COmmentary: assessment of renal artery stenosis severity by pressure gradient measurements. De Bruyne B, Manoharan G, Pijls NH, et al. J Am Coll Cardiol. 2006;48:1851-1855

available at http://content.onlinejacc.org/cgi/ content/abstract/48/9/1851.     

Professor J.H. Wolstencroft

The study investigates beliefs about control and links it to the depression found in those with chronic pain. These beliefs are interpreted within the new model of learned helplessness which distinguishes personal helplessness from universal helplessness on the basis of attributions. Despite higher levels of depressive symptoms in the pain group, this was not reflected by higher levels of self-blame or beliefs in the actions of others, so personal helplessness was discounted. Higher beliefs in chance, lack of self-blame and correlations between chance, depression and pain support the presence of universal helplessness in this group. The reporting behaviour of pain patients is discussed in the light of these findings.     

Influenza A Subtyping: Seasonal H1N1, H3N2, and the Appearance of Novel H1N1

Influenza virus subtyping has emerged as a critical tool in the diagnosis of influenza. Antiviral resistance is present in the majority of seasonal H1N1 influenza A infections, with association of viral strain type and antiviral resistance. Influenza A virus subtypes can be reliably distinguished by examining conserved sequences in the matrix protein gene. We describe our experience with an assay for influenza A subtyping based on matrix gene sequences. Viral RNA was prepared from nasopharyngeal swab samples, and real-time RT-PCR detection of influenza A and B was performed using a laboratory developed analyte-specific reagent-based assay that targets a conserved region of the influenza A matrix protein gene. FluA-positive samples were analyzed using a second RT-PCR assay targeting the matrix protein gene to distinguish seasonal influenza subtypes based on differential melting of fluorescence resonance energy transfer probes. The novel H1N1 influenza strain responsible for the 2009 pandemic showed a melting profile distinct from that of seasonal H1N1 or H3N2 and compatible with the predicted melting temperature based on the published novel H1N1 matrix gene sequence. Validation by comparison with the Centers for Disease Control and Prevention real-time RT-PCR for swine influenza A (novel H1N1) test showed this assay to be both rapid and reliable (>99% sensitive and specific) in the identification of the novel H1N1 influenza A virus strain.The 2009 novel influenza A/H1N1 viral pandemic has presented challenges for hospital laboratories and health care systems seeking to rapidly diagnose, treat, and limit the spread of this virus. As is the case for routine diagnosis of seasonal influenza infections, molecular amplification assays offer the potential for the sensitivity and speed needed to manage an influenza outbreak. However, standardized RT-PCR assays specific for this strain of influenza were not initially available, leaving many laboratories to diagnose this infection through indirect means.Our laboratory has used PCR for rapid detection of influenza A and B for several years, and more recently had implemented a rapid RT-PCR/melt-curve assay designed to differentiate seasonal influenza A subtypes H1N1 and H3N2.¹ This approach was initially developed for viral subtyping to guide clinicians on the appropriate antiviral therapy. Antiviral resistance has risen during recent years, with the majority of seasonal H1N1 strains no longer being sensitive to oseltamivir (Tamiflu), and seasonal H3N2 strains being largely resistant to adamantanes.² Rapid determination of influenza A subtype is essential for determining optimal therapy and for prudent use of antiviral agents. Consequently, this RT-PCR assay has become part of our influenza testing algorithm.The design of the RT-PCR assay exploits minor variations in a relatively conserved sequence within the matrix protein gene. Not surprisingly, the novel H1N1 strain of influenza that appeared in the spring of 2009 had a distinct melting temperature consistent with the published matrix gene sequence and the sequence of the fluorescence resonance energy transfer probes used in this assay designed to differentiate seasonal influenza A subtypes H1N1 and H3N2. As part of our influenza testing algorithm, this assay allowed definitive diagnosis of the 2009 influenza H1N1 from nasopharyngeal swabs within hours after arrival in the clinical laboratory.     

Socialization of R.N. to B.S.N.

The Nurse's Professional Orientation Scale and Schwirian's Six-Dimension Scale of Nursing Performance (Six-D Scale) were used in a five-year, longitudinal study of the professional socialization of the Registered Nurse/Bachelor of Nursing Science (RN/BSN) (n = 30) and generic baccalaureate students (n = 193) in a nursing program in the Southeast United States, Program exit socialization scores between RN/BSN and generic graduates were not significantly different. Using an ANCOVA, significantly higher socialization scores were found for the generic graduates. The scores for the RN/BSN graduates were significantly higher than the generic students at graduation on the teaching/collaboration, planning/evaluation and interpersonal communication subscales of the Six-D scale. When program entry Six-D subscales score were controlled, only the professional development subscale differentiated between RN/BSN and generic graduates. The program impact on the RN/BSN student/graduate as well as the means by which this process can be studied are questioned.