Perceptions of registered nurses in four state health insititutions on continuing formal education

This study investigated registered nurses in four selected state health institutions' perceptions with regard to continuing formal education. The relevance of continuing formal education is being emphasised globally by the increasing quest for quality assurance and quality management systems within an ethos of continuous improvement. According to Tlholoe (2006:5), it is important to be committed to continual learning, as people's knowledge become less relevant because skills gained early in a career are insufficient to avoid costly mistakes made through ignorance. Continuing formal education in nursing is a key element to the maintenance of quality in health care delivery. The study described: registered nurses' views on continuing formal education. Registered nurses' perceived barriers to continuing formal education. A quantitative descriptive survey design was chosen using a questionnaire for data collection. The sample consisted of 40 registered nurses working at four state health institutions in the Western Cape Province, South Africa. Convenience sampling was selected to include registered nurses who were on duty on the days during which the researcher visited the health institutions to distribute the questionnaires. The questionnaire contained mainly closed-ended and a few open-ended questions. Content validity of the instrument was ensured by doing a thorough literature review before construction of items and a pretest. Reliability was established by the pretest and providing the same information to all respondents before completion of the questionnaires. The ethical considerations of informed consent, anonymity and confidentiality were adhered to and consent to conduct the study was obtained from relevant authorities. Descriptive statistics, based on calculations using the Microsoft (MS) Excel (for Windows 2000) programme, were used to summarise and describe the research results. The research results indicated that most registered nurses perceive continuing formal education as beneficial to their personal and professional growth and that it could lead towards improving the quality of patient/client care, but barriers exist which prevent or deter them from undertaking continuing formal education programmes. The main structural barriers included lack of funding and lack of coherent staff development planning and physical barriers including job and family responsibilities.

Rapid Optical Imaging of Breast Tumor Margins: Final Results from a 100-Patient Clinical Study

Background: Increasing attention has been given to the surgical margin status in primary breast conserving therapy (BCT) due to reports which indicate that 20-70% of patients undergoing BCT must undergo multiple surgeries for complete tumor resection. For the past 4 years, our multidisciplinary group has been working to address this clinical need via the development of an optically-based intraoperative breast tumor margin assessment device. This device, based on diffuse reflectance spectroscopy, is sensitive to biochemical and morphological changes associated with cancer and has a sensing depth of 1-2 mm which is compatible with widely used criteria for cancer-free margins. The device is capable of surveying the entire specimen surface intraoperatively in imaging mode. Here we report the results of a non-significant-risk study of the device in over 100 patients at Duke University Medical Center.Materials and Methods: Under an institutionally-approved protocol, we tested our device on consented patients undergoing a partial mastectomy at DukeUniversity Medical Center for invasive or in situ malignancies. Optical spectral images of tumor margins were recorded within 20 minutes of excision and converted into tissue compositional parameter maps that reflect the vascular density, fat content and cell density in the tissue. The pathologic status of the imaged margins was collected from standard post-operative surgical pathology reports. Intraoperative frozen section and touch prep analysis was not performed on these specimens. Margins were considered positive if residual malignancy was found within 2 mm of the tissue surface.Results and Discussion: BCT specimens from 121 patients have been imaged with the optical device. One to four margins were imaged on each BCT specimen. Data from 112 patients were retained for analysis (51 negative margins, and 47 margins containing cancer within 1mm). Images of negative margins from patients with at least one positive margin (9 patients) elsewhere on the specimen were excluded from analysis due to the potential for presence of margin positivity that was not identified pathologically. For each margin, a set of 8 tissue composition maps were generated, from which a set of 36 image-descriptive variables were obtained. Wilcoxon rank-sum tests were used to determine which of the variables best separated negative from positive margins. A predictive model was developed using conditional inference trees to identify the optimal partitions from all 36 image-descriptive variables. The model selected variables related to the light scattering properties, total hemoglobin content, and β-carotene content of the underlying tissue, which are related to tissue density and morphology, vascular volume, and fat content, respectively. This model resulted in a sensitivity of 80% for detecting cancer at the margin, a sensitivity of 73% for detecting residual disease within 1mm of the margin, and a specificity of 65%. These results are promising and a prospective validation trial of the device is under development.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5017.

