The persistence of Borrelia burgdorferi in patients treated with antibiotics is described. The diagnosis of Lyme disease is based on clinical symptoms, epidemiology and specific IgG and IgM antibody titers to B. burgdorferi in serum. Antibiotic therapy may abrogate the antibody response to the infection as shown in our patients. B. burgdorferi may persist as shown by positive culture in MKP-medium; patients may have subclinical or clinical disease without diagnostic antibody titers to B. burgdorferi. We conclude that early stage of the disease as well as chronic Lyme disease with persistence of B. burgdorferi after antibiotic therapy cannot be excluded when the serum is negative for antibodies against B. burgdorferi.

Adult↗

PubMedDate not supplied

A cGMP-gated channel subunit in Limulus photoreceptors.

The phototransduction cascade in invertebrate photoreceptors has not been fully elucidated. It has been proposed that in Limulus ventral photoreceptor cGMP is the intracellular second messenger that directly controls the gating of the light-dependent channels (Johnson et al., 1986: Bacigalupo et al., 1991). Recently, a putative cGMP-gated channel cDNA, Lcng1, has been cloned from Limulus and shown to be expressed in the brain and the ventral eye (Chen et al., 1999). In this study, we sought to more specifically localize the LCNG1 transcript and protein. In situ hybridization was used to determine whether the gene is expressed in glia or photoreceptor cells in the ventral eye. The results clearly demonstrated that Lcngl mRNA is transcribed in the ventral photoreceptors. On Western blots probed with a polyclonal antibody raised against the C-terminus of LCNGI, a 100-kDa band and an 80-kDa band was labeled in the membrane protein preparations from brain and ventral eye, respectively. The labeling of these bands was blocked by preabsorption of the antibody with the antigen, indicating the labeling specificity. Immunocytochemistry and confocal microscopy were applied to investigate the subcellular localization of this antigen. Immunolabeling was highly localized in the transducing lobes of ventral eye photoreceptors and lateral eye photoreceptors. In both cases, the labeling was associated with membrane regions specialized for phototransduction, but the exact pattern appeared to be somewhat different in the two eyes. Preabsorption of the antiserum with antigen abolished the labeling, confirming specificity. The results lend support to the hypothesis that a cGMP-gated channel is directly involved in the phototransduction process.

Animals↗

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[Polymyography recording in epicondylopathia humeri radialis].

The innervation pattern of arm muscles in tennis elbow during defined movement of the wrist was analysed by polymyography. 30 patients with tennis elbow and 40 control persons had been investigated. Dorsal and palmar movements of the wrist joint lifting 5 kg had been performed. The electromyogram of 8 muscles had been registered. There was no abnormality in palmar flexion. The height and integrals of amplitudes in extensor muscles during extension had been considerably smaller. It is suggested that in tennis elbow the dorsal extension is exerted by a smaller number of fibers. This might be the cause of enthesiopathy.

Adult↗

PubMedDate not supplied

Critical elements in the process of decision making: a nursing perspective.

Decision making is a fundamental element of nursing work, one that is essential to understand as organizations explore cost effective ways to deliver quality health care. While the importance of decision making has been well articulated, previous descriptions of nursing work have had difficulty describing completely this cognitive component. This paper identifies critical elements within the process of nursing decision making that have not been addressed adequately within current decision making frameworks. In this exploratory research, nursing personnel described their work; qualitative content analysis was used to categorize components of nursing decision making within these descriptions. Revealed are complex nursing decisions that occur after the selection of nursing intervention, and prior to the implementation of that intervention. These decisions address the complex network of interactions involved with enactment of the nursing role, the repertoire of leadership skills such as collaboration, negotiation, and delegation required to elicit the involvement of other individuals; discretionary decisions made in the allocation of resources; priority setting; and strategizing. These findings have implications for nursing competency and quality of care, cost-effective delivery of health care, and nursing education.

Attitude of Health Personnel↗

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RN and RPN decision making across settings.

