Nurses'' Tobacco-Related Knowledge, Attitudes, and Practice in Four Major Cities in China

PURPOSE: To (a) identify Chinese nurses' tobacco-related knowledge, attitude, and practice (KAP), including perception of competency in smoking-cessation interventions; (b) identify barriers and facilitators to smoking cessation interventions to patients; and (c) assess the learning needs and smoking status of nurses. Design: A cross-sectional survey was conducted in four major cities (Beijing, Shanghai, Guangzhou, and Chongqing) in China from November to December 2003. METHODS: 2,888 registered nurses working in hospitals affiliated with five university schools of nursing in these cities were invited to complete a questionnaire. An instrument used to assess tobacco-related KAP in Hong Kong was translated into Chinese and pilot tested to ensure reliability and validity. FINDINGS: 2,179 questionnaires were returned and after exclusion of the grossly incomplete questionnaires, 1,690 were included in the present analysis. Only 2% of participants were current and 1% were former smokers; most had not received training for smoking-cessation interventions as part of their nursing education program. Two-thirds recognized smoking as a leading cause of preventable death and that smoking cessation was the most cost effective intervention, but only a third routinely assisted patients' quit attempts. Nurses who received training reported greater competence in providing smoking-cessation intervention, and more frequent practice of cessation interventions. CONCLUSIONS: Chinese nurses had some knowledge about the health effects of tobacco use, but seldom practiced smoking-cessation interventions. Those who had prior training had greater competence and more practice. Including tobacco control, especially smoking cessation, in nursing curricula in China has the potential to save millions of lives.     

Rapid Systematic Review: Intra-Arterial Thrombectomy (“Clot Retrieval”) for Selected Patients with Acute Ischemic Stroke

Background

Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality. However, precisely defining the optimal treatment for individual patients early after AIS onset remains elusive. There has recently been a surge in published studies documenting the effectiveness of mechanical intra-arterial thrombectomy for treatment of a subset of patients with AIS. This therapy has been proposed and studied for the small (<1.2%) subgroup of patients with ischemic strokes who have “large vessel” strokes or strokes that fail to improve after the administration of tissue plasminogen activator (t-PA). The current rapid systematic review provides practicing emergency physicians updated information regarding mechanical thrombectomy as a treatment option for carefully selected AIS patients.

The importance of the case management approach: perceptions of multidisciplinary team members

This article attempts to determine the importance of the case management approach as perceived by health professionals working in multidisciplinary teams. The case management approach is reported to streamline care and contain cost. The literature calls for continuing education in a multidisciplinary forum for all health professions; however, data on perceived or actual educational needs is scant. One hundred forty-one health practitioners working in clinical teams rated four case management components on 100 mm scales: assessing patient needs; educating caregivers; community agency liaison; and, cost monitoring. Statistical significance of differences was determined by Mann Whitney U and Wilcoxon rank sum testing. All scores were high, and of all variables tested, varied only by profession (p < .01). Administrators and nurses had relatively higher scores than physicians and physiotherapists. Patient needs were valued above education, education above liaison, and liaison above cost monitoring (p < .01, < .01, < .01, respectively). Continuing education providers should note that health professionals value case management and may be receptive to education. Further study is required to design educational modules for multidisciplinary use, test impact on knowledge and skills, and determine if transdisciplinary case management education can improve quality of care while containing costs.     

