocols, and this may have immediate benefit for individual patients. When there is no agreed protocol the overall quality of care can still be audited against relatively explicit criteria, if there is agreement on the relevant ‘principles of clinical practice’, i.e. the rules which should guide the clinical management of individual patients. Clearly these should cover the collection, recording and analysis of patient data; planning for diagnosis, monitoring, treatment and patient education, and steps to be taken when there is uncertainty about the best course of action. Performance in these areas can be assessed by reviewing the patients' notes, but most clinical records are inadequate for this purpose.

Process audit can be applied to all clinical problems, and is the method of choice for assessing the actions of individuals. Its educational value is self‐ evident. It allows the identification of deficiencies, and the provision of feedback to correct them. Furthermore, it provides for a continuum of audit through the undergraduate and postgraduate years of a doctor's training.
Acquisition and use of clinical data for audit and research
Authors: MRCP Jeremy Wyatt DM
Published: December 2007

Acquisition of adequate patient data for clinical management is hard enough, but higher quality patient data are needed for clinical audit and research. This article discusses some of the problems of using routine clinical data for audit and research, aspects of data quality, sources of audit or research data and their problems, methods for improving data quality, the benefits and problems of computer‐based systems and current trends in the capture and processing of clinical data.
Meta‐analysis or best‐evidence synthesis?
Authors: Eysenck H.J.
Published: December 2007

This article examines the usefulness of meta‐analysis, and articulates many of the criticisms that have been made of its workings. An attempt is made to outline the precautions that have to be taken before a scientifically useful and meaningful meta‐analysis can be carried out. The problems encountered include heterogeneity of samples, conditions, interventions and end‐points; narrow focus; curvilinearity of regression; lack of independence of determinants; synergistic interactions; contradictory experimental results. It is suggested that best‐evidence synthesis, or theorydirected analysis, might be a safer option.
Case mix adjustment in comparative audit
Authors: Hayes Catriona , Murray Gordon D.
Published: December 2007

There is increasing pressure to measure and publicize the quality of health care, with, for example, hospital ‘league tables’; appearing regularly in the lay press. Equally, there is increasing recognition that such simplistic presentations of data can be seriously misleading, as differences in case mix mean that they do not compare like with like.

We discuss what is required of a statistical model if it is to be used to make comparisons of clinical performance which are adjusted for case mix. Outcome measures must be well defined and relevant, and the risk factors used in the model must reflect the patient's potential prognosis rather than aspects of his or her clinical care. In addition, the calibration of the statistical model is crucial.

We review a number of established clinical scoring systems and demonstrate that they fail to meet all of the required criteria. Of particular concern is the fact that these scoring systems are susceptible to biases which could actually mask differences in performance. We highlight areas where further research is required, with the aim of stimulating progress in this field.
Detecting poor design, erroneous analysis and misinterpretation of studies
Authors: Appleton D.R.
Published: December 2007

To detect bad research in published articles, it is necessary to know what to look for. Some examples of the types of poor study design, inappropriate analyses and pitfalls of interpretation which can occur are presented.
Systematic reviews of randomized controlled trials: the need for complete data
Authors: Clarke Michael J. , Stewart Lesley A.
Published: December 2007

If the relative effectiveness of different treatments that might be used in clinical practice is to be evaluated reliably, it is very important that the evaluation is carried out in an appropriate manner. This is especially true where the differences between treatments are expected to be moderate, and so easily obscured by the play of chance or systematic bias. Although such differences are often of considerable clinical importance, they can be difficult to assess and require a large amount of randomized evidence. This evidence can be obtained through prospective randomized controlled trials, meta‐analysis of results from past randomized trials, or ideally a combination of the two, with prospective trials contributing to future meta‐analyses. Whichever technique is adopted, all possible biases must be minimized through the collection of as much randomized evidence as possible. In meta‐analyses, this is best achieved by ensuring that all relevant trials, and all randomized participants in these trials, are included in the analysis. The gold standard for this might be a meta‐analysis of individual patient data, in which details for each participant in every trial are collected and analysed centrally. This approach requires considerable time and effort. However, it will add to the analyses that can be performed and will remove many of the problems associated with a reliance on published data alone and some of the problems that can arise from the use of aggregate data. This paper sets out some of the reasons for this and some of the techniques used for individual patient data‐based meta‐analysis.
Clinical audit in the National Health Service: fact or fiction?
Authors: Miles A. , Bentley P. , Polychronis A. , Price N. , Grey J.
Published: December 2007

It is increasingly recognized that the repeated rhetorical emphasis from 1989 to date on achieving measurable benefits to patients from audit, in the face of inattention to the development of methodologies with which to realize such benefits in operational practice, has represented a serious deficiency in strategic planning and direction and a consequent failure to establish functional clinical audit within the NHS. A grand revision of strategy is therefore necessary, and this should begin with the development of a research‐based method of audit, the training of clinicians and audit support staff in its use and a subsequent trial of its effectiveness prior to its implementation within the NHS. Only then will measurable improvements become possible, value for money be assured and clinicians' attitudes to audit change.
Monitoring outcomes in routine practice: defining appropriate measurement criteria
Authors: Long Andrew F. , Dixon Paul
Published: December 2007

With the development of an internal market for health care, ‘purchasing for outcomes’ has become an important if somewhat rhetorical catchphrase. While there is emerging understanding about how it can be pursued, doubts are being expressed over an outcomes rather than a process emphasis. This debate has been confused by a failure to differentiate the role and importance of monitoring outcomes at an individual patient care level from those at an aggregate population/purchaser level.

The clinical need to collect outcomes data on individual patient care within routine care settings places additional requirements on measurement development and selection. Traditional measurement criteria, stressing reliability, validity and responsiveness to change, must be supplemented by criteria of feasibility of use, clinical utility and acceptability. One option is to select domains or items of interest from longer instruments initially designed for research, carefully selected in relation to the purposes of measurement. Further measurement criteria must be addressed which stress the relevance of the proposed instrument to the condition and to the participants in the clinical interaction: in particular, patient‐centredness and sensitivity to the setting.

Monitoring the outcomes of individual patient care within routine clinical practice poses considerable challenges to researchers who are developing instruments and to clinicians who collect and use the data. A shift in emphasis is required towards more context‐specific tests, addressing relevance to lay perceptions, to clinical use and to the condition and setting under review. The content validity, the responsiveness to patient‐relevant and clinically relevant change and, of course, reliability must have greater primacy. In this way, outcome data which measure the quality of clinical practice and which provide appropriate criteria for research into effectiveness can be generated.