Cognitive-behavioural therapy for adolescents with bulimic symptomatology: the acceptability and effectiveness of internet-based delivery

BACKGROUND

The evidence base for the treatment of adolescents with bulimia nervosa (BN) is limited.

AIMS

To assess the feasibility, acceptability, and clinical outcomes of a web-based cognitive-behavioural (CBT) intervention for adolescents with bulimic symptomatology.

METHOD

101 participants were recruited from eating disorders clinics or from beat, a UK-wide eating disorders charity. The programme consisted of online CBT sessions ('Overcoming Bulimia Online'), peer support via message boards, and email support from a clinician. Participants' bulimic symptomatology and service utilisation were assessed by interview at baseline and at three and six months. Participants' views of the treatment package were also determined.

RESULTS

There were significant improvements in eating disorder symptoms and service contacts from baseline to three months, which were maintained at six months. Participants' views of the intervention were positive.

CONCLUSIONS

The intervention has the potential for use as a first step in the treatment of adolescents with bulimic symptomatology.

Identification of nanometre-sized ultra-high molecular weight polyethylene wear particles in samples retrieved in vivo

Nanometre-sized particles of ultra-high molecular weight polyethylene have been identified in the lubricants retrieved from hip simulators. Tissue samples were taken from seven failed Charnley total hip replacements, digested using strong alkali and analysed using high-resolution field emission gun-scanning electron microscopy to determine whether nanometre-sized particles of polyethylene debris were generated in vivo. A randomised method of analysis was used to quantify and characterise all the polyethylene particles isolated. We isolated nanometre-sized particles from the retrieved tissue samples. The smallest identified was 30 nm and the majority were in the 0.1 microm to 0.99 microm size range. Particles in the 1.0 microm to 9.99 microm size range represented the highest proportion of the wear volume of the tissue samples, with 35% to 98% of the total wear volume comprised of particles of this size. The number of nanometre-sized particles isolated from the tissues accounted for only a small proportion of the total wear volume. Further work is required to assess the biological response to nanometre-sized polyethylene particles.

Epigenetic influences may explain dental differences in monozygotic twin pairs

BACKGROUND

Comparisons between monozygotic (MZ) co-twins have tended to focus on the similarities between their dentitions rather than differences. The aim of this study was to determine the prevalence of discordant expression for simple hypodontia and supernumerary teeth in MZ twin pairs and to explain how phenotypic differences might occur despite their similar genotypes.

METHODS

Records of 278 pairs of MZ twins, including dental casts and radiographs, were examined and the prevalences of discordant expression for missing upper lateral incisors (ULI) or second premolars (PM2), and of mesiodentes, were determined. Zygosities were confirmed by comparisons of blood markers and DNA.

RESULTS

There was evidence of at least one missing ULI or PM2 in 24 of the 278 MZ pairs (8.6 per cent), with 21 of these 24 pairs (87.5 per cent) showing discordant expression. Nine of the 278 MZ pairs (3.2 per cent) displayed evidence of mesiodentes, with eight of these nine pairs (88.9 per cent) being discordant.

CONCLUSION

Our findings show that differences in the expression of missing or extra teeth occur often between MZ co-twins whose genetic make-up predisposes them to simple hypodontia or mesiodentes. We postulate that minor variations in epigenetic events during odontogenesis may account for these distinct differences.

Microbial contamination of hospital bed handsets

BACKGROUND

Hospital bed handsets, including nurse call equipment and television controls, have been found to contain biologic material and may be contaminated with microbes.

OBJECTIVE

The aim of this study was to assess the microbial contamination of hospital bed handsets.

METHODS

Hospital bed handsets were removed from 115 randomly chosen rooms in a suburban hospital. The handsets were transported to the laboratory in a sterile fashion and opened using a sterile technique, and cultures were obtained from both the anterior and posterior surfaces of the units.

