Designing and Evaluating an Interactive Multimedia Web-Based Simulation for Developing Nurses’ Competencies in Acute Nursing Care: Randomized Controlled Trial

BackgroundWeb-based learning is becoming an increasingly important instructional tool in nursing education. Multimedia advancements offer the potential for creating authentic nursing activities for developing nursing competency in clinical practice.ObjectiveThis study aims to describe the design, development, and evaluation of an interactive multimedia Web-based simulation for developing nurses’ competencies in acute nursing care.MethodsAuthentic nursing activities were developed in a Web-based simulation using a variety of instructional strategies including animation video, multimedia instructional material, virtual patients, and online quizzes. A randomized controlled study was conducted on 67 registered nurses who were recruited from the general ward units of an acute care tertiary hospital. Following a baseline evaluation of all participants’ clinical performance in a simulated clinical setting, the experimental group received 3 hours of Web-based simulation and completed a survey to evaluate their perceptions of the program. All participants were re-tested for their clinical performances using a validated tool.ResultsThe clinical performance posttest scores of the experimental group improved significantly (P<.001) from the pretest scores after the Web-based simulation. In addition, compared to the control group, the experimental group had significantly higher clinical performance posttest scores (P<.001) after controlling the pretest scores. The participants from the experimental group were satisfied with their learning experience and gave positive ratings for the quality of the Web-based simulation. Themes emerging from the comments about the most valuable aspects of the Web-based simulation include relevance to practice, instructional strategies, and fostering problem solving.ConclusionsEngaging in authentic nursing activities using interactive multimedia Web-based simulation can enhance nurses’ competencies in acute care. Web-based simulations provide a promising educational tool in institutions where large groups of nurses need to be trained in acute nursing care and accessibility to repetitive training is essential for achieving long-term retention of clinical competency.     

Simulación clínica online para estudiantes de ciencias de la salud durante la pandemia de COVID-19

Introduction: In April 2020, the COVID-19 pandemic forced higher education institutions to close their doors. Health sciences students were left without the opportunity for internships and rotations due to the confinement, closure of universities and collapse of hospitals. Professors had to reconvert face-to-face activities into distance learning workshops delivered online. The study aims to identify and analyse the main online clinical simulation activities carried out in Chile during the COVID-19 pandemic between 2020 and 2021, the problems the centres faced, and the protocols they defined for their reopening.Materials and methodsA quantitative, observational, cross-sectional study was conducted among clinical simulation coordinators of higher education institutions in Chile, with an exploratory scope. For data collection, an ad-hoc instrument was designed and sent to all clinical simulation centres in Chile to find out about their online activities. The instrument has 2 areas: 1) the effects of the pandemic on faculty and students, 2) the type of activities carried out during the pandemic period.Results30 centres out of 64 responded to the instrument created, representing 47% of the country. 87% of the centres implemented remote activities during confinement. The most represented activities were high fidelity scenarios with 67%, followed by simulation with simulated and standardized patients with 57 and 33%, respectively. Concerning the reopening, 50% of the centre directors stated that occupancy was low and that they had to subdivide the groups according to the permitted capacity.DiscussionTeachers and students were well suited to each centre's protocols during the COVID-19 pandemic. The centres maintained high and low-fidelity virtual simulation activities during confinement, using software and applications maintained post-confinement. In the centre reopening, the low occupancy and subdivision of groups were the main difficulties due to the allowed capacity.     

Survey of general practitioners' views on postgraduate education in North-east Scotland

A questionnaire was sent to all doctors in North-east Scotland enquiring about postgraduate education. The educational programme devised by the Education Committee of the North-east Scotland Faculty of the Royal College of General Practitioners was considered to be relevant, interesting, and well-planned. Suggestions made by the doctors have been taken account of by the Education Committee in their present programme.

Journals considered to have the best educational content were Prescriber's Journal, Update and The Practitioner. Those doctors who read The Journal of the Royal College of General Practitioners thought it expressed up-to-date and helpful views about the development of general practice. However, it was ranked poorly alongside such journals as Update.

