bluuebunny/crossref_metadata_2025_split huggingface dataset:
Training for team care
Authors: Milne M. Ann 
Published: December 2006

SUMMARYThe aim of this paper is to highlight some of the findings of a research study concerned with the perception of general practitioner trainees, health visitor, district nurse and social work students towards the primary health care team. Areas of role understanding; role restriction/role euphoria and high referral of problems to others are illustrated. The results suggest a need for role learning experiences during training which are subsequently extended and reinforced by interdisciplinary participation in simulated patient management experiences.The idea of team care in the United Kingdom was first mooted as early as 1920 when a committee under the chairmanship of Dawson proposed that doctors should work in teams from health centres. This suggestion was destined to lie dormant until the 1960s, when due to a more favourable poltical, social and economic chimate, the idea was rejuvenated. District nurses and health visitors became associated with doctors in general practice and such terms as ‘attached’, ‘aligned’, ‘linked’ and ‘in liaison with’ were in vogue (C.E.T.H.V. 1977). However, the bringing together of personnel was only the first small step in what should have been a dynamic drive to progress from an individualistic effort to that of a concerted team approach. In recent years however, there has been increasing controversy about the effectiveness of the team as a unit.
Multidisciplinary teams in geriatric wards: myth or reality?
Authors: Evers Helen K. 
Published: December 2006

This paper argues that the rhetoric of multidisciplinary teamwork is central to the provision of health care generally and geriatric care in particular. Yet the notion of teamwork is poorly defined, and the supposed benefits for patients are not always readily apparent. Looking at teamwork in practice, examples from research are used to illustrate how multidisciplinary decision making and work with patients can, under particular circumstances, take on the appearance of collaboration amongst a team of expert colleagues, which co‐opts patients and relatives to the status of team members. But very often, multidisciplinary work with patients is coordinated not by mutual collaboration amongst a team of equals, but by means of established work routines which are broadly applied to whole categories of patients, and by the operation of the traditional hierarchy of social relations in health care. For long stay patients, the pervasiveness of the teamwork mythology and the frequent concurrent withdrawal of other professionals can, at worst, leave the nurses in the invidious position of having responsibility, but no formal or legal authority for caring for their patients: work which no other professional is anxious to do. This leads to negative outcomes for patients as well as for nurses.Finally, it is stressed that analysis of multidisciplinary teamwork both in theory and in practice is vital if we are to understand the conditions under which multidisciplinary teamwork both flourishes, and can be demonstrated to be a necessary condition for the creation of positive care outcomes for geriatric patients in hospital. This paper seeks to raise some of the issues which must be confronted in this endeavour.
Recording patients blood pressure: a review
Authors: Thompson David R. 
Published: December 2006

This paper reviews the proper technique which should be adopted by the nurse in order to obtain accurate blood pressure measurements. Although this is difficult using conventional instruments, statistics uniformly confirm the harmful significance of an elevated blood pressure. Any nurse delivering high quality care must be able to carry out nursing procedures skillfully and accurately. The methodology of blood pressure recording is discussed, analysed and evaluated.It is well‐documented that there are many potential sources of error in recording blood pressure, including poor technique and observer bias. The paper deals with these and highlights some of the dilemmas that this technique presents to the nurse. A claim is made that many nurses are often inadequately trained in blood pressure measurement, and with increasing reliance on the nurse for records, much more attention needs to be focused on this area.
An investigation of distress and discontent in various types of nursing
Authors: Nichols Keith A. , Springford Veronica , Searle John 
Published: December 2006

