Thinking processes used by nurses in clinical decision making

Clinical decision making forms the basis of expert clinical practice. The purpose of this study was to investigate and document the thinking processes used by nurses in clinical decision making situations so the processes could guide educational practice. Clinical data was analyzed to reveal that clinical decision making is complex and requires a variety of thinking processes. Medical and surgical nurses used different thinking processes, showing the importance of context in clinical decision making. The nursing exemplars and working vocabulary developed in this study to describe the thinking processes used in clinical decision making can be used in nursing education.     

Barriers and facilitators in nursing home intervention research

Conducting intervention research in nursing home (NH) settings is particularly challenging because of the advanced age and frailty of the participants and the characteristics of the setting itself. The purpose of this project was to better understand the barriers and facilitators to the research process in NHs. Three primary data sources were used: investigator field notes, guided interviews with the research team and NH staff members, and research assistant (RA) e-mail communications. Data were analyzed using qualitative content and matrix analytic techniques. Barriers to the research process were largely congruent with previously identified NH staff characteristics, such as lack of communication between NH staff and the research team ineffective nursing leadership, decreased staff-to-resident ratios, and high turnover of NH staff. Research facilitators emerged in two overlapping areas, intraresearch team issues such as the flexibility and compatibility of the RAs, effective NH staff-to-research team communication, and the presence of an effective nurse leader in the NH.     

Psoriasis

Psoriasis affects patients to varying degrees, and may seriously impair their quality of life. Treatments minimise symptoms but cannot cure the condition.     

Evaluation of in vitro and in vivo activity of benzindazole-4,9-quinones against Cryptosporidium parvum

A series of benzindazole-4,9-quinones was tested for growth-inhibitory effects on Cryptosporidium parvum in vitro and in vivo. Most compounds showed considerable activity at concentrations from 25 to 100 micro M. For instance, at 25 micro M the derivatives 5-hydroxy-8-chloro-N1-methylbenz[f]-indazole-4,9-quinone and 5-chloro-N2-methylbenz[f]indazole-4,9-quinone inhibited growth of C. parvum 78-100%, and at 50 micro M seven of the 23 derivatives inhibited growth > or = 90%. The activity of the former two compounds was confirmed in a T-cell receptor alpha (TCR-alpha)-deficient mouse model of chronic cryptosporidiosis. In these mice, the mean infectivity scores (IS) in the caecum were 0.63-0.20, whereas in sham-treated mice the score was 1.44 (P < 0.05). There were similar differences in IS in the ileum, where the score for treated mice was 1.12-0.20 and that for mice receiving no drug was 1.32. There was no acute or chronic toxicity for any compound tested in vivo.     

Simultaneous acceleration of the cell cycle and suppression of apoptosis by splice variant delta-6 of the candidate tumour suppressor LUCA-15/RBM5

BACKGROUND: The short arm of chromosome 3 is thought to include one or more tumour suppressor genes (TSGs), since carcinoma of various tissues display deletions in this region. Many genes mapping to this region have recently been identified, including the LUCA-15/RBM5 gene. RESULTS: In this study we report the cloning from human bone marrow library of a splice variant of LUCA-15 which lacks exon 6, resulting in a frameshift and producing a truncated protein of 150 amino acids instead of 815 amino acids. This variant is widely expressed at a low level in normal tissues and is expressed at increased levels in T-leukaemic cell lines. Over-expression of this splice variant after electroporation both shortened the cell cycle and inhibited CD95-mediated apoptosis in CEM-C7 T-cells. In marked contrast, over-expression of the full length LUCA-15/RBM5 suppressed cell proliferation both by inducing apoptosis and by extending the G1 phase of the cell cycle. CONCLUSION: These results, taken together with previous observations from ourselves and others, suggest that LUCA-15 is involved in the control of both apoptosis and the cell cycle. Since oncogenesis often relies on separate changes in molecules regulating apoptosis on the one hand, and proliferation, on the other, the discovery of a candidate tumour suppressor gene which affects both processes simultaneously is likely to be of major significance.     