The doctors rated contact with their partners and hospital colleagues as the most important sources of education. These links must be a growth point for postgraduate education within an integrated health service.

One-week courses, covering several subjects with a variety of presentations, were most favoured by the replying doctors.

     

Fusobacterium invasive infections in children: a retrospective study in two French tertiary care centres

The purpose of this investigation was to describe the clinical and biological characteristics and evolution of invasive Fusobacterium infections in children admitted to two French paediatric tertiary care centres. Children who were admitted from 1998 to 2009 to two tertiary care centres for invasive Fusobacterium infection were included in a retrospective study. Thirty-one children with a median age of 5.7 years (interquartile range, IQR [2.3; 9.3]) were included. Nine children had an underlying condition, most commonly sickle cell disease (n?=?3) or immunodeficiency (n?=?3). Two children had skin effraction prior to the infection. The major sites of infection were the head and neck (n?=?14) and abdomen (n?=?10). Three children suffered from atypical Lemierre’s syndrome. More than half of the children had a bacterial co-infection (58 %). Six children were hospitalised in an intensive care unit, and 67 % of them had a chronic underlying disease. None of the children died. Six children with negative cultures had Fusobacterium identified through 16S RNA-PCR. Fusobacterium is responsible for severe infection in children. Microbiological diagnosis might be improved by the wider use of molecular detection.     

The immunological competence of subjects with sarcoidosis

Immunological competence in sarcoidosis was measured by in vivo and in vitro immunological testing of eighteen subjects who had never been treated with prednisone, and eleven subjects treated with prednisone. Three of the latter group had been studied before steroid therapy. Cutaneous delayed hypersensitivity was assessed by intradermal skin testing with five antigens. Thymus-derived `T' lymphocytes and bone marrow-derived `B' lymphocytes were enumerated and the ability of lymphocytes to respond to stimulation with phytohaemagglutinin (PHA), Candida albicans and allogeneic irradiated lymphocytes (mixed lymphocyte reaction) was measured and compared to results obtained with lymphocytes from healthy subjects.

The non-steroid-treated and the steroid-treated groups did not respond as well as a control group to intradermal challenge. The responses of lymphocytes from patients with untreated sarcoidosis to PHA and Candida albicans was normal but the response to allogeneic lymphocytes was reduced. In comparison stimulation indices for lymphocytes from the group who were receiving steroids were significantly reduced, with eight of eleven individuals having abnormal responses. Significant reduction in T lymphocytes was observed in only three of eleven of the non-steroid-treated subjects and five of ten of the steroid-treated subjects that were studied.

Studies on patients before and after steroid therapy suggest that steroid therapy and not sarcoidosis was responsible for the poorer responses of the steroid-treated group. The most striking finding of this study was the marked disparity between the cutaneous reactivity to Candida albicans, which was abnormal, and the in vitro lymphocyte response to this antigen which was normal. This suggests that the anergy of sarcoidosis cannot be attributed to an inherent lymphocyte dysfunction or to a depletion of these cells.

     

Association of a COL1A1 polymorphism with lumbar disc disease in young military recruits

Background: Lumbar disc disease (LDD), one of the most common conditions for which patients seek medical care, has been associated with sequence changes of the COL genes. COL1A1, however, has not been studied in young patients with LDD; COL1A1 polymorphisms have been associated with bone mineral density (BMD) in several populations and with LDD in older adults.

Objective: To study COL1A1 polymorphisms in young Greek army recruits with LDD.

Subjects: These young soldiers were diagnosed with early LDD at the time of their presentation to a military training site. All patients had radiological confirmation of their disease; a control group was also studied.

Methods: Sp1-binding site polymorphism of the COL1A1 gene was investigated by standard methods.

Results: There was an increased frequency of the "ss" genotype (33.3%) in LDD patients; none of the controls had this genotype. In addition, a significantly smaller number of controls was heterozygotes for this allele.

Conclusions: A previously studied sequence change of the regulatory region of the COL1A1 gene, the same as has previously been associated with low BMD in many populations and LDD in older adults, showed a strong association with LDD in young male soldiers who were recently diagnosed with this disease.