It has been claimed that nurses in intensive therapy units are prone to high levels of distress and discontent A questionnaire was designed to assess nurses' reactions to intensive therapy work and thus provide an objective check on these claims. Nurses from eight intensive therapy units in England took part in the survey together with comparison groups from two renal units, a medical ward and a surgical ward. High levels of job satisfaction were registered in all the intensive treatment units with very few nurses indicating distress or a wish to leave their job. Some features of the work did attract criticism though, in particular the large fluctuations in work load, the level and adequacy of support, and the sparse amount of feedback given to nurses by senior staff.Much the same pattern was recorded with the medical and surgical nurses, and from one of the renal units. The second renal unit was known to be in a state of crisis at the time and it was predicted that a high level of discontent would be registered there. This proved to be the case and was taken as confirmation of the validity of the questionnaire, and also as giving insight into the psycho‐social conditions which may foster distress in nurses.
Quality assurance programme for nursing*
Authors: Padilla Geraldine V. , Grant Marcia M. 
Published: December 2006

This article describes a conceptual and methodological framework for evaluating nursing care quality. The conceptual framework is based on Orem's theory of self‐care which emphasizes the importance of decisions in the selection of nursing process based on patient status and problems. The primary outcome criteria is self‐care. The methodological framework is based on Greenfield's criteria maps methodology for linking patient status (problems or diagnoses) to decisions about nursing interventions and linking these specific nursing intervention criteria to desired outcomes for self‐care.The article further describes a multiagency quality assurance programme for nursing. The programme includes: a definition of criteria and standards across agencies; nursing care management protocols that define standards of care; continuing education courses for nursing based on management protocols; the maps method of auditing actual and recorded nursing process and patient outcomes as defined in the management protocol.
Workshops in personal relationships
Authors: Strehlow Marion S. 
Published: December 2006

This paper describes the planning, implementation and evaluation of a series of workshops for practising health visitors, as one aspect of continuing professional education. The history demonstrates response to stated need. Planning was intensive and extensive, resulting in one broad educational objective and a flexible approach to teaching/learning, contributions of expertise from several disciplines proved valuable.Prior to full implementation, experimental workshops were organized and evaluated both objectively and subjectively. The variety of methods of evaluation permitted isolation of some factors which mitigate against success and their avoidance when possible. The objective evaluations used three criteria which appeared to demonstrate positive outcomes to a great extent.Evaluations of 17 workshops demonstrate the continuing value of this form of education, and the summarized response shows, inter alia, that impetus does not necessarily reduce with time. Of significance is the evidence that the results include improved professional practice and that there were increases in depth and breadth of knowledge. Additionally, there were developments of self‐help and professional interest groups. Finally, the sequel should lead towards a model of training resource personnel within the NHS, the trial of the model being early in 1982.
Universities and nursing education
Authors: Hayward Jack 
Published: December 2006

Trends reflected by Department of Health and Social Security statistics on the nursing workforce are examined and the ratios between grades discussed. Recruitment into nursing degree courses in the UK is considered in relation to overall recruitment into nursing.The somewhat ambiguous position of nursing degree courses in the UK leads into consideration of policy statements by the universities and the nursing profession. The importance of such policies is emphasized in the current financial climate, as are the potential contributions of university departments to professional debate, for example standards of care.Comparisons are drawn between the goals of courses involving full‐time studentships as opposed to part–time apprenticeships and the present boundaries between these noted, especially in relation to the expanding roles of courses.On–going research into the preparation of nurse–tutors in the UK is mentioned, together with a preliminary analysis of the academic basis in the biological sciences possessed by learners and tutors. Out of this is derived a suggestion that the present–day shortage of nurse teachers could be helped by varying the existing patterns of recruitment, especially involving subject specialists in the biological, behavioural and social sciences.
Spoken language and small groups: a student experience in graduate nursing education
Authors: Saunders Joy B. 
Published: December 2006

