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.      

Influence of the amount of platelet-bound IgG on platelet survival and site of sequestration in autoimmune thrombocytopenia

Seventeen patients with idiopathic autoimmune thrombocytopenic purpura were studied in order to establish whether the amount of platelet-bound antibody influenced the rate and site at which these platelets were destroyed. Platelet-bound antibody was measured by a quantitative antiglobulin consumption technique, and platelet survival and sites of sequestration were determined by the use of 51Cr-labeled platelets and surface radioactivity measurements. A correlation significant at the 5% level was observed between the amount of platelet-bound antibody and the rate of platelet destruction. A highly significant correlation (p less than 0.001) existed between antiplatelet antibody and spleen: liver surface radioactivity ratios, demonstrating that greater amounts of antibody bound to platelets result increasingly in their destruction within the liver.     

Analysis of tissue-specific lacZ mutations induced by N- nitrosodibenzylamine in transgenic mice

N-Nitrosodibenzylamine (NDBzA) is a contaminant found frequently in rubber baby bottle nipples and pacifiers. To evaluate more fully the mutagenic potential and analyse the molecular nature of possible mutations induced in vivo, we have studied the mutagenicity of NDBzA in vivo using the MutaMouse system. NDBzA, suspended in olive oil, was administered orally once to male mice at different doses (0, 30, 100, 425 and 750 mg/kg) and the mice were killed 30 and 90 days after treatment. As a positive control, and to compare relative mutagenicity, N-nitrosodimethylamine (NDMA) was also administered to animals in the same experiment at doses of 0, 2, 6 and 10 mg/kg. Mutant frequencies were increased in both 30 and 90 day liver samples, but not in bone marrow, after both NDBzA and NDMA treatment. However, NDBzA was >100 times less mutagenic than NDMA. A total of 81 mutants obtained from liver samples of treated animals (750 mg/kg) were characterized by DNA sequencing. While spontaneous mutations in transgenic mice have been characterized previously by a preponderance of G:C-->A:T transitions, mainly at 5'-CpG-3' dinucleotide sites, the predominant type of NDBzA- induced mutation in this study was transversion, mainly G:C-->T:A changes. The molecular characteristics of mutations induced by NDBzA indicate that they may arise from specific unidentified DNA adducts and benzylation appears to be the primary mechanism involved in formation of these DNA adducts.      

Morphological and molecular characteristics of living human fetuses between Carnegie stages 7 and 23: ultrasound scanning and direct measurements

The developmental age of an embryo in the first trimester ofpregnancy is generally determined by ultrasound scanning and/orby calculation from menstrual age. In the original studies,validation of the estimate of gestational age by ultrasoundwas not possible as the exact date of conception was unknown.Variation in growth rates of identically aged fetuses has previouslybeen reported after assisted conception and with the use ofultrasound scanning. As these pregnancies were ongoing the accuracyof the scanning results could not be determined. Comparisonof scanning and direct measurements after termination of pregnancyand menstrual age were carried out to determine the accuracyin fetal dating. The results suggest that the use of ultrasoundscanning to determine gestational age is of less use than previouslythought, and that the use of menstrual age is severely limited.     

催醒安在大鼠尿内代谢产物的研究

催醒安是一种新的中枢性抗胆碱酯酶药。给大鼠灌胃后,用HPLC分离纯化尿提取液中的代谢产物,得到四个组分。经MS鉴定分别为原形药物,N-羟甲基,N-甲基氨基甲酸-[间-(2-二甲氨基)]乙氧基苯酯(简称羟基化催醒安),N-甲基氨基甲酸-[间-(2-二甲氨基)乙氧基]苯酯(去甲基催醒安)及间-(2-二甲氨基)乙氧基苯酚(催醒安水解物)。原药及产物对电鳐乙酰胆碱酯酶抑制率的实验表明,去甲基催醒安抑酶活性与原药相近,羟基化催醒安活性比原药低,水解物无抑酶活性。