RESULTS

The cultures of 12 units (10.4%) revealed no microorganisms. One hundred three units (89.6%) had cultures that grew microorganisms. Of the handsets that were found to contain microorganisms, 48 units (46.6%) had only 1 microorganism, and 55 units (53.4%) had multiple organisms, including 33 units (32.0%) with 2 microorganisms, 21 units (20.4%) with 3 microorganisms, and 1 unit (1.0%) with 4 microorganisms. The microorganisms identified included 90 isolates (87.4%) of coagulase-negative staphylococcus, 51 isolates (49.5%) of bacillus species, 13 isolates (12.6%) of fungal species, 8 isolates (7.8%) of nonhemolytic streptococcus species, 7 isolates (6.8%) of alpha-hemolytic streptococcus species, 1 isolate (1.0%) of Staphylococcus aureus, and 1 isolate (1.0%) of methicillin-resistant Staphylococcus aureus.

CONCLUSION

Hospital bed handsets were found to have a high incidence of contamination with bacteria and fungus and were found to contain organisms that are known to be the etiologic agents in nosocomial infections. Because of the frequency and duration of contact between hospital patients and hospital bed handsets, existing infection control measures should be studied that could reduce the level of contamination of such handsets or that could isolate the handsets from the patient.

Lipid and hormonal profile of Panamanian women during the menstrual cycle

Forty-one women of reproductive age were included in the study, to establish the variation of serum lipids during the menstrual cycle and simultaneously, to determine the physiological fluctuation of FSH, LH, prolactin (PRL), progesterone (P4) and estradiol (E2) concentration in serum, during the menstrual cycle. A significant decrease of total serum cholesterol (165.29 +/- 3.6 mg/dl) and triglycerides (108.99 +/- 9.65) occurred during the luteal phase, as compared with the follicular phase (176.16 +/- 3.51, 108.99 +/- 9.65). Changes were not observed with HDL-cholesterol during the cycle. On the other hand, FSH showed an initial rise (mean 5 IU/l) followed by a surge (10 IU/l) and a progressive fall toward the midcycle. In contrast LH secretion showed a steady increase with a maximal concentration at surge (32.1 IU/l). PRL mean value was observed, with a discrete increase after day 13 of the menstrual cycle, that was more noticeable at the end of the cycle. Forty-eight hours after the FSH and LH midcycle surge, elevation of progesterone was observed, with maximal concentration occurring on day 24 (23 nmol/l) and later on progesterone levels fell rapidly. Thirty-six to 24 h before the surge of LH and FSH at midcycle was observed the peak serum concentration of estradiol (1300 pmol/l) followed by a progressive fall. Changes in the concentration of serum lipids during the menstrual cycle are presumably due to a direct or indirect effect of physiological fluctuation of sex hormones.

Serotonergic polymorphisms and psychotic disorders in populations from North Spain

There is strong biological evidence relating alterations in the serotonergic system with mental disorders. These alterations may be originated at the DNA level by sequence mutations that alter the functioning of serotonin receptors and transporter. To test this hypothesis we investigated three genetic variants of the 5-HT2A receptor (-1438G/A, 102T/C and His452Tyr) and two variants of the serotonin transporter (a VNTR in the second intron and a 44 bp insertion/delition in the promoter region of the gene) in a clinical sample recruited in a human isolate and in surrounding areas in Northern Spain (N = 257) and in ethnically matched controls (N = 334). No clear association was found between 5-HT2A variants and psychosis. However, marginal associations were observed between the 5-HTT LPR and VNTR variants and psychosis (P < or = 0.05) indicating a minor contribution to psychosis of genetic alterations in this gene.

The value of twins in dental research

Due to recent advances in molecular genetics, studies of twins will continue to provide important insights into how genetic and environmental factors contribute to variation in human physical and behavioural traits and disorders. This review emphasizes that biometrical genetic studies of twins are particularly valuable in complementing and directing molecular approaches to facilitate the detection of quantitative trait loci. It also describes several other research models involving twins, apart from the traditional comparison of similarities in monozygotic (identical) and dizygotic (non-identical) pairs, that have the potential to provide new information in the future. Current knowledge about the genetic bases of common dental problems is summarized and future directions in dental research involving twins are outlined.

