Automating and improving the data quality of a nursing department quality management program at a university hospital

BACKGROUND: The development and implementation of a relational database program for nursing quality management at a university hospital was stimulated by a lack of consistent data management and analysis tools in the existing noncomputerized program. PROGRAM DEVELOPMENT AND IMPLEMENTATION: An initial software prototype implemented in the critical care service included data collection instruments for five areas: medication errors, patient falls, returns to an intensive care unit within 48 hours, hospital-acquired skin breakdown, and unplanned extubations. Access to the database was limited and paper reports only were disseminated on a scheduled basis. In a second phase, the database is being deployed throughout the nursing department using a local area network. Nurse managers will enter and interact with the quality database online and have access to graphics, reports, and action plan development. POSSIBLE ERRORS: A wide range of potential errors influences decisions on how to collect, store, retrieve, and process quality management data. Each type of error affects the nurse manager's ability to identify significant patterns or trends that are amenable to intervention. There is no right way of constructing and implementing a quality improvement database; only an optimum balance between cost, complexity, and efficacy. SUMMARY AND CONCLUSIONS: Initial feedback from end uses has been positive. A three-year experience with a personal computer database suggests that the personal computer-based information technology is appropriate for small to medium applications and can support departmentwide CQI efforts. A case scenario using simulated data is included to illustrate the use of computerized reports in assessing and taking action on an increase in falls.     

A study into the effects of protein binding on nucleotide conformation

In this study, we examine the effects of binding to protein upon nucleotide conformation, by the comparison of X-ray crystal structures of free and protein-bound nucleotides. A dataset of structurally non-homologous protein-nucleotide complexes was derived from the Brookhaven Protein Data Bank by a novel protocol of dual sequential and structural alignments, and a dataset of native nucleotide structures was obtained from the Cambridge Structural Database. The nucleotide torsion angles and sugar puckers, which describe nucleotide conformation, were analysed in both datasets and compared. Differences between them are described and discussed. Overall, the nucleotides were found to bind in low energy conformations, not significantly different from their 'free' conformations except that they adopted an extended conformation in preference to the 'closed' structure predominantly observed by free nucleotide. The archetypal conformation of a protein-bound nucleotide is derived from these observations.     

A monoclonal antibody selected for probing the folding of staphylococcal nuclease and its N-terminal fragments

PURPOSE: Nitric oxide (NO) is generated in mammalian tissue by the conversion of L-arginine to L-citrulline. The reaction is catalyzed by nitric oxide synthase (NOS). NO has been suggested to have a dual role in tumor biology with both antitumor and tumor promoter activity. Furthermore, it has been proposed that NO contributes to interleukin-2-induced antitumor activity. Since interleukin-2 is used in the treatment of renal cell carcinoma (RCC) it was of interest to study the NOS activity in the human kidney and in RCC and its correlation to tumor grade. Furthermore, the effect of cytokine treatment on NOS activity and the effect of NO donor application was studied in cultured cells. MATERIALS AND METHODS: The effect of cytokine treatment on NOS activity and the effect of NO donor application on cell proliferation was studied in cultured human proximal tubular cells and in RCC cell lines HN4 and HN51. NOS activity was measured by the L-arginine to L-citrulline conversion assay. RESULTS: Calcium-dependent NOS activity was found in all non-malignant kidney tissues (486+/-63 pmol. min(-1) g(-1) tissue). The activity was significantly lower in RCC (24+/-6 pmol. min(-1) g(-1) tissue) and correlated with tumor grade; thus high grade tumors showed lower activity than low grade tumors. Calcium-independent NOS activity was not detected in non-malignant kidney tissue or in RCC tissue. In cultured proximal tubular cells and RCC cell lines HN4 and HN51, cytokine treatment induced a marked increase in NOS activity and NO exerted cytostatic effects on these cell lines. Conclusions: The NOS activity was higher in non-malignant kidney tissue than in RCC tissue and was inversely correlated with tumor grade. Furthermore, cytokine treatment induced a marked increase in NOS activity and NO exerted cytostatic effects on cultured proximal tubular cells and RCC cell lines.     

