The Inside Story: A Simulation Game on Ethical, Legal, and Political Decision Making in Health Policy for Nurse Practitioners

This game can be conducted with as many as 50 and as few as 15 players. The optimum size includes 4-5 Board members and 4-6 participants in each of the four small-group scenarios. The game takes about 11/2-2 hours to play. This includes a break between Part I and Part II. Existing state and national laws and policies are used in the game so that participants may understand their effects and limitations. The game has no winners or losers. Everyone gains if the decision markers are able to consider the needs of the individuals and the needs of the public, though some individuals may or may not benefit as much as others. This, however, is reality and is inherent in the policy-making process. In primary care, nurse practitioners (NPs) have a crucial responsibility to weigh the impact of their decisions on their clients and the community. The "Inside Story" integrates recommended NP curriculum content such as ethical decision making and health policy into a creative and powerful educational experience. This simulation game could be adapted for other topics with ethical, legal, and political implications such as issues regarding allocation of scarce resources. It could be played among students or professionals from many disciplines as part of their curriculum or in a continuing education offering.     

Prospective evaluation of posttransfusion hepatitis

The incidence of posttransfusion hepatitis (PTH) was determined prospectively at our institution. An active surveillance program of transfused surgical patients was set up; alanine aminotransferase (ALT) levels were determined before transfusion and at monthly intervals for 6 months after transfusion. Patients with confirmed ALT values greater than 2.5 times the upper reference values were referred to the out-patient clinics for diagnosis. Of 4051 surgical patients who underwent transfusion between January 1986 and December 1989, 2459 (60.7%) were enrolled in the surveillance program, and 1018 (25.1%) completed the follow-up; 238 patients received autologous blood only and were used as controls. No PTH was observed in the control patients, and the incidence of the disease in patients receiving homologous blood was 10.97 percent in 1986, 6.58 percent in 1987, 5.55 percent in 1988, and 4.29 percent in 1989; the decreasing trend is significant (p = 0.018).     

Drug-induced cholestasis

Recent progress in understanding the molecular mechanisms of bile formation and cholestasis have led to new insights into the pathogenesis of drug-induced cholestasis. This review summarizes their variable clinical presentations, examines the role of transport proteins in hepatic drug clearance and toxicity, and addresses the increasing importance of genetic determinants, as well as practical aspects of diagnosis and management.     

Perceived knowledge,skills, attitude and contextual factors affecting evidence‐based practice among nurse educators,clinical coaches and nurse specialists

Evidence‐based practice (EBP) in the clinical setting is recognized as an approach that leads to improved patient outcomes. Nurse educators (NEs), clinical coaches (CCs) and nurse specialists are in key positions to promote and facilitate EBP within clinical settings and have opportunities to advance practice. Therefore, it is important to understand their perceptions of factors promoting EBP and perceived barriers in facilitating EBP in clinical settings, before developing educational programmes. This paper reports findings from a study that aimed to explore NEs' , CCs' and nurse specialists' knowledge, skills and attitudes associated with EBP. This study used a questionnaire containing quantitative and a small number of qualitative questions to capture data collected from NEs, CCs and nurse specialists working at a tertiary health‐care facility in Victoria, Australia. The questionnaire was distributed to a total of 435 people, of whom 135 responded (31%). Findings revealed that the three senior nurse groups relied heavily on personal experience, organizational policies and protocols as formal sources of knowledge. Furthermore, they had positive attitudes towards EBP. However, participants demonstrated lack of knowledge and skills in appraising and utilizing evidence into practice. They indicated a desire to seek educational opportunities to upskill themselves in the process of EBP.     

