Same system, different outcomes: comparing the transitions from two paper-based systems to the same computerized physician order entry system

Objective

To compare how nurses in two different paper-based systems perceive the impact of a computerized physician order entry (CPOE) system on their medication-related activities.

Setting

13 non-surgical, adult inpatient wards in a Dutch academic hospital.

Methods

Questionnaire survey of 295 nurses before and 304 nurses after the implementation of a CPOE system. These nurses worked with two different paper-based medication systems before the implementation: ‘Kardex-system’ and ‘TIMED-system’. In the Kardex-system, the structure of the nursing medication work was similar to that of after the CPOE implementation, while in the TIMED-system, it was different. ‘Adaptive Structuration Theory’ (AST) was used to interpret the results.

Results

The response rates were 52.2% (154/295) before and 44.7% (136/304) after the implementation. Kardex-nurses reported more positive effects than TIMED-nurses. TIMED-nurses reported that the computerized system was more inflexible, more difficult to work with, and slower than the TIMED-system. In the TIMED group, the overall mean score of the computerized process was not significantly different from that of the paper-based process. Moreover, nurses in both groups were more satisfied with the post-implementation process than with the pre-implementation process. Nevertheless, none of groups reported a better workflow support in the computerized system when compared to that of the paper-based systems.

Conclusions

Our findings suggest that not only the technology but also large differences between pre- and post-implementation work structure influence the perceptions of users, and probably make the transition more difficult. This study also suggests that greater satisfaction with a system may not necessarily be a reflection of better workflow support.     

Community structure of metazoan parasites from Pimelodus blochii in two rivers of the Western Brazilian Amazon: same seasonal traits,but different anthropogenic impacts

Parasitology Research - The present investigation evaluated the influence of seasonality and locality on the structure of the parasite community of the catfish Pimelodus blochii. A total of 160...     

Immunoepidemiology of Wuchereria bancrofti infection: parasite transmission intensity, filaria-specific antibodies, and host immunity in two East African communities

We compared the age profiles of infection and specific antibody intensities in two communities with different transmission levels in East Africa to examine the contribution of humoral responses to human immunity to the vector-borne helminth Wuchereria bancrofti. The worm intensities were higher and exhibited a nonlinear age pattern in a high-transmission community, Masaika, in contrast to the low but linearly increasing age infection profile observed for a low-transmission community, Kingwede. The mean levels of specific immunoglobulin G1 (IgG1), IgG2, IgG4, and IgE were also higher in Masaika, but intriguingly, the IgG3 response was higher in Kingwede. The age-antibody patterns differed in the two communities but in a manner apparently contrary to a role in acquired immunity when the data were assessed using simple correlation methods. By contrast, multivariate analyses showed that the antibody response to infection may be classified into three types and that two of these types, a IgG3-type response and a response measuring a trade-off in host production of IgG4 and IgG3 versus production of IgG1, IgG2, and IgE, had a negative effect on Wuchereria circulating antigen levels in a manner that supported a role for these responses in the generation of acquired immunity to infection. Mathematical modeling supported the conclusions drawn from empirical data analyses that variations in both transmission and worm intensity can explain community differences in the age profiles and impacts of these antibody response types. This study showed that parasite-specific antibody responses may be associated with the generation of acquired immunity to human filarial infection but in a form which is dependent on worm transmission intensity and interactions between immune components.     

The human cationic host defense peptide LL-37 mediates contrasting effects on apoptotic pathways in different primary cells of the innate immune system