     

General practitioners' attendance at courses accredited for the postgraduate education allowance.

An analysis was undertaken in the northern half of the South Western Regional Health Authority of general practitioners' attendance at courses accredited for the postgraduate educational allowance over one year. A total of 358 courses provided 2341 hours of accredited education and produced a total general practitioner attendance of 50,389 hours. The mean attendance per principal in the area was 49.2 hours although the region may be a net importer of attenders from outside the area. Of the 50,389 total hours of attendance, 28.3% were in health promotion, 48.2% in disease management and 23.5% in service management. Course provision and attendance varied considerably over the year. September, October and November accounted for 42.7% of the total hours of attendance, compared with 6.8% in June, July and August. Courses of two to four days or of one week duration accounted for 48.3% of total attendance hours; 10.1% of total attendance hours were at commercially organized courses and 5.6% at courses organized by practices. A total of 66.1% of attendance hours were in postgraduate centres and 6.8% in the practice. Courses with more than 30 participants accounted for 15.9% of courses attended. A total of 174 general practitioners and others organized courses, 21 of them influencing 33,521 hours of general practitioner education. The study shows that in this area, there was an encouraging provision, range and uptake of continuing education courses for general practitioners. The concentration of educational activities in postgraduate centres underlines the need for increased provision for developing educational skills for clinical tutors.     

Enhanced in vitro phagocytic power of macrophages from PPD-stimulated skin sites in human subjects hypersensitive to PPD

By a quantitative Rebuck's skin-window technique human macrophages were collected from individuals either unreactive or hypersensitive to PPD, the latter having recovered from tuberculous infection.

In vitro testing of macrophages with a strain of Paracolonbacter aerogenoides proved that cells from hypersensitive convalescents were provided with increased pagocytic and bactericidal activities. An even higher degree of macrophage activation was attained when cells from hypersensitive individuals had previously been stimulated in vitro with PPD. Changes of macrophage functions such as those mentioned above might well result from the action on macrophages of lympho-kine-like agents released by sensitized lymphocytes coming in contact with PPD.

     

Effectiveness of online peer assisted learning as a teaching methodology for dental undergraduate students

IntroductionPeer-assisted learning (PAL) has been extensively used in professional courses. However, its effectiveness as an adjunct to teacher-assisted learning (TAL) has not been evaluated. The objective of this study was to evaluate the effectiveness of Online PAL as an independent teaching methodology and as an adjunct to TAL, for dental students.MethodsForty BDS year 3 students were divided into 2 groups of 20 each. Four year 5 students were chosen as tutors to teach 4 different topics using the Microsoft teams platform. The study was conducted in two parts. At first, two topics were taught to one group by the tutor (peer-led group) and the other group, by a teacher (teacher-led group). Next, the remaining two topics were taught to both groups by the teacher initially. This was followed by repeated teaching of the topics to peer-led group by tutors, while other group did self-study. Students’ perception and performance scores were compared using an independent sample t-test for all the topics.ResultsThe mean performance scores in the teacher-led group for topics 1 and 2 were 86.15 and 90.22, whereas scores in the peer-led group were 75.38 and 79.21 which was statistically significant (p < 0.05). The mean scores in the teacher-led group for topics 3 and 4 were 71.82 and 65.42, whereas in the peer-led group as an adjunct to TAL were 84.55 and 82.50. This was statistically significant (p < 0.01).DiscussionOnline PAL as an adjunct to teacher-assisted learning can be useful for teaching dental undergraduate students.     

Nervous factors influencing the membrane activity of intestinal smooth muscle

The effects of various chemical agents on the spontaneous membrane activities and those electrically elicited in the smooth muscles of small intestine were investigated.

