Adult asthma review in general practice: nurses' perception of their role

BACKGROUND: Asthma clinics have become widespread in general practice with nurses now playing an important role in asthma review. However, little is known about training of nurses carrying out reviews and how this affects the nurse role in patient management. OBJECTIVES: We aimed to discover the level of asthma training of practice nurses carrying out review of adult asthma patients in one Health Authority and to see if this has any effect on their perception of their role. METHOD: All 187 practice nurses in Grampian were sent a postal questionnaire investigating how asthma review is organized in general practice, their role in review and the asthma training they had received. Personal interviews were carried out with 17 nurses, exploring in more depth the topics covered in the questionnaire. RESULTS: A total of 167 nurses from 92% of the practices in Grampian responded, of whom 61% carried out asthma reviews. Among nurses carrying out reviews 71% did so on their own. 49% of nurses had or were training for advanced asthma qualification. Nurses without an asthma qualification were significantly more likely to feel that their training was not sufficient for their asthma related tasks (54% versus 11%, P = 0.0002). Nurses without advanced asthma qualifications were less likely to provide or review a self-management plan (29% versus 49%, P = 0.01), to review patient PEF recording (38% versus 65%, P < 0.01), to discuss patient worries (75% versus 94%, P < 0.05) or to make the initial diagnosis of asthma (24% versus 76%, P < 0.005). Nurses were unlikely to view their role as fully responsible unless they had an asthma qualification (13% versus 49%, P < 0.001). CONCLUSION: Nurses without advanced asthma qualifications do not feel fully confident in responsibility for patient management. Nurses without training are more likely to only carry out routine monitoring at reviews while nurses with asthma training are more likely to actively develop patient self- management skills. This suggests that nurses should be supported to obtain asthma qualifications if they are to give the best possible care to asthma patients.      

Esophageal strictures: balloon dilation

One hundred seventy transnasal balloon catheter dilation procedures were performed in 35 patients with esophageal strictures to assess the efficacy and safety of the procedure. On the average, five dilations were required per patient. Depending on the cause of the esophageal stricture, success rates for the technique ranged from 67% to 87%, with success defined as the resolution of dysphagia to both fluids and solids. Three complications, all perforations, were seen; one perforation required surgical repair. No procedure-related deaths were identified in this series. Balloon catheter dilation can be safely applied to esophageal strictures from a variety of causes, with a high degree of clinical success.     

Haplotype-specific differences in signaling by transfected class II molecules to a Ly-1+ B-cell clone

CH12.LX B cells are responsive to antigen-dependent differentiative signals transmitted through their surface Ek molecules. Although CH12.LX cells express surface Ak molecules with normal protein sequence, the Ak molecules do not deliver differentiative signal to these B cells. To determine whether introduction of a new A molecule into CH12.LX cells would correct this deficiency, CH12.LX cells were transfected with the genes encoding new Aalpha and/or Abeta molecules. It was found that transfected cells responded to antigen-specific signals delivered via the Ealphak Ebetak, Aalphab Abetab, or Aalphak Abetab molecule. However, the B cells did not respond to signals generated by the molecule Aalpha kAbetak, Aalphab Abetak, Aalphak Abetad, or Aalpha kAbetau. Comparison of these sequences suggests that two Abeta residues, His-47 and Trp-197, are important to the transmission of differentiative signals to B cells.     

Cerebral sparganosis: CT characteristics

Cerebral sparganosis is an extremely rare parasitic zoonosis caused by a migrating plerocercoid tapeworm larva, genus Spirometra. Nineteen computed tomography (CT) scans of 12 patients with cerebral sparganosis were retrospectively analyzed and correlated with clinical and pathologic data. On CT scans, the following characteristics were noted: (a) unilateral involvement; (b) extensive or multifocal areas of low density along white matter bundles, with ipsilateral ventricular dilatation and localized cortical atrophy; (c) nodular or irregular enhancement with spotty calcification; and (d) change in location of enhancing nodules on sequential scans. These pathognomonic features reflect a chronic inflammatory process with both active granulomatous lesions and widespread degeneration of brain tissue, especially in the white matter. Degeneration is probably caused by migration of the long-surviving larva along the fiber tracts of white matter.     

维生素B2和B6的同步荧光分析法及其在维生素复合制剂中的应用

本文建立了维生素B₂和B₆的同步荧光分析法。以△λ=58nm进行同步扫描所得的两个同步荧光峰(以发射波长表示,分别位于526nm和389nm)可用以同时分别定量维生素B₂和B₆。方法快速、灵敏。维生素B₂和B₆的工作曲线线性范围分别为0～1μg/ml和0～1.5μg/ml,检出限分别为0.5ng/ml和1ng/ml。方法已应用于三种复合维生素B制剂中维生素B₂和B₆的分析。     

A comparison of a Patient Enablement Instrument (PEI) against two established satisfaction scales as an outcome measure of primary care consultations

OBJECTIVES: We aimed to compare a new primary care outcome measure-the Patient Enablement Instrument (PEI)-against two established satisfaction measures [the Medical Interview Satisfaction Scale (MISS) and the Consultation Satisfaction Questionnaire (CSQ)]. Specifically, we sought (i) to test whether enablement and satisfaction are related or separate concepts; and (ii) to assess whether the internal consistency of the PEI might be enhanced by the inclusion of items from the satisfaction instruments. METHODS: Questionnaire forms containing the three instruments in a variety of combinations were distributed to a total of 818 patients attending for routine surgery consultations in three urban general practices of varying socio-economic mix. The main outcome measures were: scores on the PEI; scores on the CSQ, the MISS and their individual components; rank correlations between scores on the PEI and scores on the CSQ, the MISS and their component subscales; and Cronbach's alpha coefficient for the PEI. RESULTS: Overall mean scores, expressed as percentages of maximum scores attainable, were 44.1% for the PEI, 76.9% for the CSQ and 77.6% for the MISS. Rank correlations between PEI scores and scores for the complete CSQ and MISS instruments were 0.48 (P < 0.01) and 0.47 (P < 0.01), respectively. Correlations of PEI scores with individual component scores on the CSQ were generally lower and ranged from 0.14 to 0.53; correlations of PEI scored with MISS component scores were also generally lower and ranged from 0.21 to 0.53. Internal consistency of the PEI items (assessed by Cronbach's alpha coefficient) was lowered when items from the CSQ or MISS were added. CONCLUSIONS: The study shows that 'enablement' is a primary care outcome measure which is related to but is different from general satisfaction.      

国产檀香中α-反式香柠烯醇化学结构研究

从国产檀香木Santalum ablum L.分得一个新倍半萜醇,根据光谱(IR,MS,¹H-¹H COSY,¹³C-¹H COSY和¹H-¹H NOESY)解析,确定了它的化学结构和相对立体化学为9(10)-顺,α-反式香柠烯醇[9(10)Z,α-trans-bergamotenol](Ia)。