The study investigates student verbal activities in six small discussion groups. A total of 18 registered nurse graduate students from two schools participated. The content for their discussion was based on three nursing practice situations that focused on adult medical‐surgical nursingThe components that served as basic units of analysis for the data were four types of pedagogical move that characterized the verbal interplay of the students. [These include structuring, soliciting, responding and reacting. Within each pedagogical move four categories of meanings are identified. These categories include substantive‐discipline, method of inquiry (nursing process), substantive‐logical and digresion.]The descriptive data suggest that the discussion pattern was characterized by a high proportion of cyclical reacting moves. The referential base for much of the substantive‐discipline meanings was the patient's disease processes, with discipline referenced content primarily in nursing, pathology, and psychology. The general character for the nursing process suggests frequent use of the assessment phase and minimal use of the remaining four phases, especially the nursing diagnosis and evaluation phases. Additionally, the collection of assessment data was guided by a perceptual emphasis on the pathophysiological manifestations of the patient.These data replicate earlier reports on the frequency with which students verbalize empirical meanings of fact‐stating and explaining more often than either evaluative or analytic meanings.The findings support current concern with one of the major challenges still facing nursing, that of shifting from disease centred nursing to patient centred nursing. The aim of the shift is to encourage wholism in the nursing care of patients and avoid reducing nursing inquiry to only one discipline perspective, attainment of a balanced perspective for the nursing activities discussed by the students in this study was not evident.
Glutamate receptor activation evokes calpain‐mediated degradation of Sp3 and Sp4, the prominent Sp‐family transcription factors in neurons
Authors: Mao Xianrong , Yang Shao‐Hua , Simpkins James W. , Barger Steven W. 
Published: December 2006

AbstractSp‐family transcription factors (Sp1, Sp3 and Sp4) contain a zinc‐finger domain that binds to DNA sequences rich in G–C/T. As assayed by RT‐PCR analysis of mRNA, western‐blot analysis, immunofluorescence, and antibody‐dependent “supershift” of DNA‐binding assays, the prominent Sp‐family factors in cerebral neurons were identified as Sp3 and Sp4. By contrast, glial cells were found to express Sp1 and Sp3. We previously showed that the pattern of G–C/T binding activity of Sp‐family factors is rapidly and specifically altered by the calcium influx accompanying activation of glutamate receptors. Here, we demonstrate that Sp‐factor activity is also lost after a cerebral ischemia/reperfusion injuryin vivo. Consistent with its calcium‐dependent nature, we found that glutamate’s effect on Sp‐family factors could be blocked by inhibitors of calpains, neutral cysteine proteases activated by calcium. Purified calpain I cleaved Sp3 and Sp4 into products that retained G–C/T‐binding activity, consistent with species observed in glutamate‐treated neurons. These data provide details of an impact of glutamate‐receptor activation on molecular events connected to gene expression.
Increased mast cell density in invasive melanoma
Authors: Duncan Lyn M. , Richards Lisa A. , Mihm Martin C. 
Published: December 2006

Mast cell participation in immune responses, tumor progression, and vascularization has been studied extensively in vitro. In situ investigation of mast cells in routinely processed tissues is hampered by difficulty in reliable detection of mast cells. We studied the tissue density of mast cells using a morphometric point‐counting technique in 1 μm‐thick, Giemsa‐stained, tissue sections from epon‐embedded samples of skin biopsies. This technique has been demonstrated to be an accurate and reproducible method for determining mast cell density.Mast cell density in 15 cases of invasive melanoma was compared to that of 9 cases of benign melanocytic nevi and 4 cases of melanoma in situ. Mast cell density was greatest in invasive melanoma (mean density = 0.61 vol.%). The mean density of mast cells in nevi and in situ melanoma was 0.33 and 0.5 respectively. Six of 15 cases of melanoma had mast cell densities > 0.6, whereas mast cell density did not exceed 0.6 in any cases of melanoma in situ or benign melanocytic nevi (p < 0.02). Our findings confirm an increase in mast cell tissue density in some cases of invasive melanoma when compared to mast cell density in benign nevi and in situ melanoma.
Topical tretinoin replenishes CD1a‐positive epidermal Langerhans cells in chronically photodamaged human skin
Authors: Murphy George F. , Katz Sara , Kligman Albert M. 
Published: December 2006