Molar intercuspal dimensions: genetic input to phenotypic variation

Molecular studies indicate that epigenetic events are important in determining how the internal enamel epithelium folds during odontogenesis. Since this process of folding leads to the subsequent arrangement of cusps on molar teeth, we hypothesized that intercuspal distances of human molar teeth would display greater phenotypic variation but lower heritabilities than overall crown diameters. Intercuspal distances and maximum crown diameters were recorded from digitized images of dental casts in 100 monozygotic and 74 dizygotic twin pairs. Intercuspal distances displayed less sexual dimorphism in mean values but greater relative variability and fluctuating asymmetry than overall crown measures. Correlations between intercuspal distances and overall crown measures were low. Models incorporating only environmental effects accounted for observed variation in several intercuspal measures. For those intercuspal variables displaying significant additive genetic variance, estimates of heritability ranged from 43 to 79%, whereas those for overall crown size were higher generally, ranging from 60 to 82%. Our finding of high phenotypic variation in intercuspal distances with only moderate genetic contribution is consistent with substantial epigenetic influence on the progressive folding of the internal enamel epithelium, following formation of the primary and secondary enamel knots.

Undergraduate student experience in dental service delivery in rural South Australia: an analysis of costs and benefits

BACKGROUND

Rural experience for dental students can provide valuable clinical education, change attitudes to rural practice, and make a valuable contribution to clinical service provision. The aim of this paper is to assess the costs and benefits of service delivery by students through rural training programmes.

METHODS

Groups of two students worked in the public dental clinics in adjacent rural centres where there had been long-term difficulties in recruiting staff. The costs and benefits of the programme were assessed by the impact on waiting lists, the total cost per patient of a course of care and by the marginal cost of adding service provision by students to existing arrangements.

RESULTS

The total costs of emergency and complete treatment provided by students were greater than the costs of treatment provided by public-sector dentists but less than the costs of private providers treating public patients. However, the value of services were greater when care was provided by students or private providers and the marginal cost of students providing services was 50-70 per cent of the cost of care provided by public dentists.

CONCLUSION

This assessment suggests that the service benefits achieved compliment the primary objective of influencing the attitude of students to rural practice.

Accelerating flap maturation by vascular endothelium growth factorin a rat tube flap model

The effect of exogenous vascular endothelium growth factor (VEGF) on the survival of the distal skin paddle with early pedicle division was studied in a rat tubed pedicle flap model. In part I, tubed pedicle skin flaps were created on the backs of 14 rats. The pedicle was divided after an interval of 3, 4, 5 or 7 days, and the survival area of each distal skin paddle was measured 5 days after the pedicle was divided. The percentages of survival were 0, 24.9%, 89.9% and 100%, respectively. In part II, tube flaps were created in 20 rats. In the experimental group, 2 ml of VEGF (50 microg ml(-1)) was injected into the recipient bed during tube flap creation in each rat. In the control group, 2 ml of saline was given. The tubed pedicle was divided 4 days after creation. The mean survival area of the distal skin paddle in the group treated with VEGF was 7.32 +/- 1.36 cm(2) (80.91%) at 5 days after pedicle division, which was of statistical significance when compared with the survival in the control group of 2.70 +/- 1.89 cm(2) (27.9%). The histology showed angiogenesis at the skin paddle-recipient bed interface following VEGF injection. These results demonstrate that the subcutaneous administration of VEGF into the recipient bed of the tube flap transfer can induce angiogenes is at the junction between the donor and the recipient bed, and improve skin paddle survival with early pedicle division.