1. The effects of various chemicals on the spontaneously active membrane might be summarized as follows. (a) Cholinergic agents; atropine slightly hyperpolarized the membrane and reduced the amplitude of slow potential changes even in aged preparations. Prostigmine depolarized the membrane, and enhanced the amplitude and prolonged the duration of the slow potential changes. Atropine prevented the actions of prostigmine on the membrane. (b) Ba²⁺ depolarized the membrane, and enhanced the amplitude and prolonged the duration of the slow potential changes. The spike frequency was initially increased, then reduced. Atropine and tetrodotoxin partially prevented the action of Ba²⁺ on the membrane activities.

2. Effects of chemical agents on the membrane activity elicited by electrical stimulation might be summarized as follows. (a) Short pulse stimulation (0·5-1 msec) generated the spike as a direct response of the muscle cell membrane, then it was followed by slow depolarization, delayed hyperpolarization, i.e. the `inhibitory potential', and post-inhibitory rebound successively. (b) The slow depolarization and the post-inhibitory rebound were reduced in amplitude by treatment with atropine, and enhanced by treatments with prostigmine and Ba²⁺. Tetrodotoxin blocked all activities except the spike.

3. When repetitive stimulation (20 c/s) was applied to the membrane, the membrane hyperpolarized; then, after 3-5 sec, it gradually depolarized even if the stimulation was continued, and triggered spikes. The hyperpolarization always preceded depolarization. The duration and the amplitude of the delayed depolarization was proportionally increased by the increased intensity and duration of stimulation. Atropine and tetrodotoxin blocked the generation of the post-inhibitory rebound.

4. Effects of repetitive stimulation on the stored tissues were observed. The responses to repetitive stimulation of the membrane of muscles which had been stored 50 hr at 4 °C, were the same as those observed in the fresh tissue. The response of the tissue which had been stored 100 hr was the same as that observed in the fresh tissue treated with tetrodotoxin, i.e. all activities except the spikes were blocked.

     

Precipitins to candida albicans in chronic mucocutaneous candidiasis studied by crossed immunoelectrophoresis with intermediate gel. Correlation with clinical and immunological findings

The precipitating antibodies in the sera of fifteen patients with chronic mucocutaneous candidiasis were examined by crossed immunoelectrophoresis with intermediate gel. The method permitted identification and quantitation of precipitins against thirty-four of the seventy-eight known antigenic components of Candida albicans.

The sera from every patient contained precipitins and the number of reactivities per serum ranged from two to thirty-nine. All patients had antibodies to antigen 78, a mannan–protein complex. Many sera also possessed antibodies to many other components of the organism, suggesting that some of the yeast cells had been disrupted in the patients' tissues. However, there were no precipitin profiles that characterized patients with specific forms of chronic candidiasis. Instead, in two cases, the antibody profiles appeared to be related to the patients' ability to develop humoral immune responses. Serial studies of patients during remissions and exacerbations showed that there were no consistent changes in antibody activities.

The role of Candida precipitins in chronic candidiasis remains uncertain. Possible functions include prevention of dissemination of the infection from superficial sites, formation of immune complexes in superficial sites and suppression of cell-mediated immunity as suggested by in vitro tests.

     

Antigens in immunity: XVI. A light and electron microscope study of antigen localization in the rat spleen*

This paper describes the ultrastructural location of labelled antigens and carbon in the spleens of rats from 4 minutes to 5 days after injection. Particular attention was focused on the sites of deposition 4 minutes after intra-arterial injection of microgram quantities of ¹²⁵I-labelled Salmonella flagellar antigens, crayfish haemocyanin and BSA, using colloidal carbon for comparison. The combination of radioautography with both light and electron microscopy showed the importance of antigen binding by lymphocytes in the marginal zone of the spleen. Macrophage sequestration of antigens was not prominent in the spleen, although it occurred in the liver with the flagellar antigens and haemocyanin.

In the spleen marginal zone, avid antigen-binding cells were found in situ 4 minutes after the injection of labelled haemocyanin. These appear to be the counterpart in vivo of antigen-binding lymphocytes prepared in vitro. Such cells also occurred infrequently after the injection of labelled polymerized flagellin, but were not found with either BSA or carbon.