Excessive exposure to sunlight results in drastic degradative changes in the constitutive cells of the epidermis. Among these is a profound abrogation of Langerhans cell number and function, leading to compromised immunologic competency. Retinoids have recently been shown to restore immunologic function in the setting of iatrogenic immunosuppresion. We asked whether topical tretinoin would reverse Langerhans cell depletion in chronically photodamaged skin.We examined the skin of 8 volunteers immunohistochemically before and after 6 months of daily applications of tretinoin. At baseline, there was a profound depletion of CD1a‐positive Langerhans cells in the interfollicular epidermis, but not in the adjoining follicular epithelium. After tretinoin, all patients demonstrated replenishment of interfollicular epidermis by CD1a‐positive Langerhans cells. This was associated with induction of HLA‐DR expression on infundibular keratinocytes, as well as the appearance of CD1a dendritic cells in the papillary dermis. Thus, the enhancement of epidermal immunity in photodamaged skin may reflect restoration of antigen‐presenting Langerhans cells. The source of this renewed dendritic cell population is likely to be follicular infundibulum and the papillary dermis.
Proliferation and adhesion of periodontal ligament cells on synthetic biominerals
Authors: Hatakeyama J , Hatakeyama Y , Takahashi I , Suzuki O , Sasano Y 
Published: December 2006

Objective:  Hydroxiapatite (HA) has been suggested as a useful biomaterial to support the regeneration of tissues. In this study, we investigated the adhesion of periodontal ligament (PDL) cells on octacalcium phosphate (OCP) and its hydrolyzed apatitic product (HL), which are known precursors of HA.Methods:  Rat PDL cells were cultured on OCP or HL‐coated dishes. Cell proliferation and adhesion and mRNA expression of collagen I, fibronectin integrin subunits were examined. Cell adhesion inhibition assays were carried out by GRGDSPK (Gly‐Arg‐Gly‐Asp‐Ser‐Pro‐Lys).Results:  In early culture period, the cell number of PDL cells was lower on OCP and HL than that on control without any coating. However, the cell number on OCP or HL caught up with control later period. mRNA expression level of collagen I and fibronectin on OCP and HL were similar among OCP HL and control, although they differed early in the culture period. Integrin subunits were expressed on both OCP and HL as well as on control. Cell adhesion was inhibited by RGD inhibitor peptide.Conclusion:  Our findings indicated that rat PDL cells produce collagen I and fibronectin on OCP and HL, and then show increased cell numbers depending on adhesion to the matrices through integrins.
Policies and Opportunities for Physical Activity in Middle School Environments
Authors: Young Deborah R. , Felton Gwen M. , Grieser Mira , Elder John P. , Johnson Carolyn , Lee Jung‐Sun , Kubik Martha Y. 
Published: December 2006

ABSTRACTBackground:  This study examined physical activity opportunities and barriers at 36 geographically diverse middle schools participating in the Trial of Activity for Adolescent Girls.Methods:  Principals, physical education and health education department heads, and program leaders were interviewed to assess policies and instructional practices that support physical activity.Results:  Schools provided approximately 110 hours per year in physical education instruction. Approximately 20% of students walked or bicycled to school. Eighty‐three percent of schools offered interscholastic sports and 69% offered intramural sports. Most schools offered programs for girls, but on average, only 24 girls (∼5%) in the schools attended any programs. Only 25% of schools allowed after school free play. An overall score created to assess school environmental support for physical activity indicated that, on average, schools met 6.7 items of 10 items. Free/reduced lunch program participation versus not (p = .04), perceived priority of physical education instruction over coaching (p = .02), and safety for walking/bicycling to school (p = .02) predicted environmental support score.Conclusions:  Schools have policies and practices that support physical activity, although unfavorable practices exist. Schools must work with community partners and officials to provide environments that optimally support physical activity, especially schools that serve low‐income students.
Transcriptional Repression of HepaticCytochrome P450 3A4Gene in the Presence of Cancer
Authors: Charles Kellie A. , Rivory Laurent P. , Brown Sandie L. , Liddle Christopher , Clarke Stephen J. , Robertson Graham R. 
Published: December 2006