A novel construct of an electrochemical acetylcholinesterase biosensor for the investigation of malathion sensitivity to three different insect species using a NiCr2O4/g-C3N4 composite integrated pencil graphite electrode

Herein, an electrochemical biosensor has been prepared to assess the sensitivity of an organophosphate insecticide, malathion, to acetylcholinesterase (AChE) enzyme of three insects including Apis mellifera (honeybee), Tribolium castaneum (red flour beetle), and Zootermopsis nevadensis (dampwood termite). A composite of nickel chromite (NiCr₂O₄) and graphitic carbon nitride (g-C₃N₄) was prepared and characterized for its morphological, chemical and electrical properties. The NiCr₂O₄/g-C₃N₄ composite integrated pencil graphite electrodes were used to covalently immobilize insect AChE enzymes and amperometric response of bioelectrodes was determined through cyclic voltammetry. The prepared bioelectrodes exhibited high enzyme immobilization efficiency and electro-catalytic performance. The integrated bioelectrodes could efficiently detect malathion induced inhibition of insects'' AChEs. The linear ranges for malathion were found to be 0.1–1.6 μM, 1–40 nM and 2–100 nM, and LODs were 2 nM, 0.86 nM and 2.3 nM for A. mellifera, T. castaneum, and Z. nevadensis, respectively. Additionally, the biosensing platform developed using A. mellifera AChE was found highly sensitive and effective for malathion recoveries from spiked wheat flour samples with high recovery rates. Moreover, the proposed method was adequately reproducible and selective. The results revealed that A. mellifera AChE is less sensitive to inhibition by malathion as compared to T. castaneum, and Z. nevadensis AChE. The experimental results were validated through computational docking of malathion with insect AChEs and the results were in correspondence to experimental outcomes. The proposed method can be a plausible alternate to conventional analytical methods to assess the pesticide sensitivity and toxicity of various compounds against insect enzymes.

An innovative electrochemical assay has been established to determine pesticide sensitivity against acetylcholinesterase and possible toxicity against insects. The analytical efficiency of three common insect AChEs was determined through this method.     

Diabetes-induced renal vascular dysfunction is normalized by inhibition of epidermal growth factor receptor tyrosine kinase

Contribution of receptor tyrosine kinase activation to development of diabetes-induced renal artery dysfunction is not known. We investigated the ability of a chronic administration of genistein, a broad-spectrum inhibitor of tyrosine kinases (TKs), and AG1478, a specific inhibitor of epidermal growth factor receptor (EGFR) TK activity, to modulate the altered vasoreactivity of isolated renal artery ring segments to common vasoconstrictors in streptozotocin-induced diabetes. In diabetic renal artery, the vasoconstrictor responses induced by norepinephrine, endothelin-1 and angiotensin II were significantly increased. Inhibition of TKs or the EGFR pathway did not affect the agonist-induced vasoconstrictor responses in the non-diabetic control animals. However, inhibition of TKs by genistein or EGFR TK by AG1478 treatment produced a significant normalization of the altered agonist-induced vasoconstrictor responses without affecting blood glucose levels. Treatment with diadzein, an inactive analogue of genistein, did not affect the vasoconstrictor responses in the diabetic animals. Western blotting showed that phosphorylated EGFR protein levels were increased in vehicle-treated diabetic animals. In renal arteries from AG1478-treated diabetic animals, EGFR protein levels were similar to non-diabetic control animals. These data suggest that activation of TK-mediated pathways, including the EGFR TK signalling pathway, are involved in the development of diabetic vascular dysfunction in the renal artery.     

Molecular characterization and clinical evaluation of dengue outbreak in 2002 in Bangladesh

During the febrile illness epidemic in Bangladesh in 2002, 58 people died out of the 6,132 affected. Two hundred hospitalized patients were analyzed clinically, serologically and virologically to determine the features of this dengue infection. Among the 10- to 70-year-old age group of the 200 clinically suspected dengue patients, 100 (50%) were confirmed as dengue cases by virus isolation and dengue IgM-capture ELISA. Of the 100 dengue-confirmed cases, the mean age was 29.0 (+/-12.4). The possible dengue secondary infection rate determined by Flavivirus IgG-indirect ELISA was 78% in 2002. Eight dengue virus strains were isolated, representing the first dengue virus isolation in the country, and all of the strains were dengue virus type-3 (DEN-3). Sequence data for the envelope gene of the DEN-3 Bangladeshi isolates were used in a phylogenetic comparison with DEN-3 from other countries. A phylogenetic analysis revealed that all 8 strains of DEN-3 were clustered within a well-supported independent sub-cluster of genotype II and were closely related to the Thai isolates from the 1990s. Therefore, it is likely that the currently circulating DEN-3 viruses entered Bangladesh from neighboring countries.