The human cathelicidin LL-37 is a cationic host defense peptide (antimicrobial peptide) expressed primarily by neutrophils and epithelial cells. This peptide, up-regulated under conditions of inflammation, has immunomodulatory and antimicrobial functions. We demonstrate that LL-37 is a potent inhibitor of human neutrophil apoptosis, signaling through P2X(7) receptors and G-protein-coupled receptors other than the formyl peptide receptor-like-1 molecule. This process involved modulation of Mcl-1 expression, inhibition of BID and procaspase-3 cleavage, and the activation of phosphatidylinositol-3 kinase but not the extracellular signal-regulated kinase 1/2 mitogen-activated protein kinase pathway. In contrast to the inhibition of neutrophil apoptosis, LL-37 induced apoptosis in primary airway epithelial cells, demonstrating alternate consequences of LL-37-mediated modulation of apoptotic pathways in different human primary cells. We propose that these novel immunomodulatory properties of LL-37 contribute to peptide-mediated enhancement of innate host defenses against acute infection and are of considerable significance in the development of such peptides and their synthetic analogs as potential therapeutics for use against multiple antibiotic-resistant infectious diseases.     

Three functionally distinct helper T-cell clones: the roles for antigen non-specific helper factors in B-cell activation through two different pathways.

We established three functionally distinct purified protein derivative (PPD)-reactive T-cell clones (B11.15, B12.F and D-2). Clone B11.15 could co-operate with DNP-primed B cells to induce anti-DNP IgG plaque-forming cell (PFC) responses only when high amounts of PPD were added to the culture, whereas stimulation of a low amount of DNP-PPD was ineffective (factor-mediated interaction). On the other hand, clone D-2 activated those B cells in a MHC-restricted manner only when DNP-PPD was added to the culture (cognate interaction). B12.F could stimulate B cells with either PPD or DNP-PPD. Antigen non-specific helper factors (lymphokines) responsible for B-cell activation produced by cloned T cells upon stimulation with PPD and antigen-presenting cells were then investigated. Lymphokine activities determined in the present study were IL-2, BCGF I, BCGF II and TRF. BCGF I activity was determined by proliferation-inducing activity on purified B cells in the presence of anti-IgM antibody. BCGF II activity was measured by proliferation-inducing activity on purified B cells in the presence of dextran sulphate. TRF activity was determined on DNP-primed B cells for inducing further differentiation into anti-DNP IgG PFC. BCGF I active molecules were eluted in the fraction at apparent MW of 50,000-70,000 and 8,000-10,000 in gel-permeation column chromatography.     

Effects of temperature on the larval development ofAngiostrongylus cantonensis in the intermediate host,Biomphalaria glabrata

The effects of temperature on the larval development ofAngiostrongylus cantonensis inBiomphalaria glabrata were studied under controlled conditions. WhenB. glabrata were maintained at different, constant temperatures, the first-stage larvae developed to third-stage larvae between 20° and 31° C. The velocity of development to the third-stage in the snail depended on the relationship,Y=–0.1281+0.0081X (Y velocity of development;X rearing temperature). The threshold of development was 15.8° C and the thermal constant 123 degree-days. It is concluded that there might be a possibility ofA. cantonensis spreading to temperate regions in the world, if, in addition to the temperature, other factors allowed the completion of the life cycle of this worm.     

Haemosporidian parasites of a European passerine wintering in South Asia: diversity, mixed infections and effect on host condition

We studied haemosporidian parasites in the scarlet rosefinch Carpodacus erythrinus in a small isolated semicolony during an eight-year period using molecular methods of parasite detection. The scarlet rosefinch is an interesting model of parasite host species. It winters in South Asia which represents a rare exception among European passerines. Males express yellow to red carotenoid-based plumage ornament which is a good predictor of male reproductive success. In 240 blood samples originating from 199 adult individuals, the total parasite prevalence reached 60 %. Prevalence varied among years from 36 to 81 % in Haemoproteus, 8 to 22 % in Plasmodium, and 0 to 14 % in Leucocytozoon. Twenty parasite lineages were detected (Haemoproteus: 5 lineages, Plasmodium: 10 lineages, and Leucocytozoon: 5 lineages). Among them, the Haemoproteus ROFI2 lineage, which is a host-specific parasite lineage of the scarlet rosefinch, was the most frequently found. Parasite lineages showed varying degree of lineage specificity. While Haemoproteus lineages detected in the scarlet rosefinch have relatively narrow host breadth restricted mainly to Fringillidae family, Leucocytozoon and Plasmodium lineages generally showed wider host range. The presence of some parasite lineages hitherto detected in sedentary European passerines (SISKIN1, CCF3, BT2) or in Culicoides biting midges at the same locality (ROFI1) suggest local transmission. On the contrary, lineages LK05 and FANTAIL1 that were previously reported exclusively from Asian hosts imply parasite transmission at the scarlet rosefinch wintering sites in South Asia. Mixed infections were found in 17 % of infected samples and comprised mainly the most frequent lineages. The pattern of concomitant infections seemed to be rather random and matched expected levels based on lineage frequencies. Between-year comparisons revealed that in a majority of the repeatedly captured individual hosts the infection status remained unchanged (individuals stayed uninfected or possessed the same parasite lineages). However, 16 gains and 8 losses of lineages were also reported. We have not found any effect of haemosporidians on male carotenoid ornament expression or host body mass.     

