Investigating and implementing change within the primary health care nursing team

Primary care is developing rapidly with significant impacts on the nursing team. Such changes have brought inter-professional team-working into sharper focus, particularly community care and collaborative working. This paper: examines the nursing roles within a general practice; describes the perspectives of service users; identifies areas of change; clarifies core and specialist skills; defines new roles among the primary health care nursing team; proposes a new model of working; and identifies appropriate education. The project was set in a general practice in south-west England and used an action research methodology. The objectives were to create a change in practice and to develop and refine existing theory to underpin nursing roles. Throughout the research regular team meetings allowed reflection and discussion about research findings and progress. Data were collected from multiple sources, including team workshops, patient focus group interviews, and individual interviews with GPs, practice managers and area managers. Reflective diaries and a patient survey were also used. The analysis of the quantitative and qualitative data collected from patients formed a basis for practice development and facilitated the team's reflection on the areas of change. Overall high satisfaction with services and care was expressed in the patient interviews and the questionnaire. The themes from the data highlighted areas important for patients and helped in shaping the new roles and responsibilities for team members. Regarding the team perspective, the data indicated many areas that could be considered for development. The community nursing team decided to concentrate on three key areas: child health, leg ulcer management, and cardiovascular health. The research concludes that action research presents some problems and challenges but is a useful approach to developing team-working in primary health care.     

Molecular characterization of Mycobacterium tuberculosis isolates from Kandy,Sri Lanka

ObjectiveTo determine tuberculosis epidemiology in Kandy, Sri Lanka.MethodsIS6110 RFLP and spoligotyping analyses were performed on 100 Mycobacterium tuberculosis (M. tuberculosis) clinical isolates from Kandy district, Sri Lanka. RFLP hybridization patterns (n=73) were analysed by the software GeneDirectory. Spoligotypes (n=110) were compared with the international database SPOTCLUST.ResultsThe majority of the circulating M. tuberculosis strains in Kandy belong to a single family, but the degree of IS6110 DNA polymorphism was high. 71 (80%) of the strains displayed distinct RFLP patterns and 63 (71%) were clustered into one main family. Within the family three isolates were grouped into one cluster while the rest isolates were grouped into one. The copy number varied from 1 to 17 while single copy strains were predominant (12) and 15 lacked the IS6110 element. Spoligotyping revealed a total of 24 families including the 9 major families. Strains were distributed among all the three principle genetic groups PGG1, PGG2, and PGG3. Except for two strains, the rest were not defined in the latest spoligotype database SpolDB4/SITVIT.ConclusionsThe first study of RFLP and spoligotyping of M. tuberculosis strains in Sri Lanka demonstrates the applicability of the genetic marker IS6110 to differentiate strains and the heterogeneity and predominance of several worldwide-distributed spoligotypes.     

静脉注射途径移植骨髓基质细胞的特点

目的:探讨在大鼠脑缺血的情况下经尾静脉注射移植骨髓基质细胞的可行性,为骨髓基质细胞脑移植治疗提供一种简捷、安全、有效的途径。方法:实验于2005-10/2006-08在北华大学医学院实验中心完成。取1～2个月龄SD大鼠双侧股骨和胫骨,体外分离培养大鼠骨髓基质细胞。取体质量为280～320g的SD大鼠25只,采用颈内动脉线栓法制作大脑中动脉梗死模型,造模成功后在25只大鼠中随机盲抓分为2组:骨髓基质细胞移植组(n=15)、对照组(n=10)。骨髓基质细胞移植组经静脉缓慢推入含Hoeschst33342标记的骨髓基质细胞细胞悬液1mL(2.0×107个细胞),对照组用同样方法经尾静脉注入等量不含骨髓基质细胞的DMEM培养液作为对照。分别于移植后1d、7d、14d时间点对两组大鼠进行神经功能损害严重程度评分及大脑组织切片观察比较。结果:25只大鼠均进入结果分析。①各代细胞90%以上表达巢蛋白阳性。②与对照组相比,骨髓基质细胞移植组大鼠运动、神经功能恢复明显[骨髓基质细胞移植组:(6.10±2.96),(3.30±1.83),(2.10±1.20)分;对照组:(7.43±1.51),(6.14±1.35),(4.43±1.40)分,P<0.05]。③骨髓基质细胞移植组大鼠脑组织结构较清晰、完整;对照组大鼠脑组织破坏溶解,组织结构松散,细胞结构不完整,胞浆疏松,染色变浅,间质水肿。结论:通过静脉注射进行骨髓基质细胞移植,方法简便、安全,对神经损伤动物组织重建及神经功能有确切的修复效果。     

Lack of significant association of an insertion/deletion polymorphism in the angiotensin converting enzyme (ACE) gene with tropical calcific pancreatitis

Background  

The genetic basis of tropical calcific pancreatitis (TCP) is different and is explained by mutations in the pancreatic secretory trypsin inhibitor (SPINK1) gene. However, mutated SPINK1 does not account for the disease in all the patients, neither does it explain the phenotypic heterogeneity between TCP and fibro-calculous pancreatic diabetes (FCPD). Recent studies suggest a crucial role for pancreatic renin-angiotensin system during chronic hypoxia in acute pancreatitis and for angiotensin converting enzyme (ACE) inhibitors in reducing pancreatic fibrosis in experimental models. We investigated the association of ACE gene insertion/deletion (I/D) polymorphism in TCP patients using a case-control approach. Since SPINK1 mutations are proposed a modifier role, we also investigated its interaction with the ACE gene variant.     

Information needs and sources of information for women with breast cancer: a follow-up study

This paper reports a study which examined the specific information needs and sources of information for 105 women with breast cancer at two time points, the time of diagnosis and a mean of 21 months from diagnosis At diagnosis the priority information needs concerned survival issues Further from diagnosis survival issues were still a concern, but information about the risk to family members of getting breast cancer showed a significant increase in importance Information about sexual attractiveness was ranked last at both the newly diagnosed and follow-up stages Information sources at the time of diagnosis centred around the specialist breast care service, while further from diagnosis few professional or voluntary sector sources were utilized, with women receiving most of their information from media sources such as women's magazines The relevance of these findings for nurses and other health care professionals is discussed