The apparent movement of flagellar antigen from the marginal zone to the white pulp between 1 and 2 hours after injection was seen to involve lymphocyte-associated antigen. The follicular antigen localization occurring from 1 day onwards after injection was on the dendritic reticular cells of germinal centres, as has been described in lymph nodes after subcutaneous injection.

Carbon particles were rapidly sequestered in macrophages of the spleen and liver, although some particles were found between cells in the marginal zone for as long as 2 hours after injection. By 2 and 5 days, however, all the carbon was in phagocytes, even in the white pulp. Differences between the localization of antigens and carbon were clear, even in the ultrastructural sites of their location in tingible body macrophages of germinal centres.

The unexpected emphasis of lymphocyte association with labelled antigens in the spleen marginal zone has allowed a revison of the mechanism previously proposed for the movement of antigens within the microenvironments of the spleen.

     

The localization of antigen in relation to specific antibody-producing cells: I. Use of a synthetic polypeptide [(T,G)-A--L] labelled with iodine-125

A synthetic multichain polypeptide, (T,G,)-A--L 509, was trace labelled with ¹²⁵I in the tyrosine end groups, composing the main antigenic determinants, and used to study the distribution of antigen in the draining lymph nodes after injection into the footpads of mice. The polypeptide was administered: (a) in saline solution into unprimed mice—in which form it is not demonstrably immunogenic; (b) in Freund's adjuvant into unprimed mice—in which form it is immunogenic; and (c) in saline solution to primed mice, so as to give a booster response. Experiments comparable to (c) were also done with [¹²⁵I]haemocyanin.

At various time intervals from 12 hours to 21 days later sections of the draining nodes were examined by radioautography and methylgreen—pyronine staining, or by a combination of immunofluorescent staining for antibody containing cells with radioautography. In unprimed mice, irrespective of whether they made antibody, labelling was found predominantly in the phagocytic cells of the medulla and the cortical sinus, but definite weaker labelling was also seen in the germinal centres. The label persisted throughout the period of observation, but tended to become more prominent with time in the germinal centres of mice making antibody in response to antigen in Freund's adjuvant. In primed mice the label was rapidly and predominantly concentrated in germinal centres, where it persisted throughout the period of observation while its intensity gradually diminished in other sites. The distribution of label in germinal centres was in a lace-like or dendritic pattern, similar to that described by Nossal and co-workers, and did not correspond to the lymphocytes or pyroninophilic cells in the centres.

Grain counts were made over specific antibody containing cells in both primary and booster responses to (T,G)-A--L. Such cells sometimes lay close to and sometimes many cell diameters distant from phagocytic cells containing concentrations of the antigen, but the cells themselves did not have grain counts significantly different from the background count. If the antigen remained undegraded, under the conditions of the experiment it would have been possible to detect the presence of fifteen molecules or less in a cell. Reasons are given for supposing that ¹²⁵I constituted a valid label of the main antigenic determinant groups, of which there were a maximum of 100 per molecule.

     

Reversed passive haemagglutination systems for the estimation of tetanus toxins and antitoxins

Preserved sheep erythrocytes sensitized with tetanus antitoxins of varying purity have been used as the indicator in the estimation of tetanus toxins and antitoxins.

Suspensions giving good agglutination patterns were produced using unrefined serum from well-immunized horses, pepsin-refined serum and preparations of γ-globulin. The most stable preparation was a freeze-dried suspension that had been sensitized with immune γ-globulin.

When these suspensions were used for the estimation of tetanus toxic filtrates by direct agglutination and tetanus antitoxins by haemagglutination inhibition the results in both cases were in close aggrement with the in vivo values as estimated by the mouse test at the 0.1 L+ level.