AbstractPurpose: Many chemotherapeutic drugs have an inherent lack of safety due to interindividual variability of hepatic cytochrome P450 (CYP) 3A4 drug metabolism. This reduction in CYP3A4 in cancer patients is possibly mediated by cytokines associated with tumor-derived inflammation. We sought to examine this link by using an explant sarcoma in a novel transgenic mouse model of human CYP3A4 regulation.Experimental Design: Engelbreth-Holm-Swarm sarcoma cells were injected into the hindlimb of transgenic CYP3A4/lacZ mice. Hepatic expression of the human CYP3A4 transgene was analyzed by direct measurement of the reporter gene product, β-galactosidase enzyme activity. Hepatic expression of murine Cyp3a was analyzed at the mRNA, protein, and function levels. The acute phase response was assessed by examining cytokines [interleukin-6 (IL-6) and tumor necrosis factor] in serum, liver, or tumor as well as hepatic expression of serum amyloid protein P.Results: Engelbreth-Holm-Swarm sarcoma elicited an acute phase response that coincided with down-regulation of the human CYP3A4 transgene in the liver as well as the mouse orthologue Cyp3a11. The reduction of murine hepatic Cyp3a gene expression in tumor-bearing mice resulted in decreased Cyp3a protein expression and consequently a significant reduction in Cyp3a-mediated metabolism of midazolam. Circulating IL-6 was elevated and IL-6 protein was only detected in tumor tissue but not in hepatic tissue.Conclusions: The current study provides a mechanistic link between cancer-associated inflammation and impaired drug metabolism in vivo. Targeted therapy to reduce inflammation may provide improved clinical benefit for chemotherapy drugs metabolized by hepatic CYP3A4 by improving their pharmacokinetic profile.
HER2-Specific T-Cell Immune Responses in Patients Vaccinated with Truncated HER2 Protein Complexed with Nanogels of Cholesteryl Pullulan
Authors: Kitano Shigehisa , Kageyama Shinichi , Nagata Yasuhiro , Miyahara Yoshihiro , Hiasa Atsunori , Naota Hiroaki , Okumura Satoshi , Imai Hiroshi , Shiraishi Taizo , Masuya Masahiro , Nishikawa Masakatsu , Sunamoto Junzo , Akiyoshi Kazunari , Kanematsu Takashi , Scott Andrew M. , Murphy Roger , Hoffman Eric W. , Old Lloyd J. , Shiku Hiroshi 
Published: December 2006

AbstractPurpose: We developed a complex of tumor antigen protein with a novel nanoparticle antigen delivery system of cholesteryl pullulan (CHP). To target HER2 antigen, we prepared truncated HER2 protein 1-146 (146HER2) complexed with CHP, the CHP-HER2 vaccine. We designed a clinical study to assess the safety of the vaccine and HER2-specific T-cell immune responses measured by the newly developed enzyme-linked immunospot assay with mRNA-transduced phytohemagglutinin-stimulated CD4+ T cells in HLA-A2402-positive patients with therapy-refractory HER2-expressing cancers.Experimental Design: Nine patients with various types of solid tumors were enrolled. Each patient was s.c. vaccinated biweekly with 300 μg of CHP-HER2 vaccine for three times followed by booster doses. HER2-specific T-cell responses were evaluated by enzyme-linked immunospot assay by targeting autologous phytohemagglutinin-stimulated CD4+ T cells transduced with 146HER2-encoding mRNA to cover both identified peptides and unknown epitopes for MHC class I and class II that might exist in the sequence of the vaccine protein.Results: CHP-HER2 vaccine was well tolerated; the only adverse effect was grade 1 transient skin reaction at the sites of vaccination. HER2-specific CD8+ and/or CD4+ T-cell immune responses were detected in five patients who received four to eight vaccinations, among whom both T-cell responses were detected in these patients. In four patients with CD8+ T-cell responses, two patients reacted to previously identified HER263-71 peptide and the other two reacted only to 146HER2 mRNA-transduced cells.Conclusions: CHP-HER2 vaccine was safe and induced HER2-specific CD8+ and/or CD4+ T-cell immune responses.