Carrier-directed anti-hapten responses by b-cell subsets

The capacity of the trinitrophenyl (TNP) haptenic group, coupled to a series of chemically dissimilar carriers, to cross-stimulate putative T- dependent and T-independent murine B-cell subpepulations was determined by using an in vitro limiting dilution technique to generate primary IgM responses. It was found that TNP-Ficoll and TNP-dextran, two T- independent antigens with little or no polyclonal mitogenicity, stimulate the same population of anti-TNP precursors, which is distinct from the precursor population activated by TNP-bacterial lipopolysaccharide (LPS), a T-independent polyclonal mitogen, or TNP-horse erythrocytes (HRBC), a T-dependent antigen. On the other hand, TNP-LPS and TNP-HRBC activate the same precursor population, indicating that LPS can substitute for the T- cell signal in T-dependent B-cell responses, whereas nonmitogenic T- independent antigens cannot. However, the cumulative evidence from this and other laboratories strongly indicates that LPS and T-dependent antigens activate B cells by different mechanisms. Of particular interest, LPS is incapable of activating B cells responsive to weakly- or nonmitogenic T-independent antigens. Based on clonal burst size, T-dependent antigens are capable of inducing greater antigen-specific B-cell proliferation than T-independent antigens. However, TNP conjugates of Ficoll and dextran, which are relatively poor inducers of polyclonal B-cell activation, induced larger anti-TNP clones than did TNP-LPS, a strong polyclonal mitogen. The findings reinforce the evidence favoring existence of multiple B- cell subpopulations with distinctive activation pathways. They also strengthen the proposition that a given B-cell subset can be activated by more than one mechanism.     

血管内皮细胞生长因子受体KDR基因靶向RNA干扰质粒的构建

目的:应用RNA干扰技术设计构建针对血管内皮细胞生长因子受体KDR的小干扰RNA,并观察脂质体转染肺癌细胞A549后的干扰效果。方法:实验于2005-03/2006-01在沈阳医学院生物化学及分子生物学教研室完成。①设计针对KDR编码区有短发夹结构的3条mRNA序列,经退火成互补双链,克隆到pGCsi.H1/neo/GFP载体中构建3个重组质粒,分别命名为KDR-siRNA1、KDR-siRNA2和KDR-siRNA3。②设立5组:小干扰RNA组,分别转染KDR-siRNA1、KDR-siRNA2和KDR-siRNA3;阳性对照组,转染pGCsi.H1/neo/siGFP,该质粒载体中的插入序列为针对绿色荧光蛋白的小干扰RNA,不干扰待研究的内源性基因;阴性对照组,转染pGCsi.H1/neo/GFP/NON,该载体为不干扰任何内源性基因的小干扰RNA;空白对照组,转染pGCsi.H1/neo/GFP空载体;正常对照组,不进行任何转染。③对重组质粒进行酶切鉴定、DNA测序分析;脂质体法转染质粒至肺癌A549细胞株后,实时定量PCR检测KDRmRNA的水平变化;细胞计数法绘制细胞生长曲线。结果:①小干扰RNA表达载体的鉴定:KDR-siRNA1、KDR-siRNA2和KDR-siRNA3表达载体用限制性内切酶NdeⅠ和SmaⅠ进行单酶切后,均产生约713bp、5480bp和2403bp、3790bp两个片段,与预期结果相同。测序结果与设计的编码相应短发夹状KDR-小干扰RNA的寡核苷酸序列一致,证明KDR-小干扰RNA真核表达载体构建成功。②KDR-小干扰RNA对A549细胞中KDRmRNA水平的影响:与阳性对照组、阴性对照组、空白对照组和正常对照组的A549细胞相比,KDR-siRNA1,2,3表达载体转染后的A549细胞KDR基因表达水平均明显受到抑制,抑制率分别为64%、81%和72%,其中以KDR-siRNA2抑制作用最为明显。③KDR-小干扰RNA对A549细胞生长的影响:阳性对照组、阴性对照组、空白对照组、正常对照组的A549细胞生长趋势较为一致,且生长速度均明显高于转染3种KDR-小干扰RNA表达载体的A549细胞,从接种第2天开始差异有显著性意义(t=15.29～17.65,P均<0.01)。结论:血管内皮细胞生长因子受体KDR靶向RNA干扰重组质粒构建成功,该载体能有效抑制肺癌A549细胞KDR基因表达与细胞增殖。