     

A Web-Based Telehealth Training Platform Incorporating Automated Nonverbal Behavior Feedback for Teaching Communication Skills to Medical Students: A Randomized Crossover Study

BackgroundIn the interests of patient health outcomes, it is important for medical students to develop clinical communication skills. We previously proposed a telehealth communication skills training platform (EQClinic) with automated nonverbal behavior feedback for medical students, and it was able to improve medical students’ awareness of their nonverbal communication.ObjectiveThis study aimed to evaluate the effectiveness of EQClinic to improve clinical communication skills of medical students.MethodsWe conducted a 2-group randomized crossover trial between February and June 2016. Participants were second-year medical students enrolled in a clinical communication skills course at an Australian university. Students were randomly allocated to complete online EQClinic training during weeks 1–5 (group A) or to complete EQClinic training during weeks 8–11 (group B). EQClinic delivered an automated visual presentation of students’ nonverbal behavior coupled with human feedback from a standardized patient (SP). All students were offered two opportunities to complete face-to-face consultations with SPs. The two face-to-face consultations were conducted in weeks 6–7 and 12–13 for both groups, and were rated by tutors who were blinded to group allocation. Student-Patient Observed Communication Assessment (SOCA) was collected by blinded assessors (n=28) at 2 time points and also by an SP (n=83). Tutor-rated clinical communications skill in face-to-face consultations was the primary outcome and was assessed with the SOCA. We used t tests to examine the students’ performance during face-to-face consultations pre- and postexposure to EQClinic.ResultsWe randomly allocated 268 medical students to the 2 groups (group A: n=133; group B: n=135). SOCA communication skills measures (score range 4–16) from the first face-to-face consultation were significantly higher for students in group A who had completed EQClinic training and reviewed the nonverbal behavior feedback, compared with group B, who had completed only the course curriculum components (P=.04). Furthermore, at the second face-to-face assessment, the group that completed a teleconsultation between the two face-to-face consultations (group B) showed improved communication skills (P=.005), and the one that had teleconsultations before the first face-to-face consultation (group A) did not show improvement.ConclusionsThe EQClinic is a useful tool for medical students’ clinical communication skills training that can be applied to university settings to improve students clinical communication skills development.     

Phylogenetic studies on the immune response: I. Localization of antigens and immune response in the toad, Bufo marinus

Toads of the species Bufo marinus were injected subcutaneously with ¹²⁵I-labelled flagella from Salmonella adelaide. Observations were made on the ensuing serum antibody response, the antigen localization pattern and sequential cellular changes in lymphatic and other tissues.

The serum antibody findings confirmed the work of previous investigators in showing a good primary response, prolonged synthesis of mercaptoethanol sensitive antibody and little or no evidence of secondary responsiveness.

Antigen became localized in the jugular bodies and spleen where proliferation of pyroninophilic cells could be observed after 5 days. Both the antigen-trapping cells and the first pyroninophilic blasts were scattered randomly throughout the jugular bodies. There was no clear-cut separation into cortex and medulla. Nothing resembling the antigen-trapping web of rat lymph node follicles was observed, nor were there any germinal centres. In the spleen, antigen was trapped in the red pulp and some degree of concentration around the islands of white pulp could be noted 1 day later. However, unlike in the rat, entry of antigen into the white pulp did not occur.

Both focal and diffuse collections of lymphoid and pyroninophilic cells were found in the kidney after antigenic stimulation. It seems likely that the kidney is a major antibody-forming organ in the toad.

The hypothesis is advanced that the absence of immunological memory may be due to the absence of the follicular antigen-trapping web and of resultant germinal centres.

     

The impact of COVID-19 pandemic on blood supplies and transfusion services in Eastern Mediterranean Region

BackgroundSevere Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spurred a global health crisis. The safety and supply of blood during this pandemic has been a concern of blood banks and transfusion services as it is expected to adversely affect blood system activities. We aim to assess the situation in the Eastern Mediterranean Region (EMR) during the first months of the pandemic.Materials and methodsA survey was designed to address blood supply, transfusion demand, and donor management during the coronavirus disease-19 (COVID-19) pandemic. Medical directors of different blood banks were invited to participate.ResultsA total of 16 centers participated with representation from 15/19 countries in the region. In total, 75% were from national blood banks. Most centres had a decrease in the blood supply, ranging from 26–50%. Representatives from 14 countries (93.3%) believed that public fear has contributed to a decrease in donations. Most centres (n = 12, 75%) had a reduction in transfusion demand, while those who did not, reported heavy involvement in treating patients with underlying haemoglobinopathies and haematological malignancies. Half of the centres activated their contingency plans. Four centres had to alter the blood donor eligibility criteria to meet demands. All centres implemented donor deferral criteria in relation to SARS-CoV-2, but were variable in measures to mitigate the risk of donor and staff exposure.ConclusionBlood services in the region faced variable degrees of blood shortages. We summarize lessons learnt during this pandemic for the blood banks to consider to plan, assess, and respond proportionately to future similar pandemics.     

