Reluctant collaborators: do patients want to be involved in decisions concerning care?

Against the background of the popularity of the concept of 'patient collaboration' in care, this paper describes, from the frame of reference of the patients, how they perceive being involved in decisions concerning their own treatment and nursing care. A convenience sample of 12 patients were selected. The data collection and analysis were informed to some extent by the approach known as grounded theory. Although only 12 in-depth interviews were conducted, one major theme emerged from the data and that was named 'toeing the line'. The data suggests that some patients are more concerned about doing what is right, that is, pleasing the nurse, than participating in decisions concerning care. It is contended that if nurses adopt practices which encourage involvement they may unwittingly coerse patients to comply. It is argued that patients will accept this situation even if they do not wish a collaborative role. Despite the small sample size, interesting questions are raised concerning the underlying rationale of patient involvement. The conclusion is drawn that promoting individualized care is not necessarily synonymous with active patient involvement as advocated in much of the literature.

Exploring the value of clinical nursing practice: the practitioner's perspective

This paper describes a preliminary study which attempted to explore the value of nursing practice from the viewpoint of practitioners. The objective was to further knowledge and develop insights into nursing practice, identifying concepts central to therapeutic care. Integral to the study was the development of a model for reflective practice.

New species in the sponge genus Tsitsikamma (Poecilosclerida, Latrunculiidae) from South Africa

The genus Tsitsikamma Samaai & Kelly, 2002 is to date exclusively reported from South Africa. Three species are known from the southern coast: Tsitsikammafavus Samaai & Kelly, 2002, from the Garden Route National Park Tsitsikamma Marine Protected Area (MPA) and Algoa Bay; T.pedunculata Samaai, Gibbons, Kelly and Davies-Coleman, 2003, collected from Cape Recife in St. Francis Bay, and T.scurra Samaai, Gibbons, Kelly and Davies-Coleman, 2003, collected from a wreck site in a small bay west of Hout Bay on the west coast of South Africa. Here two new species are described: Tsitsikammamichaeli Parker-Nance, sp. nov., a small green purse-like species, collected from Algoa Bay, and Tsitsikammanguni Parker-Nance, sp. nov., from The Garden Route National Park, Tsitsikamma MPA. Additional morphological characteristics, spicule morphology, and distribution records are provided for T.favus and T.pedunculata from Algoa Bay. The phylogenetic relationship of these five Tsitsikamma species is investigated.

Basing practice on research

Susan Waterworth argues that adopting a research-based model for clinical practice is necessary both to improve standards and to ensure a more informed approach for the delivery of patient care. She outlines the purposes of research in nursing and goes on to describe how clinical practitioners can identify and carry out relevant research topics. A collaborative approach is, she suggests, often the key to addressing problems successfully, and promoting links with a university nursing department may prove beneficial.

Long-term effects of cancer on children and their families

An increasing number of children now survive malignancies, which has implications for nursing practice in caring for long-term survivors and their families. This article will examine the physical, psychological and social consequences of surviving childhood cancer and will suggest how nurses can meet the needs of long-term survivors.

A change worth the making. Implementing primary nursing

Adopting primary nursing can be a difficult task, involving a great deal of planning, and change for all nursing staff. One haematology ward, however, found it resulted in improved satisfaction for both patients and nurses.

Large outbreak of infection with Escherichia coli O157 PT21/28 in Eccleston, Lancashire, due to cross contamination at a butcher's counter

An outbreak of infection with Escherichia coli O157 Phage Type 21/28 occurred between the 23rd November 2001 and the 7th December 2001 in Eccleston, Lancashire. There were 30 confirmed cases (23 with positive faecal isolates and seven serologically positive). Eccleston is a village of approximately 5,000 inhabitants with a single medical practice where many of the cases were patients. Initial investigations identified the suspected source as a butcher's counter, operated as a franchise, in a supermarket in Eccleston. The butcher closed voluntarily on the 24th November. The median age of cases was 60 with a mean of 56 and a range of 2-91 years. Of the 30 confirmed cases, 22 were admitted to hospital. Two patients developed serious complications but all 30 made a full recovery. Microbiological investigations confirmed the butcher's counter as the source of the outbreak. The epidemiological evidence implicated cooked meats and microbiological evidence confirmed that contamination had occurred between raw and cooked meats. The deficiencies in meat hygiene practice that were identified could have led to the cross contamination. This outbreak illustrates the risk associated with the handling of raw and cooked meats in the same shop. Complete physical separation of raw and cooked meat operations reduces the risk of such outbreaks.

Discovery of a lagriamide polyketide by integrated genome mining, isotopic labeling, and untargeted metabolomics

Microorganisms from the order Burkholderiales have been the source of a number of important classes of natural products in recent years. For example, study of the beetle-associated symbiont Burkholderia gladioli led to the discovery of the antifungal polyketide lagriamide; an important molecule from the perspectives of both biotechnology and chemical ecology. As part of a wider project to sequence Burkholderiales genomes from our in-house Burkholderiales library we identified a strain containing a biosynthetic gene cluster (BGC) similar to the original lagriamide BGC. Structure prediction failed to identify any candidate masses for the products of this BGC from untargeted metabolomics mass spectrometry data. However, genome mining from publicly available databases identified fragments of this BGC from a culture collection strain of Paraburkholderia. Whole genome sequencing of this strain revealed the presence of a homologue of this BGC with very high sequence identity. Stable isotope feeding of the two strains in parallel using our newly developed IsoAnalyst platform identified the product of this lagriamide-like BGC directly from the crude fermentation extracts, affording a culturable supply of this interesting compound class. Using a combination of bioinformatic, computational and spectroscopic methods we defined the absolute configurations for all 11 chiral centers in this new metabolite, which we named lagriamide B. Biological testing of lagriamide B against a panel of 21 bacterial and fungal pathogens revealed antifungal activity against the opportunistic human pathogen Aspergillus niger, while image-based Cell Painting analysis indicated that lagriamide B also causes actin filament disruption in U2-OS osteosarcoma cells.