Routine questioning about non-consenting sex: a survey of practice in Australasian sexual health clinics

The objectives of the study were, 1. To ascertain if sexual health physicians and practitioners believe a question concerning a past history of non-consensual sex should be asked routinely and are asking it. 2. To identify whether sexual health services have established protocols to integrate this question into practice. 3. To identify the barriers to this becoming part of a routine sexual health history. A questionnaire covering demographics, protocols and practice around asking the question and reasons for not asking was sent to all (20) sexual health clinics in New Zealand and 7 sexual health clinics in Australia, inviting participation from all staff who took routine sexual health histories. Twenty-seven sexual health clinics participated with a total of 122 (69% response rate) questionnaires completed and returned. One hundred and thirteen (93%) participants believed it was a relevant question to ask. Seventy-eight (63%) said asking the question was encouraged, and routinely or mostly asked the question. Only 40 (33%) identified their workplace had a written policy and 52 (43%) had not received specific training in asking the question. The majority who asked routinely said their client never or rarely objected and that it did not often add significantly to the time. The main reasons for not asking were the belief it was nothing to do with the person's presenting complaint, concern the client would find it too disturbing, inadequate training, and lack of time. Sexual health clinics should develop protocols and guidelines and provide appropriate training to ensure that routine questioning about non-consenting sex is integrated into safe practice.     

Mlh1 can function in antibody class switch recombination independently of Msh2

Mismatch repair proteins participate in antibody class switch recombination, although their roles are unknown. Previous nucleotide sequence analyses of switch recombination junctions indicated that the roles of Msh2 and the MutL homologues, Mlh1 and Pms2, differ. We now asked if Msh2 and Mlh1 function in the same pathway during switch recombination. Splenic B cells from mice deficient in both these proteins were induced to undergo switching in culture. The frequency of switching is reduced, similarly to that of B cells singly deficient in Msh2 or Mlh1. However, the nucleotide sequences of the Smu-Sgamma3 junctions resemble junctions from Mlh1- but not from Msh2-deficient cells, suggesting Mlh1 functions either independently of or before Msh2. The substitution mutations within S regions that are known to accompany switch recombination are increased in Msh2- and Mlh1 single-deficient cells and further increased in the double-deficient cells, again suggesting these proteins function independently in class switch recombination. The finding that MMR functions to reduce mutations in switch regions is unexpected since MMR proteins have been shown to contribute to somatic hypermutation of antibody variable region genes.     

FcepsilonRI signaling observed from the inside of the mast cell membrane

Crosslinking the high affinity IgE receptor, FcrepsilonRI, on basophils and mast cells initiates cascades of biochemical events leading to degranulation, membrane ruffling and other physiological responses. Downstream of FcepsilonRI and its coupled tyrosine kinases, Lyn and Syk, scores of different proteins and lipids are implicated in these signaling cascades and new players are being identified continuously. Here, we use immunogold probes to label receptors and signaling proteins on the cytoplasmic face of membrane sheets prepared from RBL-2H3 mast cells and transmission electron microscopy to examine their distributions in relationship to each other and to features of the membrane. New topographical data are integrated with existing knowledge of the biochemistry of FcepsilonRI signaling and of cell shape during signaling to implicate at least two distinct membrane domains in FcepsilonRI signaling. "Primary signaling domains", also called osmiophilic patches, are recognized by their dark staining with osmium, adjacency to coated pits (previously mapped to planar membrane between lamellae) and by the characteristic presence of receptor, Syk and PLCgamma2, but not Lyn. "Secondary signaling domains" are characterized by the presence of large elliptical linker for activation of T cells (LAT) rafts and of PLCgamma1 (previously mapped to lamellae) but not receptor. The signaling proteins, Vav, Grb2, Cbl and Gab2, and the endocytic proteins, AP2 and clathrin, all map to the primary domains, while the p85 regulatory subunit of phosphatidylinositol 3 (PI 3)-kinase maps to both domains. Recognition that FcepsilonRI signaling is controlled not only by which chemical species are available for interaction, but also by where the interactions occur, may provide new opportunities for the modeling of signaling cascades and new targets for the development of drugs to treat allergies and asthma.