Task-dependent gating of somatosensory transmission in two different motor tasks in man: falling and writing

The cerebral potentials induced by an electrical stimulus (median nerve or finger) were recorded over the central region of the scalp and were analysed during falling onto the extended arms or during writing to investigate the influence of different motor tasks on the transmission of a synchronous afferent volley to the brain. During both falling (before landing) and writing, the first peaks (20-40 ms) were reduced. Later peaks (60-200 ms) were enhanced during writing but reduced during falling. A reduction of the first peak was also obtained after ischaemic blockade of group I afferents, suggesting that the cerebral transmission of group I afferents is inhibited during falling and writing. The subjects reported a corresponding reduction in the perception of the stimulus during falling. During writing, however, the large late waves indicate a task specific processing of the remaining afferent volley. Such a gating of sensory information to the brain is assumed to play a functional role in the respective motor tasks.     

Two different strains of an alphaherpesvirus can establish latency in the same tissue of the host animal: evidence from bovine herpesvirus 1

Summary We inoculated plaque-purified bovine herpesvirus type 1 (BHV 1), strain K22, subtype BHV 1.2b, intravenously into susceptible cattle. Five months later, we reactivated latent virus with dexamethasone and then super-infected the same cattle intranasally and intravaginally with a different plaquepurified BHV1, strain Cooper, subtype BHV 1.1. After a second dexamethasone treatment four months later, reactivated viruses were isolated and examined with restriction endonucleases. We showed that both virus subtypes were reactivated, proving that 2 different strains of an alphaherpesvirus can establish latency in the same tissue in the host animal.     

Same information, different decisions: the influence of evidence on the management of hypertension in the elderly.

BACKGROUND: Evidence-based medicine requires general practitioners (GPs) to act upon the results of clinical trials. Clinical trial evidence may be difficult to understand and apply in practice. AIM: To investigate whether GPs were unduly influenced in managing hypertension in the elderly by the ways in which benefits of trial results were presented, and to establish whether their current treatment of an elderly hypertensive patient was broadly in line with recent clinical trial evidence. METHOD: Seventy-three GPs attending a refresher course were given a written questionnaire containing data from one clinical trial of treatment of hypertension in the elderly presented in four different ways (absolute risk reduction, relative risk reduction, difference in event-free patients, and number of patients who had to be treated in order to prevent one clinical event), as if from four different trials. The effect of each presentation on treatment preferences was assessed using Likert scales. The results were analysed to determine whether the method of presentation of results influenced decision making. A clinical scenario was presented to investigate their current treatment preferences in an elderly hypertensive. RESULTS: All GPs returned completed questionnaires. Relative risk reduction was the only presentation which was significantly different from the others, and was the most likely to influence prescribing. In free-text comments, 75% of GPs admitted having problems understanding statistics commonly found in medical journals. More than 90% conformed with recent clinical trial evidence for the management of hypertension. CONCLUSION: GPs were most influenced by relative risk reduction, and were unaware of how the presentation of research results could affect treatment decisions. Most GPs freely admitted to difficulty in comprehending medical statistics. Almost all of the GPs expressed treatment decisions which were broadly in line with clinical evidence.     