TraceLink: a model of amnesia and consolidation of memory

This investigation examined the feasibility of applying the conductance catheter technique for measurement of absolute aortic segmental volume. Aortic segment volume was estimated simultaneously in vitro by using the conductance catheter technique and sonomicrometer crystals. Experiments were performed in five isolated canine aortas. Vessel diameter and pressure were altered, as were the conductive properties of the surrounding medium. In addition, a three-dimensional finite-element model of the vessel and apparatus was developed to examine the electric field and parallel conductance volume under different experimental conditions. The results indicated that in the absence of parallel conductance volume, the conductance catheter technique predicted absolute changes in segmental volumes and segmental pressure-volume relationships that agreed closely with those determined by sonomicrometry. The introduction of parallel conductance volume added a significant offset error to measurements of volume made with the conductance catheter that were nonlinearly related to the conductive properties of the surrounding medium. The finite-element model was able to predict measured resistance and parallel conductance volume, which correlated strongly with those measured in vitro. The results imply that absolute segmental volume and distensibility may be determined only if the parallel conductance volume is known. If the offset volume is not known precisely, the conductance catheter technique may still be applied to measure absolute changes in aortic segmental volume and compliance.     

Developing visiting surgical services for rural and remote Australian communities

The University Department of Surgery at Queen Elizabeth II Medical Centre (Perth, Western Australia) has undertaken a pilot project to provide surgical services to country communities where no such service exists. Three surgeons undertake a regular schedule of appointments, and are accompanied by final-year medical students to give them experience with common conditions rarely managed in teaching hospitals. The service is supported by a central administrative office and coordinated by a general practitioner, who negotiates with the regional healthcare providers. Patients are referred by their general practitioner, who may work with the surgeon as anaesthetist or surgical assistant.     

Traumatic myocardial infarction caused by lead shot

The authors report the case of a 32 year old woman who was shot with a shotgun. Acute inferior wall infarction was detected fortuitously on electrocardiography and coronary angiography showed occlusion of the right coronary artery with lead shot. The single coronary lesion, absence, of other cardiac complications (haemopericardium, cardiac perforation, ...) and the favourable outcome with conservative medical treatment has not been previously reported to the authors' knowledge.     

Development of a vibratory white finger prevention program for shipyard workers: an exploratory study

OBJECTIVE: To study the effects of thevetoside (TS), a cardiac glycoside, and an inhibitor of Na+, K(+)-ATPase, on tumor cells cultured in vitro. METHODS: The cytotoxic effects of TS on tumor cells were determined by trypan blue dye exclusion, neutral red vital staining and clonogenic assay. The time-effect relationship and growth inhibition of tumor cells by TS were assayed with trypan blue exclusion method. RESULTS: TS at low doses (0.005-0.1 mg.L-1), with dose dependence, was able to kill SMMC-7721, SGC-7901 and HeLa cells. IC50 values for SMMC-7721, SGC-7901 and HeLa cells were 0.007, 0.011 and 0.018 mg.L-1 by trypan blue dye exclusion test and 0.016, 0.055 and 0.078 mg.L-1 by neutral red vital staining test. TS inhibited the clonal forming rate of SMMC-7721 and SGC-7901 significantly with IC50 values of 0.021 and 0.036 mg.L-1, respectively. Only when the cells were continuously treated with TS for more than 8 hours, the drug-induced cell lethality could be displayed and strengthened quickly. The growth of tumor cells was notably inhibited after they were exposed to 0.1 microgram/ml of TS for 12 hours. All the experimental results of antitumor activity in vitro showed that SMMC-7721 was most sensitive to TS among the three kinds of tumor cells. CONCLUSIONS: TS has cytotoxic action on tumor cells cultured in vitro and this lethal effect must have an action process, in which tumor cells are not dead but suffer from deadly injury and lost the capability of unlimited proliferation.