A study of occlusal variation in the primary dentition of Australian twins and singletons

In this study, we quantified the extent of variation in different occlusal features of Australian children of European descent with complete primary dentitions, but no permanent teeth present in the mouth. The study group consisted of 412 individuals, aged between 3 and 7 years, including 70 monozygous (MZ) twin pairs, 68 same-sexed dizygous (DZ) twin pairs, 11 opposite-sexed DZ twin pairs, and 114 singletons. Occlusal traits, including inter-dental spacing, incisal overbite and overjet, arch breadth and arch depth, were obtained directly from dental casts or indirectly from photocopies or impressions of the casts. Descriptive statistics summarised the data and indicated that distributions were similar to those published for other populations. Univariate genetic analysis, using the structural equation modelling package Mx, was carried out on the quantitative data using the normal assumptions of the twin model. Genetic modelling indicated that a model incorporating additive genetic (A) and unique environmental variation (E) was the most parsimonious for interdental spacing, overbite, overjet and arch dimensions. Estimates of heritability for interdental spacing ranged from 0.62 to 0.81. Estimates for overbite and overjet were 0.53 and 0.28, respectively, and estimates for arch dimensions ranged from 0.69 to 0.89. These results indicated a moderate to relatively high genetic contribution to observed variation.

Vascular grafts in the rat model: an anatomic study

Vascular grafts in animal models have been used extensively in the microsurgical laboratory, and the rat offers an excellent source of graft to meet these needs. In this study, we compiled a list of vessels that were previously identified in experimental literature for use as vascular grafts in the rat model. We then dissected and measured both arterial and venous grafts taken from these sites in 12 adult rats. The surgical procedure for approaching each vascular graft was recorded. The diameter and harvestable length, the start and end points, and the number of branches of the graft were tabulated. We believe that these data will provide valuable insight applicable to the use of the rat vascular graft in microsurgical research and training.

Quantification of nerve tension after nerve repair: correlations with nerve defects and nerve regeneration

This study tested the validity of a quantitative in vitro nerve-tension-measuring technique, by correlating the tension measurements with functional and morphologic assessments of nerve regeneration. Initially, harvested nerves were used in vitro to determine a K value for lateral displacement in this tissue. Next, this value was used to calculate the tension of nerve repair, following 0-, 3-, 6-, and 9-mm resections of nerves in groups of rats. After quantifying the nerve tensions following excision and repair, the authors determined a sciatic function index to evaluate functional recovery and axon diameter in the animals. Functional recovery was significantly impaired in animals with elevated measurable tension (9.04 +/- 0.74 g in a 6-mm defect, 27.76 +/- 8.86 g in a 9-mm defect), compared to animals with no or 3-mm excision and measured tension of 3.3 +/- 1.09 g or less. Increased tension was also associated with a significant decrease in axon diameter. This study succeeded, therefore, in quantitatively relating the elements of measured nerve tension, nerve gaps, functional nerve recovery, and morphologic regeneration. Quantification of nerve tension by lateral displacement in vivo offers a possible solution to clinical management of nerve gaps, when the choice between primary repair and nerve grafting is not a clear one.

Studies leading to the identification of ZD1839 (IRESSA): an orally active, selective epidermal growth factor receptor tyrosine kinase inhibitor targeted to the treatment of cancer

This paper describes the development of the epidermal growth factor receptor tyrosine kinase inhibitor ZD1839 from a lead series of 4-anilinoquinazoline compounds. ZD1839 has suitable properties for use as a clinically effective drug and shows activity against human tumours. In particular, the use of pharmacokinetic data in the development of ZD1839 is discussed.

Treatment of facial angiofibromas of tuberous sclerosis by shave excision and dermabrasion in a dark-skinned patient

Tuberous sclerosis is an inherited disease expressed clinically by the triad of mental retardation, seizures, and tuberous lesions. Facial angiofibromas, a common manifestation of tuberous sclerosis, can cause considerable cosmetic disfigurement, emotional distress, obstruction of vision, and hemorrhage. Treatment by shave excision, as the first step to remove the larger nodules, followed by dermabrasion, to smooth and sculpt the final surface, has been recommended as the most effective form of therapy. However, this method of treatment raises the question of risk for development of hypopigmentation in susceptible patients. The authors present their treatment of angiofibromas with shave excision and dermabrasion in a dark-skinned patient.