Comparison of effects of monoamines on transmission in spinal pathways from group I and II muscle afferents in the cat

Summary The actions of noradrenaline (NA) and 5-hydroxytryptamine (5-HT; serotonin) were compared with those of L-3,4-dihydroxyphenylalanine methyl ester (Methyl-L-DOPA) on transmission to spinal interneurones in mid-lumbar (L4 and L5) segments of the cat spinal cord. The drugs were applied ionophoretically and their effects were tested on monosynaptic field potentials evoked by nerve impulses in hindlimb group I and group II muscle afferent fibres and on responses of interneurones with synaptic input from these fibres. Of field potentials recorded at various locations, both NA and 5-HT depressed those evoked from group II fibres in the intermediate and ventral horn regions of the spinal cord but not, or only occasionally, in the dorsal horn. Field potentials of group I origin were not depressed. The tested interneurones were located where group II field potentials were affected. NA, 5-HT and Methyl-L-DOPA depressed responses to electrical stimulation of group II fibres but not responses evoked by group I fibres. The depression consisted of an increase in the latency and a decrease in the number of action potentials evoked by the stimuli. All three drugs were also found to decrease the amplitude of intracellularly recorded monosynaptic EPSPs of group II origin but not of monosynaptic EPSPs evoked in the same neurones by group I fibres. Interneuronal firing induced by DL-homocysteic acid was depressed as effectively as responses to electrical stimulation of peripheral nerves. The possibility of presynaptic and/or postsynaptic mechanisms of the selective depression of synaptic actions of group II origin are discussed.     

两类降脂中药对大鼠LDL经受体与非受体途径代谢影响的研究

本文用放射性同位素双标记示踪技术观察了血脂平,大槐合剂两类降脂中药对大鼠LDL经受体与非受体途径代谢的影响。结果表明,血脂平和大槐合剂分别使LDL经受体途径的FCR增加43%和35%,非受体途径的FCR也增加了34%和40%。这两类降脂中药促进LDL自血浆中清除的作用均比安妥明强。提示这两类降脂中药降血浆TC和LDL-C的作用在于促进LDL经受体与非受体途径降解。本文结果也提示,将免疫刺激剂与胆汁酸络合剂合并应用于降血脂,可为高胆固醇血症和动脉粥样硬化的防治提供一条新途径。     

Small RNAs, big impact: small RNA pathways in transposon control and their effect on the host stress response

Transposons are mobile genetic elements that are a major constituent of most genomes. Organisms regulate transposable element expression, transposition, and insertion site preference, mitigating the genome instability caused by uncontrolled transposition. A recent burst of research has demonstrated the critical role of small non-coding RNAs in regulating transposition in fungi, plants, and animals. While mechanistically distinct, these pathways work through a conserved paradigm. The presence of a transposon is communicated by the presence of its RNA or by its integration into specific genomic loci. These signals are then translated into small non-coding RNAs that guide epigenetic modifications and gene silencing back to the transposon. In addition to being regulated by the host, transposable elements are themselves capable of influencing host gene expression. Transposon expression is responsive to environmental signals, and many transposons are activated by various cellular stresses. TEs can confer local gene regulation by acting as enhancers and can also confer global gene regulation through their non-coding RNAs. Thus, transposable elements can act as stress-responsive regulators that control host gene expression in cis and trans.     