Hereditary haemorrhagic telangiectasia: a questionnaire based study to delineate the different phenotypes caused by endoglin and ALK1 mutations

Background: Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant vascular dysplasia characterised by mucocutaneous telangiectasis, epistaxis, gastrointestinal haemorrhage, and arteriovenous malformations in the lung and brain. Causative mutations for HHT have been identified in two genes, endoglin and ALK1, which encode proteins involved in serine-threonine kinase signalling in the endothelial cell.

Methods: A number of people affected with HHT had completed a postal questionnaire as part of an international study to delineate the HHT phenotype. We identified questionnaires completed by subjects in whom we had identified a mutation in endoglin or ALK1. Further questionnaires were sent to families with known mutations. Data were only included from questionnaires returned by people known to carry disease causing mutations.

Results: Questionnaires were completed by 83 subjects with known mutations. Of these, 49 had endoglin mutations (HHT1) and 34 had ALK1 mutations (HHT2). Subjects with HHT1 reported an earlier onset of epistaxis (p=0.01) and telangiectasis (p=0.0001) than those with HHT2. Pulmonary arteriovenous malformations were only reported in the endoglin mutation group in our study (p<0.001).

Conclusions: Our questionnaire based study provides evidence that the HHT phenotype caused by mutations in endoglin (HHT1) is distinct from, and more severe than, HHT caused by mutations in ALK1 (HHT2). This has significant implications for diagnosis, screening, and treatment in the two different forms of HHT, as well as for understanding the pathogenesis of the disease.

     

The Complement-Fixation Test in Hepatic Coccidiosis of Rabbits

Antibodies to Eimeria stiedae were measured in rabbit serum by complement fixation. The titre rose to a maximum at about the 22nd day after infection, remained at this level for about 20 days and then declined. Antibodies were still detectable up to 160 days after infection.

Evidence of past or present slight E. stiedae infection was found in clinically normal rabbits whose sera fixed complement with E. stiedae antigens.

Challenge of rabbits which had recovered from a near-fatal infection had no effect upon the complement fixation titres of their sera.

The serum of a rabbit which had been injected with alum-precipitated antigen fixed complement with E. stiedae antigens. However, the animal was still susceptible to a superimposed oral infection which had the effect of further increasing the serum titre.

     

The effect of an educational programme consisting of group and individual arthritis education for patients with polyarthritis--a randomised controlled trial

Objective

The aim of this study was to investigate the effect of an educational programme for patients with polyarthritis compared to usual care.

Methods

Patients with rheumatoid arthritis, psoriatic arthritis and unspecified polyarthritis were randomised to the intervention (n = 71) or usual care (n = 70). The intervention consisted of three group educational sessions followed by one individual educational session. The primary outcomes were a patient's global well-being and arthritis self-efficacy. Secondary outcomes were patient activation, physical and psychological health status, educational needs and disease activity.

Results

After four months the intervention group had significantly better global well-being, 95% CI (2.3–14.1), p = 0.01, and self-efficacy, 95% CI (0.2–8.1), p = 0.04, than the control group. There were also trends for improved disease activity, and a statistically significant improvement in patient activation and pain in the intervention group.

Conclusion

This patient educational programme consisting of group sessions and nurse-delivered individual education has statistically significant benefits for global well-being and maintaining a level of self-efficacy in managing other symptoms in patients with polyarthritis.

Practice implications

This educational programme allows patients to learn from each other in addition to addressing individual educational needs.