Nursing decision making was a focus of the Province-Wide Nursing Project (PWNP), a 3-year project to promote best nursing practice. In much of the growing literature on nursing decision making, it is assumed that there are differences in the way RNs and RPNs make decisions. However, there is little scientific evidence to support this assumption. The RN and RPN decision making across settings questionnaire was completed by nurses employed in the 23 agencies of the 4 Participating Complexes taking part in the project. The survey questions were subjected to factor analysis and reduced to five factors. Results revealed measurable differences between the way that RNs and RPNs made decisions. Both RNs and RPNs reported making decisions frequently and experiencing little difficulty in making them. However, there were statistically significant differences in the frequency with which RNs and RPNs perceived they made decisions and the difficulty they found in making them. To plan effective health care, it is important to take account of the strengths of different health care workers. There is a need for further research to investigate the reasons behind the differences revealed in these findings.

Adult↗

PubMedDate not supplied

Healthcare restructuring: the impact of job change.

Restructuring, particularly redeployment and job change, had a dramatic impact on the working conditions and practices of nursing personnel. This study was conducted to determine whether nurses (RNs and RPNs) who experienced job change perceived their work-lives differently than those who did not undergo job change and, whether nurses who experienced different types of job change (new role, new unit, or new hospital) varied in their perceptions. A questionnaire exploring themes relevant to redeployment was administered to all nurses (N = 3,408) in two large teaching hospitals that had undergone restructuring. The response rate was 50.7% (n = 1,728). Of the responses, 1,662 were used in the analysis. T-tests and ANOVAs were used to compare groups of nurses. Nurses who changed their jobs perceived their commitment to the organization, their work environment and quality of care differently than those who did not change jobs. Nurses with different types of job change differed in their organizational commitment, perceptions of work-related injuries, attitudes towards job change, need for orientation and new knowledge, and feelings about the health care team. Results will assist managers to address the specific needs of nurses with different experiences of job change in the restructured workplace.

Adult↗

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Individualized enhancement programs for nurses that promote competency.

Working in a cost-conscious health care environment changes the accessibility to conferences, workshops and other continuing education offerings. Educators, employers and individual nurses are compelled to be innovative in their approach to maintaining competency through continuing education (CE). Greater emphasis must be placed on effectively matching CE programs with carefully targeted learning needs. This article illustrates a four-phase approach to an individualized enhancement program that incorporates job expectations and competencies. The phases are: 1) completing a needs assessment, 2) defining learning objectives, 3) assessing available learning resources, and 4) evaluating the CE experience.

Clinical Competence↗

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Quality of nursing worklife issues--a unifying framework.

This article describes a theoretical view of the many variables that influence nurses' worklife. It summarizes the national perspective and the provincial initiatives undertaken during the last decade that focus on issues of nursing worklife. The authors present a model that unifies the many dimensions that must be examined in studying this important problem. Nurse administrators will find this review valuable as a guide to research and practice initiatives associated with quality of working life.

Employment↗

PubMedDate not supplied

Alzheimer's disease: the silent epidemic.

Explore the source record for details and available documents.

Alzheimer Disease↗

PubMedDate not supplied

Comparison of liaison and staff nurses in discharge referrals of postpartum patients for public health nursing follow-up.

The purpose of this study was to compare hospital staff nurses to public health liaison nurses in the accuracy and cost of postpartum referrals for public health nursing follow-up in the community. In the before phase of the study, public health liaison nurses assessed 304 mothers to determine the need for a follow-up visit by the public health nurse. In the after phase, staff nurses assessed 326 mothers. Public health nurses, unaware of the identity of the referring nurse and the referral decision, judged whether their visit had been required. Staff nurses correctly identified a higher proportion of referrals requiring public health nurse follow-up than liaison nurses. Although they referred more clients who did not require a public health nurse visit, costs of referrals by staff nurses remained lower.

Adult↗

PubMedDate not supplied

Changing nursing practice--trisectoral collaboration in decision making.

In an age of cost containment, agency partnerships have become an essential element for future planning and program implementation. This paper describes a trisectoral collaboration of a hospital, health department, university and school of nursing to compare the efficacy and efficiency of referral decisions of hospital staff nurses to those of the public health liaison nurses (LNs). A process to identify decision criteria was undertaken and an educational programme was designed to assist the staff nurses with the referral process and to assure consistency of decision making. The two groups were then compared. The results of the study found staff nurses, using the decision criteria, identified more patients who required public health nursing visits than did the liaison nurses, refusal rate of the patients to participate was no different, staff nurses cost less than LNs and job satisfaction was not significantly altered for either group. In addition to providing information to guide administrative and clinical decision making, the project also provided a learning experience for the staff of three agencies in conducting research and in using evidence-based practice to change traditional practice.

Decision Making, Organizational↗