The effects of herpes simplex virus-2 on HIV-1 acquisition and transmission: a review of two overlapping epidemics

Increasing evidence demonstrates a substantial link between the epidemics of sexually transmitted HIV-1 and herpes simplex virus (HSV)-2 infection. More than 30 epidemiologic studies have demonstrated that prevalent HSV-2 is associated with a 2- to 4-fold increased risk of HIV-1 acquisition. Per-sexual contact transmission rates among couples from Rakai, Uganda indicate that at all levels of plasma HIV-1 RNA in the source partner, HSV-2-seropositive HIV-1-susceptible persons have a 5-fold greater risk of acquiring HIV-1 compared with HSV-2-negative persons. In vitro and in vivo studies suggest that mucosal HIV-1 shedding is more frequent and in greater amounts during mucocutaneous HSV-2 replication, including subclinical mucosal reactivations. Most HIV-1-infected persons are coinfected with HSV-2, and most experience frequent subclinical and clinical reactivations of HSV-2. Subclinical HSV reactivation elevates serum HIV-1 RNA levels, and daily therapy with acyclovir appears to reduce plasma HIV-1 RNA. These data show that greater attention to the diagnosis and treatment of HSV-2 among HIV-1-infected persons is warranted, especially those who continue to be sexually active, those not on antiretroviral therapy, or those whose disease is not well suppressed by antiretrovirals.     

A comparison of the effects of two antispastic drugs,tizanidine and baclofen,on synaptic transmission from muscle spindle afferents to spinal interneurones in cats

The α₂-adrenergic agonist tizanidine was reported to be more efficient than baclofen in reducing muscle tone in some spastic patients. The aim of this study was to investigate if this might be due to more specific depressive actions of tizanidine on transmission from muscle afferents which contribute to muscle tone. This was done by comparing the effects of tizanidine and baclofen on amplitudes of monosynaptic spinal focal field potentials produced by stimulation of muscle nerves in the cat. Such field potentials were recorded in the intermediate zone of the fourth lumbar segment, where they display two distinct components, an early one from group I afferents and a later one from group II afferents. Both reflect EPSPs produced in interneurones in disynaptic pathways to motoneurones. Tizanidine strongly depressed potentials caused by group II afferents, while it had no effect or slightly facilitated potentials produced by group I afferents. In contrast, baclofen had inconsistent effects on the group II potentials; in some cases it caused a depression and in others it caused only an increase in the latency and time to peak, at doses that strongly and consistently depressed the group I potentials. These effects have been found after both local and systemic applications. The antispastic actions of tizanidine may therefore only be related to the depression of transmission from group II muscle afferents, while antispastic actions of baclofen may be secondary to the depression of any sensory fibres. Since tizanidine is as effective in depressing spasticity as baclofen, it is suggested that the enhancement in synaptic transmission from group II muscle afferents may play an important role in the development of exaggerated stretch reflexes in spastic patients.     

Comparison of the effects of neurokinin-3 receptor blockade on two forms of slow synaptic transmission in myenteric AH neurons

AH neurons are intrinsic sensory neurons of the intestine that exhibit two types of slow synaptic event: slow excitatory postsynaptic potentials which increase their excitability for about 2-4 min, and sustained slow postsynaptic excitation which can persist for several hours, and may be involved in long-term changes in the sensitivity of the intestine to sensory stimuli. The effects of the neurokinin-3 tachykinin receptor antagonist, SR142801, on these two types of synaptic event in AH neurons of the myenteric ganglia of guinea-pig small intestine were compared. Slow excitatory postsynaptic potentials were evoked by stimulation of synaptic inputs at 10-20 Hz for 1s, and sustained slow postsynaptic excitation was evoked by stimulation of inputs at 1Hz for 4 min. SR142801 (1microM) reduced the amplitude of the slow excitatory postsynaptic potential to 26% of control, and also reduced the increase in input resistance and the extent of anode break excitation associated with the slow excitatory postsynaptic potential. In contrast, SR142801 did not reduce the increase in excitability, the increase in input resistance or the depolarisation that occur during the sustained slow postsynaptic excitation. SR142801 did not change the resting membrane potential or the resting input resistance.We conclude that tachykinins, acting through neurokinin-3 receptors, are involved in the generation of the slow excitatory postsynaptic potential, but not in the sustained slow postsynaptic excitation, and that the release of transmitters from synaptic inputs to AH neurons is frequency coded.